I really wanted to skip over chapter 2 and chapter 3 for the moment and comeback to them later. Both of these chapters get in the way of the main idea that we will learn in Ben Melech. In chapter 1 we learned that hishtadlus is not optional. We would be much better served by moving forward from chapter 1 directly to chapter 4, where Rav Mintzberg will begin to discuss the shiur (measure) for how much is the appropriate amount of hishtadlus.
In chapter 3 of Ben Melech, Rav Leib Mintzberg starts by quoting, from the Gemara in Brachos 60a which brings a disagreement between Rav Acha and Abaye. Basically, Rav Acha is of the opinion that people should not go to doctors, while Abaye holds that they can go to doctors. Rav Acha says that sick people should pray to HaShem that they be cured and not go to doctors. Abaye disagrees and maintains that people are allowed to go to doctors to be healed, quoting as proof from Tana d'Vei Rav Yishmael, who learns from the verse, ורפוא ירפא - "and he shall cause him to be thoroughly healed" (Shemos 21:19), that doctors are permitted to heal people. Rashi and Tosfos write that what the Baraisa is teaching us is that we might have thought that if HaShem made a person sick, then what business do I have to get involved and heal the person? Therefore the Torah tells us ורפוא ירפא - "and he shall cause him to be thoroughly healed" (the Torah repeats the root of the word 'heal' רפא), to teach us that this is not the case. Doctors are permitted to treat people in all cases.
The way that Rashi and Tosfos understand the Gemara, if the word 'heal' was only used once in the phrase, one might have thought that the permission that is granted to doctors to heal, is only when the doctor is healing wounds inflicted by human beings and not from natural diseases. We might have had the idea that if it was an natural illness, perforce decreed by HaShem, the doctor would be violating HaShem's will, by treating the person who is ill. And as the Rashba (Teshuvos HaRashba 1:413) adds, that for the patient, there is also a problem with going to a doctor. We might have thought that the patient should have faith in HaShem and pray to Him to take it away, just as HaShem brought it upon the person in the first place. In order to teach us that this understanding is incorrect and in fact, doctors are allowed to heal people in all cases, the Torah repeats the word 'heal' ורפוא ירפא. This teaches us, that a doctor is even permitted to heal an illness inflicted by HaShem and not just where healing is needed for a wound was inflicted by another human being. Likewise, it is not a lack of faith on the part of the patient to go to a doctor to be healed.
The Tur and Shulchan Aruch render the final halakha as being, "the Torah gave permission to doctors to heal people and it is a mitzvah and is covered under the general rule of preservation of human life; and if a doctor refrains from healing someone, he is a blood spiller". (YD 336:1)
In chapter 3 of Ben Melech, Rav Leib Mintzberg starts by quoting, from the Gemara in Brachos 60a which brings a disagreement between Rav Acha and Abaye. Basically, Rav Acha is of the opinion that people should not go to doctors, while Abaye holds that they can go to doctors. Rav Acha says that sick people should pray to HaShem that they be cured and not go to doctors. Abaye disagrees and maintains that people are allowed to go to doctors to be healed, quoting as proof from Tana d'Vei Rav Yishmael, who learns from the verse, ורפוא ירפא - "and he shall cause him to be thoroughly healed" (Shemos 21:19), that doctors are permitted to heal people. Rashi and Tosfos write that what the Baraisa is teaching us is that we might have thought that if HaShem made a person sick, then what business do I have to get involved and heal the person? Therefore the Torah tells us ורפוא ירפא - "and he shall cause him to be thoroughly healed" (the Torah repeats the root of the word 'heal' רפא), to teach us that this is not the case. Doctors are permitted to treat people in all cases.
The way that Rashi and Tosfos understand the Gemara, if the word 'heal' was only used once in the phrase, one might have thought that the permission that is granted to doctors to heal, is only when the doctor is healing wounds inflicted by human beings and not from natural diseases. We might have had the idea that if it was an natural illness, perforce decreed by HaShem, the doctor would be violating HaShem's will, by treating the person who is ill. And as the Rashba (Teshuvos HaRashba 1:413) adds, that for the patient, there is also a problem with going to a doctor. We might have thought that the patient should have faith in HaShem and pray to Him to take it away, just as HaShem brought it upon the person in the first place. In order to teach us that this understanding is incorrect and in fact, doctors are allowed to heal people in all cases, the Torah repeats the word 'heal' ורפוא ירפא. This teaches us, that a doctor is even permitted to heal an illness inflicted by HaShem and not just where healing is needed for a wound was inflicted by another human being. Likewise, it is not a lack of faith on the part of the patient to go to a doctor to be healed.
The Tur and Shulchan Aruch render the final halakha as being, "the Torah gave permission to doctors to heal people and it is a mitzvah and is covered under the general rule of preservation of human life; and if a doctor refrains from healing someone, he is a blood spiller". (YD 336:1)
נתנה התורה רשות לרופא לרפאות ומצוה היא ובכלל
פיקוח נפש הוא ואם מו נע עצמו הרי זה שופך דמים
The Ramban had a different take on the place of doctors in Jewish life here. Among the points that the Ramban makes,
"What place do doctors have in the house of those who carry out the will of God, after He promised that `He will bless their bread and their water, and remove illness from their midst'?...
...had they not been in the habit of resorting to medicine, a person who became sick because of his sin could have been healed through the will of God alone. However, since they resorted to medicines, God abandoned them to the vicissitudes of nature.
...the Torah lays down that the attacker must pay the medical expenses of the injured party (Exodus 21:18). But this is because Torah law does not rely on miracles, for God knew that `the needy will not cease from the midst of the earth' (Deuteronomy 15:11). But when a person's ways find favor in God's eyes, he has no business with doctors."
This Ramban became a lightening rod for other Rishonim. You may remember that one of the sources brought in chapter 1 to buttress the idea that you must do thing in the normal way that people do things and are prohibited from relying on miracles, was the Akeidas Yitzchak by R. Yitzchak Arama. In Akeidas Yitzchak, immediately preceding the section quoted in chapter 1 of our Ben Melech, R Yitzchak Arama writes at length against the opinion of the Ramban. The entire citation in Hebrew can be found here
Now let's make it clear that the Ramban is not coming out against hishtadlus. The Ramban is quite vocal in favor of hishtadlus and unless we re-interpret the Ramban (which we just might, since everybody else alive seems to do that anyway), it would seem that the hishtadlus that the Ramban expects people to be doing is the hishtadlus of the Akeidas Yitzchak and the Ralbag. A hishtadlus that does not take darko shel olam into account. The only pre-requisite for a baal bitachon's hishtadlus is that he keep in mind that his hishtadlus will accomplish nothing without HKBH's dictating that what he did, should succeed. However, the Ramban sees illness as something out of the ordinary, not darko shel olam and therefore a person should take it as a message from HKBH that the person needs to do something to get back in HKBH's good graces. While the Tur and Shulchan Aruch understand ורפוא ירפא - and he shall cause him to be thoroughly healed, to be telling us that illness is also darko shel olam and a person should do hishtadlus in the normal fashion in seeking medical treatment for whatever ails him.
So here Rav Mintzberg makes a point that is relevant to what we've learned until now. He says that we can take a lesson in analyzing all that occurs in our lives. The lesson that we can take from this understanding of the Ramban, is that the Ramban would agree that for something that occurs that IS darko shel olam and not something that he sees as totally out of the ordinary like illness, the proper hishtadlus would be to do whatever is darko shel olam. The lesson that we can take from this understanding of the Tur and Shulchan Aruch's position is, that the Tur and Shulchan Aruch would agree that if something occurred that is NOT darko shel olam then the proper approach would be to take it as a message from HKBH that he needs to do something to repair his relationship (I hate that word in this context) with HKBH. Of course, Rav Mintzberg ends off with the caveat that you need great wisdom to differentiate between when something is darko shel olam VS. when something is out of the ordinary, because in truth the question of whether something is just there, so that you can exert yourself or whether it's meant to be a direct communication from HKBH, alerting the person that something is amiss.
Rav Mintzberg suggests that a way to gauge what is going on, is by asking yourself whether this or things very similar to this have occurred in your life before? If things like this have happened before, it is more likely that it is just darko shel olam, while if this is something that is extraordinarily out of the ordinary, the likelihood that HKBH is telling you something, becomes greater.
"What place do doctors have in the house of those who carry out the will of God, after He promised that `He will bless their bread and their water, and remove illness from their midst'?...
...had they not been in the habit of resorting to medicine, a person who became sick because of his sin could have been healed through the will of God alone. However, since they resorted to medicines, God abandoned them to the vicissitudes of nature.
...the Torah lays down that the attacker must pay the medical expenses of the injured party (Exodus 21:18). But this is because Torah law does not rely on miracles, for God knew that `the needy will not cease from the midst of the earth' (Deuteronomy 15:11). But when a person's ways find favor in God's eyes, he has no business with doctors."
(Ramban, Commentary on the Torah, Leviticus 26:11)
This Ramban became a lightening rod for other Rishonim. You may remember that one of the sources brought in chapter 1 to buttress the idea that you must do thing in the normal way that people do things and are prohibited from relying on miracles, was the Akeidas Yitzchak by R. Yitzchak Arama. In Akeidas Yitzchak, immediately preceding the section quoted in chapter 1 of our Ben Melech, R Yitzchak Arama writes at length against the opinion of the Ramban. The entire citation in Hebrew can be found here
Now let's make it clear that the Ramban is not coming out against hishtadlus. The Ramban is quite vocal in favor of hishtadlus and unless we re-interpret the Ramban (which we just might, since everybody else alive seems to do that anyway), it would seem that the hishtadlus that the Ramban expects people to be doing is the hishtadlus of the Akeidas Yitzchak and the Ralbag. A hishtadlus that does not take darko shel olam into account. The only pre-requisite for a baal bitachon's hishtadlus is that he keep in mind that his hishtadlus will accomplish nothing without HKBH's dictating that what he did, should succeed. However, the Ramban sees illness as something out of the ordinary, not darko shel olam and therefore a person should take it as a message from HKBH that the person needs to do something to get back in HKBH's good graces. While the Tur and Shulchan Aruch understand ורפוא ירפא - and he shall cause him to be thoroughly healed, to be telling us that illness is also darko shel olam and a person should do hishtadlus in the normal fashion in seeking medical treatment for whatever ails him.
So here Rav Mintzberg makes a point that is relevant to what we've learned until now. He says that we can take a lesson in analyzing all that occurs in our lives. The lesson that we can take from this understanding of the Ramban, is that the Ramban would agree that for something that occurs that IS darko shel olam and not something that he sees as totally out of the ordinary like illness, the proper hishtadlus would be to do whatever is darko shel olam. The lesson that we can take from this understanding of the Tur and Shulchan Aruch's position is, that the Tur and Shulchan Aruch would agree that if something occurred that is NOT darko shel olam then the proper approach would be to take it as a message from HKBH that he needs to do something to repair his relationship (I hate that word in this context) with HKBH. Of course, Rav Mintzberg ends off with the caveat that you need great wisdom to differentiate between when something is darko shel olam VS. when something is out of the ordinary, because in truth the question of whether something is just there, so that you can exert yourself or whether it's meant to be a direct communication from HKBH, alerting the person that something is amiss.
Rav Mintzberg suggests that a way to gauge what is going on, is by asking yourself whether this or things very similar to this have occurred in your life before? If things like this have happened before, it is more likely that it is just darko shel olam, while if this is something that is extraordinarily out of the ordinary, the likelihood that HKBH is telling you something, becomes greater.
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