Clean Hands

From the 1940s until his death in 1986, Rabbi Moshe Feinstein was the most prominent authority on Jewish law in America. One of his briefer responses addressed an inquiry about whether it was permissible to play ball for a living. What about the threat of serious injury? No, said R. Moshe, adducing Talmudic precedent regarding fruit pickers who risk a fall when ascending to the high branches. Risk that is a normal and reasonable part of making a living is not excessive; we are not enjoined to avoid it.

This ruling came to mind recently as I read Clean Hands, a volume of analytic philosophy focused on excessively scrupulous behavior and overly meticulous character traits by Walter Sinnott-Armstrong, a veteran philosopher of psychology and psychiatry, and Jesse Summers. Think of one who triple-checks whether he has locked the door; a father haunted, when he changes a diaper, by thoughts of molesting the baby; or the worshipper paralyzed by ­anxiety that he has failed to recite an obligatory prayer with precision, intention, or concentration.

A high proportion of examples adduced by Sinnott-Armstrong and Summers involve religious people and religious practices. My participation in public prayer gives me passing familiarity with what I consider odd manifestations of devoutness, and on the job I hear about some that do not occur in public. Sometimes these kinds of concerns are praiseworthy, instances of extreme but meritoriously painstaking efforts. Often, however, one wishes the scrupulous would keep a sense of proportion; if they can’t, we think, maybe a therapist is called for.

Clean Hands can be surprisingly down to earth even as it operates resolutely on the level of conceptual analysis. One fundamental question is whether and how to apply medical categories to idiosyncratic actions and dispositions. It is in fashion to see biological determinism not only when the links between chemical processes and physical illness have been demonstrated, but even when they have not. Increasingly, the popular treatment of “abnormal” tendencies is pharmacological. These applications of drug technology to the distempers of the soul have powerful implications for the way people understand others and how they come to understand themselves. The reimbursement policies of insurance companies, including taxpayer-financed plans like Medicare, are more likely to encourage drug treatment than protracted, open-ended talk therapy.

And then, beyond the economics of psychiatric treatment, one confronts unavoidable moral and legal conundrums. To what extent can we, as judges, juries, fellow citizens, and family members, hold individuals responsible for the deformations of their character or for what we regard as dysfunctional or annoying behavior? Are they in control, or are they victims of bad circumstances or defective DNA? Should we apply verbal or coercive pressure for the sake of bringing such individuals closer to our standard of conformity?

Clean Hands (and much of the literature it draws on) offers a sober guide to many of these questions. It avoids over-reliance on reductive biochemical explanations of psychological phenomena. I did not detect any pronounced tendencies to delegitimize or deprecate religious commitments and beliefs.

In my case, the ontological questions about how to define illness and legal responsibility, as well as questions concerning the moral framework for thinking about medical insurance, are matters of philosophical and cultural interest rather than day-to-day concerns. I dislike telling others what to do. Unless someone asks, I don’t attempt to advise those who engage in “overscrupulous” behavior. Those who want my opinion are generally unhappy about impulses they deem excessive because they interfere with their religious and social lives. Worrying, for instance, about perfectionist recitation of certain prayers is, I think, a distraction from praying to God with proper feeling. Prolonged attention to a “crucial” passage causes one to rush through the rest of the prayers or to steal time and energy from equally or more important duties and pursuits. In the social realm, the effect can be shirking inconvenient duties (excused by purported duties to perfection) and imposing on relationships (mandated by the same purported duties). Here, the overly scrupulous face a further burden. The very effort to overcome fixations on perfect outcomes engenders further waves of anxiety and frustration—“Am I trying hard enough to avoid trying too hard?” When I hear these stories, the primary question is whether I am up to providing good counsel or would do better to recommend engaging a professional.

We cannot avoid the conclusion that it is impossible to diagnose and intervene in these situations (or any matters of interior life) from a supposedly value-neutral scientific vantage point. We inevitably introduce our moral and religious beliefs, and even our basic notions of rationality. Any time we deem behavior abnormal, we are appealing to a standard of normality, which means an at least implicit judgment about man’s true ends. And when we talk about certain behaviors as “crazy” or “neurotic,” we’re assuming a notion of what would count as rational behavior in such circumstances.

To those who want to invoke an impersonal, objective standard for their judgments, this is an embarrassment. The province of psychotherapy and psychiatry is exceptionally sensitive to the always-intruding normative dimension. It touches so intimately on our self-image and on core conceptions of human existence that mental health professionals dearly want to believe that they are not imposing their views on patients. But they cannot avoid doing so. As we noted at the outset, R. Moshe’s ruling reminds us that essentially contested decisions about what is right or normal pervade nonclinical life. These decisions and the resources we use to inform our judgments should not be outsourced to a guild of credentialed experts.

Everything in R. Moshe’s background would have predisposed him to say “no” to the question of whether we can make a living playing games that run the risk of bodily injury. In R. Moshe’s circles, earning one’s daily bread as a sportsman is not common, nor is athletics esteemed a useful or edifying vocation. R. Moshe looked past the norms of his milieu. But such detached neutrality is not as common as we might wish. Our milieu is dominated by technological promises of cure and convenience. This entices us to delude ourselves that science alone can provide us with practical answers.

For example, should medical insurance treat conditions stemming from recreational drug use, excessive drinking, or sexual recklessness as if they were diseases no different from those with a more “innocent” etiology? Can we blame the victims for injuries due to excessive jogging or tennis-playing when aging athletes can stay safe and healthy by doing calisthenics instead? To what extent should we expect people to adopt the safest course of action, and should we censure them when they don’t?

These are not idle questions. They have political salience. New York City has recently invited bitter complaints from some quarters. Public health experts and civil authorities appear to have adopted a double standard. Mass rallies for progressive causes have been exempted from social distancing and other precautions against the spread of the COVID-19 virus, and in some cases these activities have been championed and celebrated. At the same time, houses of worship have been subjected to harsh limitations on prayer services. The mayor of New York City has justified the discrepancy on the grounds that the former has redeeming social-political value that is lacking in the latter. He has a right to his view that social justice is more important than our duty to honor and worship God. But he has no business wrapping it in the mantle of dispassionate science.

Each of us faces decisions about safety and responsibility, and those decisions are necessarily informed by how we rank the goods of life. I returned to my university campus the moment it became feasible. I resumed face-to-face classes with those students who attended, while continuing online instruction for those who remained at home. I undertook the inconvenience of commuting and the minor risk of infection on the subway because I value my work and expect some students to benefit substantially from in-person teaching.

Many, perhaps, disagree with this decision and will maintain we should stay home. Because online classes are possible, it is more rational to remain at home until a vaccine is readily available. They may say that, if I or my students contract the disease, we are shown to have been acting irresponsibly—and we should be censured ­accordingly.

The predictable American individualist reaction is that, barring genuine emergency, neither government nor society should interfere with the private decisions of the individual. My argument here goes beyond that. R. Moshe recognizes that maximal safety is not always the normative good. Certain risks adhere to important human activities, and we can rightfully assume those risks without forfeiting our moral integrity or standing as a rational person. I fear a world in which authority, behind the mask of objective science, obscures this important truth and imposes contested ethical intuitions on people who have no obligation to submit to them.

Shalom Carmy teaches Jewish studies and philosophy at Yeshiva University and is editor emeritus of Tradition.