"The Heart Knows Its Own Bitterness" (Hebrew: לֵ֗ב י֭וֹדֵעַ מׇרַּ֣ת נַפְשׁ֑וֹ) is a sugya (passage) in the Babylonian Talmud's tractate Yoma, which discusses when a person may be exempt from fasting on Yom Kippur, the Day of Atonement.
For centuries, the sugya has been relevant to deliberations over real or perceived health risks, especially when facing religious obligations such as fasting on Yom Kippur.
In a more expansive move, progressive (non-Orthodox) Jews have invoked this principle and its sugya to adjust rabbinic law for gay, transgender, and disabled Jewish lives.
And if there are no experts there, one feeds him according to his own instructions, until he says that he has eaten enough and needs no more.In its plain meaning, this mishnah says when a sick person may eat during the fast of Yom Kippur.
Tracing the history of this sugya, Law Professor Ayelet Hoffmann Libson states that these stories show that exemptions to fasting "were used sparingly.
[2] In the Talmudic sugya, the Gemara passage quotes from the mishnah above (Yoma 8:5) and then brings a statement about Yom Kippur fasting by Rabbi Yannai (3rd C. CE).
Mar bar Rav Ashi advances a lenient position, which permits people to eat on Yom Kippur if they say it is necessary, even if 100 physicians are present.
[4]According to Libson, for the fasting situation, both the Jerusalem and Babylonian Talmud versions elevated the value of the preservation of human life (pikuach nefesh).
On their use of the Proverb, "The Heart Knows its Own Bitterness," Libson sees a dual purpose: "first, [the verse] anchors the argument that favours the individual’s own medical assessment of his condition over that of an external agent.
She suggests that Hellenistic and Christian views, of the self and of suffering, may have influenced the redaction-era rabbis to treat Yom Kippur as an opportunity for self-regulated suffering: "Only the individual can correctly assess the bitterness for which she may be atoning on Yom Kippur, and therefore only the individual can engage in prohairesis, determining whether to risk pain and even life for the sake of purification and atonement.
"[2] Along these lines, Libson mentions the case of a rabbi (a Tosafist, Isaac ben Asher) who fasted to death in the medieval period, earning some recognition for piety as well as push back on the rabbinic acceptance of such conduct.
An authoritative source of rabbinic law, the Shulchan Aruch, uses the sugya of "The Hearts Knows its own Bitterness" to determine the behavior of a sick person on Yom Kippur.
In Siman 618 of Orach Chayim, the Shulchan Aruch states that fasting would be waived based on the opinion of one expert, including a non-Jewish doctor, if the person's condition might worsen, even if the patient's life is not in danger.
With several variables at play, Immanuel Jakobovits created a detailed chart for his pioneering Jewish Medical Ethics (1959).
For example, David ben Solomon ibn Abi Zimra (16th C.) wrote that, thanks to the principle of "The Heart Knows its Own Bitterness," a patient's treatment decisions should be honored, even for the sake of "peace of mind.
Nonetheless, one should not frighten him by telling him that today is Yom Kippur...."[9] As noted by bioethicist Daniel Sinclair, the principle of The Heart Knows it Own Bitterness can be invoked when medical treatment is doubted or resisted by patients.
Halevi allowed the young man to choose his treatment, based on The Heart Knows it Own Bitterness, deferring to the "subjective wishes and impressions of the patient" (as summarized by Sinclair).
"[12] Berger and Cahan's point hinges on an interpretation of the final voice in the Talmudic passage, Mar Bar Rav Ashi.
[12] In a 2022 law review article, Laynie Soloman and Russell G. Pearce deploy The Heart Knows its Own Bitterness as one of two principles for their constructive development of a progressive, "liberatory" approach to halakhic decision-making for heterodox (i.e., non-Orthodox) Jews, especially for those who experience a negative impact from traditionalist halakhah.
While applying The Heart Knows its Own Bitterness for a Jewish ethics by a those outside the mainstream, the authors say that such projects could be developed and expanded by groups with mixed identities (not all from a single impacted subgroup).
It is because the verse states: "The heart knows the bitterness of its soul" (Proverbs 14:10), meaning an ill person knows the intensity of his pain and weakness, and doctors cannot say otherwise.A Talmud voice (anonymous) then challenges Rabbi Yannai's view as too obvious, as if it adds nothing to the mishna.
But the Talmud then says that Rabbi Yannai was making a novel point, that people know their own condition (and "suffering") better than a doctor, when the person says they want to eat on Yom Kippur.