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This question came up last year and I'm still puzzling over it. I had a patient with quite severe anxiety disorder trying to get me to tell him he could eat on Yom Kippur, because he was so anxious about fasting. I told him he there was no medical reason for
him not to fast, ie no sakana or safek sakana, and that any further query should be addressed to his rav. He persisted, and I stuck to my guns, because there wasn't any more I could tell him. Except that I also then pointed out that in OC 518 the halacha is
that a choleh who he says he needs to eat is listened to over the contrary advice of one hundred doctors, and ended the conversation.
<div>I was troubled though so I asked a couple of talmidei chachamim who both said that halacha doesn't apply to him, it only applies to someone whose doctor says he's a choleh. In this case he didn't have that label applied by a doctor. A person can't just
decide he's ill and that he needs to eat, and take that position against medical opinion. </div>
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<div>Except I'm not convinced. There is no equivalent category of 'choleh' in modern medical thinking. Each medical situation is individual and unique depending on diagnoses, age, background conditions and so on. There is no application of a label of 'ill'
or 'not ill'. There is an objective spectrum of illness from minimal to critical. It is possible to ascertain presence and degree of risk of dehydration and complications thereof, but if if someone has no discernable risk due to fasting beyond the healthy
baseline, then he could not be considered 'ill' in any objective manner. </div>
<div>That seems to means that the halacha in OC 518:1 is no longer applicable, if my interlocutors are correct. </div>
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<div>Modern medical theory does however recognise that when someone says they are ill, then that needs to be taken at face value. In short being ill is at least as much subjective as objective, and there are a host of recognised conditions which depend on symptoms
alone without objective findings and which can be disabling. And even when you can't fit a patient into a diagnostic box, if they're ill they're ill.</div>
<div><span style="font-size: 12pt;">Psychiatric conditions in particular depend largely on subjective symptomology but are certainly real and disabling. </span></div>
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<div>Bottom line question: Is it really the case that someone is only a choleh in halacha when their doctor says so? </div>
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<div>Gmar chasima tova</div>
<div>Ben</div>
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