“We are punished by our sins, not for them.”
—ELBERT HUBBARD, AMERICAN AUTHOR AND PHILOSOPHER
Perhaps the simplest explanation for religiously motivated medical neglect is that some people choose to interpret the Bible literally and without question. The logic of faith healing is simple: if the Bible says it, then it must be so. Before the Parkers withheld insulin from their son, they read Mark 11:24: Whatever things you desire, when you pray, believe that you receive them, and you shall have them. They read Matthew 18:19: Anything that they shall ask, it shall be done for them by my Father who is in Heaven. And they read John 5:7: If you abide in me, and my words abide in you, you shall ask what you will, and it shall be done unto you. Larry Parker remembered asking himself, “Aren’t we Christians living for the Lord in His perfect will? Yes. Then why shouldn’t these words of Jesus be applied to us?” “Who,” asked Larry Parker, “is a greater healer than God?”
Faith-healing parents often reject medical advances because they’re a product of man, not God—a position that is not only illogical, but inconsistent. Let’s assume the following. One: God created man in His image. Two: that image includes a brain. Three: the human brain is responsible for scientific and medical advances. The New Testament was written about eighteen hundred years before antibiotics, clotting factors, and insulin were discovered; that’s why these therapies are never mentioned. Other scientific advances also aren’t mentioned. For example, centuries passed before refrigeration and pasteurization were found to reduce contamination of food and beverages; or before high-powered lenses allowed people to see distant stars or low-powered ones to read books; or before it was understood that water—if it was to be safe—had to be separated from sewage. And although all of these inventions were a product of man, the Swans, Parkers, Mudds, and Beagleys embraced them. They didn’t pray for toilets or refrigerators or safe water or eyeglasses; they paid for them. But when it came time to save their children’s lives, they demurred. “I do not feel obliged to believe that the same God who has endowed us with sense, reason, and intellect,” wrote Galileo, “has intended us to forgo their use.”
THE PROBLEM WITH literally interpreting the Bible also extends to Jehovah’s Witnesses, who point in part to Acts 15:29 to explain why they reject blood transfusions, even in the most dire circumstances: You are to abstain from food sacrificed to idols, from blood and from the meat of strangled animals. Acts was written around AD 60. The first successful blood transfusion was in the early 1800s. One can reasonably assume that when Acts was written, people hadn’t imagined that one person’s blood could save the life of another. Indeed, at the time of Jesus, physicians—largely influenced by the teachings of Hippocrates—removed blood from patients to treat diseases. (This practice, called bloodletting, survived well into the nineteenth century.)
Despite their abhorrence of blood transfusions, Jehovah’s Witnesses aren’t faith healers. When they’re sick, they go to the doctor. But when it comes to blood transfusions, they share one thing in common with all faith healers: a remarkable capacity to live with their own inconsistencies. Although Jehovah’s Witnesses don’t accept transfusions of whole blood, they do accept transfusions of fractioned blood. The logic here is obscure. Acts was written well before doctors knew that blood could be divided into a solid fraction, containing red blood cells, and a soluble fraction containing albumin, clotting factors, and nutrients. It’s hard to claim Divine Will as a reason to embrace one blood component over another.
LITERAL INTERPRETATIONS of the Bible also extend to a rather surprising modern-day practice: exorcism.
In 2003, Tamara Tolefree paid a visit to Pat Cooper, the mother of an eight-year-old boy named Terrance Cottrell Jr., whose autism had become increasingly more difficult to handle. Tolefree suggested that Pat should bring Terrance to her church, the Faith Temple Church of Apostolic Faith.
Founded in 1977 and located in a Milwaukee strip mall between a pizzeria and a dry cleaning store, the Faith Temple Church contained a small stage, ten pews, and a half dozen ceiling fans. David Hemphill was the church pastor; his brother, Ray, was the church evangelist. Ray was also the church exorcist. “He has the gift to cast out devils,” David explained.
The church held two services a week, both on Sundays. It wasn’t long before Pat Cooper was a regular, convinced she had finally found a place that could help her son. It didn’t work out that way. When Terrance’s behavior worsened, the social worker assigned to his case threatened to remove him from her care. Isolated, scared, and with no support from Terrance’s father, Pat was at her wits’ end. But Tamara had a solution. “Terrance wasn’t only suffering from autism,” she said, “but also from demons in his soul.”
At first, churchgoers offered special prayers for Terrance. When that didn’t work, they asked Ray Hemphill to perform an exorcism. So, on the evening of August 22, 2003, Hemphill placed Terrance on the floor, wrapped him in a sheet, pinned down his arms and legs, and put his knee on the boy’s chest. Hemphill leaned over and screamed, “In the name of Jesus, Devil get out!” Because children with autism are uncomfortable with physical contact—and because no child likes to be suffocated—Terrance fought to get away. Two hours later, drenched in sweat, Ray Hemphill stood up to go to the restroom. When he left, several church members walked over to Terrance, curious to see if the exorcism had worked. What they found was that he had urinated on himself, that his lips and face had turned blue, and that he wasn’t breathing. One congregant called 9-1-1, but it was too late. The coroner reported that Terrance had died from “mechanical asphyxiation due to external chest compression.”
Milwaukee County’s district attorney charged Ray Hemphill with felony child abuse—a crime punishable by up to ten years in prison and a $25,000 fine. It wasn’t the first time the Faith Temple Church had been in trouble with the law. In 1998, a twelve-year-old girl claimed to have been beaten with a stick during a church service. When the police and district attorney investigated the case, David Hemphill argued that the beating wasn’t severe and that the congregation was merely doing what the Bible teaches.
In July 2004, in a trial witnessed by millions of Americans on Court TV, Ray and David Hemphill faced their accusers. One notable exchange occurred when prosecutor Mark Williams suggested to David that his church had taken religious healing to a dangerous extreme. Hemphill objected.
HEMPHILL: My church is going to do exactly what the word of God tells us to do.
WILLIAMS: So, you’re saying God is giving you the power to take away. . . .
HEMPHILL: I say He has the power! If I lay down on someone and he passes away—God took him. I didn’t!
WILLIAMS: [Your brother] did it to Terrance, didn’t he? Your brother did it!
HEMPHILL: No, he didn’t!
On July 9, after deliberating for four hours, the jury found Ray Hemphill guilty of felony child abuse. One month later, Milwaukee County Circuit Court Judge Jean DiMotto delivered a sentence that was without precedent in the annals of American jurisprudence.
TO UNDERSTAND DIMOTTO’S verdict, one first needs to understand the history of exorcism, a ritual practiced by virtually every major religion.
In Judaism, exorcism is mentioned in the Talmud. To drive out the evil spirit, or dybbuk, a rabbi recites Psalm 91 three times and then blows the shofar (ram’s horn). In 2012, Jewish exorcisms were popularized in the movie The Possession, which starred Kyra Sedgwick. Influenced by the 1914 play The Dybbuk, The Possession tells the story of Em, an eleven-year-old girl who is possessed by the spirit of a sinner seeking refuge from avenging angels. Unknown to Em or her parents, the spirit was contained in a strange box picked up at a yard sale. The box contained a lock of hair, a tooth, a bird’s skeleton, an ancient ring, and unusual carvings. (All of which should have been clues that this was a box to avoid.) Soon after, Em stabs her father with a fork, fingers crawl up the back of her throat, and giant moths invade her bedroom. The family is eventually directed to an old Hasidic rabbi in Brooklyn who removes the evil spirit. The Possession was promoted with the question, “Thought your daughter’s odd behavior was just another preteen phase? There may be an alternate explanation: the dybbuk is back.”
Like The Possession, Christian exorcisms have also been popularized in movies. In 1949, doctors and psychiatrists were unable to explain the strange behavior of a teenager named Robbie Mannheim. The boy’s pastor referred him to an exorcist, Reverend Edward Hughes. Years later, William Peter Blatty wrote a book about it. Titled The Exorcist, the book was later made into a movie, which starred Ellen Burstyn, Max Von Sydow, and Linda Blair, and which featured the shocking image of a young girl vomiting and screaming profanities while turning her head a full 360 degrees. Entertainment Weekly called The Exorcist “the scariest movie ever made.”
But when it comes to exorcisms, no group has been more enthusiastic than the Roman Catholic Church. Although exorcisms had largely fallen out of favor by the eighteenth century, recently they’ve made a comeback. The revival started in 1972 when Pope Paul VI declared that Satan was part of everyday life and must be defeated. “Sin, on its part, affords a dark, aggressive evildoer, the Devil, an opportunity to act in us and in our world,” he said. “Anyone who disputes the existence of this reality places himself outside biblical and Church teachings.” Many Americans embrace this concept; recent polls found that 40 percent believe that “people on this earth are sometimes possessed by the devil” and 70 percent believe that “angels and demons are active in the world.” In June 2009, a mother in Georgia was charged with child cruelty and false imprisonment for an exorcism that involved handcuffing her teenage son to a chair while denying him food and water for three days. The judge dismissed the case saying, “I’m going to have a hard time [getting] anybody in Gwinnett County, Georgia, to say that Satan doesn’t exist.”
Worldwide, hundreds of exorcists practice their craft; Italy alone boasts about four hundred official exorcists. There’s even an International Association of Exorcists, which holds biannual meetings in Rome and publishes a quarterly newsletter in which practitioners share tricks of the trade.
In 2005, in response to a growing demand for exorcists in the United States, the Regina Apostolorum, a pontifical academy in Rome, held an eight-week course in Baltimore to train more exorcists; sixty-six priests and fifty-six bishops showed up. Clerics were instructed on the four telltale signs of demonic possession: speaking languages that the possessed had never learned; knowing something that the possessed could not possibly have known; having strength beyond the possessed person’s physical makeup; and displaying a violent aversion to God, the Virgin Mary, the cross, or other images of the Catholic faith. (Terrance Cottrell Jr. fit into none of these categories.) “What they’re trying to do in restoring exorcisms,” said Dr. Scott Appleby, a professor of American Catholic history at the University of Notre Dame, “is to strengthen and enhance what seems to be lost in the Church, which is the sense that the Church is not like any other institution; it is supernatural. It’s a strategy for saying: ‘We are not the Federal Reserve, and we are not the World Council of Churches. We deal with angels and demons.’” During the past few decades, the Catholic Church has appointed more than a dozen priests to perform exorcisms in the United States.
As Ray Hemphill demonstrated, however, exorcisms can be quite dangerous. In 1976, West Germany’s Bishop Josef Stangl granted permission to two priests to exorcise a twenty-three-year-old woman named Anneliese Michel, who had suffered from depression, seizures, and hallucinations. The priests determined that the spirits of Lucifer, Adolf Hitler, Judas Iscariot, and Emperor Nero had inhabited Annaliese. For ten months, she was subjected to sixty-seven exorcisms, ending in her death. At autopsy, having suffered beating and starvation, she weighed only sixty-nine pounds. Her parents and the two priests who performed the exorcisms were convicted of negligent homicide; all received suspended sentences. In 2005, Anneliese’s story inspired the movie The Exorcism of Emily Rose. (A documentary titled The Exorcism of Anneliese Michel contains the original audiotapes from the exorcisms.) Following Anneliese’s death, the Catholic Church in Germany required exorcism permits. Most Germans now have to travel to Switzerland or Poland for their spirit removals.
Anneliese Michel and Terrance Cottrell Jr. aren’t the only people to have died during exorcisms. In 1997, a Korean American woman was stomped to death in Glendale, California. That same year, a five-year-old girl in the Bronx died after being forced to swallow a mixture of ammonia and vinegar, followed by having her mouth taped shut. In 1998, a mother in Sayville, New York, convinced that her seventeen-year-old daughter was possessed, suffocated her. In 2001, a Korean exorcist strangled a thirty-seven-year-old woman to death in New Zealand. And in 2014, a woman stabbed and killed her two young children during an exorcism in Germantown, Maryland.
ON AUGUST 20, 2004, Judge Jean DiMotto sentenced Ray Hemphill to thirty months in prison for the death of Terrance Cottrell Jr. and ordered him to pay $1,224.75 in restitution. DiMotto also barred Hemphill from performing exorcisms until he had received more formal training in the art. In other words, the problem wasn’t that Ray Hemphill had performed an exorcism; it was that he needed to learn a safer way to do it.
FATAL CONFLICTS BETWEEN modern medicine and biblical interpretations aren’t limited to the New Testament.
In Genesis 17:10–11, God made a deal with Abraham, the father of the Jewish people: Every male child among you shall be circumcised. And you shall circumcise the flesh of your foreskin, and it shall be a token of a covenant between Me and you. Of the 613 mitzvahs (commandments or good deeds) mentioned in the Torah, circumcision—a sacred covenant between God and every Jewish male—is second only to Be fruitful and multiply. (Genesis 1:28) This practice, which is at least five thousand years old, has several health benefits. Circumcised men are less likely to be infected with human immunodeficiency virus (the cause of AIDS) and human papillomavirus (a common cause of anal, genital, cervical, and head and neck cancers). They’re also less likely to suffer urinary tract infections. For these reasons, the American Academy of Pediatrics and the World Health Organization recommend circumcision. About one-third of the world’s male population is circumcised.
The ritual, however, has a dark side.
On September 12, 2012, Sharon Otterman, a reporter for the New York Times, watched Romi Cohen perform a circumcision. “The mohel [person who performs a ritual circumcision] lifted the infant’s clothing to expose his tiny penis. With a rapid flick of a sharp, two-sided scalpel, the mohel sliced off the foreskin and held it between his fingers. Then he took a sip of red wine from a cup and bent his head. He placed his lips below the cut around the base of the baby’s penis for a split second creating suction, then let the wine spill from his mouth out over the wound.” In other words, to remove blood from the circumcision site, Cohen didn’t use sterile gauze; he used his mouth. The ritual, called metzitzah b’peh (sucking with the mouth), dates back to the Babylonian Talmud, a fifth-century text that states “the [metzitzah] is performed for the sake of the infant’s safety. And if a mohel does not perform the suction [of the wound], this is deemed dangerous and he is to be dismissed.” Although the Talmud doesn’t mention how suction should be performed, the method is implied in the Shulkhan Arukh—the most authoritative code of Jewish law—written in the 1500s. One section, the “Yoreh Deah,” states that following circumcision, “We spit blood into the earth.”
The ritual of metzitzah was practiced throughout the Middle Ages. By the nineteenth century, however, it had fallen out of favor. Two reasons. First, Ignaz Semmelweis had established the basic principles of hygiene. Doctors now knew that the mouth contained germs that were potentially dangerous and that could be spread from one person to another. Second, metzitzah had caused tuberculosis and syphilis in more than seventy babies. As a consequence, Rabbi Moses Schreiber, a leading rabbinical authority, declared that blood from a circumcision should be cleaned using a sterile instrument such as a pipette; this ruling was quickly adopted by most rabbinical authorities.
But not all.
IN NOVEMBER 2004, New York City’s Department of Health received a report about twin boys from Brooklyn who had each suffered a herpes simplex virus (HSV) infection. Two different types of HSV infect people: HSV-1 and HSV-2. Typically, HSV-1 is spread from the mouth, and HSV-2 is spread from the genitals. To determine how the twins had contracted the infection, health department workers went to the hospital where they had been born. They found that the twins had been delivered by Caesarian section and, as is traditional, had been circumcised when they were eight days old. One week later, they each developed blisters on their genitals, abdomen, and back. HSV-1 was isolated from both babies; one survived, the other didn’t. Continuing to gather clues, investigators found that their mothers had never had herpes and that their placentas didn’t show any evidence of the infection. Babies usually contract herpes before they’re born (following premature rupture of the membranes in a woman who has genital herpes), while they’re being born (when the child passes through a birth canal infected with herpes), or after they’re born (when they’re kissed by family members or friends who don’t realize they have herpes virus in their mouths). Because the mothers weren’t infected, investigators concluded that the babies must have contracted the infection after they had been born. So they evaluated the fourteen hospital workers who had cared for the babies. None of them had herpes. Then the investigators were alerted to another infant, this one from Staten Island, who had been infected with herpes the year before. The Staten Island baby provided the clue they needed to solve the case. All three babies had been circumcised by the same mohel, Rabbi Yitzchok Fischer, who had used his mouth to clean the circumcision wounds.
Eight years later, on June 8, 2012, the problem of herpes among Jewish babies received national attention when researchers from the CDC were dispatched to New York City to investigate another herpes outbreak among infants. This time it wasn’t two babies who’d been infected; it was eleven. Two of the eleven had died, and two others had suffered permanent brain damage. All of the children had been circumcised by mohels who had used their mouths to suck off the blood. And all of the cases occurred in a zip code that contained the largest population of Orthodox and ultra-Orthodox Jews, the most fundamentalist observers of the religion. CDC investigators concluded their report with an insight into the obvious: “Circumcision is a surgical procedure that involves cutting intact skin; sterile technique should be used to minimize infection risk.”
After the CDC issued its report, the mayor of New York City, Michael Bloomberg, took action. “There is probably nobody in public life who fights harder for the separation of church and state than I do,” he said, “but I just wanted to remind everyone that religious liberty does not extend to injuring others or putting children at risk.” New York City health officials estimated that metzitzah was performed on about 3,600 babies in their city every year. Armed with incontrovertible evidence that metzitzah was commonly practiced and potentially harmful, city legislators could have chosen to outlaw it. But they didn’t. Preferring a more lenient approach, they asked only that mohels who used their mouths to suck blood from an infant’s penis provide an educational pamphlet to parents describing the risk of acquiring herpes; mohels who refused to comply would be sent a warning letter and fined up to $2,000. The New York City law was the first time in United States history that the government had tried to regulate a Jewish ritual.
Arguing for the right to practice their religion freely, some mohels fought back. “The mayor is the mayor of New York City,” said Romi Cohen, “but we have a mayor. He’s the mayor of the universe. We’re going to follow His instructions.” Cohen, who was 83, said that he would go to jail rather than comply with the law. Others weighed in. “The Orthodox Jewish community will continue to practice what has been practiced for over five thousand years,” said Rabbi David Niederman of the United Jewish Organization in Brooklyn. “We do not change. And we will not change.” Some Orthodox Jewish parents were also unfazed by the risk. Isaac Mortob said he still wanted metzitzah performed on his first-born son. “I don’t want a 99 percent job,” he said. “I want a 100 percent job. I want [my son] to be fully Jewish.” In the end, more than two hundred ultra-Orthodox rabbis issued a statement accusing the health department of spreading “lies and misinformation.” Ordering their adherents not to comply with the city’s regulation, they wrote, “It is forbidden according to the Torah to participate in the evil plans of the New York City health department in any form.” On October 11, 2012, a group of rabbis sued the health department, claiming that the regulation was “in violation of their rights to freedom of speech and freedom of religious exercise.”
As the conflict escalated, public health experts weighed in. “It’s certainly not something any of us recommend in the modern infection-control era,” said Dr. William Schaffner, chief of preventive medicine at Vanderbilt University. “This is a ritual that has now met modern science. It was never a good idea. The ancients were simply wrong about this.” In response to the mohels’ contention that they had sterilized their mouths with Listerine or wine before sucking the penis, Dr. Jay Varma, New York City’s deputy commissioner for disease control, said, “There is no safe way to perform oral suction on an open wound in a newborn.”
In the end, the most vocal support for the health department’s position came from members of the Jewish community—most of whom were embarrassed and horrified that such an ancient, dangerous practice had survived. Rabbi Moshe Tendler, professor of Talmudic Law and Bioethics at Yeshiva University, called metzitzah “primitive nonsense.” “The ritual has nothing to do with religion,” he said. Rabbi Gerald Skolnik, president of the Rabbinical Assembly, an international association of Conservative rabbis, said the procedure was “inconsistent with the Jewish tradition’s pre-eminent concern with human life and health.” Even in Israel, the practice has been forbidden; in 2002, the Chief Rabbinate declared that blood from a circumcision should be removed with a sterile pipette.
Like faith healers and Jehovah’s Witnesses—who often ignore some scientific advances while embracing others—mohels who stubbornly hold on to the ancient practice of metzitzah are equally inconsistent. Ancient Jewish writings describe many practices that have long since been abandoned. For example, the Mishnah, an oral history of Jewish ideas and practices, states that the open wound of a circumcision should be sprinkled with cumin. No one does this. And verses 32, 35, and 36 in Numbers 15 state, And while the children of Israel were in the wilderness, they found a man who gathered sticks upon the Sabbath day. . . . And the Lord said unto Moses, ‘The man shall be surely put to death; all the congregation shall stone him with stones outside the camp.’ And all the congregation brought him outside the camp, and stoned him with stones, and he died; as the Lord commanded Moses. Despite this biblical edict, all observant Jews refrain from killing people who ignore the Sabbath.
Indeed, metzitzah is a clear and direct violation of Jewish law. Whereas the government in Western cultures has a limited ability to force people to undergo any therapy that is against their wishes, such is not the case in Jewish law. In Judaism, people don’t own their bodies. They’re on loan, in a manner of speaking, from God. This is why followers are not allowed to get tattoos (Leviticus 21:5) or commit suicide. In a Jewish theocracy, one could theoretically force people to get lifesaving surgeries against their will. For Jews, the life and health of children are paramount. Which is why the choice of a few ultra-Orthodox Jewish sects to put children in harm’s way in the name of their faith is particularly troubling.
In January 2013, a federal judge ruled against the rabbis’ attempt to block New York City’s directive warning parents about the possibility of herpes infections following metzitzah. Three months later, on April 5, 2013, two more infants were infected with herpes; in January 2014, another case was reported. In none of these instances had the parents been warned of the danger.
PARENTHETICALLY, IN DECEMBER 2013, I was asked to speak to a group of twenty pediatricians in northern New Jersey—home to one of the largest Orthodox Jewish communities in the world. I talked about vaccines. When the talk was over, several Orthodox Jewish physicians came up to the podium. Their questions showed a deep understanding of the science of vaccines and vaccine-preventable diseases. It was impressive. When they were finished, I asked how many babies in their care had been subjected to the metzitzah ritual. Many, they said. Then I asked how they could conscience such a procedure, knowing the potential for harm. One of the younger physicians was the first to answer. “All medical procedures have side effects,” he said.
His answer took me aback. The choice to use one’s mouth to clean off blood following a circumcision isn’t a medical procedure. It’s a religious ritual. If it were a medical procedure—and therefore required to be performed as safely as possible—blood would be removed using sterile gauze.
This interchange provided yet another insight into how people can allow religion to trump reason. When Rita and Doug Swan chose prayer instead of antibiotics for their son’s meningitis, they didn’t know what meningitis was; Christian Science had surrounded them with a shield of ignorance. The physician who defended the metzitzah ritual, on the other hand, knew that mohels could transmit herpes by sucking a baby’s penis; knew that herpes could cause permanent brain damage and death in babies; knew that the problem wasn’t just theoretical—two babies from his city had recently been hospitalized with herpes caused by metzitzah; and knew that the infection was completely preventable. Still, when faced with two conflicting ideologies—an Orthodox Jewish upbringing and a scientific and medical training—the doctor yielded to his religious beliefs, choosing a weak rationalization that “all medical procedures have side effects.” Such is the power of religious belief.