Talmudology on the Parsha, Vayera: Visiting the Sick

בראשית 18:1

וַיֵּרָ֤א אֵלָיו֙ ה׳ בְּאֵלֹנֵ֖י מַמְרֵ֑א וְה֛וּא יֹשֵׁ֥ב פֶּֽתַח־הָאֹ֖הֶל כְּחֹ֥ם הַיּֽוֹם׃

And the Lord appeared to him [Amraham] by the terebinths of Mamre,

as he sat in the tent door in the heat of the day.

Rashi, the famous eleventh century commentator, cites a statement by Rabbi Hama that explains what exactly it was that God was doing when he appeared to Abraham:

רש׳י שם

וירא אליו. לְבַקֵּר אֶת הַחוֹלֶה. אָמַר רַבִּי חָמָא בַּר חֲנִינָא, יוֹם שְׁלִישִׁי לְמִילָתוֹ הָיָה, וּבָא הַקָּבָּ"ה וְשָׁאַל בִּשְׁלוֹמוֹ (בבא מציעא פ"ו)

וירא אליו AND THE LORD APPEARED UNTO HIM to visit the sick man. R. Hama the son of Hanina said: it was the third day after his circumcision and the Holy One, blessed be He, came and enquired after the state of his health (Bava Metzia 86b)

More from Rabbi Hama

Rabbi Hama bar Hanina, who lived in Israel in the third century CE turned his exegetical comment into a social action program. Here it is:

סוטה יד, א

ואמר רבי חמא ברבי חנינא מאי דכתיב אחרי ה' אלהיכם תלכו וכי אפשר לו לאדם להלך אחר שכינה והלא כבר נאמר כי ה' אלהיך אש אוכלה הוא אלא להלך אחר מדותיו של הקב"ה מה הוא מלביש ערומים דכתיב ויעש ה' אלהים לאדם ולאשתו כתנות עור וילבישם אף אתה הלבש ערומים הקב"ה ביקר חולים דכתיב וירא אליו ה' באלוני ממרא אף אתה בקר חולים

Rabbi Chama the son of Rabbi Chanina said: What is the meaning of the verse (Deut 13:5) "You should follow the Lord your God"? Is it possible for a human to follow the Divine?...The verse mean that you should emulate God's attributes. Just as he clothed the naked...you should clothe the naked. Just as Holy One, Blessed be He visited the sick...you too should visit the sick...

The Talmud on visiting the sick

For Rabbi Hama, visiting the sick should be performed because it's the right thing to do: after all, God himself visited Abraham as he was recovering from circumcision. Elsewhere, the rabbis of the Talmud taught that visiting the sick wasn’t just a kind action; it actually aided in their recovery:

נדרים לט, ב - מ, א

תניא ביקור חולים אין לה שיעור ... אמר אביי: אפי' גדול אצל קטן רבא אמר אפי' מאה פעמים ביום אמר רבי אחא בר חנינא כל המבקר חולה נוטל אחד מששים בצערו

יצא ר' עקיבא ודרש: כל מי שאין מבקר חולים כאילו שופך דמים. כי אתא רב דימי אמר: כל המבקר את החולה גורם לו שיחיה וכל שאינו מבקר את החולה גורם לו שימות

Visiting the sick is a mitzvah that has no limit... Abaye said that even an important person must visit a lesser person who is ill...Rava said: [you must visit a sick person] even one hundred times a day...Rabbi Acha bar China said: "Whoever visits a sick person takes away one-sixtieth of his suffering...

Rabbi Akiva expounded and said: "Whoever does not visit the sick, it is as if he sheds blood." When Rav Dimi came [from Israel to Babylon] he said: "Whoever visits the sick causes the person to live, and whoever does not visit the sick, causes the person to die." (Nedarim 39b-40a)

Visiting the Sick in the Modern Intensive Care Unit

Many years ago, as part of my day job, I visited the famous Grady Memorial Hospital in Atlanta, and was privileged to be given a tour of their new Neurocritical Care Unit, part of the Marcus Stroke and Neuroscience Center (and thank you, Bernie "Home Depot" Marcus). While the unit has all the fancy equipment you'd expect, what impressed me the most was a feature I had not seen in any other intensive care unit (ICU): every patient room has an adjoining suite where a family member can eat, sleep, shower and wait (and there is a lot of waiting in ICUs). There are no visiting hours; the family member literally lives in the ICU with their loved one.  My tour guide explained that the unit sees the presence of  visitors as a way of offering the best care to the patient. It is a wonderful approach to the care of the sick - but it wasn't always like that.

A HISTORY OF VISITING THE SICK - IN HOSPITALS

Visiting times in hospitals still vary greatly, and many have an open door policy. But not too long ago, you might only be able to visit a patient in a hospital for a couple of hours each week. In the 1870s, Doncaster Royal Infirmary in Britain limited visiting to three afternoons a week - which was a more generous policy than that of the Royal Berkshire Hospital, which allowed only one 15 minute visits twice a week. In a survey of over 400 British hospitals conducted in 1988, over a quarter of those which replied allowed visiting for no more than two hours a day. Perhaps these restrictive policies were in response to some visitors who abused the generosity of Britain's glorious National Health Service. 

“[A more open visiting policy] proved to be a disaster, primarily because of abuse of the system by visitors. Many would arrive promptly at 8 am and stay all day. They would bring sandwiches and flasks . . . and camp out by their relative’s bed . . . Others would eat patients’ food, [and] ask for extra cups of tea...there was even a threat of violence from a visitor asked to leave temporarily...”

— Alderman B. Hospital visiting hours. BMJ 1988;296:1798-9.

HELP PATIENTS GET WELL SOONER - BY VISITING THEM

According to Rabbi Acha bar China, visiting the sick actually aids in their recovery (“Whoever visits a sick person takes away one-sixtieth of his suffering...). Perhaps this is less far-fetched than it sounds. In 2006 an Italian group reported the results of a study on the effects of hospital visitors on patient outcomes in its small intensive care unit.  The ICU changed its visiting policy from a restricted one (one visitor twice a day for thirty minutes) to an unrestricted one every two months.  After two years of this alternating policy, the authors compared the outcomes of their 226 patients. Despite significantly higher environmental microbial contamination during the unrestricted visiting periods, septic complications were similar. But the risk of cardiocirculatory complications was twice as high in the restricted visiting periods, which were also associated with a (non-significantly) higher mortality rate. The unrestricted group was associated with a greater reduction in anxiety score and a significantly lower increase in thyroid stimulating hormone from admission to discharge. The authors concluded that "liberalizing the visiting hours seems to be more protective because it is associated with a reduction in severe cardiovascular complications."

Incidence, with Odds Ratio and 95% Confidence Intervals, of septic and major cardiovascular complications in patients enrolled during the restricted (RVP) and unrestricted visiting periods (UVP) adjusted for age, gender, and time of enrollment. RR indicates relative risk; UT, urinary tract; pul., pulmonary; and CV compl., cardiovascular complication. From Fumagalli et al. Reduced Cardiocirculatory Complications With Unrestrictive Visiting Policy in an Intensive Care Unit Results From a Pilot, Randomized Trial. Circulation. 2006;113:946-952.

Writing in The Journal of the American Medical Association in 2004, Donald Berwick and Meeta Kotogal called for a change in the policy of restricted visiting hours in intensive care units.  They noted three areas which are often of concern to ICU staff when considering the question of visiting hours.  They also noted that although these concerns seem reasonable, the scientific literature tells "quite a different story."

Physiologic Stress for the Patient: "The concern that the patient should be left alone to rest incorrectly assumes that family presence at the bedside causes stress. The empirical literature suggests that the presence of family and friends tends to reassure and soothe the patient, providing sensory organization in an overstimulated environment and familiarity in unfamiliar surroundings. Visits of family and friends do not usually increase patients’ stress levels, as measured by blood pressure, heart rate, and intracranial pressure, but may in fact lower them. Nursing visits, on the other hand, often increase stress." 

Barriers to the Provision of Care: "The second concern is that the unrestricted presence of loved ones at the bedside will make it more difficult for nurses and physicians to do their jobs and may interfere with the delivery of care. The evidence suggests, however, that the family more often serves as a helpful support structure, increasing opportunities for patient and family education, and facilitating communication between the patient and clinicians." 

Exhaustion of Family and Friends: "The third concern is that constant visiting with the patient may prove exhausting for family and friends who fail to recognize the need to pace themselves. While that does sometimes happen, it is also true that open visiting hours help alleviate the anxiety of family and friends, allowing them to spend time with the patient when they want and to feel more secure and relaxed during the time they are not with the patient. One study found that open visitation had a beneficial effect on 88% of families and decreased anxiety in 65% of families."

A review of visitation policies in ICUs produced by the American College of Critical Care Medicine Task Force went one step further and found "no evidence that pets that are clean and properly immunized should be restricted from the ICU environment." So don't forget to bring the dog next time you visit a family member or friend in the ICU (or anywhere else for that matter). 

““...the preponderance of the literature supports greater flexibility in ICU visitation policies. Descriptive studies of the physiologic effects of visiting on mental status, intracranial pressure, heart rate, and ectopy demonstrated no physiologic rationale for restricting visiting. In fact, in seven of 24 patients with neurologic injuries, family visits produced a significant positive effect, measured by decrease in intracranial pressure.
”

— Davidson et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Critical Care Medicine 2007; 35 (2): 612.

HOW TO VISIT A FRIEND WHO'S SICK - THEN, AND NOW

Most of the evidence about the benefits of visiting the sick that we've been discussing have centered on the ICU- because that's where most of the research has been done. But for most of the time, an ill friend will not be in the ICU, or even in the hospital. Instead they will be at home, and so that is where the visit will occur.  Sadly, the ability to be a friend to a friend who is sick does not come easy to all of us.  Here's what Letty Pogrebin noted, in her recent book How to be a Friend to a Friend Who's Sick:

It's not uncommon for people to freeze or panic in the company of misery, botch gestures that were meant to ease, attempt to problem-solve when we have no idea what we're talking about, say the wrong thing, talk too much, fidget in the sick room, sit too close to the patient or stand too far away. Some of us don't visit our sick friends at all...

The Talmud sensed that visitors need some guidelines as to how to behave, and Rav Shisha suggested the following rule (Nedarim 40): "One should not visit a sick person in the first three hours of the day or in the last three hours of the day." In addition, the Talmud notes that "one who goes to visit the sick should not sit on the bed nor on a bench or a chair, but instead should wrap himself up in his cloak and sit on the ground, because the divine presence rests above the bed of a sick person." While we may no-longer follow this advice, the suggestion that we take our visits to the sick seriously is one that we should heed. Let's close with some more advice, updated for the modern era, from Pogrebin's 2013 handbook (p86-86):

1. Ask the patient to be honest with you and all their friends.

2. Be honest with yourself about your attitude toward the visit.

3. Think through your role in the visit.

4. Don't visit if you can't abide silence.

5. Be prepared to respond without flinching to whatever scene or circumstances greet you during your visit.

6. Be sensitive to your friend's losses.

7. Talk honestly with your children about the demands illness makes on friendship and how important it is to visit people who want company.

““What is the reward given for visiting the sick in this world? “God will guard him and restore him to life and he will be fortunate on earth, and You will not give him over to the desire of his foes.” [Ps 41:3.]:
”God will guard him” - from the evil inclination.
”And restore him to life” - from his suffering.
”And he will be fortunate on earth”- in that everyone will take pride in him.
”And You will not give him over to the desire of his foes”- for he will have good friends... ”

— TB Nedarim 40a.

Talmudology on the Parsha: Milah and Credibility Enhancing Displays

בראשית 17: 9-10

וַיֹּ֤אמֶר אֱלֹהִים֙ אֶל־אַבְרָהָ֔ם וְאַתָּ֖ה אֶת־בְּרִיתִ֣י תִשְׁמֹ֑ר אַתָּ֛ה וְזַרְעֲךָ֥ אַֽחֲרֶ֖יךָ לְדֹרֹתָֽם׃

זֹ֣את בְּרִיתִ֞י אֲשֶׁ֣ר תִּשְׁמְר֗וּ בֵּינִי֙ וּבֵ֣ינֵיכֶ֔ם וּבֵ֥ין זַרְעֲךָ֖ אַחֲרֶ֑יךָ הִמּ֥וֹל לָכֶ֖ם כל־זָכָֽר׃

And God said to Avraham, Thou shalt keep My covenant therefore, thou, and thy seed after thee in their generations.

This is My covenant, which you shall keep, between Me and you and thy seed after thee; Every male among you shall be circumcised.

In this week’s parsha, God promises to Abraham that he will have countless descendents, be an ancestor of kings and inherit the entire land of Canaan. And what does God ask in return? Just one thing: circumcision.

Here are five talmudic sages who thought the idea was, well, great.

נדרים לא, ב

רבי ישמעאל אומר: גדולה מילה שנכרתו עליה שלש עשרה בריתות. רבי יוסי אומר: גדולה מילה שדוחה את השבת חמורה. רבי יהושע בן קרחה אומר: גדולה מילה שלא נתלה לו למשה הצדיק עליה מלא שעה. רבי נחמיה אומר: גדולה מילה שדוחה את הנגעים. רבי אומר: גדולה מילה שכל המצות שעשה אברהם אבינו לא נקרא שלם עד שמל שנאמר "התהלך לפני והיה תמים" דבר אחר גדולה מילה שאלמלא היא לא ברא הקב"ה את עולמו שנאמר כה אמר ה' אם לא בריתי יומם ולילה חקות שמים וארץ לא שמתי

R. Ishmael said, great is [the precept] of Milah (circumcision), Since thirteen covenants were made concerning it.  R. Jose said, circumcision is a great precept, for it overrides the strict laws of  Shabbat. R. Joshua b. Karha said: great is [the precept of] circumcision. For [neglecting] which Moses did not have [his punishment] suspended even for a single hour. R. Nehemiah said, great is [the precept of] circumcision, since it supersedes the laws of Nega'im. Rabbi said, great is circumcision, for in spite of all the commands that Abraham fulfilled, he was not called complete until he circumcised himself, as it is written, “walk before me, and be complete.” Another explanation: great is circumcision, since but for that, the Holy One, Blessed be he, would not have created the universe, as it is written, “but for my covenant (בריתי) by day and night, the laws of Heaven and Earth I would not have established." (Nedarim 31b).

Non-Religiously Motivated Circumcision

Medical circumcision is widely practiced in the US where the rate of male newborn circumcision is about 55%, down from a high of about 62% in 1999. (This change may be due to an increase in the Hispanic population, which is traditionally non-circumcising.) In Europe the rate varies greatly by country. In Britain about 16% of male babies are circumcised; in Denmark, the figure is less than 2%. Worldwide, about one-third of all male boys are circumcised by the age of fifteen.

In 2012 the Task Force on Circumcision of American Academy of Pediatrics reviewed the scientific literature about the health benefits of male circumcision.  The Task Force concluded that “the preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure.”  However, these health benefits were not enough for them to recommend circumcision as a routine procedure for all male newborns - and this position is also held by Britain's National Health Service.  What then, are the health benefits of male circumcision?

Global prevalence of male circumcision. From Male circumcision: global trends and determinants of prevalence, safety and acceptability. World Health Organizations and the Joint United Nations Program on HIV/AIDS, 2007. 

“In the pluralistic society of the United States, where parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account their own cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice.”

— Technical Report: Male Circumcision. American Academy of Pediatrics. Pediatrics 2012; 130 (3): e756-785.

 Sexually Transmitted Diseases – including HIV

In 2005 the first study on the role of circumcision in protecting against HIV infection was published. The study was run in South Africa, where over 3,200 men were randomized to circumcision or no-circumcision. The study was stopped early when an interim analysis showed that HIV infection was 60% lower in the circumcision group. Male circumcision prevented six out of ten potential HIV infections. This was a remarkable finding.  In fact the study team commented that male circumcision provided an equivalent degree of protection against acquiring HIV infection “to what a vaccine of high efficacy would have achieved.”

And male circumcision is not just protective against HIV. It decreases the transmission rates for human papilloma virus (HPV) and herpes simplex virus 2 (HSV-2) in female partners, and the balance of evidence suggests that it also protective against syphilis. (But it doesn’t seem to protect against the two most common sexually transmitted diseases in the US – chlamydia and gonorrhea.) A team from John Hopkins University School of Public Health predicted that if neonatal circumcision rates in the US would fall to European levels of about 10%, the result would be an additional $500 million in healthcare costs. Over a ten year period, there would be more than 4,000 new HIV infections in men and more than 125,000 new herpes simplex infections.

“With an estimated cost per infection averted in the range of $150 to $900 over a 10-year period (depending on the local incidence of HIV infection), male circumcision appears to be one of the most cost-effective preventive approaches, requiring only a one-time intervention.”

— Piot and Quinn. Response to the AIDS Pandemic - A Global Health Model.New England Journal of Medicine 2013. 368;23. 2210-2218

Urinary Tract Infections and Phimosis

Male circumcision also protects against urinary tract infections – but according to the Task Force you’d have to circumcise about 100 babies to prevent one such infection. Phimosis (an inability to retract the foreskin) and other inflammatory problems of the penis are either absent or much reduced in circumcised boys:  “From ages 1 through 8 years, the rates were 6.5 penile problems per 100 circumcised boys over the study period, compared with 17.2 penile problems per 100 uncircumcised boys.”

Penile and Cervical Cancer

Penile cancer is rare, but cervical cancer is not.  Male circumcision reduces the risk of penile cancer by about 50%, and it seems that it also reduces the odds of cervical cancer in the man’s partner (especially if he has had six or more lifetime sexual partners.)

The Risks from Male Circumcision

There are of course risks associated with the procedure of male circumcision itself, but these are rare.  A recent study reviewed 1.4 million male circumcisions and found only 16 cases in which an adverse event occurred, although ten of these were serious.  Overall, the procedure is very safe when properly performed in the first year of life, but complications rise up to twenty-fold if the procedure is performed after infancy. (It goes without saying that the dangerous practice of metzizah  be-peh should never be performed.)

What about life after a safely performed circumcision? Does that change? One recent Belgium study of more than 1,000 men,  “circumcised men reported decreased sexual pleasure and lower orgasm intensity. They also stated more effort was required to achieve orgasm, and a higher percentage of them experienced unusual sensations (burning, prickling, itching, or tingling and numbness of the glans penis).” A Danish study found a similar result: “circumcised men …were more likely to report frequent orgasm difficulties…and women with circumcised spouses more often reported incomplete sexual needs fulfillment.” These were however, individual studies, and in 2013, the Journal of Sexual Medicine published an exhaustive meta-analysis of 36 publications describing the effects of male circumcision on aspects of male sexual function. It found no evidence overall "for any significant difference in components of sexual function, sensitivity, sexual sensation, or sexual pleasure in men who are circumcised and men who are not." Furthermore, it examined several studies of men circumcised in adulthood, which are of particular research interest since these men serve as their own control.  In this group too, the meta-analysis failed to find any adverse effect of circumcision on the parameters examined. 

The Costly Investment of Brit Milah

The medical benefits of male circumcision are well documented, and its risks are small. But none of these benefits were known to those who first introduced the ritual, and anthropologists wonder why circumcision, and other painful and irrevocable rites of passage, should be so common across cultures.  One possible answer comes from the theory of costly investment.

This is based on the finding that religious, ethnic and tribal groups that demand more from their members do better in the long run than those that demand less. These groups have to insure that all members contribute equally, and that there are no “free-riders” – those who are taking from the group but not giving back. One way to weed out the free-riders is to demand a costly and irrevocable investment in order to join the group – and that investment might be circumcision, tattooing or scarification, all of which are used as a means to induct new members. Once the costly investment is made, a person will be less likely to leave the group. Joseph Henrich (The Ruth Moore Professor of Biological Anthropology Professor of Human Evolutionary Biology at Harvard) has a term for these investments: credibility enhancing displays (CREDs):

Participation in rituals involving costly acts will elevate people's degree of belief commitment. If the professed beliefs involve group commitment, cooperation toward fellow in- group members, or the hatred of out-groups, then ritual attendees will trust, identify and cooperate with in-group members more than non attendees.

...In learning how to behave and what to believe, learners give weight to both prestige and CREDs, among other things. Thus, successful cultural forms, especially those involving deep commitment to counterintuitive beliefs, will tend to begin with and be sustained by prestigious individuals performing CREDs. Cues of prestige influence who people pay attention to for learning, while CREDs convince them that the prestigious model really believes (is committed to) his or her professed beliefs. The “virtuous- ness” arises from these prestigious individuals' role as models. CGS [Cultural Group Selection] will favor, over long swaths of historical time, religions with role models who effectively transmit beliefs and practices that strengthen in-group cooperation, promote intra-group harmony and increase competitiveness against out-groups. 

From Henrich, J. The evolution of costly displays, cooperation and religion: credibility enhancing displays and their implications for cultural evolution. Evolution and Human Behavior 2009; 30: 244-260.

Nelson Mandela's Ritual Circumcision

Whether or not Brit Milah is just another credibility enhancing display, it is a very widely practiced ritual- and extends far beyond the Jewish and Muslim communities.  Nelson Mandela recalled his own circumcision (at the age of 16!) in his autobiography: 

When I was sixteen, the regent decided that it was time I became a man. In Xhosa tradition this is achieved through one means only: circumcision.  In my tradition, an uncircumcised male cannot be heir to his father's wealth, cannot marry or officiate at tribal rituals. An uncircumcised Xhosa man is a contradiction in terms, for he is not considered a man at all, but a boy...

The night before the circumcision there was a ceremony near our huts with singing and dancing. Women came from the nearby villages, and we danced to their singing and clapping...At dawn, when the stars  were still in the sky...we were escorted to the river to bath in its cold waters, a ritual that signified our purification before the ceremony...We were clad only in our blankets, and as the  ceremony began, with drums pounding, we were ordered to sit on a blanket n the ground with our legs spread out in front of us...I could see a thin elderly man emerged from a tent and knee in front of the first boy...The old man was a famous ingcibi, ad circumcision expert...

Suddenly, I heard the first boy cry out: "Ndyindoda!"   (I am a man!), which we were trained to say at the moment of circumcision...before I new it, the old man was kneeling in from of me...without a word he took my foreskin, pulled it forward, and then, in a single motion, brought down his assegai...I felt fire shooting through my veins; the pain was so intense that I buried my chin into my chest. Many seconds seemed to pass before I remembered the cry, and then I recovered and called out, "Ndiyindoda"...A boy may cry; a man conceals his pain...I was given my circumcision name, Dalibunga, meaning "Founder of the Bunga,"...

Jewish Criticism of Milah

Among the most vocal critics of the practice today are those who are born Jewish. But circumcision has been criticized for as long as it has been practiced, and these self-criticisms are not new.  In the 1780s, a British Jew (who wrote anonymously) published a pamphlet called A Peep into the Synagogue, in which he was critical of many Jewish practices.  And his most scathing words were those he penned about circumcision:

In the extravagant Catalogue of Jewish absurdities, there is not one more shameful than that of Circumsition [sic], it is a barbarous violation of the principles of Nature,  For what can be more unhuman, than to punish an Infant by a cruel operation on a part of its body, done by a bungling Butcher of a Priest! Or what can be more insulting to all-wise Creator, than for a stupid Fool of a Fellow, to presume to correct His workmanship, by finding one superfluous part, and taking that away to reduce the subject to perfection. (Anonymous. A Peep into the Synagogue, or A Letter to the Jews. London, undated.) 

The Joy of Milah

Although it is under attack in Europe and is less popular than it has been US, circumcision remains a time for joy for the many faith communities in which it is practiced. The ritual is often accompanied by feasting and gift-giving, whether it is performed in Muslim or Jewish communities, or by members of African tribes.  The Talmud explains why, for Jews, the ritual is one that is associated with so much joy. It is an explanation that is as simple as it is profound:

שבת קל, א

 תניא רשב"ג אומר כל מצוה שקיבלו עליהם בשמחה כגון מילה דכתיב "שש אנכי על אמרתך כמוצא שלל רב" עדיין עושין אותה בשמחה

It was taught in a Baraisa: Rabban Shimon ben Gamliel says: Any commandment that the Jewish people accepted with joy - like circumcision, as it it written: "I rejoice over your word like one who finds great spoils" [Ps. 119:162]  - they still perform with joy...(Shabbat 130b.)

Kiddushin 69a ~ Nationality, Class and Caste

קידושין סט, א

 עשרה יוחסים עלו מבבל כהני לויי ישראלי חללי גירי וחרורי ממזירי נתיני שתוקי ואסופי כהני לויי וישראלי מותרין לבא זה בזה לויי ישראלי חללי גירי וחרורי מותרין לבא זה בזה גירי וחרורי ממזירי ונתיני שתוקי ואסופי כולם מותרין לבא זה בזה ואלו הם שתוקי כל שהוא מכיר את אמו ואינו מכיר את אביו אסופי כל שנאסף מן השוק ואינו מכיר לא את אביו ולא אמו אבא שאול היה קורא לשתוקי בדוקי

Ten genealogical classes went up from Babylon: Cohanim (priests) Levi'im (Levites), Israelites, halalim, converts, freedmen, mamzerim, netinim, shethuki and foundlings. Priests, Levites and Israelites may intermarry with each other. Levites, Israelites, halalim, converts, and freedmen may intermarry. Converts and freedmen, mamzerim and netinim, shethuki and foundlings, are all permitted to intermarry. This is the definition of a shethuki: he who knows his mother but not his father; a foundling: he who was found in the streets but does not know his father nor his mother....(Kiddushin 69a)

For the last few pages, the Talmud has been focussed on the status of various classes of Jews, Gentiles, and those in-between.  The last Mishnah of the previous chapter detailed a method devised by Rabbi Tarphon (who lived between the destruction of the Second Temple in 70 CE and the Bar Kochba revolt in 135 CE) to allow the descendants of a mamzer to marry into the Jewish people, and the laws of genealogy continue in this, the last chapter of the last tractate of Nashim. So what is it about class and geneology that makes it so important to our social interactions?  Can science shed any light on the rabbinic obsession with who is in, who is out, who is in-between?

Kinship Selection

Kinship selection  - our favoring of relatives or those most like us - is a fundamental part of evolutionary theory. It is best understood by considering altruistic behavior, which here means "self-sacrifice behavior performed of the benefit of others." If I exhibit altruistic behavior for my offspring - be they chicks or children - then these offspring are more likely to survive and breed. In this way, my altruistic behavior has increased the chances of my genes being carried on to my descendants - which is all that evolution cares about. If I don't exhibit altruistic behavior and just focus on my own needs, I may leave my offspring more vulnerable, and hence less likely to survive. In this way, altruistic behavior, or better, the genes for altruistic behavior, are passed on and give those individuals who demonstrate it a competitive advantage over others. This idea is also true for my siblings and my cousins, who, after all, share some, or a lot, of my DNA.  A great example of this are the sterile worker bees, ants and wasps, who sacrifice themselves so that their kin - their bee, and or wasp cousins - will survive to breed. So looking after those to whom we are closely related is part of our genetic blueprint.  Here evolution acts not on individuals but on groups. The groups in which individuals exhibit altruism are more likely to survive.  We favor those in our group, and are hostile (to varying degrees of course) to those outside of it.  

National Character

Before we look at class within a race or social group, it is worth pausing to think for a moment about how we characterize nationalities. In 2006 researchers from the National Institute on Aging reviewed the stereotypes of several nationalities, which include the sterotype that  views Americans as "rude, arrogant, and self-centered...the Chinese as industrious, Latins as hot-tempered, and Scandinavians as somber." Except that they didn't really call these beliefs stereotypes. Instead, they  referred to "a standard set from a comprehensive taxonomy of personality traits [which] allows comparisons across many different groups. " These perceptions, "and the high inter rater reliabilities (agreement among judges) document that these are indeed shared perceptions of groups— and thus, stereotypes." What is most interesting to learn is that these shared beliefs about a national character are not only held within a culture; there is consensus across cultures. Thus, "the French view of Germans is similar to Germans’ view of themselves, and vice versa." 

“Popular thought characterizes the Chinese as industrious, Latins as hot-tempered, and Scandinavians as somber. Although Americans may not have clear ideas about the typical Ethiopian or Indonesian, Ethiopians and Indonesians surely do.”

— McCrae R, Terracciano A. National Character and Personality. Current Directions in Psychological Science 2006: 15 (4). 156-161.

The attribution of psychological characteristics to ethnic or racial groups has of course been used to justify genocide and slavery, but as the psychologist Steven Pinker noted,

...the problem is not with the possibility that people might differ from one another, which is a factual question that could turn out one way or the other. The problem is with the line of reasoning that says that if people do turn out to be different, then discrimination, oppression, or genocide would be OK after all. 

So with that caveat, researchers recruited an international team to measure five personality dimensions (each with a further five sub-categories) in 51 cultures across six continents.  And here is what they found:

Multidimensional scaling plot of 51 cultures for the 30 facet scores of the Revised NEO Personality Inventory, standardized across cultures. The vertical axis is maximally aligned with the Neuroticism factor, the horizontal axis with the Extraversion factor. From McCrae R. and Terracciano A, and 79 others). Personality Profiles of Cultures: Aggregate Personality Traits. Journal of Personality and Social Psychology 2005: 89(3); 420. Hey - where are the Israelis?

In the plot, cultures are arranged such that the closer they appear, the more similar are their personality profiles. For example, the profile for the French closely resembles that of the French Swiss, and is quite different from the profile of Mexicans. "On average," the authors conclude, "the French are relatively high in Neuroticism and Mexicans relatively low." 

The Psychology of Prejudice

In 1906, William Sumner, the country's first professor of sociology (and at Yale, no less!) published his classic work Folkways: A Study of the Sociological Importance of Usages, Manners, Customs, Mores and Morals.  In it, he suggested a role for ethnocenterism, that is to say, a positive sentiment and feeling of superiority towards one's own ingroup:

For Sumner, a strong allegiance to an in-group automatically meant a hostility to those outside:

The relation of comradeship and peace in the we-group and that of hostility and war towards others-groups are correlative to each other. The exigencies of war with outsiders are what make peace inside...Loyalty to the group, sacrifice for it, hatred and contempt for outsiders, brotherhood within, warlikeness without - all grow together, common products of the same situation...

Oxytocin and Ethnocentrism

In 2011 a group of Dutch researchers explored the idea that because ethnocentrism also facilitates within-group trust, cooperation, and coordination, it may be modulated by brain oxytocin, a peptide which has been shown to promote cooperation among in-group members. In a double-blind, placebo-controlled study, men self-administered oxytocin or placebo and privately performed computer-guided tasks to gauge different manifestations of ethnocentric in-group favoritism as well as out-group derogation. Their results, published in published a paper in the widely respected Proceedings of the National Academies of Sciences, found that oxytocin creates intergroup bias because it motivates in-group favoritism and, to a lesser extent, out-group derogation. The researchers suggest that oxytocin has a role in the emergence of intergroup conflict and violence. By my count this is now the bazillionth thing that oxytocin does.  

Oxytocin reduces the willingness to sacrifice in-group targets to save a larger collective but not the readiness to sacrifice out-group targets. Results range from 0 to 5 (displayed ± SE). (A) Results for experiment 4 with Arabs as out-group. (B) Results for experiment 5 with Germans as out-group. From De Dreu, CK. Greer LL. Van Kleff GA. et al. Oxytocin promotes human ethnocentrism. PNAS 2011:108 (4); 1264.

There are hundreds of scientific papers that study the phenomenon of in-group and out-group dynamics.  Among my favorites are:

For Members Only: Ingroup Punishment of Fairness Norm Violations in the Ultimatum Game (2014) which demonstrated that participants exacted stricter costly punishment on racial in-group than out-group members for marginally unfair game offers. Of course it helps to know how to play ultimatum.

Groupwise information sharing promotes ingroup favoritism in indirect reciprocity (2012) which suggested that ingroup favoritism can emerge when players implement reputation-based decision making and do not favor ingroup members.

Fear Among the Extremes: How Political Ideology Predicts Negative Emotions and Outgroup Derogation (2015), a Dutch study that showed that socio-economic fear, as well as negative political emotions, could be meaningfully predicted by political extremism. No kidding. But the really interesting part of the study is this finding: Political extremists—at both the left and the right—derogated a larger number of societal groups than political moderates did. It would seem that political extremists of any persuasion may be similar to each other psychologically.

Evolution of in-group favoritism (2012) which showed that in-group bias emerges through the co-evolution of group membership and strategy without invoking the mechanism of multi-level selection. Actually I have no idea what this paper is all about, since it included the equation on the right. If you can explain it to me, I would be grateful.

the Mamzer

דברים פרק כג, ג 

'לא יבא ממזר בקהל ה' גם דור עשירי לא יבא לו בקהל ה

In his paper The Attitude toward Mamzerim in Jewish Society in Late Antiquity Meir Bar-Ilan wrote that

The only interpretation accepted as law in Talmudic literature for the verse "No mamzer shall be admitted into the community of the Lord" relates exclusively to the prohibition of marriage. That is, the words "shall not be admitted" were interpreted as a prohibition of an Israelite (and a fortiori Levite and Cohen) to be married to a mamzer (male or female). This is a social separation with only one application (a meaning that is disclosed to the individual only once and at a relatively mature age).

(Meir Bar-Ilan, who teaches history at Bar-Ilan University in Tel Aviv, is a direct descendent of Rabbi Meir Bar-Ilan, (and hence of the Netziv,) after whom Bar-Ilan university was named. In the early 1980s my family hosted him on a visit to London, and it was on that visit that I took him to see the Valmadonna collection.  I wonder if he remembers? I certainly do. Now, where was I?) 

Bar-Ilan also notes that the Mishnah that opens this last chapter of Kiddushin is special because 

it depicts historically the formation of Jewish society in Palestine and its dependence on the previous period in the time of Ezra and the returnees from Babylon. The author of this Mishnah claims - or transmits - a tradition of what occurred centuries earlier. In this matter too this Mishnah has few parallels. Note, immediately after the "historical" heading, the author lists the different levels of Jewish society, a hierarchical list in descending order. Only after this social introduction does he turn to the law - the primary interest of the sages of the Mishnah.

After noting some further textual difficulties, Bar-Ilan suggests that rather than giving a historical accounting, this Mishnah actually expresses a sociological position. In other words, the Mishnah is trying to clarify the social structure of its time, and hence  "...may definitely be designated as a Mishnah of mythological nature, that is, a narrative of the formation of the society known to the narrator." There is a debate in the Mishnah (Yevamot 4:13) as to the precise definition of a mamzer: according to Rabbi Akivah, it is a person born of a relationship that is forbidden in Lev 18: 6-20; according to Shimon Hatimni it is a person born of a union whose punishment is kareth (this would include a person who has intercourse with his menstruating wife); and according to R. Yehoshua it is a person born from a union punishable by execution. These Tanna'im, wrote the scion of the Bar-Ilan family,

"...were engaged not only in a theoretical dispute but ... they represent different approaches in Jewish society. (The first Tanna anonymously represents a more ancient approach whereas Rabbi Simon represents a relatively new approach)...Though there were different opinions regarding the definition of a mamzer, the rabbinic law is seen to restrict the application of the definition of the mamzer to limited individuals...the rabbinic law of the Talmudic period shows a trend to limit the law as applied to the mamzer in two ways: first, in the definition of the mamzer; and second, in the nature and scope of his exclusion from society...

Thus mamzerim were more readily integrated into society, though the prohibition of marriage to them remained in force. That is to say, the social stratification based on ancestry continually weakened as can be seem from the narrowing of the exclusive characteristics of the priests on one hand and abolition - even if only partial - of the discrimination against mamzerim on the other...

Ancient Jewish society was one of many societies that used a caste system. These systems are still prevalent in India (even though discrimination against lower castes is illegal under Article 15 of its constitution), and in Pakistan, Nepal and Southeast Asia. In Korea, the baekjeong are an outcaste group and varieties of castes exit in Africa. In western countries the caste system may not exist, but intermarriage between classes may still be difficult. In 1936 Edward VII had to abdicate as king of Great Britain in order to marry the divorcee Wallis Simpson. Although I am a naturalized American, I am disqualified from being a candidate for President because I am not a natural born citizen. The disqualifications outlined in today's Mishnah differ from these, for they penalize not only the Jew-by-choice, but also the Jewish child whose parents' union was forbidden.  Liberal democratic societies (that is, the WEIRD ones) have mostly left the issues of class and caste behind, leaving some religions with a great deal of work to do.  

“No Person except a natural born Citizen, or a Citizen of the United States, at the time of the Adoption of this Constitution, shall be eligible to the Office of President...”

— The Constitution of the United States, Article II, Section I, Clause 5

Want more on the mamzer? Click here. and next time, on talmudology, why the best doctors should go to hell.

Kiddushin 69 ~ How High is Jerusalem?

This is the FIRST of two posts For the page of Talmud to be studied this Shabbat.

On this page of Talmud we read in a Mishna that ten lines of lineage left Babylon and went “up” to Israel with Ezra, around 450 BCE.

עֲשָׂרָה יוּחֲסִים עָלוּ מִבָּבֶל: כָּהֲנֵי, לְוִיֵּי, יִשְׂרְאֵלִי, חֲלָלֵי, גֵּירֵי, וַחֲרוֹרֵי, מַמְזֵירֵי, נְתִינֵי, שְׁתוּקֵי, וַאֲסוּפֵי.

MISHNA: There were ten categories of lineage, with varying restrictions on marriage, among the Jews who ascended from Babylonia to Eretz Yisrael with Ezra before the building of the Second Temple. They are as follows: Priests; Levites; Israelites; priests disqualified due to flawed lineage [ḥalalim]; converts, and emancipated slaves; mamzerim; Gibeonites, i.e., the descendants of the Gibeonites who converted in the time of Joshua; children of unknown paternity [shetuki]; and foundlings.

The Talmud wonders about the opening phrase of the Mishna:

גְּמָ׳ עֲשָׂרָה יוּחֲסִין עָלוּ מִבָּבֶל: מַאי אִירְיָא דְּתָנֵי ״עָלוּ מִבָּבֶל״? נִיתְנֵי ״הָלְכוּ לְאֶרֶץ יִשְׂרָאֵל״! מִילְּתָא אַגַּב אוֹרְחֵיהּ קָא מַשְׁמַע לַן, כִּדְתַנְיָא: ״וְקַמְתָּ וְעָלִיתָ אֶל הַמָּקוֹם אֲשֶׁר יִבְחַר ה׳ אֱלֹהֶיךָ״, מְלַמֵּד שֶׁבֵּית הַמִּקְדָּשׁ גָּבוֹהַּ מִכל אֶרֶץ יִשְׂרָאֵל, וְאֶרֶץ יִשְׂרָאֵל גְּבוֹהָה מִכל הָאֲרָצוֹת.

Why does the Mishna specifically use the phrase “ascended from Babylonia”? Why was it important for the tanna to specify their place of origin? Let him teach that they went to Eretz Yisrael. The Gemara answers: It teaches us a matter in passing, as it is taught in a baraita: The verse states: “And you shall arise and go up to the place that the Lord, your God, shall choose” (Deuteronomy 17:8). This teaches that the Temple is higher than all of Eretz Yisrael, which is why the verse speaks of ascending from the cities of Eretz Yisrael to the Temple. And it teaches that Eretz Yisrael is higher than all of the lands.

This passage is unequivocal in its meaning: Jerusalem - that is, the Temple Mount -  is the highest place in Israel, and Israel itself is the highest place on earth. Now you don't need me to tell you that this is not a true statement. But I will anyway. It's not true. When I lived in Efrat it would often snow there while in Jerusalem, a mere twenty minutes away, there would be no snow. Why? Because Efrat is at a higher elevation than is Jerusalem. And if you have looked out from the Bet Midrash of the Hebrew University's Mount Scopus campus you will look down on the Temple Mount some three hundred feet below. The Talmud teaches the same idea in at least two other places:

זבחים נד, ב

דרש רבא מאי דכתיב (שמואל א יט, יח) "וילך דוד ושמואל וישבו בנויות ברמה" וכי מה ענין נויות אצל רמה? אלא שהיו יושבין ברמה ועוסקין בנויו של עולם אמרי כתיב (דברים יז, ח) וקמת ועלית אל המקום מלמד שבית המקדש גבוה מכל ארץ ישראל וארץ ישראל גבוהה מכל ארצות

Rava taught: What is the meaning of that which is written concerning David: “And he and Samuel went and dwelt in Naioth. And it was told Saul, saying: Behold, David is at Naioth in Ramah” (I Samuel 19:18–19)? But what does Naioth have to do with Ramah? They are in two distinct places. Rather, this means that they were sitting in Ramah and were involved in discussing the beauty [benoyo] of the world, i.e., the Temple. David and Samuel said: It is written: “Then you shall arise, and get you up unto the place which the Lord your God shall choose” (Deuteronomy 17:8). This teaches that the Temple is higher than all places in Eretz Yisrael. And Eretz Yisrael is higher than all countries. 

There is another passage in the Talmud that teaches the same point but uses some additional verses from the Book of Jeremiah to prove (as it were) that the Land of Israel is higher than all other places on earth. Here it is:

סנהדרין פז, א 

ועלית מלמד שבית המקדש גבוה מא"י וא"י גבוה מכל הארצות אל המקום בשלמא בית המקדש גבוה מא"י דכתיב ועלית אלא א"י גבוה מכל הארצות מנא ליה דכתיב לכן הנה ימים באים נאם ה' (לא יאמר) חי ה' אשר העלה את בני ישראל מארץ מצרים כי אם חי ה' אשר העלה ואשר הביא את זרע בית ישראל מארץ צפונה ומכל הארצות אשר הדחתים שם וישבו על אדמתם

"And you shall go up" [Deut 17:8] This teaches that the Holy Temple is higher than all other places in Israel...And from where do we now that Israel is higher than all other lands? From the verses [Jeremiah 23: 7-8] "Therefore, behold the days come, saith the Lord, that they shall no more say, The Lord liveth, which brought up the children of Israel out of the land of Egypt,' But the Lord liveth, which brought up and which led the seed of the house of Israel out of the north country, and from all the countries whither I have driven them; and they shall dwell in their own land."

And Rashi points to yet another verse from the Book of Jeremiah (16:23) that teaches that Israel is the highest place on earth.

רשי, זבחים נד, ב

וארץ ישראל גבוהה מכל הארצות - לא מיבעיא לן הכא ולאו מהכא נפקא לן אלא מקרא אחרינא דכתיב (ירמיהו טז כג) לא יאמר עוד חי וגו' כי אם חי ה' אשר העלה ואשר הביא את בני ישראל מארץ צפון ומכל המקומות אשר הדחתים שם וגו

So it's not just a one-off statement. The Talmud in at least three places, and Rashi in a fourth, claim that Israel is the highest place on earth. But after a quick check in your reference book or internet search engine of choice you will see this is not correct. It's not even close. (I'm talking to you, Denver).

it's true; Google said so

Here are some other places, randomly chosen that are physically higher than Jerusalem.

Location	Elevation (feet)
Jerusalem	2,424
Mount of Olives	2,710
Hebron	3,051
Efrat	3,150
Ben Nevis (UK)	4,413
Denver, Colorado	5,280
Johannesburg, South Africa	5,751
Mount Everest	29,029

Maharsha to the Rescue?

The Maharsha, R. Shmuel Eidels (1555 – 1631) in his commentary to Kiddushin 69a  suggests that since the Earth is a sphere, Israel and Jerusalem can be seen as if they were its "center."

מהרש"א חידושי אגדות מסכת קידושין דף סט עמוד א

 שהעולם הוא כתפוח ומקום בהמ"ק הוא מרכז עולם וכן א"י ולכך אמרו בא"י כיון דהוא מקום הממוצע אוירו מזוג ומחכים ויותר מקום המקדש שע"כ היו שם בלשכת הגזית חכמי סנהדרין וק"ל

Perhaps the Maharsha means that the spherical earth spins on its axis and that is the highest point, just like you might see a model of the earth on a bookshelf that spins on an axis with the North Pole at the top. But that cannot be, because the axis of the rotation of the Earth does not pass through Israel. It passes through the North Pole.  

No No. It is all metaphorical

The Talmud's claim is measurably incorrect, and several commentators suggest a metaphorical explanation. For example, the mystically inclined Maharal of Prague, Rabbi Yeduah Loew, wrote that Jerusalem is, spiritually speaking, the highest point on Earth (באר הגולה, הבאר הששי). Elsewhere, the Maharal suggests that just as water flows from the peaks of mountains down into valleys, it is Torah teachings that flow down from the spiritual capital Jerusalem to water the rest of the world.  Perhaps it is this that gives Israel and its capital a shot at the claim of being the most spiritually elevated. But it's a claim that is contingent on the behavior of all those who live there. And this week, having witnessed remarkable displays of kindness in the face of evil, I think the that the rabbis were on to something. Israel, and her inhabitants, indeed demonstrate a unity and compassion for one another that is something to look up to, and admire.

אמר ר' יוסי: מבקש אתה לראות פני השכינה בעולם הזה? עסוק בתורה בארץ ישראל"

(מדרש תהלים, תחילת פרק ק"ה)

Rav Yosi said: Do you desire to see the face of the Divine in this world? 

Then study Torah in the Land of Israel.

[ Want more on this topic? Then try this nice essay from Dr Nissin Elikim in Hebrew.]