The Medical Model of Orthodoxy Part 3: Understanding the Literature

The problem with Torah is that it is quite complex. As opposed to the simplified version provided by many kiruv organizations and other outreach groups, halachic decision making is not an easy process. Fluency in many authoritative sources and a firm knowledge of Chumash and Gemara are required to reach important decisions or, even more critically, innovate in response to new and novel situations.


Unfortunately, most people seem to have an aversion to such demands. For them, it boils down to a simple question: Is "X" permitted or forbidden? Some of this is because of the ba'al teshuvah phenomenon. People returning to Torah from a secular lifestyle can be intimidated when they discover the sheer volume of knowledge required for competent practice of Judaism. It is not wrong to want short cuts, at least in the beginning, to help a person develop an observant lifestyle relatively quickly.


The problem is what comes after. Most of the short cuts are generally chumros and they're adopted for the obvious reason - to avoid accidental sinning. This is certainly laudable but this runs the risk of then becomming a pattern. If the initial trend is to answer every doubt with a stringent ruling, this often persists even once the ba'al teshuvah (BT) has acquired a decent Torah education and some comfort with daily Jewish practice. What's more, there is a ripple effect on the dati mimolad (frum from birth, FFB). These chumros quickly spread until they become the new standard behaviour, adding a level of stringency to practice that, al pi hadin, is not necessary.





To use a medical analogy, one need not look any further than the state of medical training today. Years ago, before the advent of sophisiticated testing, medical school training emphasized the history and physical exam of a patient to a far greater degree than it does today. Without a CT scanner, one is more likely to ask a more thorough history and perform a more complete physical exam. Without ultarsound backup, minor clues that might otherwise be ignored take on definite prominence.


However, with the widespread availability of diagnostic imaging, much of the stress on thorough history and physical exam skill has fallen by the wayside. This is for two reasons. The first is because the sheer volume of information that the training physician must absorb has expanded to the degree that nothing is covered as thoroughly as it used to be. And since the tests are available, they become a short cut of their own. Why do a thorough neurological exam on this stroke patient when I can get a CT scan and just look a the brain's structure directly?


The second is the expectation of the patient. A few years ago a study was published looking at several current guidelines in the USA for the use of diagnostic imaging. What was determined was that much of the testing that is considered standard actually isn't. Why are relatively minor head injuries all getting CT's? In a word: medicolegal. Physicians know that the diagnostic process is not 100% (except in decaptitation but that's another story) but also realize that some patients may have unrealistic expectations as to the certainty of their diagnosis. If I see a patient in the ER with a minor head injury and find no neurological problems, there is a 99% chance the patient can go home and will do fine. In 1% of cases, something make have been missed, with catastrophic results for the patient. In such cases, a CT scan at the initial assessment will add nothing to my decision. However, if the patient goes home and then suffers an intracranial bleed, then if I don't have a normal CT I might be sued because the patient's family will contend that the test might have picked something up. So, not wanting the trouble, I order the CT. And when everyone does it, it becomes the new standard.





Returning to our examination of Torah behaviour, one can quickly see how this anaology holds up. I recall years ago having a conversation with someone on a particular activity on Shabbos. She wanted to know if it was permitted or not. I told her I had actually just read the relevant section in Shemirath Shabbath Kehilchathah and that it was allowed. She thought about it for a moment and then shrugged. "Well, I won't do it anyway, just in case." Just in case of what? That a very stringent and thorough book that almost everyone holds by is wrong? Had she a deep understanding of halacha and understood how and why the decision was reached, she might have thought differently but she had been taught in a different way: "everything is forbidden until you can prove it's permitted and even then it might not be"

However, this is not how halacha works. Preconceived notions, answering the question before you've even looked up the sources, are all easier ways to practice but they deny the depth and complexity of Torah. They lead to a simplistic practice that some might feel leads to a greater level of holiness simply because holiness is determined by counting the chumros taken on.

It cannot be stressed enough: the person who treats a particular activity as permitted after having researched the Gemara, Poskim and contemporary sources is practising on a far higher level than the person who, not knowing the sources but wishing to avoid even accidental wrong doing, simply forbids the same activity. Unfortunately in this day and age, the opposite is often perceived. The simplistic behaviour often looks down condescendingly on the more complex. This is especially relevant come Pesach.



In medicine, there are two basic levels to the literature. There are the primary sources which include studies and other experiments. Then there are guildelines which look at the primary sources and attempt to synthesize coherent conclusions for the practising physician. The primary sources are called "the evidence" in this context.

Not unlike rabbonim, doctors can have a multitude of opinions and constantly disagree with one another. Given the complex nature of statistics and their interpretations, two people can read the same story and reach diametrically opposed conclusions. Thus what evidence is considered to be good quality and worthy of being considered in the formulation of guidelines is often a source of lively debate.

The practising physician can therefore confront the evidence in one of four ways. He can develop a limited connection with the evidence, reading and analyzing studies of importance to him, and he can study the guidelines to see why they recommend what they do and what their limitations are. Or he can assume that he trusts that the people who made the guidelines knew what they were doing and just learn them. He might decide to call a specialist every time a complex or new case faces him. Finally, he can snort and say he has no interest in the latest findings. He's going to give everyone with a cold antibiotics even though current evidence suggests that's a bad thing.

The vast majority of physicians practise in a clinical setting. Given time restrictions and other responsibilites, it is not possible to survery the primary literature to the depth needed to fully understand all the evidence. Thus a high level of reliance on guidelines, amplified by the occasional reading of primary sources, is necessary. A small group of physicians do spend their days involved in clinical research and analysis of the literature. They see far less patients (if at all) but their work contributes to the body of medical information available for use.



Once more returning to the Torah model, the analogy can be applied as followed. In the Torah world, the primary sources, the evidence, are the Gemara and the various Poskim who have arisen since that time. Treating these authorities as primary sources, one can see why, despite their obvious overarching brilliance no one authority's rulings, not even the Rambam or the Rav Yosef Karo are completely accepted without provision. After all, any of their rulings must be interpreted in light of other primary sources that might amplify or contradict them.
Thus the observant Jew also has four choices in terms of practice. The first is to take on the life of full time learning. One like this would spend his time delving into our rich and deep legal history, developing an appreciation for how seemingly simple situations can have a level of complexity completely hidden from superficial understanding. Or he can learn the basic sources with a heavy emphasis on some of the many modern halachic books where the final decisions (at least, in the opinion of the authors of those books) are simply presented. He could become dependent on a Rav, constantly calling with shailos. Finally, he too could snort and decide that whenever faced with indecision he can simply forbid the questionable activity, just "to be safe".

Using the medical analogy, one can see how simplistic and limited the final approach to Torah is. As it says in Devarim, the Torah is our wisdom and the length of our days, not a "how to and how not to" handbook. The final approach is one that might at first be thought to be fine given its cautious attitude but as Rav Shimon Eider points out concerning, in particular, the laws of Niddah, stringency in some areas might lead to unintended leniencies in other areas or outright violations. Thus is cannot be recommended as an appropriate outlook.
Simiarly, the first options, that of full time study is certainly laudable but canot be recommended as a universal option. It's one thing to sit all day reviewing the literature. It's quite another to understand it on such a level that the reviewing actually matters. For the ilui such a lifestyle is to be commended and recommended. For the average person it is, to be put bluntly, a waste of time and resources. One must view the idea that it should be the default lifestyle choice of the observant Jew with a very jaundiced eye. Perhaps in the years after the Holocaust when there was a need to rebuild the Torah world it would have had priority but today that situation has clearly changed. For every future Posek there are dozens if not hundred of "bench warmers", boys and men who are hiding out from their real responsibilites by adopting a lifestyle which they cannot fulfill realize the potential of.
Finally, the third category, that of calling one's Rav all the time, is also not a great idea. Imagine the poor Rav whose phone never stops ringing because of all the inane questions that are asked simply because the questioner is too lazy to try and find out the answer for himself. I'm not referring to complex or novel situations but ones which, in today's information age, can easily be determined. A Rav is an expert in halachah. Asking him how to toivel dishes is like asking a family doctor how to treat the common cold.
So this leave one category, the one requiring the person to develop a decent knowledge of the basic halachic literature and some fluency in the primary evidence while recognizing that the complexity of Torah means that sometimes there are no definite answers, that contradicting positions can often both be right for different people, that always taking the stricter approach does not make one more observant, and that tolerance of this variety enhances a person's practice of Judaism.