What Was Job's Malady? *

1. Introduction

In the story of Job, as contained in the prose tale, a familiar aspect is Job's affliction with illness. After the initial challenge from the Satan to God concerning Job's righteousness, the Satan is allowed to ‘touch all that he has’ but not to ‘stretch out your hand against him’ (Job 1.11). The loss of family, servants and all possessions swiftly follows. But after the second challenge, the Satan suggests that God ‘stretch out your hand now and touch his bone and his flesh and he will curse you to your face’ (Job 2.5). This is the moment that Job's health is affected, with the only proviso being to ‘spare his life’. And so we read, ‘So Satan went out from the presence of the Lord and inflicted loathsome sores on Job from the sole of his foot to the crown of his head. Job took a potsherd with which to scrape himself, and sat among the ashes’ (Job 2.7–8).

Shortly afterward the dialogue ensues in which Job bewails his lot. The suffering he is experiencing clearly involves physical suffering. In this article I want to explore just how much of his complaint can indeed be put down to illness. I want to look at what Job's illness probably was, at how it affects him first physically and then mentally, and also at its wider effects on his feelings of social ostracization and place in society. I plan to draw on some insights from disability/impairment studies to illuminate this debate and discuss the moral parameters of this issue—is disease always the direct result of wickedness? Finally, I will reconsider the ending of Job in the light of this discussion.

2. Job's Skin Disease

First, though, on a medical level, what exactly was Job's disease? Older scholars debated this question at length. The first mention of the disease is in Job 2.7, where it strikes quickly as ‘the Satan … inflicted loathsome sores on Job from the sole of his foot to the crown of his head’. This phrase ‘from the sole …’ (‭ודקדק[דעו]דעולגרףכמ‬) appears in Deut. 28.35 and 2 Sam. 14.25 and indicates the entirety of the body. It is clearly a skin disease, the term ‭‭ער ןיחשב‬‬ being a general one that could cover various diseases of the skin. Skin diseases normally take some time to spread, but maybe for the sake of narrative impact this disease is described as sudden. The term is mentioned in Lev. 13.18–23 as a boil (‭ןיחש‬), which may be an initial sign of leprosy (although there is a special word for leprosy—‭ערצמ‬).

Another possibility is elephantiasis, a disease producing swollen limbs and blackened skin (which might explain the reference to bones in v. 5). Many suggestions have been made for Job's condition, including by professional medics. Here are just a few: chronic eczema, smallpox, malignant or infectious ulcer, ulcerous boil known as the ‘Baghdad button’, syphilis, pellagra, scurvy, or simply vitamin deficiency. Take your pick! Rather than trying to be specific about the illness, it is probably better to translate the term ‭ער ןיחשב‬ here in 2.7 with a general phrase such as ‘running sore’, ‘severe boils’ or ‘painful sores’. ¹ Verse 8 tells us that Job used a potsherd to scrape himself, and sat among the ashes. He might have already been there as a result of his mourning for his children. It is usually supposed that this ash-heap was a public one, outside the town, the resort of outcasts and persons with infectious diseases. The LXX has ‘dungheap outside the city’ (ϰoπρίας ἒξω τῆς πόλεως) and it was common practice to dump dung there and then burn it. The heap of ashes would often be so high as to be useful as a watchtower. ² This has strengthened the suggestion that it was from leprosy that Job was suffering. It would also fit the mention in 2.12 that the friends ‘did not recognize’ Job ‘from a distance’ (‭קוחרמ‬)—were they so distant that they did not see him clearly, or, more probably, did they not recognize him because he was so physically changed by his disease?

Looking into the dialogue at Job's own description might also shed light on the nature of the illness. He describes the repeated eruption of pustules in 7.5 (‘my skin hardens, then breaks out again’), which might be maggots breeding in his sores or more likely a discharge of pus, and he speaks in 30.30 of a blackening and peeling off of the skin, both of which are signs of a skin disease. Other symptoms Job describes are less specific—emaciation (19.20), fever (30.30b), nightmares (7.14), sleeplessness (7.4), wasting away as if rotten (13.28), putrid breath (19.17)—and could belong to any number of complaints. He refers to aching in or rotting of his bones (30.17) and to their burning (30.30), which could either be further symptoms or a more general reference to the bones as the seat of disease. ³ Some scholars have suggested, because of the fairly general description of Job's illness, that his disease is psychosomatic in origin, springing from his other misfortunes. ⁴ Whilst this seems unlikely given the severe nature of his symptoms, it does bring out the point that much disease is made better or worse by the state of mind of the patient. It is also a reminder that we need to look at the mental anguish of Job in this context.

3. Disability Studies

So far I have pursued the older scholarly line of trying to define Job's malady in a medical framework. It is at this point that helpful correctives to this rather narrow approach are given by the burgeoning area of disability studies. Schipper ⁵ makes the point that disability is often only seen in individual and medical terms, ignoring social, political, legal or other cultural terms which provide the wider framework for understanding any kind of illness, impairment or disability, be it short or long term. This is a helpful reminder that there is clearly a social dimension (notably social ostracization) to Job's malady, that we should not ignore. Before turning to this, though, should we regard Job's ‘illness’ as a disability? Schipper makes an important distinction between permanent and temporary disability, and the normal assumption concerning Job is that since we know that the Satan inflicted the disease in the first place and since the ending of the story is a happy one, the temporary model fits him best. Schipper argues that we tend to assume able-bodiedness where nothing is stated (e.g. after Jacob dislocates his hip after his wrestling with God we assume that he recovered since it is nowhere stated that he limped for the rest of his life [Gen. 32.25, 31, 32]) and that we tend also to interpret poetic descriptions metaphorically (e.g. the description of the sufferings of the Deutero-Isaianic servant in Isa. 52.13–53.12 ⁶ ). The development of his disease is clearly a dramatic change of circumstance for Job, and so has the nature of being a life-changing injury for the whole of its course. In modern terms we would say that it affects his ‘employability’. Schipper argues that all disability is relative—indeed, we are all ill at times in our lives; we sometimes feel less ‘able’ than we normally do, and we all age and may feel more impaired as we get older. In fact, he argues that our perception of disability depends on age. If we see an old man with a walking stick we would not think of him as disabled—simply as old. Yet if we see a young man with a walking stick we assume disability of some kind. We also tend to measure cognitive impairment by children's ages, so we say ‘an adult with a mental age of 6’. Schipper points to disability as in many ways a social construction, the result of social norms that tend to pick out people with impairments. It should not be forgotten, though, that disability is a lived experience for those suffering from it. It is a medical condition and an individual experience on one level, but the social and wider cultural experience that it leads to is an essential part of that experience. A good example from the Hebrew Bible is infertility. This is a medical condition, but also something that is a key social experience that is socially judged by others. It is also a condition that is a ripe subject for divine intervention, as shown in many examples. It also intrigues me that there is so much skin disease in the Hebrew Bible and less of other diseases.

Turning back to Job, this time to the dialogue and with this disability debate in mind, I want to look for wider signs of the effects of Job's impairment beyond simply his description of his medical condition (as in chs. 7, 19 and 30 described above). For Job, I would argue that there are two factors that contribute to his disease which are as much a factor in his ‘malady’ as his physical condition. These are, first, his mental torment and, second, the social ostracization to which his disease leads—both of which are emphasized by those working in disability studies. Let us look at Job's sentiments in the dialogue in the light of these two categories, but also consider similar lamenting sentiments from the Psalms and elsewhere that ground Job in a wider intertextual tradition. ⁷

4. Job's Mental Torment

There is no doubt that Job's mental state is linked to his physical ailments. The body is, to be sure, a psychosomatic unity. But what I want to draw out here are the wider aspects of his despair that are both introspective and yet also focus on his personal relationship with God. It will also be seen that Job's complaints fit into a broader intertextual resonance of lament as known mainly from certain Psalms.

5. Social Exclusion

We have observed how God is seen by Job to have become his enemy. Indeed, sometimes the language seems to be interchangeable between enemies and God. For example, in Job 16.10 we read that ‘they gaped with their mouths and struck me on the cheek’—this could refer back to his ‘adversaries’ or could refer to God (cf. Pss. 22.13; 102.8). ¹⁵ Former friends and also former recipients of his largesse have all turned against him. In 6.20 Job's enemies loom large (cf. Ps. 35.3, 25). In 6.21 he feels excluded by those who were once his companions: ‘You see my calamity and are afraid’. But their reaction is not only fear but contempt—in 12.4 he is a ‘laughingstock to my friends’ and in 12.5 ‘those at ease have contempt for my misfortune’. He calls his three friends ‘miserable comforters’ (16.2; cf. Ps. 69.21) and one gets the impression that it is the loss of other friends and former companions that troubles him more. In 16.4 he describes their shaking heads—the very actions of those who mock (cf. Ps. 22.7). Job could once assuage the pain of others (16.5). In 16.20 he feels the scorn of friends that brings him to tears. People mock (17.2) and spit (17.6; cf. Ps. 69.7, 11). In 19.13–16 Job describes at length the estrangement he feels from family and friends (cf. Ps. 69.8). In 19.17 his breath is repulsive—a physical aspect but one with social ramifications in that people do not wish to come near. In 19.18 he describes being despised even by young children. In 19.19 intimate friends abhor him. And in v. 20 his bones cling to skin, another sign of his illness but also the reason for his rejection by others (cf. Ps. 102.5). He feels their pity (19.21; cf. Ps. 69.20) but that gives him no comfort, after all he was once their champion. It was he who tended to the needy and overcame his physical repulsion to help those who were afflicted. In 21.3 Job encourages them to ‘mock on’ (cf. 30.9; cf. Ps 69.12); in 21.5 he cries, ‘Look at me and be appalled’. It is clearly his appearance that is most off-putting to people—they cannot get beyond the physical impairment to have real concern for the person suffering underneath. All respect that he formerly commanded is gone.

These ideas of social exclusion gain momentum in the second cycle of the dialogue. They reach their climax in 30.1–15, 24–25. However, there is a longer note in the summary chapters, chs. 29–31, of recalling the past and his former social acceptance. Chapter 29 as a whole looks longingly back and in detail at a past that now takes on a rosy hue. In ch. 30 this has decisively changed. Job 30.1–8 describes disreputable people who mock him. In 30.9–10 he is mocked in song; he has become a byword. In v. 10 he is abhorred and spat upon by others. In v. 11 they show no restraint. He is ruined and attacked by these people (vv. 12–15)—this has clearly grown in his own mind in the same way that illness often leads to disproportion, but how far is it real? He complains in vv. 24–25 how unnatural it is to turn against the needy in this way and remembers how he, by contrast, helped the needy. It was Job who wept and fasted for others, as in 30.25 (cf. Ps. 35.16). By the end of the chapter Job decides that he only has wild animals for company (cf. Ps. 102.6)—that is about the level of his social interaction. Job 31.16–22 also recalls the past, as in ch. 29—the repetition of ‘if I’ recalls his good deeds with the poor in the context of a sad reflection on his past life.

In short, social exclusion is clearly a major factor in Job's complaint, an exclusion directly linked to his illness, in that one is a direct result of the other. ¹⁶ The idea that it might be due to wickedness is not entertained by Job. Social rejection of the disabled/impaired is a well-documented fact within disability studies, often exacerbated by physical repulsion by others, and embarrassment at the fact of physical or mental disability. Social rejection is also influenced by the perception by others that the disabled person is over-preoccupied by their illness and with moaning about it so as to be unable to converse in the usual manner.

6. Moral Aspects

A moral dimension is immediately apparent when one turns to the dialogue between Job and the friends. Schipper makes the point that for the friends Job's disease is all about wrongdoing. ¹⁷ They are not experiencing it and they see their role as standing in judgment upon it. For Job, however, the disease is all about his personal experience of pain and the outward signs of disease are the outward signs of his inward misery. Similarly, Greenstein writes, ‘Job's epistemology is, then, the opposite of his friends. Their world view is theoretical and abstract, while his is felt in the bone. While they stumble in attempting to apply a general, traditional doctrine to the specific case of Job, he relies on what he personally knows and interprets the workings of the world in the light of his experience.’ ¹⁸ The friends’ perspective that directly links the disease to sin is given to us by Bildad in 18.13, when he mentions skin disease in the context of the punishment of the wicked—‘By disease their skin is consumed, the firstborn of Death consumes their limbs‘—and by Zophar in 11.15 when he mentions a future when ‘you will lift up your face without blemish’. ¹⁹ Elihu makes a clear connection between diseased skin and wrongdoing when he describes the wicked—‘Their flesh is so wasted away that it cannot be seen and their bones, once invisible, now stick out’ (33.21)—and then the possibility of a ransom which will involve ‘his flesh becoming] fresh with youth’ (33.25).

There is no doubt that sickness and disease were widely regarded as coming from God and as being a punishment. ²⁰ On the other hand, God could also choose to heal. ²¹ The author of Psalm 38 explicitly makes the link between God's anger at his wrongdoing and his disease: ‘There is no soundness in my flesh because of your indignation; there is no health in my bones because of my sin … My wounds grow foul and fester because of my foolishness’ (vv. 3, 5). Yet, ironically, the psalmist's lament is to God as healer, as the only one who can lift his burden and restore him to health. In the wisdom literature, in Prov. 3.8, the acquisition of wisdom will be ‘healing for your flesh and a refreshment for your body’ (cf. Prov. 14.30), suggesting that rejection of wisdom will lead to illness. However, God is not mentioned as the cause of illness. In fact, it is the wisdom that is on offer that can provide much-needed medicine, as Prov. 17.22 makes clear: ‘A cheerful heart is a good medicine, but a downcast spirit dries up the bones’. Furthermore, the teaching of the wise brings healing, ‘For they [my sayings] are life to those who find them, and healing to all their flesh’ (Prov. 4.22). Readers or listeners are presented with a choice—one might say, in modern terms, a ‘lifestyle’ choice. Human beings are not simply the passive recipients of good and evil from God; rather, they can choose a life of wellbeing for themselves.

Like the friends, the assumption that we all, as readers, tend to make in the book of Job is that Job's illness is part of his punishment for wickedness. In fact, although all the calamities point in that direction, we know, with Job himself, that he has not been wicked, that he is ‘blameless and upright’ (1.1) and that this is all part of the ‘test’. The illness is, like the other disasters, inflicted by ‘the Satan’, but he is not the embodiment of evil this figure later became. The question arises, however, is Job's illness of a different quality to the other ‘punishments’ that he receives? Why is it picked out as the ultimate test and given a separate mention in the Prologue? Job had chosen that proverbial life of wellbeing and yet calamity struck nevertheless, not just in terms of destruction of children, property and possessions, but in a personal, life-threatening way with the infliction of the skin disease. It leads to pain, incapacity, humiliation and withdrawal from normal life. It leads to Job feeling alienated both from human society and from God. There is then a profound personal aspect to Job's suffering which is often forgotten by interpreters who stress the broad themes of human suffering and the problem of theodicy in the book. As Clements writes, ‘It is in a real sense a book about sickness, if only because it singles out this type of human misfortune as one that is especially personal and acute’. ²² Clements traces a development away from a more cultic concern with illness, as found in Leviticus and Numbers, being caused by uncleanness/evil to a secularization of the issue in Proverbs and Job. This development might not be quite so linear and clear-cut as Clements proposes, but he goes on helpfully to say, ‘there is reason to suspect that the author's purpose lay not in reaching deep and ultimate conclusions about all human suffering, but rather in establishing the parameters within which certain aspects of it should be understood’. ²³ Perhaps the author of Job is exploring the attempt to understand the elusive nature of life-threatening illness. Illness is not something that is so obviously occasioned by ‘bad actions’ and seems to lack a straightforward moral explanation—it is still in God's sphere, but arguably slightly dislocated from human causality and hence morality. Perhaps this understanding explains why the infliction of the disease is treated as a separate item in the Prologue. Disease has the character of simply appearing to strike at random—if God is the cause, this simply adds to the problem of why the innocent suffer. ²⁴ Job is an innocent, a man of piety and devotion, who nevertheless becomes the victim of a severe, disabling disease which is certainly not self-inflicted.

7. The Resolution of the Story

The Job drama is resolved on three levels: first, with the God speeches, which strangely mention nothing to do with Job's physical illness; ²⁵ second, in Job's two responses to God in 40.4–5 and 42.1–6; and third, the Epilogue in 42.7–14, where, also strangely, there is no restoration of Job's disease. ²⁶ I will focus on the third aspect here. In disability studies the point is well made by Schipper ²⁷ that we tend to assume, in the absence of any information to the contrary, that an afflicted biblical character is made well again. For example, we assume Jacob did not have a hip problem for the whole of his life, but it is not explicitly stated. It is an assumption of the able-bodied that this state is the ‘norm’. In fact, this is often not the case—many ailments, once present, last for the rest of one's life.

In the Job Epilogue there is no mention of the Satan and no mention of the restoration of Job's disease. ²⁸ Most assume that he is restored to good health as he lives for many years and enjoys new offspring and their offspring. The restoration of Job from his illness may be implied, but it is not actually stated. Whilst v. 10 could refer to a general restoration, the following verses go on to itemize the specifics of it (vv. 12–13), and, whilst new family and material goods feature, the skin disease is not mentioned. As often noted, there is not the exact matching of the Prologue that one would expect in a ‘folk tale’ kind of tale—the element that is lacking is the healing of Job from his skin disease. Maybe the reason for this is that Job was indeed not restored to health. He may have had a long-term physical illness. Unsurprisingly there is no mention of his social displacement in the Epilogue and we assume that because he has a new family, these problems about his place in the community are also solved. But again this is not stated—does the loss of respect ever change back? Are things ever the same again?

This may have a moral ramification—it may strengthen the idea that the disease was less to do with Job's wrongdoing than has generally also been assumed. Schipper frames his discussion of the absence of mention of the skin disease in the Epilogue in terms of a moral difference in how Job and his friends approach Job's disease. For the friends the disease is evidence of moral wrongdoing; for Job it is simply the manifestation of his pain. As Schipper writes, ‘The unusual silence in the epilogue of Job regarding any healing of Job's skin diseases undermines the friends’ rhetorical connections between diseased skin and wrongdoing’. ²⁹ The friends had no doubt expected that Job's disease would be removed at the point of his restoration, which would have involved the forgiveness of Job's moral wrongs. And yet ironically this does not occur and what is restored is possessions and children (which, strangely, the friends do not discuss in the dialogue). Schipper argues that in this change of focus, the argument of the Epilogue moves beyond the ‘impasse’ of the dialogue to open up new possibilities instigated by God. In this land of new possibility, restoration from disease is not the primary focus, and hence the moral link made by the friends between disease and wrongdoing is undermined.

I would support the idea that the moral framing of Job's disease is more of a concern of the friends than Job and that this is not the primary message of Job's experience. Nor is the healing from the disease at the forefront of God's concern in the Epilogue. What I want to stress is that there is a possibility of evidence for a long-term illness here on Job's part that is not linked to moral wrongdoing and spawns his mental torment and feelings of social exclusion and ostracization. Whilst these feelings are to a certain extent removed by the restoration of Job, there is no evidence to suggest that there has not been a longer-term impact upon him. Verse 16 refers to the fourth generation with Job as head of the household, but this does not preclude him from having a long-term impairment or from negative sentiments that might ensue. ³⁰ The narrative is terse and these details not recorded.

Finally, the prediction that Job's face would be ‘lifted up’ (as Zophar says in 11.15) is fulfilled (42.9b), although it is God who lifts it, not Job himself. This only happens, though, when Job, presumably still in his blemished state, since it happens before the restoration, intercedes for his friends (42.8). God offers no explanation of Job's physical pain, nor does God explicitly offer healing of his body. The outcome is left for the reader to decide.