Adir wasn’t in the best place in terms of his mental health.

He’d had a bad bipolar episode back in the army and had been hospitalized before being discharged from his mandatory service.

True, the paranoia and grandiose thoughts of running the Mossad had been subdued, but he hadn’t been in treatment for over a year and had gone off his mood stabilizers, so between his unnatural nighttime hours as a waiter at a local bar and his regular marijuana abuse, Adir was like a walking powder keg, ready at any moment to explode with another episode.

Adir, however, thought his life was perfectly fine, and thought it was his sister Iris who was crazy for becoming a baalas teshuvah. Iris, who’d always taken responsibility for her younger brother, had been bugging him to resume seeing a psychiatrist, and found me through her rebbetzin. He actually agreed to come, on condition that she’d stop harassing him about it after our first appointment.

Basically, that meant I had 45 minutes to convince a hostile, drug-infused Adir that he should resume therapy.

“I gotta tell you, Adir,” I said, “This combination of smoking all day and working all night is pretty awful for a guy with a history of bipolar disorder.”

Adir was obviously annoyed, and had little patience for me or this discussion, but I forged on. “Baruch Hashem you’ve avoided hospitalization, but every day without treatment for you is playing Russian roulette.

Adir snapped. “Baruch Hashem!? Baruch Hashem!? That’s all you got?” He rolled up his sleeves and pointed to a tattoo of a many-armed Indian avodah zarah. “You see this? This means I don’t believe in ‘Baruch Hashem!’ ”

Iris, visibly embarrassed, tried to shush her younger brother, and I had my own yetzer hara to kick him out of the office, but this kid was at risk of another episode and I needed to build some level of trust. The first thing Adir needed to know was that I was on his side — that was a prerequisite for him keeping up with psychiatric treatment.

“Listen, Adir,” I said. “If you didn’t want a religious doctor, then why did you bother coming here? You don’t want to talk to a frum guy, and you don’t want to talk to a psychiatrist. So why are you sitting here?”

“You’re kicking us out?” Iris asked with an edge of desperation. “But my rebbetzin said you’d help us even though Adir isn’t religious. Please, don’t back out on us!”

“Don’t worry, I’m not kicking you out just because Adir is anti-religious, but I’m also not kicking you out because we can accomplish a lot today. Adir, you may not believe it, but I care about you and I’m really nervous for you. You were really sick back in the army and now you’re living a life that’s high risk for a relapse.”

“Well, there’s no way I’m getting all drugged up again on psych meds, no way! I’m never doing that again! You’re the one who’s crazy, talking about Hashem all the time when you can’t even see Him! Are you a psychiatrist or a witch doctor?! Where was your Hashem when my buddies were shot by sniper fire in Gaza? Where was your Hashem when I felt my brain was about to explode and there was no one to help?”

“Adir, I’m not going to make you do anything you don’t want to do. I’m not going to force you to take drugs, even though I think it would help you, keep you out of trouble, and keep you mentally balanced.”

“You’re not?” he asked in surprise. “But you’re a psychiatrist! You’re not going to give me pills? Really?”

“I can’t force you to take pills, and I’m not going to push you in a direction you don’t want to go, although I will tell you that the way you’re headed, your chances of a relapse are close to 100 percent. But you can make changes, Adir. You can get a healthier program, get off the dope, work on stress management, and who knows — maybe in the end you won’t need the meds.”

In general, a bipolar treatment protocol includes meds, but right now we were at the point of meeting each other where Adir was holding, in order to build a relationship where he would come back and take the next steps. Turning to Iris, I said meaningfully, “We have to respect Adir’s wishes. Just like I can’t tie up his arm in tefillin, I also can’t shove mood-stabilizers down his throat.”

“I appreciate you working with me where I’m at,” interjected Adir. “I really respect that. No coercion, no conversion, just honesty. Working with me on my own terms. Really, thanks.”

Iris was nearly in tears as she began to thank me profusely.

“You know that Avraham Avinu had a hotel in the middle of the desert where anyone could come for a meal and a place to sleep,” I said. “After they’d finish their breakfast and prepare to head on their way, Avraham would give them a bill. A big bill too. After all, he was the only hotel in the Negev at that time. When his visitors would try to bargain him down, Avraham Avinu would tell them, ‘You can settle the bill with me, or you can settle it with HaKadosh Baruch Hu by saying Bircat Hamazon.’ ”

“So you’re saying we should thank Hashem instead of you, Dr. Freedman?” asked Adir skeptically. “Hey, I don’t even believe in Hashem, remember? Nothing good ever happens to me, so why believe?”

“Well, you can say thank you anyway. You could have easily been stuck with someone who just shoved a prescription in your face and expected you to take it without so much as a five-minute discussion.”

“Todah, Hashem,” said Iris, elbowing her younger brother in that overprotective way big sisters have.

“Fine, Iris,” mumbled Adir. He then turned to me and begrudgingly said with a hint of a grin on his face, “Todah, Hashem.”

Originally featured in Mishpacha, Issue 715. Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman can be found learning Torah in The Old City or hiking the hills outside of Jerusalem.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.