Sury Freund was a young mother with overlapping depression and anxiety following the birth of her first baby.

She and her husband were from Brooklyn and they were nearing the two-year anniversary of their time together in Eretz Yisrael as a young kollel couple.

“I just feel down.  But not just down — completely squished.  Like a balloon they let the air out of that’s barely floating.  And the fear I have of something happening to the baby is absolutely awful,” she told me as she continued to describe her symptoms, painting a classic picture of postpartum depression.

Sury had been referred by her husband’s rosh kollel, a sweet fellow I knew from the Romema neighborhood in Jerusalem. Often there is a lot of denial about this condition, which causes unnecessary pain and heartache. But Sury knew something was off and desperately wanted to get her life back on track.

“You’re not trying to give me any false reassurance?” she asked nervously, when I outlined a treatment protocol that would combine mental health therapy with a safe-for-baby antidepressant.

“Straightforward cases get a straightforward treatment,” I explained optimistically.

Sury was relieved by the hopeful news that there might be light at the end of her dark tunnel. Her husband, however, wasn’t as confident.

“Dr. Freedman,” said an agitated Duvi Freund, “are you sure my wife needs meds and all this stuff? Because I was speaking with my mother, who raised 11 of her own kids, and she claims every woman feels a little down after childbirth and one just pushes forward and snaps out of it. She says psychiatrists like to create stories in order to boost their business….”

I calmly explained that PPD isn’t just “baby blues,” which tend to last a few weeks due to added stress and hormonal changes. The most distinguishing factor is the time frame — baby blues should subside within a few weeks, but Sury was already four months after birth and exhibiting signs of moderate to severe depression.

I could see that Duvi was feeling conflicted, a young married man caught between the advice of his confident, opinionated mother and the suffering of his wife. But by the end of our appointment, they both seemed significantly reassured and we scheduled to meet again the following month after beginning the protocol.

By the time Sury and her husband came into my office for a follow-up visit five weeks later, she was doing significantly better.

“We love the therapist you put us in touch with, Dr. Freedman,” she told me right off the bat. “I’ve already met with her six times and I’m doing really good work.  And I think the medication you gave me is starting to kick in,” she added.  “I know you said it can take a month or two to have its full effect, but I just feel… well, I don’t know exactly how to say it, but I feel lighter.”

“It’s true, Dr. Freedman, she’s really back to her old self,” her husband Duvi told me. “I don’t know what you did, but it worked! I’m gonna let my mom know that this postpartum thing is real.”

Our next follow-up appointment showed continued improvement, and because Sury was also seeing a therapist, we made up to reevaluate in six months.  As it turned out, the Freunds ended up moving back to Brooklyn where Dovi would learn part-time and take a job in his father-in-law’s real estate business. I made the appropriate referral for ongoing care via my friend at Relief Resources and didn’t plan to hear from Reb Duvi or his rebbetzin again.

But Hashem had other plans, and15 months later I received an email from the Freunds asking for a time to speak. Two hours later, there was an email from the same friendly Duvi with a decidedly angrier tone, demanding an immediate phone call.  I was actually planning to call him after my last appointment, when I received a third, overtly furious email: “Dr. Freedman, I have half a mind to take you to beis din if I don’t hear from you immediately regarding that lecture you just gave in Beit Shemesh!”

Whoa! This was a real shocker, given how well everything had gone with his wife’s treatment, but I literally had no idea what he was referring to by referencing the talk I’d given to 100 parents the previous month.

I went to daven Maariv and had my secretary schedule a time with him for later that evening.  By the time I got in touch with him, it was clear that Dovi Freund was simply fuming.

“I can’t believe you did this to us!” he yelled from the other end of the phone.

“Did what?” I asked. “Is your rebbetzin okay?”

“Yes, she’s great.  Baruch Hashem she’s fine, which, as you know, is part of the problem. I should have listened to my mother. You double-crossed us!”

He was going to be tough to reason with, but I had literally zero idea what he was talking about.

“You maligned us! You broke our confidentiality! You terrible, terrible man!”

“Reb Duvi,” I spoke calmly and slowly to try and de-escalate him.  “Let’s try to figure this out and see what I can do to be helpful.”

“Too late, Dr. Freedman — you already spoke about us in your recent lecture, which was livestreamed. Now, the whole world already knows about how Sury Freund had postpartum depression!”

Now I really had no idea what he was talking about because I’d never done such a thing.

“The Persian family from Great Neck where the woman had a depressive episode with anxiety after her twins?  You think I didn’t know that was talking about me and Sury? Did you really think that we are so stupid?  That you could just pull a fast one on Duvi Freund and tell the whole world about his wife’s postpartum depression during that lecture you gave?!”

I finally understood what he was talking about.

“Reb Duvi,” I continued to talk in as relaxing a tone as I could muster under the circumstances.  “I never speak about patients I’ve seen or treated as a psychiatrist without their permission. That would be illegal in a court of law and assur in a beis din.”

“Then how do you explain the story about the Abrahamians — a kollel guy whose wife ends up having problems after she has a kid? I heard it myself! It was exactly what you claim happened to us!”

“Reb Duvi, as you saw yourself in that lecture I gave, it’s because this is a very common story.  One in ten women will experience postpartum depression, and there are thousands of kollel wives here in Jerusalem alone.”

“Oh,” he said, and was then silent for a few moments.  “Well, they were American… so are we!”

“There are tens of thousands of Americans here in Israel at any given time, Reb Duvi.”

“Wait, Dr. Freedman, are you saying this really wasn’t about me?”

“Nope. Any similarities to a particular individual are coincidental, because the themes are so relevant and prevalent.

“Oh…” he paused for a moment.  “I mean, I guess I’m sorry, Dr. Freedman,” he said sheepishly. “I thought we were like the only people this happened to.”

“No worries, Reb Duvi. The ikar is that your wife should feel good.”

“Amen…. Uh, Dr. Freedman, I want to tell you something. I was really upset about that lecture, but honestly, my wife was sort of relieved. She told me, ‘Duvi, don’t you see? This means we’re not alone.’ ”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Dear Readers,

It’s been an amazing experience to have been a part of your week these past five years. Mishpacha Magazine is a powerful force and I am grateful to have worked with such dedicated editors and colleagues. When I first started out writing this column, my goal was to improve the dialogue around mental health in our community, and I couldn’t be more honored to have been on this journey together with you. As this chapter of “Off the Couch” comes to a close, please don’t hesitate to be in touch if I can ever be helpful. Stay grateful and be healthy! 

Yaakov Freedman, MD 

Jacob L. Freedman is a psychiatrist and business consultant based in Israel.  His new children’s book — Me and Uncle Baruch — is available through Menucha Publishers.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 912)

The post You’re Not Alone first appeared on Mishpacha Magazine.

“I can’t believe you won’t help us, Dr. Freedman! We schlepped all the way out here and you won’t even see my son?!”

I took a deep breath and encouraged Rabbi Hershkovitz to do the same. It didn’t help. Of course, I’d never said such a thing. I just didn’t agree with Rabbi Hershkovitz’s plan of action.

“We paid for your time! We brought his records! And now you’re refusing to help us! What’s the big deal with coming to the house and pretending that you’re a new chavrusa of mine who just wants to schmooze with the family? That’s a perfectly reasonable idea! Why can’t you cooperate?”

Rebbetzin Hershkovitz tried to calm her husband down, but it didn’t seem to help either. He stormed out the door and slammed it on his way out.

Rebbetzin Hershkovitz was infinitely less flustered than I would have expected under the circumstances. She sat calmly, preferring to finish up the time they’d booked.

A veteran Torah teacher throughout the seminaries around Jerusalem, she carried a certain self-respect that went beyond her yichus as a daughter of a prominent American rosh yeshivah. It was the kind of dignity that wouldn’t unravel so easily in spite of her husband’s temper tantrum.

“My husband is a good man, Dr. Freedman, I’m sure you can imagine how hard this is for him, given that Chaim Ozer is our only son. And as much as I agree with everything you said today, I just want to make sure I have it all set in my mind. It will help me to better explain it to my husband — and to help him really understand Chaim Ozer’s addiction.”

We spent some time reviewing her son’s history: Chaim Ozer was 19, the last of six kids and the only boy. The Hershkovitzes had lived in Eretz Yisrael since their marriage, with Rabbi Hershkovitz making great strides in his learning and eventually heading a chaburah. But he also became increasingly rigid and less flexible in his Yiddishkeit as he waited for a son who he had no doubt would become the next gadol hador. By the time Chaim Ozer was born, Rabbi Hershkovitz had already picked out the cheder and yeshivos that would be battling for the zechus of teaching the baby Torah.

But Hashem had other plans, and Chaim Ozer struggled intensely throughout his early years in school. He had some learning issues, plus a crippling stutter that resulted in serious bullying. By the time his parents got him the treatment he needed, Chaim Ozer was already a broken bochur in yeshivah ketanah with one foot out the door. This led to a cycle of treatment programs, therapeutic yeshivos, and eventually bouncing in and out of expensive rehabs across the world. What was clear to me, at least, was that no intervention or program — no matter how fancy or exciting — would be effective until Chaim Ozer was ready to honestly invest himself.

As I reviewed the boy’s history with Rebbetzin Hershkovitz, she nodded in agreement and added, “And then my husband asked if you would be willing to pretend to be just a chavrusa and to come over to the house and ‘trick him’ into doing a consultation with you…. But you were right to hold your ground, Dr. Freedman. My son is not an idiot and would figure it out immediately. And trying to force him to see a psychiatrist to talk about his daily marijuana smoking and the cocaine and psychedelics on the weekends will only make him angry, even though my husband thinks that’s good. He’s convinced that even if Chaim Ozer gets angry, it will be worth it, because in the end he’ll finally change his ways.

“But I know that isn’t how it works,” she continued. “Like you said, a person has to really want it, to be open and willing to ask for help.”

We sat again in silence. She was thinking hard and I wanted to give her the space and time to find her inner truth and to know what she needed to do.

“And if we push him,” she said after a few moments, “it will only make him push back twice as hard. And then my husband will get frustrated and will fight with our son. And when that happens, Chaim Ozer will go straight back to drugs, because not only will he have to feed his addiction, he’ll also be angry at his father, and he’ll need to use and use until that pain goes away.”

“I couldn’t have said it better myself, Rebbetzin,” I told her.

As we stood up and I began to walk her out of my office, we were both surprised to see her husband sitting in the waiting room.

“I figured that the tikkun for slamming your office door was to sit here quietly and replay that scene, this time leaving in shalom,” Rabbi Hershkovitz said as he stuck out his hand. “Do you mochel me, Dr. Freedman?”

I took his hand between my own and shook it briskly. I was a bit overwhelmed myself — it’s not every day you see a person so candidly willing to admit his pain or weakness.

“You’re in a tough situation, Rabbi Hershkovitz. I see how much you want to help Chaim Ozer. The problem is that you can’t control your son, you can only control yourself.”

I motioned for everyone to come back into my office for us to sit down together. And then I told them about this famous Hispanic rapper who I saw as a psychiatrist in training.

“One Sunday while I was on call,” I began, “I was paged by the surgical team to see a Latino hip-hop star who had passed out from drinking and snorting pills after a big concert one night in Boston. They’d resuscitated him and stitched up a big cut on his forehead where he’d been whacked with a whiskey bottle during an intoxicated brawl. Anyway, as the team was getting ready to discharge him, someone decided he should see a psychiatrist to discuss his substance abuse. The nurse had told this fellow and his entourage that he couldn’t leave until the psychiatrist came, so by the time I arrived, they were already fuming. The Spanish curse words that were flying throughout the surgical ward could be heard from inside the elevator all the way down the hallway

“By the time I entered the room, the patient and his friends were already knee-deep into their second brawl of the weekend with a few security guards who had been summoned. Needless to say, the rapper never got his psychiatric consultation and was discharged in handcuffs. The good news is that he later released a track about the incident that actually references a psychiatrist, so I had my five minutes of fame on the Latino rap scene.”

By now, both Rabbi and Rebbetzin Hershkovitz were laughing, but they also both understood: A patient dragged to therapy against his will won’t see success.

We made up to meet again and discuss some motivational strategies that have had good results in order to help their son move forward, although I explained that therapy alone can never cure addiction — it can just be a tool to help someone like Chaim Ozer find his own strengths.

Rabbi Hershkovitz shook my hand once more. This time, he closed the door softly on the way out. It seemed like he’d found his.

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel.  His new children’s book — Me and Uncle Baruch — is available through Menucha Publishers.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 911)

The post Don’t Force It first appeared on Mishpacha Magazine.

The phone call from my good friend Rav Ratzabi took me by surprise.

He wanted to book an appointment for his elderly Uncle Yichye, who had lived his entire life in Yemen before moving in with his nephew and their French-speaking household in 2013, when he arrived with one of the last groups of immigrants from that country.

Uncle Yichye was suffering from PTSD due to the stresses and oppression the kehillah faced in the years before he left, even though the community was officially protected. Somehow, although he’d survived many decades under the radar, finally being safe triggered haunting fears.

“The thing is,” Rav Ratzabi continued, “is that he doesn’t speak Hebrew, so I’ll come along as his translator. And the second thing is that he’s blind, and I want to make sure you’re okay with him bringing his seeing eye dog.”

I generally don’t let folks bring their animals into my office as it can get messy, allergic, or frightening for the other humans in the building. But I was more than willing to make an exception. It was a wonderful thing that his uncle was able to be more independent with the use of one of Hashem’s creations.

About a quarter of an hour before our scheduled appointment, as I was walking back to my office, Rav Ratzabi called to tell me that he’d be delayed due to a family emergency he needed to take care of, but meanwhile he would drop his uncle off so that we could get started and not delay the schedules of subsequent patients.

Under most circumstances it wouldn’t be an issue, but I was not going to be able to get started without a translator. Rav Ratzabi didn’t seem to think it was such a big deal, though.

“I appreciate your perspective, Dr. Freedman,” he told me, “but in truth, his Hebrew is probably better than I initially told you. Plus, I think his case is pretty straightforward.”

To his chagrin, I told him we’d wait until he arrived about 25 minutes late.

As I rounded the path behind the King David Hotel and neared my office, I remembered a case from medical school close to 20 years ago. I was a med student working the weekend shift in the psychiatric emergency room and the staff was completely overwhelmed in the aftermath of a gang-related shooting and the mix of intoxicated, violent patients who sat opposite the sober and traumatized ones.  A page came in from the medical floors to see a Moldovan man with acute schizophrenia.  As the attending psychiatrists were too busy to see the case, they sent me up with my trusty stethoscope and clipboard to speak with the medical team.

The cardiologist wasn’t particularly interested in the poor fellow’s situation, as was evident by his tone on the phone as I answered the page.

“The guy was admitted to our service on cardiac monitoring because he had an elevated heart rate, but he’s completely insane, can’t communicate at all in a sensible fashion and keeps flapping his hands and slapping his head. We have an orderly by his side because he fell out of bed. We thought maybe he was drunk, but his toxicity screen came back negative. Can you just get him off of our service already and admit him to the psych ward?”

I tried to slow things down and get a better picture but I wasn’t getting too far. How did he get to the hospital? Don’t know. Who is involved from his family that can provide us some history? No idea. What does the patient think is wrong with him? “No idea — don’t speak Moldavan. And we definitely don’t have a Moldovan translator in the hospital,” the cardiologist snapped.

“Maybe we can get a Romanian translator via the telephone-translator service?  I’m pretty sure it’s the same language.”

“You can do whatever you want with him. I’m a cardiologist and this guy doesn’t need a valve replacement or an angioplasty. He needs a psych hospital.”

I could tell we weren’t getting anywhere fast and decided to go upstairs to meet my first Moldovan patient. He was sweating profusely and thrashing around in his hospital bed as the orderly at his side periodically made sure he didn’t fall out.

“You have any idea what’s wrong with this guy?” I asked.

He didn’t. Apparently, he was even less interested in the case than the cardiologist.

I brought in the telephone-translator device and dialed up a Romanian translator. It wasn’t of much use though, as my new patient was making unintelligible noises as he rolled back and forth and repeatedly slapped his head with his left hand. The translator told me very quickly that the patient wasn’t making any sense.

“Something is wrong with this guy,” the translator told me.

“The doctor who checked him in thinks he’s crazy,” I offered. “What do you think?”

“No, he’s not crazy like he’s a psychiatric patient, more like he’s broken. It’s like something happened to him and his brain is broken.”

It all made sense. This guy hadn’t moved his right side since I entered the room. Something was absolutely wrong and it wasn’t an acute psychiatric illness.

I pulled out my stethoscope and began to examine the patient. But before I could even listen to his heart, the poor fellow made eye contact and my jaw dropped.  The pupil in his right eye was the size of a grapefruit.

“Call the doctor, immediately!” I yelled to the orderly.

A nurse came running in and I told her, “This patient needs an urgent evaluation by the neurosurgeon. We need to make sure his brain is okay.”

Coming back to the present, I turned onto my street and saw an elderly Yemenite man sitting with a white cane on the bench outside of my building.  A huge Belgian Shepherd was by his side, wearing the harness of a seeing-eye dog.

“Uncle Yichye,” I said calmly and put my hand on his shoulder lightly.  “I’m Doctor Yaakov. Do you mind if I sit down next to you?”

In broken Hebrew, he responded that his nephew would be late and that he needed a translator, so he hoped we would wait until Rabbi Ratzabi arrived.

I tried to make small talk but Uncle Yichye had a hard time transitioning between French and Arabic as he struggled to speak Hebrew.

“It’s okay,” I said. “It’s a beautiful day so we’ll just sit here and wait for your nephew.”

I wasn’t sure if he understood me, but I understood that he wanted to wait and that he was grateful I agreed. Life was confusing enough for him being blind in a new country. My Moldovan patient from two decades ago taught me how important it is to get a good translator on board.

Rabbi Ratzabi eventually arrived to find us sitting on the bench, where I was keeping his uncle company in companionable silence and petting his dog.  He smiled at me and apologized profusely. And his uncle, who had lived through so much, was obviously awash with relief.

“I see that even if you don’t speak French or Arabic, you’ve found a commom language,” Rav Ratzabi said. “And that you’re not afraid of the dog.”

It was my turn to make light of the situation and for this I was grateful for my high school French. “Actually, les chiens ont peur de moi (dogs are afraid of me).”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel.  His new children’s book — Me and Uncle Baruch — is available through Menucha Publishers.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 910)

The post Tu Quoi?  first appeared on Mishpacha Magazine.

Meir Elbagdadi was dressed like a thousand other young men from wealthy Israeli Shas-affiliated families whose fathers,

through grit and determination, pulled themselves up from the poverty in which they’d grown up and secured the brachah of parnassah.

Sharp suit? Check. Neatly trimmed peyos tucked behind the ears? Check. Limited exposure to high-quality information about mental health? Unfortunately, that was also a check.

Meir had a classic case of OCD, complete with intrusive, obsessive thoughts about his halachic observance, plus compensatory compulsive behaviors. Some of his most debilitating symptoms included the need to repeat the Shema or to restart his Shemoneh Esreh over and over due to fears of lacking proper kavanos.

After suffering for nearly two years during yeshivah ketanah, Meir eventually found his way to an unlicensed therapist.

“My rebbi had recommended him, and he was known to our community as a good and compassionate person,” Meir described as he sat across from me, relating his generally unsuccessful therapy journey.

The man claimed to be an expert in CBT after having taken a course with a well-known coach in Bnei Brak who offered a popular six-month training program. He probably picked up the rudiments of the methodology, and might have even helped some people with minor issues, but he was totally out of his league when it came to understanding the complexities of full-blown OCD. While this man was intuitive and supporting, spending a full year in whatever therapy he was offering not only didn’t do Meir any good, it cost the family close to 15,000 shekel.

“In the end I saw it wasn’t for me, and all he did was scare me away from therapy,” Meir recalled. “My experience with a ‘real’ psychiatrist wasn’t any better though.”

After obsessive thoughts regarding personal hygiene and compulsive behaviors were keeping Meir in the bathroom for nearly four hours a day, he wasn’t able to maintain the pace or pressure of yeshivah gedolah and had returned home. His parents then contacted a local askan who brought Meir to a famous professor at a big academic hospital in Tel Aviv.

“The appointment lasted 15 minutes, and I’m embarrassed to tell you how much my Abba shelled out for it,” Meir related. “The doctor basically just threw a piece of paper from his prescription pad in my direction.”

Meir took those pills for a month but didn’t feel much real change, so he stopped the medication after it ran out. There was no follow-up appointment scheduled, and given that the family wasn’t particularly impressed, they never returned.

What Meir did have going for him was yichus. His grandfather, Chacham David Elbagdadi, was a highly respected Iraqi rav and dayan. I had actually met Chacham Elbagdadi earlier that year after I’d consulted him on a complicated shalom bayis case that had ended up in his beis din.

Meir’s pedigree, and his father’s financial standing, stood in his favor when it was time to do a shidduch, and the OCD was never brought up as an issue.

“But now,” Meir admitted, “my wife has had it with my OCD, and she even told my Saba about all my weird behaviors. He insisted that I see you, which is how I ended up here.”

I had the utmost respect for Chacham Elbagdadi and was truly honored to help his grandson. But Meir needed to understand that there were no shortcuts on this one.

Classic cases require standardized treatment and therefore recommendations for Meir were pretty straightforward: He’d need to start an SSRI (selective serotonin reuptake inhibitor) medication and steadily increase the dosage with regular follow-ups. He would also need weekly skills-based therapy with an expert, frum psychologist who specialized in OCD and also understood his religious needs.

“Dr. Freedman, do you mind calling my Saba to tell him the plan?” Meir asked. “I’m feeling a little embarrassed. I never even let him know about my challenges, and here he’s the one who’s putting me on the right path.”

I was honored to help the Chacham’s family any way I could, and apparently the feeling of respect was mutual: He asked me to come over later when he’d be going to Maariv and made me an offer I couldn’t refuse — his wife’s famous sambusak.

I swung by Chacham Elbagdadi’s apartment near the Moussayoff beit knesset on my way home that evening. Fresh and crispy sambusak held the kind of pull on my stomach that made it easy to go a bit out of my way. Chacham Elbagdadi’s wife opened the door and handed me an aromatic paper bag filled with traditional Iraqi Jewish delicacies and let me know that her husband was getting ready to walk to Maariv.

I waited in the doorway for the Rav to come, escorted by his shamash whose arm the elderly Chacham held as he slowly walked from his study through the kitchen and into my view. The Rav was dressed in the long coat of a dayan, and it was clear from his gait that merely walking to tefillah required assistance.

“I see my wife gave you your present, Doctor. I hope you enjoy it, and thank you for your help,” he said. “I am honored if you will walk with me so that I can ask you a question that has been on my mind.”

I nodded and followed the Rav out into the street.

“I wonder if you might tell me why there is so much mental illness in today’s generation,” he began. “It was not the same a generation ago when I was a younger man, nachon?”

As we walked through the starlit and winding streets, we discussed many things that were already quite evident to us both: the clear presence of mental illness in prior generations irrespective of a proper diagnosis, the lack of understanding and referrals to professionals that was only slowly being addressed in many populations, and particular stressors new to the current times. Chacham Elbagdadi would walk a few feet and then stop, sometimes nodding his head in agreement and other times simply saying nachon.

“I wonder if perhaps there is another reason, Doctor. Perhaps it is the tremendous brachah of gashmiyut in this generation that has become a pitfall for so many, nachon?”

This time I nodded my head in interest.

“I remember as a child that we did not have electricity or even running water. If you wanted to see at night, you had to build a fire or light a candle. If you wanted a shower, you had to heat the water that you had drawn from a well in the shared courtyard outside of the house,” he recalled. “Even for people who were sad or anxious, the daily pressures required so much of us just to stay alive. There was no free moment to worry about what would be.”

“Wealth can be a double-edged sword,” I said in agreement.

“Nachon. I am grateful to live in an age where we have refrigerators to hold amounts of food that I never could have imagined as a child, Doctor. Todah l’Hashem. But I wonder if all of this has made us soft and rebellious and opened us up to new sorts of problems.”

We had arrived at the gate of Beit Knesset Moussayoff and Chacham Elbagdadi reached up, together with the steadying hand of his shamash, to kiss the mezuzah.

As we walked in, he looked at me and said, “Dr. Freedman, when I was young dayan in Baghdad, I’d watched children starve to death. And I prayed fervently for parnassah of our community. Hashem heard my tefillot, but now I pray for something else: the seichel to use it properly.”

There was only one word for me to say: Nachon.

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel.  His new children’s book — Me and Uncle Baruch — is available through Menucha Publishers.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 909)

The post What You Pray For first appeared on Mishpacha Magazine.

Rabbi Yossel Isaacson ran a program in Jerusalem training avreichim to be community leaders in chutz l’Aretz.

It was known for attracting young men with a combination of a solid learning background and a go-getter personality.

Rabbi Isaacson not only focused the learning on practical topics like Shabbos, kashrus, and rabbinic functions such as marriages and funerals. He also brought in a variety of speakers such as an accountant to lecture about balancing a communal budget, fundraisers who spoke about how to keep their organization afloat, and a psychiatrist to discuss mental health matters — that was me.

And that’s how I came to meet Aryeh Froilich and his wife, a young couple who were set to embark on a five-year stint in a Southwestern kehillah.

After my third talk in the series, Rabbi Isaacson approached me to let me know that his student, Aryeh Froilich, would be in touch about his wife. Apparently, at least from what Reb Aryeh told his rebbi, the young Mrs. Froilich — who was always so supportive of their mutual mission — was having anxiety issues over their plans, to the extent that it was affecting her daily moods and functioning. Could I help them navigate this? I told Rabbi Isaacson that I’m not a marriage counselor, I’m a psychiatrist, but it was bashert that we talked, and maybe I’d be able to steer them in the right direction.

At Rabbi Isaacson’s prodding, Aryeh Froilich booked an appointment for the two of them to see me — but before he hung up, he made sure to tell me how he hoped I’d be able to help get his wife back on track, how he’d already interviewed for the position and was even negotiating a contract, yet how his wife basically freaked out whenever he brought up details of their projected move — and even when he didn’t.

They arrived to my office with an infant girl in a baby carriage, and from the get-go, I sensed a certain helplessness from Reb Aryeh… and an overcompensating chattiness from his wife. To his credit though, he gave her the first opportunity to talk, not wanting to come off as a critical, ungrateful husband — at least not in front of me.

“You know, we’re both from Flatbush,” Chevi told me, smiling nervously, “and our fathers actually serve together on several organizational chesed boards…” She continued to tell me how they met, how their cousins were chavrusas, a time they saw each other at a neighborhood simchah from afar, and their third date at the Bronx Zoo.

I didn’t want to waste their entire hour and decided to steer back the conversation. “So let’s take a moment to discuss what—”

“Oops, it’s time for the baby’s bottle,” Chevy said as she scooped up her little girl and ran out of the room with her infant, ostensibly fill up a bottle at the least convenient time in our appointment — or maybe the most convenient, as she obviously didn’t want to talk about her anxiety issues.

I raised an eyebrow curiously as I looked at Aryeh, who shrugged his shoulders, a little less confident than he’d been on the phone.

“Let’s wait for my wife if that’s okay, Dr. Freedman?” he suggested.

Chevy came back in a full ten minutes later, having deliberately made a bottle and fed the baby outside in the waiting area to avoid coming in to speak with me.

When she finally returned, we had about half of their scheduled time to talk.

“Baby comes first,” she said as she smiled nervously.

I was about to open up the discussion when Chevy again cut me off. “So Dr. Freedman,” she said almost too casually, “did Aryeh tell you we might be going to either Dallas or Phoenix?”

She could’ve continued on, but I didn’t feel it was honest or professional to facilitate the charade of pleasant chatter any longer.

I stood up and walked through the door into the waiting room where I poured myself a glass of cold water. After a minute, Aryeh came out and said, “Umm, Dr. Freedman, can you come back in and talk to us?”

I unceremoniously took out my wallet and tossed them a wad of cash. “I know you made a bank transfer but it’s easier just to hand you the money back than to give my secretary any more paperwork.  Take it, it’s yours.”

They were quiet for at least 90 seconds before Aryeh broke the silence. “But Rabbi Isaacson said you’d help us.”

“I can try, if you want me to.”

“Of course we do,” he said.  “Right, Chevy?”

“Absolutely, why do you think we came?” she added a bit too cheerfully.

“Okay, let’s try this again. Reb Aryeh,” I said as we reseated ourselves, “maybe you tell me why the two of you are here today?”

He looked a little flustered, glanced at his wife, and then turned back to me. “Okay, so it’s like this, Dr. Freedman. Uh, we have plans… or maybe I should say ‘had.’ But now, every time I mention the position, she starts to cry and scream, like some petulant child. We talked about this, it was our dream together, and now she’s totally chickening out… Chevy,” he suddenly turned to her, “Why can’t you just be happy like we talked about? What’s happening with you? Why isn’t this parenting thing making you ecstatic, like we expected? Why are you so angry and down, looking at me like I’m some kind of enemy? Why can’t you just get normal so that we can proceed as planned!?”

Chevy turned white. And then this chatty young woman practically crumbled before my eyes. And suddenly, I suspected that there was more happening here than some immature anxiety over a move, or even a bout of baby-blues.

“Mrs. Froilich,” I asked gently, “I want you to answer honestly. Are you having difficulty sleeping yet feel overwhelming fatigue?”

She nodded.

“Feeling depressed and antisocial? Worthless and inadequate? Afraid and lost? Unable to bond with your baby and fear that you’ll hurt her?”

This time, she didn’t nod — she started to cry.

Our society makes it difficult for a woman to acknowledge that she may be dealing with postpartum depression, when she keeps hearing about the joys and bliss of motherhood. Her need to be seen as a normal and good mother is so strong that she’ll mask her symptoms with incredible effort, even from her spouse, as she convinces the world that she’s doing fine, when in reality she’s falling apart on the inside. In fact, many women facing the challenges of PPD — which affects about ten percent of new mothers — are in such strong denial that unless a close family member realizes what’s happening, they may never get the treatment they need. But in fact, denial is actually the enemy of recovery.

“Dr. Freedman, my husband keeps telling me that I should be happy because we have such a beautiful baby! He gets to go to yeshivah, see friends, make plans… Why is he pressuring me so much? Why does he keep giving me that look that makes me feel like such a failure?”

“Mrs. Froilich, postpartum depression is a serious mood disorder, a chemical imbalance, and absolutely nothing to be ashamed of. But there’s a way out, and as overwhelming as it all feels right now, it’s okay to take it one step at a time. And soon you’ll both find yourselves on solid ground as your healing unfolds.”

Aryeh looked like a ghost. Postpartum depression? Chevy? Nah, impossible. But then, looking over at his wife, for the first time he saw more than an interview and a position and a woman who suddenly no longer shared his dreams.

“Chevy… I’m… sorry… Dr. Freedman, can you help us through this together?”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel.  His new children’s book — Me and Uncle Baruch — is available through Menucha Publishers.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 908)

The post The Best-Laid Plans first appeared on Mishpacha Magazine.

Lazer was a British bochur who was allegedly learning in yeshivah, but spent most of his days sleeping and watching TV. He had an abusive childhood at the hands of a vicious father and was struggling to find his way out of the negative self-image that was defining and sabotaging his life. PART III

Lazer had been in treatment for about a year and I was grateful for the progress we’d made, honored to have been a part of his recovery journey.  The combination of antidepressant treatment and psychotherapy had done wonders for him — he was overcoming his painful past and was living a very meaningful life in the present, having finished up an amazing zeman of learning in the Mir by surrounding himself with good chavrusas, dedicated rabbanim, and positive friendships. He was finally soaring toward his potential without the heavy weights of his traumatic childhood to pull him down.

And then came the frantic phone call.

His father had come to visit.

Now, while there are sometimes parent-child relationships  so toxic that they must be severed, relationships are rarely all good or all bad. Even the most abusive parents can sometimes be loving, which can be extremely confusing for the child, even an adult child like Lazer. And of course, we Jews have a commandment to honor our parents unconditionally.

“Dr. Freedman, I feel like I’m facing a ticking time bomb, and that every tool we learned and practiced is out the window,” Lazer said in a panic. “So far my dad’s been pretty nice, happy that I have good learning sedorim, but I just know it’s a matter of time until he explodes with a barrage of criticism or worse.”

I told Lazer to come over, and we discussed techniques for being caring and respectful while protecting himself from further abuse, all the while making sure not to fall into the trap of false guilt. I didn’t want him to regress into old patters of self-hate, no matter what his father spewed at him.

Whether or not Lazer’s newfound strength and self-identity had an influence on his father, one thing he told me after the week-long visit brought tears to my eyes: Before he left, Lazer’s father gave him a hug.

Lazer stayed in yeshivah for another year, and then decided to continue on to a beis medrash in the US that was looking to recruit solid bochurim. We parted ways and I reminded him to keep me posted if I could ever be of help. “Remember, tzaddik, you might no longer be my patient, but I’ll always be your doctor. I’m here if you need me, so don’t be shy if you ever need to call.”

The call wasn’t long in coming.

“Lazer! What can I do for you?” I asked.

“Well, I mean, I guess I’m okay. I’m just kind of having a tough time.”

Lazer explained that it was nothing catastrophic. In fact, he sounded relatively solid. He’d been back at home in England for a few weeks and had avoided the standard pitfalls that many bochurim get caught up in.  He was still waking up for early Shacharis and had found himself a great morning chavrusa and a nice group of fellows at home for bein hazmanim.

“Sounds good, Lazer. So what are we nervous about?” I asked curiously.

“Dr. Freedman, this is the thing. For the last two years, I’ve been in a pretty good place, but now, I’m back here with my brothers and it’s really throwing me for a loop. I thought I was fine, cured and everything, but now I’m feeling destabilized.”

I recalled his family: four older brothers, the oldest with chronic drug problems, two twin brothers who had permanently distanced themselves from the family, and another brother spending most of the year in Las Vegas as a professional poker player who was covered head-to-toe in tattoos.

“It’s just hard, Dr. Freedman. Two brothers refuse to come home because they’ve learned to cope by never seeing my parents. So our nuclear family is now me and my brothers who do come home: Shimi, who just got out of a rehab again, and gambling-addict Zalmy, who isn’t any healthier.

“I really thought I was in a good place, but it’s back to the old garbage, and their barbs are just wearing me down. Things like, ‘Oh, now you’re pretending to be so frum but we know you’re just a big faker,’ stuff like that.  Or, ‘Don’t you want to come to a club with us tonight?  You can’t tell us it’s assur, we know what you did when you were in Israel, you’re just like us, don’t pretend you aren’t.’”

“Lazer,” I said, “you’re not like them. You’re healthy, and you’ve done a ton of personal growth.”

“I know, and that’s the funny thing. It’s like a flashback. Their comments and beratings are bringing me back to a bad place, cutting me down and making me feel like I’m not so good after all.”

I tried to walk Lazar back to a calm place. We recalled the loving memories of his childhood with his Zaydie Ephraim and it helped him relax. I then walked him through a mental exercise to try and keep things in perspective.

“Think of some exquisite beauty you once saw — the Grand Canyon as a kid? The Great Barrier Reef in Australia? A sunset at the beach or a sunrise in the desert? A rainbow after a thunderstorm? One way or another, every one of us has had the opportunity to see some serious beauty in Hashem’s world, and witnessing the sheer majesty of Hashem’s creation is a powerful experience. It helps us to realize the insignificance that characterizes so many of our concerns and gives us that deep, unifying consciousness that we’re part of something so much bigger than ourselves.

“But when everyone else is busy appreciating the deep, spiritual beauty of snow-covered peaks in the Swiss Alps,” I continued, “there is also that one person with you who says, ‘I don’t get it, it’s just few big rocks next to each other.’ For everyone who is inspired by the Redwoods in Sequoia National Park, there will always be that cousin who says, ‘I can’t believe we shlepped all the way here just to stare at a bunch of big trees.’

“You, dear Lazer, are an enormous, ancient tree.  In fact, you’re higher than any peak in the Himalayas and deeper than the Mariana Trench. Just because a family member doesn’t appreciate you doesn’t mean you aren’t worth more than all the gold in Fort Knox. You’re the only one out of billions and billions of people who is exactly like you. You’re one of a kind and made in Hashem’s image, gifted with the creative energy to make this world a better place with your own unique set of skills and abilities.”

“Wow, thanks, Dr. Freedman. I mean it.”

“Lazer, just remember this the next time someone criticizes you, whether it’s a neighbor, a friend, or even a brother. You’re still a diamond. Their behavior doesn’t change your inherent value, all it does is prove that they aren’t good gemologists.”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills around Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 907)

The post You’re a Gem first appeared on Mishpacha Magazine.

Lazer was a British bochur who was allegedly learning in yeshivah but spent most of his days sleeping and watching TV. He’d had an abusive childhood at the hands of a vicious father and was struggling to find his way out of the sinkhole that had become his life.

PART II

Lazer had been diagnosed with various ailments over the years

and correspondingly medicated along the way: Ritalin for ADHD when he’d spaced out as a parentally abused second grader. Prozac when he’d cowered as an abused sixth grader. Seroquel when he’d been unable to sleep as an abused ninth grader.

Now, I’m definitely not a pill-pusher, but I did feel that a low-dosage antidepressant would help alleviate the lack of energy, motivation, and chronic sadness that he was stuck in and jump-start the healing process he seemed ready to try, by virtue of the fact that he was sitting here.

“But Dr. Freedman,” he said, “you know that an antidepressant isn’t the answer to my problems. I still need to find some way to untangle myself from this terrible life that I live.”

“Lazer, I think of it as the grease for your wheels that makes it easier to push the car out of the rut it’s stuck in.”

“Yeah, but I’m in a pit with four flat tires, a busted engine, and my taillight’s out.” He laughed sadly. “I mean… sometimes I think I’m such a failure that maybe it’s better to just abandon the car and let the bums steal the hubcaps than to pay for a tow truck and—”

I interrupted him because I wasn’t even sure he was aware of how hard he was being on himself. “Who gave you all this negativity, Lazer?”

“What do you mean?”

“What I mean is, who gave you the idea that you’re a worthless failure?”

Lazer blushed nervously before he responded, “I didn’t think it was a debate. All I do is sit in my dirah and watch TV.”

People who receive consistent love and support during childhood grow up with the feeling that they’re valuable and loved. But a bochur like Lazer, who faced excessive humiliation and trauma during childhood, will generally wind up with a poor sense of self, lack of trust, and an extreme fear of failure, based on a feeling that he must be worthless and good for nothing. That’s because a child who gets consistent love is aware of his intrinsic value even with all his flaws and imperfections, so failure doesn’t define his self-worth and he’s equipped to overcome challenges. But someone who thinks he’s not good enough believes failure is a reflection of his intrinsic worth and becomes too petrified to step out of his cocoon and risk anything he might fail at. This was Lazer. It was easier to sleep all day than show up to seder, or even to minyan.

But the fact that Lazer wanted to get some help meant he was ahead of the game. For some people, it takes years to unravel the mess, to figure out why they fail and why they can’t have normal relationships.

But although Lazer’s days weren’t filled with meaningful activities and there wasn’t too much movement toward anything solid or of substance, he wasn’t a bad kid by any means; baruch Hashem he was sober, he still kept Shabbos, and was holding on to emunah by his fingernails.

“Lazer, I’m not so sure you’re as big a disaster as you think you are,” I said bluntly.  “I’m pretty sure you’re whipping yourself up a bit too hard. If you called your roommates worthless piles of garbage and worse, like you call yourself, they’d clobber you.”

“I’m probably worse, but let’s say…”

“Lazer,” I said, holding his gaze, “the first thing you have to do is to realize that this is happening, that you’ve been spending the last few years torturing this poor kid Lazer and force-feeding yourself a lot of toxic negativity. You can then ask yourself: Is there a different strategy that I can use to approach myself? One that isn’t so punishing?”

Lazer sat and thought again.  He took a few deep breaths before he answered as the tears welled up in his eyes, “Yeah… like maybe thinking about love and positivity?”

“Great idea, Lazer. Boundless and unconditional love is an infinitely better system for building someone up than cruel, conditional love. How can you show yourself true love, then?”

Lazer drew a blank, as he thought of all the negative experiences he’d had over the years with his parents and other adults.

“Can I push you?” I asked. “Have you ever felt that love? That unconditional love? I know it feels like it never came from your parents. But maybe from someone else, somewhere else you felt it? A rebbi who really supported you, your bubby?”

“My Zaydie Ephraim!” Lazer said, fairly shocking himself as he burst into tears.  “My Zaydie Ephraim zichrono livrachah was the one who loved me. The only one.”

“Tell me about him, tell me how it felt to have him in your life.”

Lazer told me about his Zaydie Ephraim, a fifth-grade rebbi who understood the nefesh of a young boy, who respected Lazer’s brothers even as they charted their own way, who did his best to protect their fragile souls under the circumstances. Lazer told me about their Shabbos walks together, their summer weekends on the coast in Northern England. “Zaydie Ephraim was always in my corner. He was the shomer that kept me alive throughout my messed-up life.”

“Lazer,” I practically whispered, “you can give yourself that same feeling. Even though Zaydie Ephraim is up in Shamayim, his love is still deep within you. You just need to work on accessing it.”

We spent time on a deep and meditative journey to remember the warmth and unconditional love that Lazer’s grandfather had shown him. We spoke about walking on the shoreline, the rough sand in his feet between his toes, the softness of Zaydie Ephraim’s fingers as they held hands. The smell of the salt from the sea and the cold spray from the waves with their repetitive-yet-ever-changing crash. The blue of the sea and the sky and the green of the hills with the brown shoreline between. Lazer was there as a child again and feeling the love he needed.

As we finished our mindfulness exercise, I encouraged Lazer to practice it again and again to allow himself to feel the positivity he needed to stay afloat.

“You mean I need to give myself that love, that feeling, that focus on the positivity within me that Zaydie Ephraim gave me?”

It was so much better than the negativity he was giving himself. I wondered if Lazer could maintain it after he walked out of here. “Exactly.  Find the love that Zaydie Ephraim is still giving you.”

To be continued…

(Originally featured in Mishpacha, Issue 906)

The post Find the Love first appeared on Mishpacha Magazine.

Lazer was a British bochur who was supposedly learning in yeshivah.

At least that’s what his parents thought when they’d sent the money to pay for his share of rent in an apartment with other bochurim. In actuality, he was sleeping most days through lunch and then moping around the Beis Yisrael neighborhood in the late afternoons before returning to his cave in the evening.  He’d order a pizza with the guys and then watch reruns of old sitcoms from the 1990s, mindless junk from before he was even born, until he’d crash around 4 a.m., only to awaken again around three the next afternoon and begin the cycle anew.

“Doctor Freedman, I’m miserable,” he told me. “I feel like a useless piece of garbage. Even worse. At least a piece of garbage has a place in the trash. I have no place to be and nothing to do.”

He wasn’t surrounded by a particularly inspirational cast of characters either — he gravitated to Jerusalem’s Anglo “fringe bochurim.” One guy he was friendly with smoked marijuana all day long and literally never left his dirah unless he was going to pay the pizza delivery guy on the street outside of the building. Then there was his cousin who didn’t even pretend to keep Shabbos between his electric cigarette and the movies he watched — albeit with headphones — seven nights a week. Another friend was the grandson of a well-known dayan who really tried his best to show up for at least one seder in yeshivah, but mostly spent his time bumming cigarettes from various ex-chavrusas.

It was a tough place to be in life, but if Lazer had reached out, it meant he might be willing to move forward. And after our first meeting, it was clear that he didn’t end up here without good reason.

“Doctor Freedman, you have to understand how hard it was growing up in my house. My mother was neurotic and insecure, while my father was an iron-fisted dictator. Not only was Mum nervous but she cowered in fear of Dad. Now, I don’t want to be disrespectful, but Dad is the most difficult person I’ve ever encountered — he’s a furious man and would clobber us over the smallest thing, and he’s also a baal teshuvah without any guidance who thought that screaming at us in shul would make us want to daven harder,” he reported.

“But you know what that did? It only made me and my brothers daven that we’d get run over by a car or get kidnapped on the walk home. Because after shul, we’d have to deal with his relentless criticism and smacks at the Shabbos seudah.  It was a living hell.”

I could only imagine how hard it must have been for Lazer and his four older brothers. The oldest had run away at age 15 and had been dancing in and out of rehabs ever since. The next two were twins who had each found their escape: One has joined the Israeli Army and became a career officer who never looked back, while his twin had become chassidish, married a girl from Monsey, and refused to visit his family. The brother directly on top of Lazer was a professional gambler in Las Vegas who had tattooed his entire body.

“And then there’s me. Maybe I just took everything the wrong way.  I mean, my brothers hated my dad and they also hated my mom for letting him abuse us. I just hated myself for obviously being such a terrible person to deserve such a life.”

Lazer had been diagnosed with various ailments over the years and had received his share of treatments along the way. Ritalin for ADHD when he’d spaced out as a parentally abused second grader. Prozac when he’d cowered as an abused sixth- grader.  Seroquel when he’d been unable to sleep as an abused ninth-grader.

“None of that stuff really helped me,” he admitted. “But at least I’m out of that house. I may not be making it to seder, but at least I’m not balled up in a corner avoiding my father’s belt for failing a farher on Shabbos afternoon,” he said.

And yet, after all he’d been through, Lazer was a maamin. He wasn’t a Shabbos desecrator, didn’t eat treif, and put on tefillin — usually just before shkiah.

“I got to believe,” he’d told me. “Hashem has to run the world because otherwise we’d need to make sense out of our pain and we can’t. Like, I have no other options or I’d have nothing at all to hang on to.”

Lazer’s story broke my heart. The mix of verbal and physical abuse combined with the constant pressure to excel in learning did atrocious things to young men.

As I pondered the best way to end our session, I took a sip from the water bottle at my side and winced. The shooting pain that went through my mouth was like an ice pick to my jaw.

Lazer saw my face and raised an eyebrow. “You okay?”

“For sure tzaddik, just Hashem reminding me that He runs the world, not me.”

“Well, if you want to get philosophical…. And Dr. Freedman, I know this was a last-minute appointment and your schedule is full, but any way you can squeeze me in before the zeman ends next week?”

He was finally trying to wake up earlier and to be proactive about his chronic misery. I decided to cut my lunch break out and fit him in.

“If it’s okay for me to eat a sandwich during our session, then I’ll see you Monday at 1:00.”

As I walked him outside, I felt the pain in my mouth again. It was definitely time to see my dentist.

Dr. Abramson had an office upstairs and was as nice a fellow as you could know.  I took his next opening on Monday morning, where he discovered an abscess in one of my wisdom teeth. Basically, he said, the tooth had to come out, and the sooner the better.

“How about right now?” I asked him.

I knew he was busy, but he agreed, and a second later, his hygienist brought out the kit of anesthetic syringes and began numbing me up. As I heard the crack of the tooth popping from my jaw, I looked at the clock — and remembered that I’d slotted Lazer in for my lunch time. While I wouldn’t be eating that sandwich in the end, I was a bit concerned as to whether I’d be able to talk like a functional human being.

I walked back to my office with a mouth full of gauze. Lazer was already sitting on the chair outside puffing his e-cigarette while watching something on his iPhone.

He followed me into the office and plopped down opposite me, scrutinizing my mouth.

“Dr. Freedman, are you okay? Last week you were wincing in pain, and now your face looks swollen.”

I took the wad of bloody gauze out of my mouth and threw it in the trash, much to Lazer’s horror.

“I used to be a lot smarter, Lazer, but I just lost a wisdom tooth.”

Lazer looked relieved and even chuckled at my joke as I took a swish of saltwater.

“Wow, I don’t believe it,” said Lazer, sounding genuinely moved. “You just had a tooth extraction and you still kept our appointment? You really did that for me? But I’m just a nobody.”

I thought of Dr. Abramson who’d just fit me in, and my mentors back in Boston who always came to the hospital even during  blizzards. Isn’t that what we do for each other?

“Lazer, you’re not a nobody,” I said, as the anesthetic began to wear off. “You’re a beloved child of Hashem.”

I didn’t really think he believed it, but I did notice how he sat up just a little straighter.

To be continued…

(Originally featured in Mishpacha, Issue 905)

The post Nobody’s Home first appeared on Mishpacha Magazine.

Yonatan Levi, a boy from a wealthy family in the Five Towns, had been implicated in several thefts at his Jerusalem yeshivah. Although my suspicion of antisocial personality disorder made me wary of how much he could really be helped, especially after getting off to a bumpy start by telling me a series of lies and petty pilfering, he showed a desire to change. PART III

After our session, to which Yonatan actually showed up, I was cautiously optimistic that Yonatan would be willing to put in the necessary work to begin healing. Yonatan didn’t need any of the things he’d apparently stolen from other bochurim, and with his dad’s open credit card, he could certainly have afforded the five-shekel iced tea he pilfered from my office fridge. Those escapades were giving him some kind of thrill, although when he finally faced himself and broke down in real tears, it was clear that underneath his cool, charming veneer, he was miserable and full of self-loathing.

Following our session, I called Rav King, the longtime mashgiach at Yonatan’s yeshivah. We discussed my recommendations for ongoing treatment — which was mostly about showing up for the therapeutic process — as well as a clear set of rules if he planned to stay in the dorms.

“Basic stuff,” Rav King said. “Not asking for a doctorate in derech eretz or the latter perakim of Mesilas Yesharim, just that he not steal anything or get drunk and disorderly.”

“And if he does?”

Rav King had to make a decision on this, because habitual rule-breakers habitually break the rules, and having clear consequences provides a framework for success. Defining those consequences clearly and objectively allows for less wiggle room in the manipulation department.

Rav King and I both realized that unless Yonatan was dedicated to making some serious changes in his life, things were only going to get more complicated and frustrating for him, as the doors of opportunity were already beginning to close.

“By the way,” said Rav King, “I just want to make sure the money transfer for the sessions went through.”

Actually, I told him, I didn’t see any money yet.

“Oy, you never got the transfer? Yonatan’s father assured me that he made it a few days ago. I’ll contact him to make sure he had the right account information.”

Somehow, I had the sinking suspicion that this wasn’t an issue of knowing the SWIFT banking code. During our session, Yonatan mentioned — quite proudly —  how his father always manages to wheedle his way out of paying for things, how he always managed to wind up on top in any deal. That being said, I wanted to judge favorably and a few hundred bucks wasn’t going to get in the way of giving Yonatan the chance to turn his life around. Meanwhile, I’d let Rav King handle it.

The next day, my secretary told me Mr. Levi wanted to book a slot to call me. I assumed we’d be having a “family conference.”

“Dr. Freedman, I appreciate you taking the time to speak with me,” he said heartily over the phone. “But as you can imagine, we’re both very busy and it’s time to talk tachlis.”

I reassured him that he’d have the time he needed. “Actually, Mr. Levi, my secretary booked us for a full 45-minute conversation. So all I need to do before we get started is to confirm that you’ve made the initial payment, as it still hasn’t shown up in the account.”

“That’s ridiculous. I sent it this morning, I’m a three-screen guy and I’m looking at the transfer for my son’s appointment right now.”

“Okay, great to hear. And just a reminder that we’re talking about two sessions, just like it appears on the statement you received.”

Mr. Levi sounded pretty upset — and aggressive. “You’re going to charge me for the first appointment he missed because of traffic? How’s that his fault? And anyway, he couldn’t find the place!”

Hmm… this was beginning to sound familiar, almost like Yonatan himself. I referred him to the explicit practice policies that he’d been provided with prior to Yonatan’s initial appointment where his financial responsibilities were explicitly spelled out, including payment for a no-show.

I took a deep breath and asked Hashem for help in changing the trajectory of the conversation.

“Actually, Mr. Levi, this is the fundamental issue. Your son missed his appointment because he wasn’t responsible, because he was trying to see what he could get away with, not because of nonexistent traffic.”

“You’re calling my son a liar?! First, these punks in yeshivah accuse him of being a thief, even though he has more than enough money to buy anything they falsely accused him of taking! And if we want to talk about geneivah, let’s talk about how the yeshivah treats him like a crook and sends him to a psychiatrist for no reason, even after I made a donation of $18,000 during their Purim campaign!”

So it was true — Yonatan had access to unlimited funds. Then what was the lying, stealing, and manipulating about? It’s like “rich shoplifter syndrome,” a social phenomenon where statistically, a shockingly high percent of shoplifters are actually wealthy. Is it a coping mechanism for repressed trauma, unresolved losses, a secret call for attention, the need to challenge themselves when all other areas of life seem to be handed to them on a silver platter? A thrill to outsmart the establishment?

There’s a theory that high-income people are more likely to cheat and steal because they harbor feelings of entitlement and self-interest, which sabotages their moral compass. In one experiment at a busy four-way intersection, the drivers of luxury cars were less likely to obey the right-of-way laws than the drivers of cheaper or older model cars.

“Mr. Levi, I would say that honesty is a big theme here. Your son invented excuses, and then took an iced tea out of my fridge and lied to my face about it—”

“And you want me to pay for that, too?! What are you, broke?! I think you’ve wasted enough of my time!”

“I’m not wasting your time with iced tea, Mr. Levi,” I said in my most soothing professional voice, although I was getting a bit rattled myself. “I’m letting you know that your son needs to own up to his problematic behavior before he becomes a problematic adult, ruining his professional and personal life with a web of lies and broken promises.”

“I’m hanging up, Freedman. Thanks for wasting my time. Don’t expect me to pay for this mussar derashah and don’t expect me to wire you any money for the traffic jam that made my son late to your appointment!”

I didn’t expect a dime from him. He was a grown-up version of his kid. Luckily, Rav King had a keen grasp of the situation and agreed to cover ongoing treatment for his student.

A few days later, Yonatan arrived to my office approximately 14 minutes late for his appointment.

He smiled sheepishly. “Don’t worry, Dr. Freedman, I’m not making up any stories this time. I was just late.”

I noticed the skin around his left eye was an interesting shade of purple.

“Oh, looking at this black eye? Yep, won’t try to tell you a story this time. Definitely deserved that one.” He told me how, while everyone was in seder, he’d climbed up to a storage area above a bochur’s top bunk in order to snatch a new set of mini-speakers and somehow lost his footing.

“You know,” he told me, “I would always feel rotten about myself after I’d taken something, after the rush wore off. This time, I actually felt sort of good.”

(Originally featured in Mishpacha, Issue 904)

The post Payback Time first appeared on Mishpacha Magazine.

Yonatan Levi had been implicated in several thefts at his Jerusalem yeshivah, and after showing up an hour and a half late to our appointment, he “borrowed” an iced tea from my office fridge. We’d booked an appointment for the following morning, but my suspicion of antisocial personality disorder made me wary of how much he could really be helped.  PART II

It was 9:25 a.m., and Yonatan was late for his appointment.

Really only ten minutes late, but after yesterday’s encounter, it was clear he wasn’t taking things seriously or being considerate of my schedule.

It was 9:37 when he rolled in nonchalantly 22 minutes late and handed me an iced tea with a charming smile on his face.

“I know you think I took this from your office yesterday, but I didn’t,” he said with as sincere a look as I’d ever seen.

I refused to take the bottle from his hand.

“You aren’t going to accept this from me, Dr. Freedman? You’re the one who asked for it.”

“Yonatan, I don’t want any charity from you, and I don’t need any gifts. If you didn’t steal an iced tea from my fridge yesterday then I’m not going to coerce you into replacing it,” I said flatly.

“Well, I definitely didn’t steal anything from you, but I also don’t want you hating me before we’ve even properly met, so I want to put it in your fridge if you’ll let me.”

I identified the crocodile tears welling up in his eyes, but to me it seemed like a practiced routine, as there was no other change in his body language.

“Yonatan, I don’t want you to put anything in my fridge unless you’re replacing something you took,” I reiterated clearly.

“Well, I meant I’ll just put it there so we can move on already,” he answered as he theatrically wiped away his tears and walked over to the kitchenette to replace what he’d stolen the day before. “But I didn’t steal it.”

“You’re lying again,” I pressed him as he walked back from the fridge and stood opposite me in the waiting room.

“Sheesh, can we just finish the interrogation already and start therapy or whatever?” He laughed nervously.

“Yonatan, this is perhaps the most therapeutic moment you’ve had in your entire life.”

“Definitely not, and I don’t even know what you’re talking about. And why do you even care about a stupid iced tea?”

“I don’t care about the iced tea, Yonatan. I care about helping you figure out your life. You know, if you took a beer out of the wrong guy’s fridge in yeshivah, you could get clobbered.”

“I know how to defend myself, Dr. Freedman,” he replied sharply. “Now, are we doing therapy or whatever? Anything else you want to grill me on? Can we go into the office and get started already?”

I bided my time, cracking my knuckles as I leaned comfortably against the door frame.

“Yonatan, if you really wanted to meet with me, you would have shown up on time for your appointment.”

“Well, I tried but I got lost,” he began.

“No, you didn’t.”

“I did! I mean, I forgot the address.”

“Between yesterday and today, you forgot the address. You’re lying again, Yonatan.”

Yonatan stuttered as he tried to cover his tracks. “I mean, I got a bit lost due to the terrible traffic.”

“There was no traffic this morning. I came right by your yeshivah on my way in today. Plus, it’s only a ten-minute walk, and the sun is shining. Traffic had nothing to do with it.”

He took a deep breath. There wasn’t escaping any of this.

“Lying is always harder than telling the truth, Yonatan.”

“Dr. Freedman, what can I say? You got me.”

Did he really feel remorse for that string of lies? I wasn’t sure. People with antisocial personality disorder generally disregard right and wrong, lie and deceive persistently in order to exploit others, and turn on their charm and wit to manipulate people for their own personal gain or pleasure. And because they’re often so charming, it’s hard to tell if they’re lying or telling the truth.

And the longer these behaviors are entrenched, the harder it is to help.

But now, I watched as Yonatan’s fragile ego melted in front of my eyes as he slid into a shapeless, sobbing pile of misery on the chair in my waiting room. These tears were real ones, and it was time for some straight talk.

I wondered how long this behavior had been going on, how ingrained in him it was, what the underlying causes were — was he traumatized, neglected, or abandoned as a child? — and whether other family members displayed these same behaviors. There’s always a better chance of healing if pinpointed and dealt with early, and with treatment targeting problematic behaviors and thought patterns, some antisocials are able to better understand how their actions affect others and even come around to healthy relationships.

“You know, Yonatan, it’s fascinating to watch little kids lie for the first time. That sneaky developmental milestone that occurs somewhere between three and six is an interesting mix of horrifying and cute.”

I tossed him a box of tissues. Real tears always create a real runny nose.

“Lying is a great idea when it works, because it instantly solves all of your problems,” I said. “Late for a meeting? My car broke down. Can’t pay off a debt? My banker promised to make the transfer last week. Lying is brilliant and gets you out of trouble until it goes terribly wrong. In many ways it’s sort of like a drug: great for short-term relief but awful in the long run. That’s because it’s impossible to keep your story straight when you’re busy covering for yourself in lies. Did I tell him I was out of the country on a business trip or did I say that I was at a funeral? When you’re caught in a web of lies, it becomes progressively tougher to remember how you got yourself into this mess and infinitely more difficult to extract yourself.

“On the other hand,” I pressed on, “honesty is actually easy, even though it sometimes feels so threatening and overwhelming. Just say what happened. You’ll never have to make convoluted excuses for yourself, and people will respect you for it. Most importantly, you’ll be able to respect yourself. Sure, it’s a pain to own up to your shortcomings, but you’ll be building a palace of truth, something that’ll never come crashing down.

“Rabbi Dr. Twerski a”h once told me that lying is the only sin the Torah commands us to distance ourselves from, to make sure not even to get into a place where you could set yourself up to be untrue. Why is that? Perhaps it’s because one can never be successful with the rotten core that lying created inside your heart.”

Yonatan finally looked up at me with a real face — one that suggested he knew it was time to change things around but had no idea how to do it.

“So, am I doomed to being like this, or is there a way to fix me?” he asked, and this time I was pretty sure he wasn’t being manipulative.

I clued him in. “You know Yonatan, it’s never too late to turn things around, but you’ve really got to want it, to decide that there’s a better way of living out there. It feels pretty scary, but your friends and family will be infinitely more forgiving when you come clean, as opposed to catching you in the act of trying to fool them. It might hurt to tell folks you’ve duped them, but they’ll forgive you if you’re sincere. And as my rock-climbing teacher always taught us: It’s not how far you fall, it’s how high you bounce.”

We set a time to meet the following week. I still didn’t know much about his family or what brought a talented kid into this downward spiral, but after today’s breakthrough, I had cautiously optimistic expectations.

(Originally featured in Mishpacha, Issue 903)

The post Truth or Consequences first appeared on Mishpacha Magazine.