Is Illness a Divine Punishment?

Narrative Medicine

The central idea of “narrative medicine,” a term coined by medical doctor and literature scholar Rita Charon in the early 2000s, is that constructing stories about illness—either personally experienced or closely observed in another—helps us come to terms with the illness’ disruptive effects.^[1] Severe, long-lasting pain and illness are unwelcome interruptions in the sufferer’s life—altering what they are able to do in the present and casting their future into uncertainty.

Forming narratives around these difficult experiences can mitigate sufferers’ sense of isolation by reaching out to an audience—whether present or future, real or imagined, human or divine. Illness narratives also allow the sufferer to control how they present their experience, and they facilitate the patient’s understanding of what their suffering means to them in the context of their worldview and life story.^[2]

All illness narratives are constructed within a cultural context, and they often make use of shared explanatory models, such as religious or other cultural ideas, to interpret and communicate what is happening in the patient’s life.^[3] One especially pervasive religious-cultural idea that can be found in both the Bible and in many societies today is that good people are rewarded for their behavior in this life, while “bad” people are (deservedly) punished. Thus, if a person is suffering significant, persistent pain and illness, they and/or those around them may begin to suspect that the sufferer has done something wrong: that they do not “belong” among the healthy majority.^[4]

A biblical narrative that highlights this dynamic is the sin of the golden calf.

The Golden Calf

While Moses is up on Mount Sinai, the people ask Aaron to make a golden statue of a calf for them to worship as YHWH (Exod 32:1).^[5] In anger over the Israelites’ disobedience, YHWH initially intends to destroy them and start over with Moses (v. 10). YHWH relents, however, and the people are instead punished in a more limited way, striking down 3,000 with the sword (v. 28; more on this later).

At the end of the chapter, YHWH promises additional punishment at an unspecified time and in an unspecified way:

‏^{שׁמות לב:לד} וְעַתָּה לֵךְ נְחֵה אֶת הָעָם אֶל אֲשֶׁר דִּבַּרְתִּי לָךְ הִנֵּה מַלְאָכִי יֵלֵךְ לְפָנֶיךָ וּבְיוֹם פָּקְדִי וּפָקַדְתִּי עֲלֵיהֶם חַטָּאתָם.

^{Exod 32:34} “And now go, lead the people to where I have told you. My angel will go before you. But on the day of my appointing, I will appoint their sin upon them.”^[6]

Some scholars have interpreted this threat as a reference to the fall of the northern kingdom of Israel many centuries later: a divine judgement on the golden calves of both the wilderness period and King Jeroboam (1 Kgs 12:25–33).^[7] The next verse, then, would be a later addition positing a quicker punishment more relevant to the story at hand:

‏^{שׁמות לב:לה} וַיִּגֹּף יְ־הוָה אֶת הָעָם עַל אֲשֶׁר עָשׂוּ אֶת הָעֵגֶל אֲשֶׁר עָשָׂה אַהֲרֹן.

^{Exod 32:35} And YHWH struck the people because they made the calf, which Aaron made.

Nearly all English translations interpret the verb וַיִּגֹּף, from the root נ.ג.ף, as referring to a plague. For example:

KJV – And the Lord plagued the people.

NIV – And the Lord struck the people with a plague.

NJPS – Then the Lord sent a plague upon the people.

The verb נגף, however, has a broader meaning. When used literally, it refers to a physical blow:

^{שׁמות כא:לה} וְכִי יִגֹּף שׁוֹר אִישׁ אֶת שׁוֹר רֵעֵהוּ וָמֵת וּמָכְרוּ אֶת הַשּׁוֹר הַחַי וְחָצוּ אֶת כַּסְפּוֹ וְגַם אֶת הַמֵּת יֶחֱצוּן.

^{Exod 21:35} When a man’s ox strikes his neighbor’s ox and it dies, they shall sell the live ox and divide its price; they shall also divide the dead animal.^[8]

That sense is also applied metaphorically to describe a variety of divine actions. For example, YHWH “strikes” the Egyptians with the final plague of the death of the firstborn:

^{שׁמות יב:כג} וְעָבַר יְ־הוָה לִנְגֹּף אֶת מִצְרַיִם וְרָאָה אֶת הַדָּם עַל הַמַּשְׁקוֹף וְעַל שְׁתֵּי הַמְּזוּזֹת וּפָסַח יְ־הוָה עַל הַפֶּתַח וְלֹא יִתֵּן הַמַּשְׁחִית לָבֹא אֶל בָּתֵּיכֶם לִנְגֹּף.

^{Exod 12:23} For when YHWH goes through to strike the Egyptians, He will see the blood on the lintel and the two doorposts, and YHWH will pass over the door and not let the Destroyer enter and strike your home.

Elsewhere, YHWH strikes Egypt with the plague of frogs^[9] and strikes humans with illness or death.^[10] Most biblical scholars therefore do not speculate on what exactly the final punishment for the golden calf is. William Propp, for example, who translates וַיִּגֹּף as “harmed,” simply notes: “Apparently unsatisfied by the death of 3,000 (v 28), YHWH punishes the people further—when and to what extent is left ambiguous.”^[11]

Elaine Scarry and The Body in Pain

In her influential study The Body in Pain (1985), Harvard University literature scholar Elaine Scarry contends that the Bible has had a huge influence on Western cultural perceptions of pain. She notes that when people try to describe the almost indescribable experience of pain to others, they usually use metaphors of a weapon hurting the body, such as “it feels as though a hammer is coming down on my spine.”^[12] Such imagery lends itself to imagining an invisible force wielding the weapon for a particular purpose, such as to assert power or punish.

Scarry argues that YHWH is depicted again and again in the Bible as the wielder of various weapons—“fire, storm, whirlwind, plague, rod, arrow, knife, sword”^[13]—used to inflict harm on human bodies. Pain, she suggests, is inherent to YHWH’s relationship with humans, because it confirms His otherwise invisible presence in an effective way:

The body is not simply an element in a scene of confirmation; it is the confirmation. Apart from the human body, God himself has no material reality except for the countless weapons that he exists on the invisible and disembodied side of.^[14]

In other words, we know YHWH is there because we feel the pain that He inflicts on us. In addition, there is a clear power differential between human and divine: Without a body, Scarry contends, YHWH is immune from harm Himself. This is why YHWH’s command not to make images of Him (Exod 20:4–5) is so important. Once a deity is embodied, he or she becomes vulnerable to harm, just like humans.

Scarry applies this principle to her interpretation of the golden calf narrative. At issue is Moses’ role as intermediary between YHWH and Israel. The story begins with the people having lost faith that their leader will ever return, as he has been on Mount Sinai for 40 days:

^{שׁמות לב:א} וַיַּרְא הָעָם כִּי בֹשֵׁשׁ מֹשֶׁה לָרֶדֶת מִן הָהָר וַיִּקָּהֵל הָעָם עַל אַהֲרֹן וַיֹּאמְרוּ אֵלָיו קוּם עֲשֵׂה לָנוּ אֱלֹהִים אֲשֶׁר יֵלְכוּ לְפָנֵינוּ כִּי זֶה מֹשֶׁה הָאִישׁ אֲשֶׁר הֶעֱלָנוּ מֵאֶרֶץ מִצְרַיִם לֹא יָדַעְנוּ מֶה הָיָה לוֹ.

^{Exod 32:1} When the people saw that Moses was so long in coming down from the mountain, the people gathered against Aaron and said to him, “Come, make us a god who shall go before us, for that man Moses, who brought us from the land of Egypt—we do not know what has happened to him.”

The loss of Moses would mean the loss of the divine presence as well. Thus, they ask Aaron to make the golden calf.

YHWH’s problem, according to Scarry, is twofold: Not only must He reassert His divine presence, which has been doubted, but the golden calf also makes His presence tangible, and thus He must reestablish the proper categories of disembodied deity and embodied human. Addressing these issues begins with destroying the golden calf:

^{שׁמות לב:כ} וַיִּקַּח אֶת הָעֵגֶל אֲשֶׁר עָשׂוּ וַיִּשְׂרֹף בָּאֵשׁ וַיִּטְחַן עַד אֲשֶׁר דָּק וַיִּזֶר עַל פְּנֵי הַמַּיִם וַיַּשְׁקְ אֶת בְּנֵי יִשְׂרָאֵל.

^{Exod 32:20} He [Moses] took the calf that they had made and burned it; he ground it to powder and strewed it upon the water and so made the Israelites drink it.^[15]

In addition, since YHWH’s disembodied nature has been threatened, He also intensifies the embodied nature of the humans to maintain the proper distance between human and divine by making the Israelites experience death and pain.^[16] Thus, Moses assigns the Levites to murder three thousand of their guilty fellows:

^{שׁמות לב:כז} וַיֹּאמֶר לָהֶם כֹּה אָמַר יְ־הוָה אֱלֹהֵי יִשְׂרָאֵל שִׂימוּ אִישׁ חַרְבּוֹ עַל יְרֵכוֹ עִבְרוּ וָשׁוּבוּ מִשַּׁעַר לָשַׁעַר בַּמַּחֲנֶה וְהִרְגוּ אִישׁ אֶת אָחִיו וְאִישׁ אֶת־רֵעֵהוּ וְאִישׁ אֶת קְרֹבוֹ.

^{Exod 32:27} He said to them, “Thus says YHWH, the God of Israel: Each of you put sword on thigh, go back and forth from gate to gate throughout the camp, and slay brother, neighbor, and kin.”

The final unspecified “blow” from YHWH (v. 35) would further reinforce both His disembodied presence and the Israelites’ embodied humanity.^[17]

Scarry’s innovative interpretation is itself a sort of illness narrative—attributing human pain to YHWH’s need to maintain his disembodied nature in order to be truly divine.^[18] However, it is based not in ancient Israelite culture, but in later, western preferences for mind/soul over body/matter that are not apparent in many biblical texts.^[19] A very different understanding of YHWH’s role in human health and illness emerges if we examine the golden calf narrative within its larger context in Exodus.

YHWH Has a Physical Presence

Many texts of the Bible suggest that YHWH has a physical body.^[20] Within the book of Exodus, YHWH’s body is seen by Moses, Aaron, Nadab, Abihu, and the seventy elders of Israel:

‏^{שׁמות כד:י} וַיִּרְאוּ אֵת אֱלֹהֵי יִשְׂרָאֵל וְתַחַת רַגְלָיו כְּמַעֲשֵׂה לִבְנַת הַסַּפִּיר וּכְעֶצֶם הַשָּׁמַיִם לָטֹהַר. ^כד:יא וְאֶל אֲצִילֵי בְּנֵי יִשְׂרָאֵל לֹא שָׁלַח יָדוֹ וַיֶּחֱזוּ אֶת הָאֱלֹהִים וַיֹּאכְלוּ וַיִּשְׁתּוּ.

^{Exod 24:10} And they saw the God of Israel: under His feet there was the likeness of a pavement of sapphire, like the very sky for purity. ^24:11 Yet He did not raise His hand against the leaders of the Israelites; they beheld God, and they ate and drank.

In addition, after the golden calf incident, YHWH describes His own body, which Moses is permitted to see after He has passed by:

^{שׁמות לג:כג} וַהֲסִרֹתִי אֶת כַּפִּי וְרָאִיתָ אֶת אֲחֹרָי וּפָנַי לֹא יֵרָאוּ.

^{Exod 33:23} “Then I will take My hand away and you will see My back; but My face must not be seen.”

YHWH also manifests His presence in other physical, visible ways,^[21] such as fire and cloud:^[22]

^{שׁמות יג:כא} וַי־הוָה הֹלֵךְ לִפְנֵיהֶם יוֹמָם בְּעַמּוּד עָנָן לַנְחֹתָם הַדֶּרֶךְ וְלַיְלָה בְּעַמּוּד אֵשׁ לְהָאִיר לָהֶם לָלֶכֶת יוֹמָם וָלָיְלָה.

^{Exod 13:21} YHWH went before them in a pillar of cloud by day, to guide them along the way, and in a pillar of fire by night, to give them light, that they might travel day and night.^[23]

And YHWH’s כָּבוֹד “glory,” a term that comes from the root כ.ב.ד, meaning to be heavy, conveys His weighty presence:^[24]

^{שׁמות כד:טז} וַיִּשְׁכֹּן כְּבוֹד יְ־הוָה עַל הַר סִינַי וַיְכַסֵּהוּ הֶעָנָן שֵׁשֶׁת יָמִים וַיִּקְרָא אֶל מֹשֶׁה בַּיּוֹם הַשְּׁבִיעִי מִתּוֹךְ הֶעָנָן.

^{Exod 24:16} The Presence of YHWH abode on Mount Sinai, and the cloud hid it for six days. On the seventh day He called to Moses from the midst of the cloud.^[25]

Indeed, Exodus does not assert YHWH’s disembodied presence, as Scarry claims. Rather it privileges particular embodiments of His presence (such as fire and cloud) over others (the golden calf). Moreover, the preferred means of conveying YHWH’s presence with his people seems to be via physical manifestations—both apart from and on the human body.

Materializing Divine Presence with Ritual

Exodus relates many ways in which the Israelites can remind themselves of YHWH’s presence by engaging their own bodies in practices associated with being YHWH’s chosen people, including the commands to avoid leavened bread during Passover (e.g. Exod 13:7) and to rest from work on the Sabbath (e.g. 20:8–11).^[26]

Other such practices include circumcision (Exod 4:25–26; 12:44, 48); avoiding ritually impure foods (22:30; 23:19; 34:26); making sacrifices and offerings at the tabernacle (29:38–30:16); conducting one’s behavior according to YHWH’s laws (e.g. chs. 21–23); and, of course, worshipping only YHWH (20:3–6; 22:19).

Despite Scarry’s contention that pain is inherent to YHWH’s relationship with humans, these actions are mostly not painful for the Israelites—even circumcision represents only a temporary pain and not a harmful one. Exodus dedicates much more space to detailing these ethnic- and religious identity-constructing practices than it does to describing YHWH as a causer of pain.

YHWH Promises Health and Illness

Indeed, the religious-cultural understanding of health and illness built into the construction of Israelite identity in Exodus presents good health as a sign of upholding the covenant with YHWH, while ill health is a sign of abandoning it:

^{שׁמות טו:כו} וַיֹּאמֶר אִם שָׁמוֹעַ תִּשְׁמַע לְקוֹל יְ־הוָה אֱלֹהֶיךָ וְהַיָּשָׁר בְּעֵינָיו תַּעֲשֶׂה וְהַאֲזַנְתָּ לְמִצְוֹתָיו וְשָׁמַרְתָּ כָּל חֻקָּיו כָּל הַמַּחֲלָה אֲשֶׁר שַׂמְתִּי בְמִצְרַיִם לֹא אָשִׂים עָלֶיךָ כִּי אֲנִי יְ־הוָה רֹפְאֶךָ.

^{Exod 15:26} He said, “If you will heed YHWH your God diligently, doing what is upright in His sight, giving ear to His commandments and keeping all His laws, then I will not bring upon you any of the diseases that I brought upon the Egyptians, for I YHWH am your healer.”

Not only will the Israelites be spared the diseases YHWH inflicted on the Egyptians, but they will not experience any kind of sickness, miscarriage, or infertility:

‏^{שׁמות כג:כה} וַעֲבַדְתֶּם אֵת יְ־הוָה אֱלֹהֵיכֶם וּבֵרַךְ אֶת לַחְמְךָ וְאֶת מֵימֶיךָ וַהֲסִרֹתִי מַחֲלָה מִקִּרְבֶּךָ. ^כג:כו לֹא תִהְיֶה מְשַׁכֵּלָה וַעֲקָרָה בְּאַרְצֶךָ אֶת מִסְפַּר יָמֶיךָ אֲמַלֵּא.

^{Exod 23:25} You shall serve YHWH your God, and He will bless your bread and your water. And I will remove sickness from your midst. ^23:26 No woman in your land shall miscarry or be barren. I will let you enjoy the full count of your days.

Healed at Sinai

Applying this principle literally, R. Shimon ben Yohai (2^nd century C.E.), suggests that after the Israelites received the covenant at Sinai, all were healed:

^{ויקרא רבה יח:ד} תָּנֵי רַבִּי שִׁמְעוֹן בֶּן יוֹחָאי בְּשָׁעָה שֶׁעָמְדוּ יִשְׂרָאֵל עַל הַר סִינַי וְאָמְרוּ (שמות כד:ז): כֹּל אֲשֶׁר דִּבֶּר ה׳ נַעֲשֶׂה וְנִשְׁמָע, בְּאוֹתָהּ שָׁעָה לֹא הָיָה בָּהֶן זָב וּמְצֹרָע וְלֹא חִגְרִין וְלֹא סוּמִין וְלֹא אִילְמִים וְלֹא חֵרְשִׁים וְלֹא שׁוֹטִים, עַל אוֹתָהּ שָׁעָה הוּא אוֹמֵר (שיר השירים ד:ז): כֻּלָּךְ יָפָה רַעְיָתִי וּמוּם אֵין בָּךְ.

^{Lev Rabbah 18:4} Rabbi Shimon ben Yoḥai taught: When Israel stood at Mount Sinai and said: “All that God said we will do and we will heed” (Exod 24:7), at that moment there was not among them one who experienced a discharge, or [one who was] a leper, nor lame, nor blind, nor mute, nor deaf, nor imbecile. Regarding that moment it says: “All of you is fair, my love, and there is no blemish in you” (Song 4:7).^[27]

As soon as they sinned, however, they began to experience illness:

^{ויקרא רבה יח:ד} וְכֵיוָן שֶׁחָטְאוּ לֹא עָבְרוּ יָמִים קַלִּים עַד שֶׁנִּמְצְאוּ בָּהֶן זָבִין וּמְצֹרָעִים, עַל אוֹתָהּ שָׁעָה הוּא אוֹמֵר (במדבר ה:ב): וִישַׁלְּחוּ מִן הַמַּחֲנֶה כָּל צָרוּעַ וְכָל זָב וגומר.

^{Lev Rabbah 18:4} Once they sinned, not even a brief time passed until those who experienced a discharge and lepers were found among them. Regarding that moment it says: “They shall remove from the camp anyone with a skin disease, and anyone with a discharge…” (Num 5:2).^[28]

Other rabbis identify the first sin after completion of the covenant specifically as the worship of the golden calf:

^{ויקרא רבה יח:ד} וְרַבָּנָן אָמְרֵי מִן הָעֵגֶל, דִּכְתִיב (שמות לב:כה): וַיַּרְא משֶׁה אֶת הָעָם כִּי פָרֻעַ הוּא, שֶׁפָּרְחָה בָּהֶן צָרַעַת, כְּמָה דְאַתְּ אָמַר (ויקרא יג:מה): וְרֹאשׁוֹ יִהְיֶה פָרוּעַ.

^{Lev Rabbah 18:4} The Rabbis say: It was because of the calf, as it is written: “Moses saw the people, that they were out of control [faruaʿ]” (Exod 32:25), that leprosy blossomed in them, just as it says [of the leper]: “[The hair of] his head shall be hung loose [faruaʿ]” (Lev 13:45).^[29]

The Danger of Associating Illness with Sin

This understanding that good health is the norm and that pain and illness are divine punishments for disobedience can have worrying connotations. An example from recent years is the comparison of the COVID-19 pandemic to the “plagues” in Exodus, saying that, although one should not necessarily connect the disease to individual sins, the Bible demonstrates that sin and illness have a causal relationship.^[30] Even if we include a caveat against associating disease with individual sin, the risk of such interpretations and applications of biblical texts is that they could stigmatize people who are already suffering from ill health by suggesting that they somehow deserve it.

But against such explanations are texts, like the book of Job, which portray an alternative: that some people suffer without any just cause.^[31] Thus, the Bible functions as a catalogue of narratives about pain, illness, and suffering that, in the course of interpreting what is happening in the sufferer’s life, communicate differing perceptions of illness and differing ethical visions of how the world should be.^[32]