"You’ve got to get his family here ASAP and have them take achrayus"

Rabbi Feivel Goldstein, a sincere, energetic mashgiach in a small chassidishe Jerusalem baal teshuvah yeshivah, came to see me about one of his students — a South Korean convert named Avraham Kim who thought he was a bird and believed he’d sprouted feathers. It was quite obvious to me that this fellow had been suffering from schizophrenia long before his conversion, and that Rabbi Goldstein should step aside and adhere to professional recommendations. PART II

Rabbi Goldstein was clearly distraught when I hinted that Avraham Kim’s very conversion might be a question mark if he was indeed mentally unstable, and that the best thing for his talmid would be to send him back to his family, where he would get the ongoing support that he’d need through a difficult therapeutic process. And I got that: How could he conscionably send a frum bochur back to his non-Jewish family in the Far East?

But I explained to him how people with schizophrenia — the symptoms of which generally involve delusions and hallucinations — require lifelong treatment, and how the earlier the treatment, the better chances of getting symptoms under control and improving the long-term outlook before irreversible complications develop.

I agreed that this was an emotionally wrenching decision, but my job was to make sure that the young psychotic man sitting in my waiting room who thought he was a bird would get home safely and get the treatment he needed to hopefully become healthy again.

I wrote a note to be forwarded to his family, wrote a prescription for an antipsychotic medication, and made it very clear to Reb Feivel, once again, that I felt Avraham Kim needed to get back home to his family as soon as possible. This would lower the risk of hospitalization, arrest, violent outbursts, and other bad — and perhaps irreversible — outcomes.

Reb Feivel and I went out to the waiting area and explained everything to Avraham Kim, who — immersed in a sefer — reluctantly agreed.

Which is exactly why I was so surprised to hear from Reb Feivel two weeks later when he called to schedule a follow-up appointment for his talmid.

“Dr. Freedman, it’s mamash a neis!  I can’t tell you how big a miracle it’s been,” came Reb Feivel’s excited voice over the phone.

Having done this for long enough and knowing the long-term fallout, I was a bit upset to hear that Reb Feivel had only taken bits and pieces of my recommendations. But I wasn’t shocked.

“I know you told me to send him home due to the severity of his symptoms,” Reb Feivel told me, “but I thought about it long and hard and I just couldn’t let a fellow Yid leave the kedushah of Eretz Yisrael for the galus of South Korea. It was mamash pikuach nefesh.”

His sincerity blazed brightly even through the phone.

“I’m telling you, Dr. Freedman, he takes the medication you prescribe every night, I even watched him do it for the first 12 nights, and he tells me that he’s doing wonderfully. No birds, no feathers, no malachim, just a sweet Yid who learns our heilige Torah in the beis medrash with the other bochurim.”

I hated to put a damper on his enthusiasm. Whether or not it was working out at the moment, young people who’ve experienced a severe and prolonged psychotic episode need support, close follow-up from both a therapist and a psychiatrist, and a lot of siyata d’Shmaya. The recovery that Avraham Kim had experienced might have been incredible, but this was just the first mile of a marathon.

At our meeting, Avraham looked pleasant and was more easily engaged. He denied any delusional symptoms of being a bird, told me his arms were feather-free, and laughed when I asked him about gilgulim, malachim, and other kabbalistic concepts that had been a part of his psychotic delusions.

“And what do we make of the symptoms you had the first time we met, Avraham?” I asked in my warmest, most non-confrontational voice.

Avraham laughed a bit self-consciously and then answered, “Oh, you know these things that baalei teshuvah think. Sometimes it’s easy to get carried away, but I’m just a regular bochur learning Torah now with my rebbi here in Yerushalayim.”

Reb Feivel and his talmid smiled at each other in a way that made me concerned that neither recognized the gravity of the situation. When I made it very clear that approximately half of the people who’ve had similar psychotic episodes would have another one within a year, both reacted with the same “chas v’shalom!”

I nodded my head in agreement, but I needed to ensure that they realized the need to stay on medication and to get involved in treatment specifically geared to prevent a relapse.

“It’s not enough to just take your medication, Avraham. We need a therapist who specializes in early-stage schizophrenia to work with you, and your best bet is to go home to South Korea and make sure it’s done professionally, with the family support that you deserve.”

“My family is here,” he said, looking earnestly at his rebbi, who seemed to agree that I was being unnecessarily paranoid.

“Dr. Freedman, we appreciate all of your help and we will keep taking the medicine, but Avraham is really interested in therapy and I think we’re fine for now.”

I wasn’t going to beg them to follow my treatment plan, but I wasn’t ready to let them sail into the sunset either.

“Can I recommend that you see a colleague of mine for a second opinion to ensure that I’m not just being an alarmist?”

“Sure, Dr. Freedman,” Reb Feivel agreed, and took the name and number of my friend, Dr. Zev Alexander.

It was two weeks later when I received another call from Reb Feivel. This time he actually sounded a little nervous.

“He’s not taking his medicine and he’s starting to say strange things again, Dr. Freedman. He’s not willing to listen to me and he didn’t want to come to see you again. He also refuses to see your friend Dr. Alexander.”

“Then you’ve got to get his family here ASAP and have them take achrayus,” I said.

“I guess you’re right, that’s a good idea. I’m just a bit nervous because they’re goyim and they may not know how to understand all the issues related to Yiddishkeit.”

“Forget about Yiddishkeit, Reb Feivel! This kid was clearly psychotic before he ever got near a beis din."

“Are you saying he isn’t a Yid, Dr. Freedman?”

“First of all, that’s not my call to make, and second, it’s not relevant now. You have an acutely psychotic young man who isn’t listening to anything anyone is telling him. You need to get his family here immediately, before something dangerous happens.”

I heard from Reb Feivel again a few days later. He called to let me know that Avraham Kim had been taken to a local psychiatric hospital after “pecking” at seforim in a local shul and flapping his “wings” around the building.

“Some of his family members are here, and I spoke to them when we met at the hospital. I told them everything you had recommended the two times we met and they were very grateful. They wanted your address in order to mail you a thank-you gift.”

“That’s very kind of them, but certainly not required. And I’m actually happy that Avraham is safe at the hospital. He can get the care he needs there in a safe and secure fashion.”

“Uh, Dr. Freedman?” Reb Feivel didn’t sound too confident anymore. “I feel like I really blew it. It’s true that Avraham is safe now, but I could have caused irrevocable damage. I feel like I can’t face any more bochurim.”

“Reb Feivel,” I assured him. “You’re an amazing mechanech. You chap the nefesh of these young fellows. Use it as a lesson to grow, not to fail.”

Just then, someone knocked on my office door. I opened it to a florist delivery man who handed me the most stunning twilight lilies I’d ever seen. The fiery orange and red-spotted petals were strikingly beautiful, as was the card: To Dr. Freedman, thank you for saving Sun Woo’s life. With gratitude, The Kim family  —

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 901)