‘You are all quacks;if only you would shut up’ (Job 13.4b–5a): Sin and illness in the sacred and the secular,the ancient and the modern

The poetic sections of dialogue in the book of Job are among the most emotionally charged in the entire Hebrew Bible. With an earthy rawness, they depict unspeakable tragedy and pain. As they become more firmly entrenched in their positions, the characters talk past one another in the dialogues, which themselves become increasingly heated. On one side of the argument stands Job, who expressively, often morbidly, seeks to describe and interpret his illness. A menacing El (God) is physically attacking for no reason: ‘I was at ease but he smashed and smashed me; seized my neck and bashed and bashed me … He pierced my kidneys without mercy; he spilled my bile on the ground’ (Job 16.12–13). On the other side are Job’s ‘friends’ who reason that Job’s illness is a result of sin. Thus ‘your guilt instructs your mouth! Your own mouth condemns you! … Your own lips testify against you!’ (Job 15.5–6) This latter perspective is a common response to illness in the Hebrew Bible. For example, if one breaks a covenant then illness and death can be expected to follow (Deut. 28.22, 34–35).

With continual accusations from his so-called friends about having brought illness on himself through sin, Job’s physical anguish turns into defensive rage against his obtuse friends and against El. However, what is interesting about the book is the way in which it describes the character’s feelings and reactions to illness. In many ways, the book could be understood as an early description of patients and healers (or, according to Job 13.4, ‘quacks’; the Hebrew is literally (rōp ‘ê’ ělil) ‘empty healers’, captured well in the KJV as ‘physicians of no worth’) or, at least, patients and onlookers. As Kutz argues,

Job’s friends … wish to reduce his suffering by espousing an age old moral-theological theory of illness containing both aetiology and cure. Illness emanates from sin, while symptoms are due to divine punishment. To deny wrongdoing is to obstruct the healing process. To get well, Job must repent … If such a disaster could befall Job, their equal or even their better, who can safeguard them from similar catastrophe? To feel safe they need to place Job on the other side of the morality fence. Job refuses to be quarantined in the sinners’ ward, and, by authentically expressing his emotions, he exposes his healers’ ineffectiveness. ¹

Kutz’s analysis is helpful since it demonstrates very clearly part of the potential logic underlying the link between sin and illness. However, what is most helpful about his case is the emphasis on the threatening effect that illness can have on the onlookers or healers. Sin, for Job’s friends, has to be the explanation. Otherwise they must face the anxiety of existing in an uncontrollable world. As Kutz states, the friends ‘defend themselves from being exposed to the same threat experienced by patients, the threat to the very structure of meaning and coherence’. ² Job’s insistence on his innocence, therefore, is intimidating to his friends because it undermines this worldview: his ill body and his furious descriptions of the way he understands what is happening causes them to recoil in fear. Rather than providing what Goffman calls a ‘circle of lament’ in illness for Job, their attempts to moralize are depicted as actually putting more pressure on the character Job. ³

Perhaps a natural extension of this point is to emphasize the impact this social dynamic has on community. For the Old Testament material, in the eyes of onlookers the afflicted body can only ever be a symbol of sin or moral failure and therefore leads to expulsion from social groups. As Pelham argues, ‘[t]he breakdown of the body cannot stand simply for itself, with no larger meaning, for if it did it would not require the expulsion of the afflicted one.’ ⁴ Pelham’s statement about illness not standing for itself in Job may be usefully contextualized against Kleinmann’s observations that illnesses are ‘marked with cultural salience in different epochs and societies’. ⁵ In other words, both patients and onlookers socially construct meaning from illness. Similarly, Job and his friends construct meanings from Job’s affliction. The source of contention emerges from the fact that the meanings constructed are different. What Job requires from his friends or ‘healers’ is empathy – as the narrator emphasizes through placing on Job’s lips the phrase ‘Pity me! Pity me! You are my friends’ – what he actually receives is judgement (Job 19.21). As Tham argues,

He wants to be heard and understood by his friends, not judged categorically with a mere theoretical link between sin and punishment. It is the subject in distress and not ideas that matter after all. Job wants friendship and empathy rather than a pronouncement of God’s just retribution. He desperately tries to maintain the paradox he is experiencing—simultaneously suffering and guiltlessness—which is not accounted for by his friends’ scholastic theology. ⁶

This paradox which Tham describes comes to a head in the text where Job argues that ‘my gaunt appearance testifies against me’ (Job 16.8). The Hebrew term for ‘witness’ in this quotation ( ‘ēḏ) is often used in the sense of a testimony given in a courtroom. Job’s argument here is, as Habel states, that his ‘innocent inner self cannot be heard because the court sees only his gaunt outer self. His very appearance, therefore, militates against the possibility of impartial litigation.’ ⁷

The accusatory notion that Job has done something that directly warrants his predicament, which Classens argues ‘offers an excellent example of the stereotypes regarding disability’, is found plentifully throughout the friends’ speeches. ⁸ To select but a few powerful examples, Bildad suggests in response to Job’s protestations of innocence that ‘your children must have sinned against him’, an obvious allusion to the prologue (Job 8.4; cf. 1.19). Likewise, Eliphaz’s response to Job’s reflection on the limitations and pain of mortal life is ‘the wicked one writhes in pain ⁹ all his days, and few years are in store for the tyrant’ (Job 15.20). Similarly, Zophar reassures Job with a somatically focused acrostic parable which exploits the eating metaphor: ‘the food in his bowels is turned to asps’ venom within him; The wealth he gorges he vomits. El forces it up from his stomach’ (Job 20.14–15). Thus, the way the narrator portrays Job’s friends is also akin to lawyers defending El in a courtroom. They cannot overcome the paradox of Job’s disfigured body yet claim of innocence. As such they, at best, fail in empathy. At worst, their ‘scholastic’ responses, through failing to recognize a fellow human suffering, are unwittingly shocking, offensive and cruel.

In contrast to the argument concerning illness and litigation, Erikson suggests that corporeal imagery in Job is used ‘to question and invert traditional usage of body imagery, particularly the stock of body images from the Psalms that present the body, the self, and the voice as a manifold unity’. ¹⁰ Thus, unlike ‘the psalmists, who petition God to restore them to health’, the narrator in Job positions on his lips ‘images of disembodiment and bodily disintegration to separate his broken body from his contention that he is innocent’. ¹¹ Eriksen’s perspective here maintains the courtroom metaphor but reformulates the imagery of the broken mind and body into an instrument used to affirm Job’s innocence rather than it being a symbolic counter-narrative which subverts his claims. Perhaps a good example of this is to be found in the ironic parody of Psalm 8.

what are human beings that you are mindful of them,

  mortals that you care ¹² for them?

Yet you have made them a little lower than God,

  and crowned them with glory and honour. (Psalm 8.4–5)

What are human beings, that you make so much of them,

  that you set your mind on them,

visit ¹³ them every morning,

  test them every moment?

Will you not look away from me for a while,

  let me alone until I swallow my spittle?

If I sin, what do I do to you, you watcher of humanity? ¹⁴ (Job 7.17–20a)

Thus, if we develop further the logic of Eriksen’s argument then, rather than connecting illness and sin, illness is connected with questioning and scepticism. Perhaps this can be seen in the juxtaposition of Job’s anti-psalm here wherein the narrator ‘not only overturns the question of Psalm 8 in a radically negative way but also sharply rejects the high image of humanity presented there’. ¹⁵ Thus, for Job, El’s attention is unwanted harassment or surveillance; as Habel states, ‘here God himself is the tormentor’. ¹⁶ Newsom also emphasizes the way that traditional wisdom is overturned through the focus on Job’s body. She draws attention to the friends’ speeches which simplistically restate, without quoting, what they know from tradition. In contrast, the narrator makes Job’s speech ‘the explicit subversion of common sense and the language of traditional piety’. ¹⁷ These arguments are quite helpful for uncoupling the popular link between sin and illness in the Old Testament. Despite the supposed courtroom context where Job’s guilt or innocence hangs in the balance, the way that somatic images are carefully used by the narrator prevent us from coupling sin and illness. Rather, the traditional wisdom to which Job’s ‘friends’ – lacking empathy and so implicating Job for the illnesses he describes – appeal is parodied and exposed as quackery.

The notion of blame, or in a religious context, ‘sin’, being ascribed to illness is not confined to the Old Testament. This idea was forcefully criticized during the late 1970s by Susan Sontag who examined stigmatized illnesses such as cancer and Aids. For Sontag, ‘[p]utative notions of disease have a long history’ and the controlling metaphors which describe cancer using military language stigmatize certain illnesses and, by extension, those who are ill. ¹⁸ As she argues,

The persistence of the belief that illness reveals, and is a punishment for, moral laxity or turpitude can be seen in another way, by noting the persistence of descriptions of disorder or corruption as a disease … A theodicy as well as a demonology, it not only stipulates something emblematic of evil but makes this the bearer of a rough, terrible justice. ¹⁹

Therefore, for Sontag, the process of ascribing meaning to illnesses, particularly through metaphor, is almost similar to a type of victim blaming: it makes illnesses symbolic of, or tantamount to, unethical behaviour and vilifies those who are ill. A similar, equally forcefully phrased, argument is provided by Magdalene who contends that the ‘[t]heological idea that human disability, disease, and disaster stem from human sin is very ancient and continues to hold sway’ and this has ‘contributed to the terrible abuse or total neglect of persons with disabilities and chronic illnesses in religious settings’. ²⁰ For Magdalene, such a perspective is ‘highly problematic … whether or not the subject defines himself or herself as a religious person’. ²¹

A cosmetic difference between Magdalene’s and Sontag’s perspectives is that Sontag’s case pertains only to the secular. Nevertheless, it can sometimes be quite surprising how religious language and concepts permeate beyond the boundaries of religious contexts when illness is the issue at stake. For example, Kutz’s article in the British Medical Journal refers to a ‘54 year old agnostic woman who had developed acute leukaemia’ who also developed something bordering on magical or religious reasoning when asked about her illness.

‘Why [do] I deserve this’

‘Why, indeed, do you deserve this?’ inquired the consulting psychiatrist.

‘Somebody up there is testing me.’

‘Who is that somebody?’

‘Who can it be? I have never been religious, but there’s no doubt in my mind that somebody up there is testing me.’ ²²

According to Kutz, the patient ‘had created a live deus ex morbus, [sic] a god out of illness’. ²³ Similar to the presentation of the character Job in the narrative, the patient in question interpreted her illness using a religious or magical explanatory model. The patient existed in a medicalized setting and presumably knew the name of her condition and the prognosis. This makes it absolutely fascinating that despite this information, further attempts to read meaning into the illness were made. Thankfully, unlike the narrator’s depiction of the character Job, the agnostic woman has a consulting psychiatrist and is not surrounded by so-called friends whose crushingly moralizing approach only enrages and frustrates. Nevertheless, the process through which meaning, often religious meaning, emerges within illness is interesting; both the patient and the onlookers construct meaning.

For the medical professional, the meaning is to be found in the language of disease. Medical professionals diagnose, thus adding biophysiological states to social states and assigning the meaning of illness to disease. ²⁴ Thus, illness ‘is the patient’s subjective experience of physical or mental states’, which can be social – ‘the experience of some illnesses is not limited to the symptoms but includes a “second illness” – the reactions of the social environment’. ²⁵ To rephrase, disease might be viewed as a biological condition and illness a social meaning of a condition. This is a helpful distinction, although it is sometimes blurred by the ambiguous and uneven use of the term ‘sickness’. ²⁶ Obviously, in a text such as Job it is impossible to make any diagnosis on the basis of disease not least because it is a text which has come together over a period of time, which has been edited and which makes use of various sources in its discussion of the theme of suffering rather than a straightforward description of disease. What is interesting about Job’s description of suffering, however, is the correlation between the types of responses to illness in the text and in modern times, especially the connection of illness and blame, or sin.

A description of a response to illness that aligns well with the aforementioned example of the leukaemia patient can be found in Carel’s lucid reflection on diagnosis.

In the early days after my diagnosis I couldn’t think at all … I felt that any more information would only bring with it bad news, more horror, additional grim facts to petrify me. I suffered from what Joan Didion calls ‘magical thinking’: the irrational, self-blaming, mystic thought that is apparently common in situations of distress. I blamed myself for writing a book on death. I blamed myself for going to the doctor so late. I blamed myself for being arrogant and not budgeting for something like this from the beginning. I blamed myself for daring to have a wish list. Later, as I adjusted to my situation, I felt increasingly angry. I spent several months asking: why did this happen to me? ²⁷

The number of times that the word blame emerges in this reflection is quite significant, both illustrating and emphasizing the strength of the connection between illness and blame in secular thought. Also suggestive is the notion of ‘magical thinking’; like the agnostic in the example provided by Kutz, Carel, despite having a medical diagnosis, seeks to discover and construct greater meanings within illness that are ‘magical’, or ‘religious’, through constructing her own explanatory models. One outcome of this for patients such as Carel, especially when confronted by moralizing onlookers such as Job’s friends, is anger. For example, in a recent newspaper article on cancer, Barbara Ehrenreich suggests ‘dissent is a kind of treason … Exhortations to think positively – to see the glass half full, even when it lies shattered on the floor – are not restricted to the pink ribbon culture.’ ²⁸ Seeking meaning and having unanswerable questions in illness can sometimes be understood as non-conformity to an expectation of cheerful positivity and the drive to fight.

Perhaps then, there is something to be learned through renewed attention to the language of illness within the book of Job. It is easy to use the medical humanities as a heuristic lens to inform an exegesis of the material itself. This article, however, has attempted to balance the relationship between exegesis of Job and commentary on records of modern-day patient experiences. The book of Job may be seen as one of the earliest descriptions of patients and onlookers coping with illness. Modern illness experiences, and reactions to illness, form an excellent mirror through which to understand the text. However, the text also provides critical comment on the coupling of sin, or blame, with illness. The responses of Job’s friends are exposed as problematic throughout the text by Job’s well-constructed retorts. Like Job, they assume a sort of magical thinking wherein the cause and resolution for illness is beyond their own control, rather than taking responsibility to help through listening and trying to understand Job’s questions. Unfortunately, the same buck-passing logic and lack of authentic engagement between patients and onlookers is sometimes the case nowadays, as Carel states:

If I had to pick the human emotion in greatest shortage, it would be empathy. And this is nowhere more evident than in illness. The pain, disability and fear are exacerbated by the apathy and disgust with which you are sometimes confronted when you are ill. There are many terrible things about illness; the lack of empathy hurts the most. ²⁹