Sotah 14b ~ Visiting the Sick

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...

In this daf, Rabbi Chama teaches that visiting the sick should be performed because it's the right thing to do: after all, God himself is said to have visited Abraham as he was recovering from circumcision. But as we noted when studying the tractate Nedarim,  elsewhere the rabbis of the Talmud taught that visiting the sick actually aided in their recovery.  Here's a reminder:

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 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

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.

[Repost from Nedarim 39b]

Sotah 13a ~ Metal Coffins and Green Burials

Joseph's Egyptian Coffin

סוטה יג, א

ומנין היה יודע משה רבינו היכן יוסף קבור אמרו סרח בת אשר נשתיירה מאותו הדור הלך משה אצלה אמר לה כלום את יודעת היכן יוסף קבור אמרה לו ארון של מתכת עשו לו מצרים וקבעוהו בנילוס הנהר כדי שיתברכו מימיו

הלך משה ועמד על שפת נילוס אמר לו יוסף יוסף הגיע העת שנשבע הקב"ה שאני גואל אתכם והגיעה השבועה שהשבעת את ישראל אם אתה מראה עצמך מוטב אם לאו הרי אנו מנוקין משבועתך מיד צף ארונו של יוסף

How did Moses know the place where Joseph was buried? — It is said that Serah, daughter of Asher, was a survivor of that generation. Moses went to her and asked: 'Do you know where Joseph was buried?' She answered him, 'The Egyptians made a metal coffin for him which they set in the river Nile so that its waters would be blessed'.

Moses went and stood on the bank of the Nile and said: 'Joseph, Joseph! the time has arrived about which God, swore, "I will deliver you", and the oath which you imposed on the Jewish People [to take your bones with them out of Egypt] has reached the time of fulfilment; if you show yourself, it is well and good; but if you do not show yourself, we are absolved of your oath'.  Immediately Joseph's coffin floated to the surface.

I can still recall the thrill of seeing the sarcophagus of King Tutankhamun displayed at the British Museum in 1972. The boy king had been buried inside three nested coffins: The outermost one was made of cypress overlaid with gold foil.  Inside that was another wooden coffin with a gold overlay.  And inside that was a third coffin, this time made of solid gold.   We don't have any detailed description of Joseph's coffin from the Talmud, although the tradition that it was made of metal is a fascinating, since so many of the Egyptian coffins we know of today are made of stone rather than metal.     

Wooden Coffins from Jericho

When a Jewish cemetery outside Jericho was excavated in the late 1970s, a team of archeologists led by Rachel Hachlili discovered both wooden and stone coffins. The wooden coffins were made of local cypress or sycamore, and "[f]rom one to three individuals were found in each coffin, usually an adult and a child but occasionally two or even three adults, each lying on a leather mattress one above the other."  These excavations revealed that there were "two distinct burial customs among the Jews of Jericho. During the 1st century B.C. they buried their dead in wooden coffins; suddenly, at the beginning of the 1st century A.D., they began to practice secondary burial in limestone ossuaries. No completely satisfactory explanation of this change has been found..."

Metal Coffins in America, and In Israel Too

The author Jessica Mitford was best probably known for her classic 1963 book The American Way of Death, an expose of the funeral industry in the US. Shortly before her death in 1996, Mitford updated the book which was later published as The American Way of Death Revisited.  In that book, Mitford noted that until the eighteenth century, few people except the very rich were buried in coffins.  "The "casket," and particularly the metal casket, is a phenomenon of modern America, unknown in past days and in other parts of the world." This statement appears not be entirely correct however, as we have seen the Talmud describe Joseph's coffin as having been made of metal.  Even if that description was based on rabbinic imagination and not archeological facts, lead coffins have in fact been found in several excavations in Israel - though they did not necessarily contain Jewish remains. These include the Netanya coffin from the 3rd-5th century C.E, and the Ashdod coffin, discovered in 1986 in dunes outside of the modern city of Ashdod. (These, and other lead coffins were described in a 1986 paper published in the Israel Exploration Journal titled, rather blandly, More Lead Coffins from Israel.)  Mitford noted that the metal coffin was an innovation of the nineteenth century that caused concern. Church authorities protested that "if parishioners were to get into the habit of burying their dead in coffins made proof against normal decay, in a few generations there would be no burial space left." Good point.  

“ The ‘casket,’ and particularly the metal casket, is a phenomenon of modern America, unknown in past days and in other parts of the world.”

— Jessica Mitford. The American Way of Death Revisited. Vintage Books 2000. p146

The Simplicity of Jewish Coffins

Jewish burial practices have of course varied over time and by location.  In Israel today, most religious funerals are conducted without a coffin (military funerals are an exception), which can be a jarring experience when seen for the first time. This is a change from talmudic times, when the body was first placed in a cave and some time later the bones that remained were gathered into a box  (ירושלמי ונציה מועד קטן פרק א טור ג).      

Tom Jokinen's 2010 book Curtains: Adventures of an undertaker in training is the last place I would have looked for an endorsement of Jewish burial practices. But you'll find it right there, on page 262, at the end of a chapter on the International Cemetery, Cremation and Funeral Association trade show, held, where else, in Las Vegas. There he encounters several innovative products, including "Shiva Shades, paper blinds for Jewish families, to cover mirrors during the seven days of shiva. The paper unfurls like an accordion and sticks to the glass with an adhesive strip. "No more cumbersome bedsheets."  But Jokinen then reflects on the fancy coffins and expensive funerals that are sold to families at a time they are most vulnerable, and has this to say:

I suppose if pressed to choose one way or the other I'd have to say I'm against death...I need to face up to its absurdity, find meaning in the mess. How?..Then it comes to me: I've already seen it. A simple act without the artifice of embalming or baroque funerary product. Just a direct application of body to ground where it's left to contribute to the great cycle: ashes to ashes and all that, back to Mother Earth in a shroud and a plain wooden box. Instead of confrontation with death through commerce, you face it, fill the hole by hand and then get on with the hard work of mourning..."I've seen the future...And it's Jewish."

Sotah 8b ~ Sironechi and Strangulation

Measure For Measure

In today's page of Talmud, we are reminded of the principal of "measure for measure", or as the Mishnah teaches: במדה שאדם מודד בה מודדין לו.  Rav Yosef teaches that this principal applies to the offenses that were capital crimes; although court imposed executions are no longer carried out,  במידה לא בטיל - "measure for measure remains in force."

מי שנתחייב סקילה או נופל מן הגג או חיה דורסתו ... מי שנתחייב חניקה או טובע בנהר או מת בסרונכי

One who deserved death by stoning, either falls from a roof or is trampled by a wild animal...one who deserved death by strangulation [one of the four types of biblical capital punishment] either drowns in a river or dies of sironechi (Sotah 8b)

The question that we need to answer is, of course, just what is סרונכי - sironechi ? Rashi explains that it means חולי בגרנו  "he becomes sick in his throat" but as we will see, this rather general explanation became more specific among later commentators. 

Marcus Jastrow's dictionary (published 1886-1903) defines sironechi as "choking" or "suffocation." The origins of the word, Jastrow claims, is from the root סרך meaning to clutch or hold fast.  This seems reasonable, and Jastrow's understanding of this Mishnah would be that a person who would have been liable to judicial execution by strangulation will meet his end by choking or suffocation.

Soncino, Schottenstein and Koren

The English translations of the Talmud are more specific than was Jastrow, and suggest that the condition is due to an infectious disease. The Soncino Talmud translates sironechi as quinsy, and the Schottenstein Talmud does the same.  The Koren Talmud takes a different approach, and translates the condition as diphtheria. In a side note, the Koren Talmud states that sironechi may have a semitic origin, or it may be derived from the Greek sunnakhe "referring to a form of strangulation that results from complications of diphtheria due to the trachea being blocked by pus." So let's understand what each of these conditions is, and how it may mimic execution by strangulation.

Quinsy

Peritonsillar abscess at the back of the mouth.  But even this does not occlude the airway, and breathing is not usually affected.

Quincy is an uncommonly used word that refers to an inflammation of the tonsils.  It is a complication of what Americans tend to call Strep throat, and what I grew up in London calling tonsillitis. It is most commonly caused by a bacteria known as Group A beta-hemolytic Streptococcus, and most of you reading this will have had it, or seen it in a family member. Today it is easily treated with antibiotics, but one of its rare complications  is a peri-tonsillar abscess, sometimes called quinsy.  In this condition, an abscess forms at the back of the mouth in the tonsils, which bulge forward.  When this occurs, the treatment is to lance the abscess.  I've treated hundreds of cases of strep throat and many cases of peri-tonsillar abscess, and the condition never causes suffocation - though it could in theory.  This makes it a very unlikely candidate to be the condition known as sironechi. Sorry Soncino. And sorry, Schottenstein.  

Diphtheria

Child infected with diphtheria. Photo from the CDC.

Diphtheria is a disease caused by Corynebacterium diphtheriae. Infection causes weakness and fever, followed by swelling in the throat, which gradually becomes covered in a thick grey membrane.  If that doesn't kill the victim, toxins released by the bacteria may finish him off.  According to the Centers for Disease Control and Prevention, in 1921 there were over 200,000 cases of diphtheria in the US, and over 15,000 deaths. Diphtheria is still found in the developing world, especially in parts of Africa and India, and the World Health Organization estimates that there were over 7,000 cases worldwide in 2014.

Like most physicians in the west, I've never seen a case (or met someone who has seen a case, or met someone who has met someone...) because, thanks to widespread vaccination, the disease here has been almost completely eradicated.  Diphtheria may certainly kill its victim by suffocation, and while there is no other reason to identify this with sironechi, it's a reasonable choice. So one point to Koren.

“Classical respiratory diphtheria is characterized by formation of a gray-white pseudomembrane in the throat that is firmly adherent. A swollen, bull-neck appearance caused by inflammation and edema of soft tissues surrounding lymph nodes is associated with severe illness and higher death rates...”

— Wagner K. et al. Diphtheria in the Postepidemic period, Europe, 2000-2009. Emerging Infectious Disease. 2012 18 (2):218.

EpiglottiTis

Although none of the English translations suggest epiglottis as a possible translation for sironechi, it is an infection that certainly may fit.  The disease is most commonly caused by Haemophilus influenzae type b, and results in swelling of the epiglottis, which is a flap of tissue that covers the larynx (also known to non-medically trained personnel as the voice box). It is your epiglottis that moves over the voice box every time you swallow, preventing food from entering your trachea and lungs. In acute epiglottitis, that flap of skin, and the surrounding tissues, may become swollen to such a degree that breathing becomes impossible, and the victim suffocates.  Thankfully, this disease is now extremely unusual in developed countries since there is an effective vaccine against it. In fact I can't recall having seen a single case of it. Because of the way in which the disease causes the airway to become occluded, epiglottis is good a candidate for the condition described in the Mishnah as sironechi. It's certainly as likely as quinsy or diphtheria.  

Did George Washington Die of Sironechi?

It is generally agreed that when George Washington died in December 1799, it was from some kind of throat infection, although the precise cause remains unclear. Two of the physicians who treated Washington published an account of the president's last hours. Here's an excerpt:

George Washington was attacked with an inflammatory affection of the upper part of the windpipe, called in technical language, cynanche trachealis. The disease commenced with a violent ague, accompanied with some pain in the upper and fore part of the throat, a sense of stricture in the same part, a cough, and a difficult rather than painful deglutition, which were soon succeeded by fever and a quick and laborious respiration.

Interestingly, each of the three diseases we have reviewed here have been suggested as the one that killed Washington. Writing in The New England Journal of Medicine, David Morens noted that the culprits include "inflammatory quinsy" and the relatively new diagnostic entity called cynanche trachealis ("dog strangulation"), a term likely to include "the modern diagnosis of bacterial epiglottis...[as well as other conditions such as] laryngeal diphtheria and viral croup." Morens acknowledged that historians do not agree on the cause of Washington's death, but he thought that  "the signs and symptoms point to acute bacterial epiglottitis."

Blood Letting for Sironechi, and for the President

There is more to the relationship between Washington's death and sironechi. In Masechet Yoma, the tractate that deals with the laws of Yom Kippur, a treatment for sironechi is mentioned: מקיזין דם לסרונכי בשבת - "one may let blood on shabbat to alleviate sironechi"(84a). We've addressed the issue of blood letting in the Talmud elsewhere, and noted that it was a widely used therapy until the late nineteenth century.  And as George Washington lay dying from an occluded airway, his doctors decided the best therapy was to let his blood. This they did four times, the last just a few hours before Washington died. It would appear that the medical practice to let blood for a patient with sironechi was found not only in the Jews of Babylon, but among the physicians of Washington's home at Mount Vernon too.   

Washington's death by choking was carefully documented and published, but the infectious agent behind it remains uncertain. If a single infectious agent is behind the talmudic condition of sironchi,  it remains similarly unknown. But most likely, sironechi just means choking or suffocation - (as Rashi and Jastrow suggested) a condition that could be caused by any of the diseases we've reviewed - and more besides. To identify one disease as the cause of sironechi is to miss a larger point - that is likely caused by many infections.  Today, vaccinations make many of these diseases so rare that most physicians will never see a case. Like the form of judicial execution that it mimicked, sironechi has become a feature of a past that we are all better without.    

Sotah 2~ Infidelity. Who Should be Suspecting Whom?

The new tractate that we will be studying for the next 49 days is Sotah, which outlines the ordeal of a married woman who is suspected of adultery. The ordeal outlined in במדבר (the Book of Numbers)  involves her public humiliation as she is forcibly undressed, and forced to drink a potion containing the dissolved words that describe the ceremony in the Torah. If she is guilty, she later undergoes a rather gruesome death; if she is innocent, she returns to her husband and is promised to conceive a child with him.

There is no such ceremony for a married man suspected of adultery. In fact there is no biblical prohibition for a married man to have a sexual relationship outside of his marriage. But insights from contemporary research in biology and the social sciences, together with a scandal from the sewers of the internet, have revealed (as if you needed proof for this) that married men are in fact far more likely to be the ones doing the cheating.

Rates of Infidelity

Although monogamous marriage is the norm for over 90% of humanity (with 10% practicing polygyny), up to 40% or married men and 25% of married women report having had an extramarital affair during their lifetime. Religiosity is however, negatively associated with infidelity, although there is no evidence that the religious denomination plays any role in the tendency towards philandering. Study after study have revealed that married men are more likely to be the ones doing the cheating. Here is how one recent review of the topic summed it up:

A large body of research with American samples indicated that men have a stronger desire to engage in sexual infidelity, are more likely to engage in sexual infidelity, have more extra-dyadic sexual partners, have more episodes of infidelity, including short or long term affairs and one-night stands, have more physical contact with an extra-dyadic partner (including intercourse), cite more sexual motivations for infidelity, and are less likely to fall in love with an extra-dyadic partner. 

“Gender is arguably one of the most commonly studied predictors of infidelity. Expected gender differences in infidelity are often rooted in evolutionary theory... According to this theory, women, due to internal fertilization and gestation, are more likely to benefit from long-term partner commitment and affluent partners who can provide resources that are necessary for survival; males, on the other hand, can impregnate multiple females and the desire to achieve genetic success leads men, more so than women to engage in infidelity...the literature to date suggests that men have a stronger desire to engage in infidelity… and are more likely to be unfaithful.”

— Mahalita Jackman. Understanding the Cheating Heart: What Determines Infidelity Intentions? Sexuality & Culture (2015) 19:72–84

Genes and Infidelity

New research is also suggesting that genes play a role in the complex story of infidelity.  In a study of 7,400 Finnish twins published last year in Evolution and Human Behavior, researchers found that about 10% of men and 6% of women had two or more sexual partners in the last year.  They also found a significant association with a gene for vasopressin and the likelihood of infidelity – but they only found this association in women.  This hardly makes for a compelling case that infidelity is genetically determined, but it does fit in with a body of animal evidence that supports a relationship between our genes and our ability to be monogamous. 

Some of this work comes from studies of two kinds of vole: the montane vole, which is sexually promiscuous, and the prairie vole, which is monogamous. Each of these species has vasopressin receptors that are located in different regions of the brain, and injecting the hormone vasopressin into the little vole brain causes two distinct kinds of behavioral response. When the monogamous prairie vole brain is injected with vasopressin it triggers pair bonding. Blocking of the receptors has an opposite effect – prairie voles still want vole sex, but are no longer monogamous.

Now here’s the crucial anatomical piece: The vasopressin receptors in the monogamous prairie voles lies near the brain’s reward center, so when vasopressin is released, it activates neurons in that reward center. However, the vasopressin receptors in the promiscuous montane voles is found in the amygdla, which is thought to process anxiety and fear. So releases of vasopressin in the promiscuous vole does not stimulate the reward center, and does not lead to pair bonding.  

Another team working with twins was not been able to find an association between human infidelity and the vasopressin receptor gene implicated in the sexual behavior of other mammals. However, even that team concluded that "...infidelity and number of sexual partners are both under moderate genetic influence (41% and 38% heritable, respectively) and the genetic correlation between these two traits is strong (47%)."  We are certainly very far from identifying a gene for infidelity, but there is evidence that genetics and neuroendocrine release plays some role in the expression of this behavior.

Data From a Website You Should Not Visit

There is new data to support the assertion that married men are more likely to cheat than are married women, and that data comes from the Ashley Madison breach. (Now for those of you who do not read from the sewers of the Internet, here’s what you need to know. Ashley Madison is a website that offers to pair up married people – men and women – who want to cheat on their spouse and have an affair.  In August of this year it was revealed that the website had been hacked and some of the data of the subscribers to the service was leaked. OK, that’s the background. No read on to the more important part of the story.)

In a report published in Gizmodo, it was revealed that out of a database of 37 million Ashley Madison users, only about 5.5 million were marked as female.  While acknowledging that some of these users are not real, the raw numbers show that for every married woman looking to have an affair, there were more than five married men.  The report goes on to note that

...out of 5.5 million female accounts, roughly zero percent had ever shown any kind of activity at all, after the day they were created...The men’s accounts tell a story of lively engagement with the site, with over 20 million men hopefully looking at their inboxes, and over 10 million of them initiating chats. The women’s accounts show so little activity that they might as well not be there….we’re left with data that suggests Ashley Madison is a site where tens of millions of men write mail, chat, and spend money for women who aren’t there.

Jewish Adultery In the Middle Ages

In his essay on rabbinic attitudes towards nonobservance, Ephriam Kanarfogel pointed out that "[s]exual promiscuity and even adultery were never absent from any region on the medieval Jewish world." These adulterous relationships were "widespread", but, continues Kanerfogel, "...the presence of even more objectionable possibilities (i.e., relations with married Jewish women) also had to be considered…" As evidence of just how widespread was the practice of married Jewish men having affairs, Kanarfogel cites R. Moses of Coucy of Spain who preached "at length" in 1236 about the sins of sexual relations outside of marriage. The issue of sexual promiscuity was so widespread  that in Toledo a herem (communal ban) was issued against it in 1281. Remarkably, "many who had vowed to honor the ban could not retain themselves and either openly flouted the ban or attempted to circumvent it." It was the widespread promiscuity of married Jewish men that, according to Kanarfogel, led the Ramban to accept the institution of pilagshut (concubines) as an alternative.  Married Jewish men have been cheating for rather a long time.  

“In the second half of the fifteenth century, R. Judah Mintz of Padua acknowledged that there were those in the Jewish community who approved the presence of prostitutes as a means of preventing men from committing adultery with married women...R. Judah Mintz did not himself condone this policy, but could do nothing to dislodge it.”

— Ephraim Kanerfogel. Rabbinic Attitudes towards Nonobservance. In Schachter JJ. (ed.) Jewish Tradition and the Nontraditional Jew. Jason Aronson 1992. p25

The Double Standard for Married Women

The fact is that while the Torah only mandated the Sotah ordeal for a married woman suspected of adultery but not for a married man, it is married men who are far more likely to be the ones doing the cheating.  This bias represents another way in which women are objectified – and we have observed this while studying Ketuvot.  Indeed, as several scholars have noted, the Talmud speaks to men, but it speaks about women. And nearly always the statements about women represent nothing more than the faulty perspectives of the men who uttered them. A final example of the way in which adultery is only of concern when it is committed by a woman will be encoutntered in tomorrow’s daf, Sotah 3b. Here's a sneak preview:

Rav Hisda said: Adultery in a house is like a karya worm to sesame. [Just as the worm eats and destroys the sesame, adultery destroys the family structure.] And Rav Hisda said: Anger in a house is like a karya worm to sesame. [Just as the worm eats and destroys the sesame, so anger destroys the family structure.] Both of these statements were said with respect to the behavior of the woman; however with respect to the man, we have no concern about it.

Why Was the Ritual Abolished? 

The ordeal of the Sotah was abolished sometime during the second Temple period, although there are three separate Tannaitic sources that describe why this occurred. The most well known is in the Mishnah in Sotah (9:9):

משרבו המנאפין, פסקו המים המאררים; רבן יוחנן הפסיקן, שנאמר לא אפקוד על בנותיכם כי תזנינה, ועל כלותיכם כי תנאפנה  

When adulterers increased the waters of bitterness ceased. Raban Yohanan ben Zakkai discontinued them. For it is written (Hos.4:14): I shall not punish your daughters wine they fornication nor tour daughters-in-law when they commit adulery..."

Another version is found in the Tosefta (Sotah 14:1-2):

תוספתא מסכת סוטה פרק יד הלכה ב 

משרבו המנאפין פסקו מי מרים לפי שאין מי מרים באין אלא על הספק עכשיו כבר רבו הרואין בגלוי 

When adulterers increased the water of bitterness ceased, for the waters of bitterness functions only to clarify a doubt, but now many see adultery in the open...

A third version is found in the Sifrei 21 (25):

ספרי במדבר פרשת נשא פיסקא כא 

כשהאיש מנוקה מעון האשה ההיא תשא את עונה... (הושע ד יד) אמר להם הואיל ואתם רודפים אחר הזנות אף המים לא יבדקו את נשיכם

...Only when the man is free of that sin will "the woman bear her iniquity" [ie. be punished by the ritual of the Sotah]...(Hos.4:14): I shall not punish your daughters when they fornicate nor your daughters-in-law when they commit adultery..." [Hosea] said to them: since you keep the company of whores, the water will not examine your wives...

As the scholar Ishay Rosen-Zvi notes, the Sifrei attributes the end of the ritual "to the failure to apply its moral standard to both men and women equally." Evidence from the social sciences, genetics, and even from Jewish history have demonstrated that (Jewish) men were, and are, far more likely to be the ones cheating. We know this today, but perhaps the Sifrei, (a work of halakhic midrash likely composed in Israel some time after the end of the fourth century CE.) understood this long ago. 

“Sotah stands out in its description of particularly extreme and violent gestures:intentional defacement of the female body; its exposure before an audience; and finally its mutilation to the point of death. These gestures have no trace in the biblical ritual or in sources from the Second Temple period, and they appear to be an innovation of Tannaitic discourse. Furthermore, rabbnic literature itself hardly contains parallels of these gestures, which in fact contravene this literatures’s ethos of punishment and modesty, according to which the body, especially the female body, should be protected from physical damage or the public gaze as much as possible. Thus, in any scholarly analysis of rabbininic attitudes towards questions of modesty, punishment and gender, Tractate Sotah is an anomaly that doesn’t quite fit into the overall picture.”

— Ishay Rosen-Zvi. The Mishnaic Sotah Ritual: Temple, Gender and Midrash. Brill 2012.