There are a number of methodological difficulties that face any attempt to write about conceptions of sickness and healing in the Hebrew Bible as they interrelate with ritual and worship, particularly as regards normal, everyday practices. The first is the sheer lack of information. By contrast with the plethora of information from neighboring cultures such as those of Egypt to the southwest and Mesopotamia to the east,1 there is virtually no information about medical or ritual practices of healing for Israel in the Iron Age, and the Hebrew Bible itself is no exception to that statement. It is therefore necessary to read between the lines of the texts that do exist for answers to questions about how sickness was understood and what place ritual may have had as a therapeutic measure. The second difficulty with the sources, particularly those that relate to the history of Iron-Age Israel (c. 1000–587 bce), is that they are what might be termed “high-level”; that is, they focus on overviews and on political history from the perspective of the monarchy. They are not interested in giving details of everyday life for its own sake; where such details are given, they are generally in service of the larger agenda of the work of which the individual narrative is now a part. This leads to a third related consideration about the nature of the sources: one could argue that in historical terms the narratives that are available and the information that they contain are effectively contextless, in that they exist only in their context in the HB, and there is no information about where they originally came from or how they originally functioned. For some of the material in the HB it seems fairly clear that its context in the work of which it currently forms a part is its primary context—that is, it was written to go precisely where it now exists. But for other material it is necessary to posit a longer history of development, whether in written or oral media, and to recognize that it not infrequently consists of a collation of originally separate traditions or elements. Of course, these are standard issues when engaging in the historical-critical tradition of HB scholarship; but it is important to be mindful of them in any attempt to reconstruct what might have characterized attitudes and practices regarding sickness and ritual among those who compiled the HB.
Having reviewed briefly, the methodological issues, then, we must move on to the issue of definition. For the writers of the Hebrew Bible, what constitutes sickness, and what therefore constitutes healing? Two points are important here. First, it is necessary to remember that sickness and disease are historically determined (Seybold and Mueller 1981, 10). In other words, diseases come and go, and vary across time and culture in both nature and type. Milder and more virulent forms of the same affliction can occur; diseases can be eliminated altogether by changes in cultural practices or conditions; new diseases can emerge (the appearance of AIDS in the last forty years is a chilling modern example); and specific types of disease are often limited to specific geographical or cultural areas owing to the areas’ prevailing conditions. A vivid demonstration of how culture affects disease is given by the incidence of cancer and heart disease in the West, and of afflictions linked to water-borne pathogens in the Two-Thirds World. We cannot therefore assume that the diseases suffered by those who wrote the Hebrew Bible are necessarily those that we ourselves might suffer or would even recognize.
Second, not only are sickness and disease historically determined, they are also socially determined. What constitutes being “sick,” and the social consequences of that state, can differ significantly from society to society, depending on what kind and degree of personal malfunction counts as a disease and—perhaps more importantly—how sickness is understood in the greater scheme of things. A society in which a person’s significant departures from the accepted norms of health are seen as divine or demonic visitations will respond to that person very differently from a society in which such departures are thought to result from accidental exposure to pathogens. The question of causation leads to two other questions: what any particular instance of sickness means, and what is the appropriate response to it. The “divine” model of causation may well presume divine displeasure with or malevolent supernatural intent towards the sick person, leading to social stigma. In this context, the primary healing response will be to identify the reason for the displeasure or the evil intent, perhaps with the help of spiritual mediators such as priests, and to undertake the recommended placatory or apotropaic actions. The pathogen model of causation, on the other hand, will not in itself make such metaphysical judgments; rather, its immediate healing response, again often with the help of specialists, is to identify the physical elements causing the problem and remedy them directly. More metaphysical or wider social implications may be drawn from the physical event, and appropriate action taken to address them, but this is a separate and often secondary process in this model, rather than being the primary recourse for therapeutic treatment. That said, there may well be stigma attached to certain kinds of disease event because the fact of the disease’s acquisition or manifestation is deemed to be at variance with prevailing cultural values. Well-known examples in Western society include sexually transmitted diseases and mental health conditions, the latter particularly for males.
This, of course, leaves us with the question of what constitutes “significant” departure from the healthy norms, and who makes that determination, a question that is once again answered differently according to time and place. In the sociology of medicine it is possible to draw a distinction between disease, illness, and sickness: disease is the manifestation of abnormal symptoms in a person, illness is a person’s own perception of abnormality or impairment in their customary state of well-being, and sickness is the socially acknowledged state of being ill that brings with it certain expectations and entitlements, such as being relieved of customary responsibilities, taking rest, receiving care and assistance, and so on (Boyd 2000, 9–10). The implication here is that each society has its own agreed norms of health and recognition of disease, and so the definition of what constitutes significant departure from health is socially determined, often with the input of healthcare professionals. A further implication is that being deemed “sick” is the catalyst for gaining access to a society’s healing resources; in other words, unless an individual’s abnormality or indisposition is recognized by a third party as constituting illness within the canons of their own society, the individual will be hard put to access any kind of therapeutic assistance.
Given these various concepts, then, let us turn to the Hebrew Bible and see how they play out there. The first area to consider is the kind of diseases to which those in ancient Israel were subject, and this is an area for which we might expect some help from the Hebrew Bible’s vocabulary of sickness. Sadly, however, this is not the case. There is no room here for a detailed linguistic survey, but suffice it to say that much of the vocabulary surrounding sickness is generic, speaking of being “weak” or “sick” or “struck” but without specifying a precise disease other than in occasional references to the area of the body that is affected (head, feet, hand, etc.). The main exception to this is the use of the term ṣaraʿat often translated ‘leprosy,’ and its associated verb ṣarah, ‘to be leprous,’ but scholars are widely agreed that even this is a generic term for skin disfiguration that could encompass a range of conditions. One other term with somewhat more specific reference is the root davah, used in Lam 1:13 and 5:17 in a generic sense of being “weak” or “faint,” but also in Leviticus (12:2, 15:33, 20:18), in combination with other terms, of women undergoing menstruation. Nevertheless, the vast majority of terms describing disease give little or no hint about the nature of the ailment to which they refer. Indeed, the verb halah, one of the terms for being weak or ill, can be used of the indisposition caused by wounds in battle as well as that caused by disease. This makes identification of diseases from the textual evidence alone exceedingly speculative, to say the least. The lack of specificity about types of illness is paralleled by a corresponding lack of detailed physiological information about the human body: there is hardly anything in the HB text that would indicate awareness of the body’s fundamental internal structures, let alone how those structures might conceivably work (Zucconi 2013, 101). This combination of nonspecific words for disease and a lack of detailed physiological understanding points to a generally holistic conception of human functioning that does not discriminate in a systematic or meaningful way between individual types of disease.
Given the presentation of sickness in such generic terms as “ailing” or “weakening” or being “struck” by unspecified plague, then, and the lack of explicit physiological knowledge evidenced in the text, when we come to consider how sickness is understood in the Hebrew Bible it is not surprising to find that it is located within the nexus of divine causality. This means that despite its undeniably physical manifestations, its origins are viewed as being ultimately metaphysical rather than physical, and this idea manifests itself in the Hebrew Bible in several ways.
The first and most important point to make is that in the HB disease is under YHWH’s control, and is inflicted and relieved according to YHWH’s will. Importantly, though, no diseases are said to be inflicted as part of the creation narratives or as a result of what Christian tradition has termed the “fall,” when the primeval humans are driven from paradise following their disobedience of the divine command (Genesis 3). All the negative consequences of that disobedience and expulsion are expressed in terms of human wickedness, violence, and so on (see, for example, Gen 6:5, 11–12), and although humans now have to toil for their food because the earth produces thorns and thistles alongside edible plants (Gen 3:17–19), there is nothing here about disease becoming a feature of everyday human experience. This absence of disease from the so-called Primeval History (Genesis 1–11), which runs from creation through the flood to the Tower of Babel, contrasts with the parallels to the biblical creation and flood stories found in the Old Babylonian Atrahasis epic (c.1700 bce); there, disease is a means of human population control used by the gods in the early days of human existence, soon after creation, and its lack of success in reducing the numbers of humans on earth is what prompts the gods to send a flood. As far as the biblical narrative scheme is concerned, though, the first mention of disease comes at the beginning of the Abram narrative (Genesis 12), when Pharaoh takes Abram’s wife Sarai into his harem and YHWH afflicts Egypt with plagues as punishment (Gen 12:14–17). Thereafter in the Pentateuchal narratives (Genesis-Deuteronomy), whenever disease strikes it is as the direct result of YHWH’s actions. Thus, in Exodus the plagues of cattle disease (Exod 9:1–7) and boils (Exod 9:8–11) that affect the Egyptians’ livestock and persons are entirely under YHWH’s control, to the extent that they start and stop at YHWH’s pleasure and are spatially limited according to YHWH’s will (they do not affect the Israelites or the part of Egypt where the Israelites live). This indicates a view of these illnesses, like the other environmental and meteorological plagues such as insects and hail, as being caused by supernatural forces rather than by contagion or infection. The same idea is reflected in YHWH’s promises to the Israelites, after their escape from Egypt, to keep them plague-free if they obey him (Exod 15:25–26). All the subsequent examples of plagues or illnesses that strike the Israelites as they wander through the wilderness are clearly brought about by YHWH (Exod 32:35; Num 11:33; 14:36–37; 16:41–49; 21:4–9; 25:1–9). When considering sickness in the Hebrew Bible, the Pentateuchal narratives are of more value for their theological presentations of sickness as a divine instrument than they are as an historical record of actual disease events and their treatment. Nevertheless, the picture of YHWH as responsible for illness recurs throughout the Hebrew Bible, perhaps most pointedly in Hab 3:5, where the prophet pictures YHWH’s appearance as the Divine Warrior preceded by pestilence and followed by plague.
Concomitantly, in the Hebrew Bible disease and illness are not caused by hostile divine powers working against YHWH—there is no dualism in this respect. There is some ambiguity here, but in the present form of the biblical text YHWH is always the force behind the force that causes the disease; in other words, YHWH is always the ultimate cause of any illness. Thus, the death of the Egyptian first-born is said to be caused by “the destroyer” who passes over the land but whose movements are nonetheless controlled by YHWH (Exod 12:12–13, 23); the evil spirit that troubles Saul is said to be from YHWH (1 Sam 16:14); the plague that afflicts the people of Israel as punishment for David’s sin in taking a census is brought about by an angel of YHWH (2 Sam 24:15–16), as is the plague that strikes the army of Sennacherib as it besieges Jerusalem (2 Kgs 19:35); and in the book of Job, although the one who actually inflicts bodily illness upon Job is the Satan, he does so with the full knowledge and approval of YHWH, making no move to harm Job until he has YHWH’s permission, and limiting the harm he inflicts in accordance with YHWH’s instructions (Job 2:1–7). It is also instructive to note how the books of Chronicles treat the episode from 2 Samuel 24 of the plague following David’s census. Scholars generally regard the books of Chronicles as a later selective reworking of the books of Samuel and Kings, and various theological differences can be seen between Chronicles and Samuel/Kings in the narratives that they share. In the case of this narrative, 2 Samuel 24 shows YHWH inciting David to take the census and then punishing him for doing so by means of the plague (2 Sam 24:1–2, 10–15). In Chronicles, however, it is Satan who incites David to take the census (1 Chr 21:1), to the disapproval of YHWH (God) (1 Chr 21:7), who then registers that disapproval by bringing plague on Israel (1 Chr 21:7–14). What is interesting here is that although Satan is shown to incite David to sin, thus removing the paradox of YHWH punishing David for something that YHWH initiated in the first place, it is still YHWH rather than Satan who inflicts the plague, so that the notion of plagues and diseases being under YHWH’s control is preserved. This is in stark contrast to Mesopotamian conceptions of sickness as being the work of demons, making it necessary to identify the appropriate divine agent before any treatment can begin.
It is instructive at this point to refer to Hab 3:5, mentioned earlier, where YHWH the divine warrior (here called Eloah, Hab 3:3) is pictured coming from Teman preceded by pestilence and followed by plague. The two elements “pestilence” (deber) and “plague” (resheph) are presented in a quasi-anthropomorphic fashion as retainers preceding and following their lord, and both nouns should probably be understood as the names of demons or deities seen as responsible for pestilence and plague respectively. There is widespread evidence across the ancient Near East for belief in the god Resheph as a god of plague, and though the evidence for Deber as a similar being is less definitive it makes sense in the Habakkuk passage to read both Resheph and Deber as demonic beings (Day 2000, 199). Habakkuk 3 is perhaps the clearest of several references in the HB that seem to reflect a consciousness of Resheph as a supernatural plague-bearing entity.2 That said, though, even in Habakkuk it is notable that the plague-causing powers are in a subordinate relationship to the divine warrior, so whatever their individual capabilities may be they are exercising them at the behest and under the control of YHWH.
This leads us on quite naturally to ask why YHWH should inflict sickness on human beings, and the answer to this question that presents itself most often in the pages of the HB is that sickness is a punishment for human sin. This comes through particularly clearly in the Pentateuchal narratives: wherever plagues or illnesses occur in the wilderness wanderings it is because YHWH is punishing the people for having disobeyed or rebelled against him. Thus, a plague follows the episode of the golden calf, when the Israelites make a calf to worship while Moses is on the mountain receiving the Law from YHWH (Exod 32). When the Israelites complain about eating manna all the time and demand meat, YHWH provides them with quails but strikes them with plague as they eat the meat (Num 11:4–34). When Miriam and Aaron challenge Moses’ leadership, Miriam is struck with leprosy (Numbers 12); after a group of Israelites have spied out the land of Canaan and brought back a negative report that disheartens the people, YHWH becomes angry with the spies and plague breaks out among them (Num 14:36–38; cf. 14:12), as it does when the people complain against Aaron and Moses on other occasions (Num 16:41–49; 21:4–9) and when the people turn to other gods (Num 25:1–9). Nor is it only in its narratives that the Pentateuch presents a picture of plague as divine punishment; in the legal material too plague is similarly described. In Leviticus YHWH declares he will send disease and pestilence on the people as part of their punishment for failing to obey the law (Lev 26:16, 25); and in Deuteronomy sickness and disease is promised first for those who hate the Israelites (7:15), and later on for the Israelites themselves if they disobey the law (28:21, 22, 27, 35, 60, 61). The references from Leviticus 26 and Deuteronomy 28 are particularly interesting as they place the occurrence of disease among the Israelites in a covenantal context. Leviticus and Deuteronomy both present the laws they set out as being part of a covenant arrangement into which the Israelites are entering together with YHWH. YHWH is their benefactor and savior who has done them the immense favor of rescuing them from slavery in Egypt and is now asking for their reciprocal loyalty in a binding agreement, or covenant. Assuming the Israelites agree to the covenant, the laws are the conditions of the covenant, the means whereby the Israelites express their loyalty to YHWH, and these “conditions” are accompanied by penalty clauses in the shape of curses that the Israelites will suffer if they break the conditions of the covenant. Leviticus 26 and Deuteronomy 28 with their references to sickness and disease are both part of a series of covenantal curses, and they present sickness as a divine punishment not simply for behaving badly but specifically for reneging on responsibilities to which one is bound as a result of having entered a binding agreement with a superior party—in this case, the deity’s own self.
The idea of disease as YHWH’s punishment for sin, often with a covenantal overtone, persists elsewhere in the Hebrew canon. Amos 4:10 lists pestilence as one of the punishments visited on Israel by YHWH in an attempt to turn the people back to him. The eschatological picture painted in Zechariah 14 shows YHWH bringing a rotting plague on those who fight against Jerusalem and on their animals (14:12, 15), and another undefined plague on those who do not go up to Jerusalem to celebrate the Feast of Booths (14:18). Jeremiah 21:6 shows YHWH promising to send pestilence on humans and animals in Jerusalem as punishment for the people’s and the king’s iniquities. In Ezekiel pestilence is part of YHWH’s judgment on Sidon (28:22–23), and of the eschatological judgment on Gog (38:22).
Given the depiction of sickness as punishment for sin, it is not surprising to find that many of these instances of disease or plague are shown as being averted or terminated by means of a ritual response of some kind. In practice, it is often hard to tell whether the ritual that results in the plague being terminated means that those struck by the plague are healed, or simply that no more people contract it and so die. Thus, the Passover ritual (Exodus 12–13) is clearly prophylactic, in that it protects the people of Israel from “the destroyer” who kills all the Egyptian first-born; and the bronze snake ritual (Numbers 21) is equally clearly therapeutic in that it is designed to heal those who have been bitten by the snakes sent by YHWH. But the end of the plague in 2 Samuel 24 is more difficult to decipher theologically speaking. YHWH already seems to have decided to halt it before instructing David to build an altar by Araunah’s threshing floor (2 Sam 24:15–19), although the definitive end of the plague apparently comes in response to David building the altar and offering burnt offerings upon it (2 Sam 24:25). This still leaves the question of whether the end of the plague means that those already affected are healed, or that no more individuals contract the plague which is lethal by definition. Another such incident is the rebellion of Korah (Numbers 16–17), in which those who protest against the rebels being punished are struck by plague, and Aaron has to avert the plague by taking a censer with incense and standing amidst the people, “between the dead and the living,” as the text says, in order to make atonement for them (Num 16:46–48). The plague is apparently stopped dead in its tracks by Aaron’s action, implying a conception of it as something that kills instantly rather than as something that weakens and kills its victims over a period of time. This latter is an interesting example of a priest taking direct therapeutic action in order to bring to an end the sickness. Nevertheless, it is clear that ritual action is presented as an appropriate response to plagues in order to avert or terminate them. This is the case regardless of the historicity of the Pentateuchal narratives, which as noted earlier is difficult if not impossible to verify.
Almost all of these examples, however, are instances of epidemics, and thus the previous synthesis presents primarily a theology of epidemics rather than a theology of sickness on the more every day, individual level. This therefore raises the question of whether the same paradigm applies to individual sickness. When someone falls ill, is it because that person is being punished individually for sin, or is something else going on? This is not always easy to determine, again largely because of the nature of the sources.
One such source is the psalms of individual lament in the Psalter, pleas to the deity for relief from a range of troubles that are frequently expressed in generic or metaphorical terms. A number of these psalms use language suggesting that the petitioner is experiencing physical illness, and in a detailed study from 1973 Klaus Seybold identified 38 and 88 definitely, 6, 13, and 51 probably, and 31, 35, and 71 possibly, as prayers for relief from illness. It is notable that the motif of the petitioner’s sinfulness is strong in these psalms, indicating that the illness is being viewed as divine punishment.
Outside the psalms there are a number of narratives that involve sickness and healing, although they have the limitations of agenda noted earlier: their purpose is not to provide information on ideas about disease or infirmity and how to deal with it, but to make other kinds of points. One such purpose is to confirm the identities of certain individuals as messengers of YHWH or “men of God,” and this can be seen in several narratives of healing in the books of Kings. Thus, Elijah and Elisha are both said to have raised to life a child who had died of an unspecified illness (1 Kings 17; 2 Kgs 4:18–37); Elisha is responsible for healing Na’aman the Syrian of leprosy (2 Kings 5); and the prophet Isaiah is said to have prescribed a treatment for Hezekiah king of Judah that saved him from death (namely, a fig poultice on a boil; 2 Kings 20). Certainly in the Elijah and Elisha instances it is possible to see a similarity with Jesus’s answer to the question from the disciples about the man born blind. The disciples ask, who sinned, this man or his parents, that he was born blind? Jesus says, neither, but this is so that the glory of God can be revealed in him (John 9:2–3), and then proceeds to heal the man. Likewise, in the healings carried out by Elijah and Elisha the diseases seem to function primarily as an arena for the display of divine power: the end result in all the cases noted is not simply that an individual is healed, but that the prophets are affirmed as truly men of God, and in the case of Na’aman, that YHWH is acknowledged as the only true God. The similarity with John 9:2–3 is particularly striking in 1 Kgs 17:18, where the widow whose son dies accuses Elijah of bringing her sin to remembrance and causing the death of her son; that is, she assumes her son’s death to be her punishment for sin, even though it is not.3
There are, however, also some narratives of individual sickness in which the affliction can be interpreted as punishment for sin. Such might be the evil spirit sent by YHWH on Saul when he has fallen out of favor (1 Samuel 16), or the “stroke” that afflicts the surly Nabal when he learns that his wife has given to the fugitive David the hospitality that he himself refused to give (1 Samuel 25). Such is the fatal illness that strikes the child born to David and Bathsheba from their unsanctioned liaison (2 Sam 12:15–23), an illness explicitly construed in the text as a vicarious punishment of David. Such is implicitly the case for Jeroboam’s son (1 Kings 14), who falls ill and dies as part of YHWH’s actions to end the dynasty of the sinful monarch. Such is clearly the case of Gehazi, Elisha’s servant, who, when Elisha refuses payment from Na’aman for healing his leprosy, chases after the departing Na’aman and lies to him in order to get the payment for himself; as punishment for this deceit, Gehazi is afflicted with Na’aman’s leprosy (2 Kgs 5:19–27). Such, too, are the cases of the kings Uzziah and Jehoram in the books of Chronicles, both of whom suffer from diseases that result from their sin in some way. Jehoram leads the people into unfaithfulness and is struck by YHWH with a disease of his bowels that eventually kills him (2 Chr 21:12–20); and Uzziah exceeds his prerogatives by usurping the role of the priests in the Temple and is struck with leprosy as a result (2 Chr 26:16–21)—a disease that leads to exclusion from the cult as punishment for a cultic sin. There is also a criticism of a third king in relation to illness: Asa has a disease in his feet (2 Chr 16:12), but instead of seeking the Lord he relies on physicians. Yet this is not the only view of these kings’ illnesses that is presented in the Hebrew Bible. Versions of the same narratives appear in the books of Kings, where there is no such overt link between the monarchs’ afflictions and their sin. In Kings Asa is simply noted as having been diseased in his feet in his later years (1 Kgs 15:23); no mention is made of Jehoram being afflicted with anything (2 Kgs 8:16–24); and Uzziah (called Azariah in Kings) is said to have been struck by YHWH so that he became a leper, but he is also said to have done what was right in the sight of YHWH, though illegitimate sites of worship in the kingdom were not removed during his reign (2 Kgs 15:1–6). The link between individual sickness and sin is thus debated in the pages of the Hebrew Bible, most obviously in the book of Job, where the prevailing wisdom understands sickness as punishment for sin (Job 18:13; 27:13–15), but Job questions that wisdom by protesting his innocence throughout. Nevertheless, despite the relationship between individual sickness and sin being less definitive than it might initially appear, such sickness is widely associated with YHWH, whatever the ultimate motivation for it in any given case is shown to be. In 1 Kgs 17:20, for example, when Elijah prays to YHWH to heal the widow’s son, he challenges YHWH for having killed the child in the first place, and then prays for the child to be revived, which YHWH duly accomplishes. YHWH is therefore regarded as the source of both illness and healing.
Given the range of circumstances behind individual cases of sickness, then, the question is how they would have been treated, and in particular, how far ritual responses of any sort were deemed appropriate.4 Certainly if the picture of YHWH as the causative force behind illness is correct, we might reasonably expect to see evidence of such ritual responses, on the basis that the one who has the power to inflict illness is also the one with the power to heal. Despite the caveats noted earlier concerning the propagandist nature of the narratives in which prophets heal the sick, we may discern from them a pattern whereby one recourse for those who were sick or caring for the sick was to consult a holy man or prophet for divine help in order to effect healing. There is also a group of narratives which indicate that such consultation could equally focus on prognosis, although in each case the prognosis is negative: Jeroboam sends his wife to consult the prophet Ahijah about their son, who is sick, and is told that the child will die (1 Kgs 14:1–18); Ahaziah king of Israel sends to consult Baal-zebul of Ekron about whether he will recover from injuries sustained in a fall, and is told by Elijah that he will die (2 Kgs 1:2–17); and Ben-Hadad king of Damascus sends to consult Elisha on whether or not he will recover from his illness, but again the message is negative (2 Kgs 8:7–10). Given that these are all figures connected with the northern kingdom of Israel and with Syria, who in the eyes of the compilers of Kings are sinful by definition, it is difficult to know quite what to make of these narratives for an understanding of how sickness and ill-health were conceptualized and tackled on a day-to-day basis in Iron-Age Israel. But whatever the particular bias of the sources we have, it seems reasonable to infer from them that, in cases of individual sickness, consulting a holy man for assistance, whether for diagnosis/prognosis or for treatment, may have been one ritual option.
Interestingly, though, despite the picture in Numbers 17 of Aaron the high priest stopping a plague by offering incense, what does not seem to have been a widespread ritual option for individuals is to consult a priest. Nowhere in the HB is a priest shown with the power to heal by virtue of being a priest. There are two possible counter-arguments to this point: first, the regulations in Leviticus 13 and 14 concerning leprosy do not just empower but actually require the priests to pronounce on what is and is not leprosy, and to say when leprosy is no longer present in a person or an object, which seems to imply that the priests had some kind of therapeutic responsibility in such cases. Deuteronomy 24:8, “In an attack of leprosy do everything the priests say,” might also be understood in this way. Second, on the understanding that whatever their subsequent history of usage the psalms are fundamentally liturgical compositions for use in sanctuary rituals, if they do include prayers for relief from illness they indicate that in at least some cases of illness a ritual response is deemed appropriate. This again might indicate that priests have some sort of power or responsibility in this area.
To take the second of these points first: Certainly if we understand (some of) the psalms of individual lament as potentially reflecting temple-based liturgies of healing, and the abrupt change to praise at the end of some of them as a response to a spoken assurance that the prayer has been heard, then there is potentially a role of sorts for priests in rituals relating to the healing of individuals from sickness. But the priest’s role is not as the person to whom the petitioner appeals directly for help, because the priest on this model has no power to bring about healing. The most he can do is to say whether or not the petitioner’s prayer has been heard, with the assumption that “prayer heard = prayer answered positively,” and so this might be regarded as the equivalent of giving a favorable prognosis on the outcome of the illness. But the same could be said of any individual lament ritual where some other misfortune is being brought before God and relief from it is being sought. The priest may tell the petitioner that their prayer has been heard; but that surely does not mean that the priest is personally responsible for resolving the petitioner’s misfortune, in the sense of being a vehicle through whom that resolution is brought about. By contrast, the prophets who tell people that their illnesses will not be healed are also shown as having power to heal, and there is almost the sense that because they themselves are channels for the healing power of God they also have the right to deny people healing. There is not a single instance, in the case of an individual’s illness, where a priest either heals a person or tells them that they are not going to recover.
As for the rules surrounding leprosy in Leviticus 13 and 14, it is not uncommon for them to be taken in some sort of medical sense, in the same way that the stipulations regarding clean and unclean animals in Leviticus 11 are often explained on hygienic grounds—not eating pork and shellfish because they are notorious disease-carriers, for example. In Leviticus 13, it might be thought that the priest functions in a quasi-medical role: the person with “leprosy,” whatever that might be, has to go to the priest to be examined, and it is the priest who decides on the basis of the criteria set down in Leviticus 13 whether the person is or is not suffering from leprosy; it is also the priest who has the responsibility of saying when the person is free of leprosy. But when the rules setting out the diagnostic procedure are read carefully, it becomes clear that there is nothing particularly therapeutic about it, at least not in terms of modern conceptions of pathogen-initiated disease. The priest simply identifies and isolates the sufferer. No treatment is offered whereby the leprosy can be relieved; rather, the message is, “You’ve got it, so go away and don’t come back again until it’s gone.” When the leprosy is cured, the priest declares the sufferer clean, and the patient offers sacrifices, but these in no way effect medical healing. Rather, they confirm that healing has already taken place, and that as a result the person is once again fit to participate in cultic life, but until and unless the leprosy disappears of its own accord the sacrifices cannot be offered. The same is true, according to Leviticus 15, of those afflicted with genital discharges; once the affliction has ceased the patient waits for a certain number of days and then offers sacrifices in order to restore their status as “fit to participate in the cult.” But the sacrifices in themselves are not a therapeutic procedure intended to drive away the affliction; they cannot be offered until the affliction has been absent for at least a week. The reason for including these afflictions in the provisions of the law and requiring priestly intervention to ensure their absence is because, for whatever reason, they are seen as a threat to ritual purity rather than as being in need of priestly therapeutic care. It is the priest’s job to guard the ritual purity of both the people and the deity’s shrine in their midst, and to make sure that nothing “unclean” or “impure” causes the deity to abandon them. This is the purpose of the regulations, to enable the priest to identify and neutralize threats to ritual purity in the community, not because the priest has any function in healing sufferers from leprosy or from any other kind of disease. This can readily be deduced from the fact that so few ailments are addressed in these or in any other cultic regulations: nothing is said about fever or diarrhea or vomiting or headaches or infected wounds or anything else that we might reasonably conclude would have been known to the Israelites. If it really were the priests’ responsibility to care in detail for individuals suffering illnesses, surely there would be more evidence of it in the legal codes than there currently is. In both Egyptian and Mesopotamian societies there were well-developed systems of therapeutic care, significant aspects of which were focused around certain types of priests who were guardians of medical lore; the presence of such a well-developed system in neighboring cultures serves to highlight the lack of anything similar in the Hebrew Bible.
An alternative view of the priest as in fact part of the healing system in the Hebrew Bible is put forward by Zucconi (2013, 118–125), who views all sickness and healing in the HB in the context of a covenantal monotheistic relationship between YHWH and the community, and argues that sickness is a message between YHWH and the sufferer that needs to be decoded. In this context, anyone who helps to decode the message is part of the healing process, which has both horizontal and vertical aspects: the horizontal aspect is the relationship between the sufferer and the rest of the community, and the vertical aspect is the relationship between the community (including the sufferer) and God. Sickness disrupts both aspects, and the priest as the one who receives the sacrifices to re-incorporate the sufferer into the community after the end of sickness is therefore an essential therapeutic actor in the healing process more widely conceived. Additionally, it is the priest who must say whether or not someone is afflicted with leprosy, which involves decoding the message being sent to the person about their cultic status so as to initiate the appropriate course of action—an important part of the overall process. Once isolated, the sufferer can then take further action to identify the sin that has caused the problem and thereby effect healing. On this view, then, the priests and the rituals they administer do indeed have a healing role, in the sense of repairing and maintaining community cohesion. Zucconi’s reconstruction is not without its merits, though it does depend on dating the materials in Leviticus to the pre-exilic period, a position that many scholars would challenge. That said, even though the present form of Leviticus may be relatively late, at least some of its content probably predates its present form, and leprosy is mentioned several times elsewhere in the HB as a significant health issue, so it is conceivable that priestly involvement in dealing with cases of leprosy was part of the healing process in the sense just outlined during the pre-exilic period.
Although the evidence for direct priestly involvement in rituals of healing is conjectural at best, there is more to be said about such rituals. The tendency has been to assume that the psalms that suggest the existence of rituals for healing are liturgical compositions for public use, and so the rituals would have taken place in public spheres such as temples. This assumption, however, is problematic on a number of fronts. First, if the petitioners were as gravely ill as the psalms seem to imply (at the gates of Sheol, going down into the Pit, etc.), it is doubtful whether they would be able to get to the temple at all in order to offer their prayers. Second, there is also the question of ritual purity, as highlighted by the regulations in Leviticus, which effectively keep those with leprosy and genital discharges away from the sanctuary until their affliction has gone. Granted, the Leviticus regulations may be relatively late in their present form and therefore not representative of general attitudes during the period of the monarchy, but we cannot discount the possibility that at least some kinds of bodily afflictions were regarded as ritually unclean by the Israelites from an early stage. In particular, narratives from the monarchic period show “leprosy” as causing its sufferers to be excluded from normal interaction with others (2 Kgs 7:3; 15:5), which makes it very unlikely that leprosy patients would be welcomed into a temple to pray for healing. Third, evidence from elsewhere in the HB apart from in the psalms is clear that the main locus of care for the sick was in the home rather than in any kind of institutionalized context (including temples; Avalos 1995, 251; Gerstenberger 2002, 43–45; Lohfink 1994, 66). This strongly suggests that there must have been a locus other than temples in which the psalms praying for healing were utilized.
Indeed, several scholars have concluded that the most logical place in which these psalms would have been used was in the home. Seybold points to the vocabulary of the psalms he identifies most confidently as prayers for healing, observing that in these psalms there is no cultic terminology, but that on the contrary the expressions used indicate that the sufferer is isolated at home (e.g., Ps 88:1, 8; Seybold 1973, 171–172). Gerstenberger too describes such psalms being used, with the help of the appropriate ritual expert, in the family home (Gerstenberger 2002, 43–44); and Chalmers likewise subscribes to the notion of a series of domestic healing rites which would involve among other things confessions of sin and prayers for healing (Chalmers 2011, 28–29), elements which appear in Psalm 38 (identified definitively by Seybold as a prayer for healing). Additional actions alongside the prayers might be wearing sackcloth, fasting, and mourning (cf. 2 Sam 12:16–17; Ps 35:13–14); and it might also be possible for the prayers to be offered at the sanctuary by someone on behalf of the sick person (Seybold 1973, 172). Where there is the possibility of a shrine-based ritual for the sufferer, though, is after the sufferer has recovered, as implied by some of the psalms that describe the psalmist’s experience of both sickness and healing, or even just healing: these psalms Seybold regards as originating in the context of public thanksgiving and celebratory sacrifices for healing, a procedure mentioned in Ps 107:22 (Seybold 1973, 174). In fact, Ps 107:17–22 encapsulates a mini-theological/liturgical guide for dealing with sickness: ill-health results from sin, and those affected must cry to the Lord for healing; once healed, they must thank God, offer sacrifices, and tell what God has done for them. That said, of course, some psalms such as Psalm 73 also show a view of ill-health more in line with the book of Job, indicating once more that the “sin-sickness” equation was not as straightforward or universal as it might appear. Nevertheless, even here a cultic response is proffered as the way forward for the sufferer, since it is when the innocent but beleaguered psalmist enters the sanctuary that he finds the comfort and reassurance he needs (Ps 73:13–14, 16–24).
Another interesting example of ritual treatment for sickness comes in the case of women’s diseases. Most of the individual cases of disease in the HB involve male subjects—kings, sons, servants—but there are others that involve women, and interestingly these women are the only ones who are shown receiving treatment or attention for their disorders at the temple. Perhaps not surprisingly, the disorders in question are related to reproduction, which as Avalos points out was so much a part of women’s societal role that to have a bodily malfunction such as barrenness was tantamount to being disabled (Avalos 1995, 248–249). The first example from which the custom of therapeutic treatment at a temple might be deduced is the story of Hannah in 1 Samuel 1, where the childless Hannah prays in the temple at Shiloh for conception and is offered words of encouragement for her prayer by Eli the priest, after which she goes away content and is able to conceive a child (1 Sam 1:1–20). The “sickness” in this instance is that of barrenness or infertility, and the “ritual” that might lie behind the narrative is one whereby a barren woman goes to a shrine and prays for conception, following which she receives assurance from a member of the shrine’s cultic staff (a priest?) that her prayer has been heard. It is even possible that some of the psalms of lament in the present Psalter were written with such a scenario in mind, given (as noted earlier) that if sick people were to be able to offer prayers for healing at a shrine they would have to be what might be termed the walking wounded, that is, able to get there to offer the prayers. The extravagant language of these psalms that implies that the petitioner is at the very gates of death must to that extent be rhetorical hyperbole. Barren but otherwise healthy women, on the other hand, would be able to journey to the shrines to offer their heartfelt prayers. This also makes sense of the imagery of death in many of the laments: in a culture where descendants were key to one’s post-mortem existence, barrenness was a kind of living death. Under these circumstances, to understand the language of descent into the Pit or Sheol (the realms of death) as the prayer of a barren woman makes perfect sense.5
The other scenario that is linked with the temple and involves potential irregularities in female reproductive capacity is the so-called sotah ritual (Num 5:11–31), which is used when a woman is suspected of having committed adultery but there is no proof. The woman is brought before the priest by her husband, the priest invokes curses on her if she has committed adultery, and then he writes the curses down and washes them off the page into some water to which dirt from the floor of the shrine has been added. The woman is to drink the mixture, and if she has not committed adultery she will be unharmed by it and be able to conceive children. But if she has slept with another man the mixture will have a negative effect on her pelvic organs (Num 5:21, 22, 27), the description of which effect is variously interpreted as a miscarriage of any child conceived during the adultery, a prolapsed uterus, or even sterility.
At one level this may seem an inappropriate topic to include in a discussion of sickness and healing in relation to ritual, especially given the previous comments about leprosy where the priest identifies the disease but offers no physical or pharmacological treatment. Additionally, the “illness” in the case of the sotah ritual may be the emotional or psychological illness—the so-called “spirit of jealousy” (Num 5:14)—of the insecure husband whose suspicions of his wife are groundless, rather than any indisposition of the woman who is the subject (or object) of the ritual. Nevertheless, it is the only instance we have in the HB of a ritual whereby a priest administers to a person something that is intended to effect a change in the bodily condition of that person. As hinted earlier, too, it can also be seen as a strategy, however distasteful to modern sensibilities, for dealing with a certain kind of paranoia; to that extent, therefore, it is at least on the fringes of medical practice and conceptions of sickness and healing. Indeed, it might be argued that the presenting “sickness” is the rift caused between the couple by the suspicion of adultery, whether this is because of the husband’s jealousy or the wife’s unfaithfulness, and that the healing intended by the ritual is either to cure the husband of his jealousy, or to purge the wife of her illegitimate child by inducing a miscarriage.
The view of sickness and healing in the Hebrew Bible, then, can be summarized as follows. The text gives us only the vaguest of pictures of what kind of diseases afflicted those among whom it originated. Nevertheless, there is a clear picture of disease as being under YHWH’s control, both for its cause and its cure. Though the connection of disease with sin is asserted in many parts of the text, it is not universally accepted; but the idea that disease originates from YHWH means that a cultic or ritual response to serious disease events is evidenced in both narrative and liturgical texts. Such a response might consist of consulting a prophet or holy man for help; confession of sin and prayer for healing uttered either within the family unit or at a shrine, whether by a surrogate or by the patient; wearing sackcloth, fasting, and undertaking lamentation on behalf of the patient; and offering public prayers and sacrifices of thanksgiving at the sanctuary once the patient recovered. Despite the undoubted association between YHWH and both sickness and healing, though, and in contrast to Israel’s ancient Near Eastern neighbors, there does not seem to be evidence for priests as therapeutic experts, nor for Yahwistic shrines as primary places of healing. Rather, their main function is in restoring the healed person’s social and cultic status, which may well have been damaged by the disease.