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he consultation hadn’t started out too well and it ended off even worse.

Moishe had conspicuously left out the fact that he had a serious substance abuse problem when he scheduled his appointment with me. Moishe had already been to a few rehab facilities in the past but had skipped out early from each of them, not wanting to address any of his underlying issues. He’d spent much of the last three months bouncing between doctors and trying to get prescriptions for his daily fix.

Within moments of beginning the interview, it was clear that Moishe wasn’t too interested in discussing anything beyond his quest for benzodiazepines and opiates.

“They really help my anxiety,” Moishe said. “I need about 14 pills of Ativan a day. And when it doesn’t work I need to take a Valium or a Klonopin. But Percocet and OxyContin help my anxiety too, so I’ll need that also. Do you prescribe that stuff on a first visit, or do I need to give you a drug test first?”

“Look, Moishe,” I told him honestly, “I’ve been doing this for long enough to know that anyone who’s taking such dosages has the kind of problem that isn’t going away without a serious trip to a rehab facility.”

Moishe looked like he was beginning to deflate. “You know, you guys are all alike,” he started. “That’s what Brad Salzman, Avi Tenenbaum, and Yossi Milstein told me too,” he said, becoming a bit agitated as he invoked the names of a few colleagues. “I heard you were different, a little more open-minded. Sheesh, what’s the big deal already?”

Moishe wasn’t done, though. “What do you care, anyway? I can buy it on the street. So don’t you think it’s better for me to have it prescribed in order for it to be safer?”

I didn’t necessarily agree, but Moishe didn’t seem to be too interested in my logic. He was no quitter, and proceeded to ask for a prescription for medical marijuana. As I shook my head, he became progressively more irate and started flinging curses my way.

“Some expert you are — you don’t even care about your patients!” he hollered at the top of his lungs. “You just want to take their money!”

“Relax, Moishe. Let’s tone it down a notch,” I tried to interject, but he wasn’t about to be soothed too easily.

“I’ll sue you, and then we’ll find out who’s got a problem!” he screamed, and then suddenly stood up and kicked over the chair he’d been sitting on. “You already took my money. Just write me the stupid prescription already!”

I tried to remain calm, but the last thing I needed was to have Moishe trash the office.

“Moishe, it doesn’t have to go down this way,” I said, standing up from my chair as calmly as I could. Back in Boston’s rough inner city mental health clinic where I interned, it was an unspoken recommendation that staffers would have some martial arts experience. You never knew when you’d need it. Recalling those moments, I slowly shifted into a defensive posture to protect myself as necessary in case the situation escalated any further.

“You’re making this into a federal case!” he yelled as he picked up the chair and threw it across the room. “You’re such a—”

Suddenly the door opened and my next patient, Segev — a former military man, and a massive, imposing figure even out of uniform — was standing threateningly in the entrance.

“You okay, Dr. Freedman?” Segev asked, hand on his standard-issue firearm. He was staring down Moishe, who looked as though he was in shock.

“Perfect,” I responded as I glanced at Moishe, who had begun to pick up his chair and put it back in place. “Segev, I’ll see you in a few minutes.”

He nodded and stared down Moishe until he sat back down. Segev shut the door as I looked back to Moishe, who, realizing he’d lost it, began apologizing profusely.

“Moishe, it’s okay. But I think you need to reconsider the way things are going. Can we talk about a rehab program now?” I asked, hoping he was shaken up enough to open a real discussion about the need for treatment.

But despite the tiny crack, Moishe wasn’t ready to open up or take responsibility for his situation. He walked right out to seek his fix elsewhere. I knew I had to give it my best, so I even followed him through the waiting room, telling him, “If you change your mind I’m here for you.”

But Moishe didn’t want to change his mind, and now I needed to switch gears for Segev, an IDF veteran who was seeking treatment for service-related PTSD.

Segev was about as secular as could be, and much of why he’d sought me out as his psychiatrist was still a mystery. Most of my patients were either English-speakers looking for an Anglo psychiatrist or frum Israelis who wanted a like-minded doctor. And yet here was Segev for his follow-up appointment.

Not one to waste my patient’s time, I dove straight in to Segev’s case — but he wasn’t so eager to move on.

“I can’t believe you followed him out of the office and were still trying to help him after all that abuse,” he said. “How come you acted like such a mensch after all that?”

Without going into the specifics of my own personal drive to help folks with addictions, I felt compelled to provide Segev with some sort of answer: “When I was a medical student back in America,” I told him, “the only daily minyan in town was run by Rabbi Hershel Fogelman a”h. He once told us a story about how, when he was a young rabbi running a summer camp in Detroit, he overheard the cook speaking with the boys.

“ ’I heard this African-American lady telling the campers that she appreciated how they treated her with respect’ he told us. ‘She said that she had worked at plenty of non-Jewish camps, but no one ever treated her as nicely as this group of Jewish boys. But while they were busy patting themselves on the back, I decided I needed to hit them with some serious chinuch, so later on I told them that what they did wasn’t anything too extraordinary. We’re Jews, I told them, and a Jew always acts like a mensch.’ ”

Segev laughed and gave me a pat on the back that would’ve crushed me if I didn’t stand a full six-foot-two. “That’s why I wanted a religious psychiatrist — because I knew you’d be a mensch.”

Now it was my turn not to get carried away. Remembering Rabbi Fogelman’s words, I said, “Segev, I’m just acting like a Jew.”

“You know,” Segev said, “I’m not exactly religious, but it was important for me to work with someone who’s a mensch and not just a doctor. That’s why I was happy to protect you when I heard him yelling and throwing the chair.”

“Thanks, Segev,” I said, “but I had it covered. I can still put the Jew in Jiu-Jitsu.”

Originally featured in Mishpacha, Issue 708. 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.