| Off the Couch |

All Fired Up

As a general rule, I refuse to work with arsonists or child abusers.

It’s something I’ve discussed at length with gedolei Yisrael, as I find it difficult to remain objective when dealing with such cases.

Which is why I tried to avoid seeing Dr. Appelbaum as a patient when she contacted me and asked for an evaluation, plus a letter attesting to the fact that she was definitely not a child abuser, nor an arsonist.

“Really, all I need is a letter for the courts stating that I don’t have, and never had, any intention or plan to burn my baby,” she told me over the phone, sounding like she was about to cry. “Look, Dr. Freedman, I’m a nice lady and a dedicated mother. I’m also a pediatrician. But there’s an emergency restraining order out against me for trying to burn my infant son. My husband took it out last night, and I have no idea what to do. I figured if I had a letter from a respected forensic psychiatrist, I could have my lawyer talk some sanity into the judge.”

Legal issues. Fires. Child abuse. These themes certainly ran together. But for a pediatrician? Clearly there was something unusual about this case. And because there was going to be no X-ray to confirm her diagnosis as a child-abusing, fire-setting maniac, we were going to need collateral information. For some reason, against my better judgment, I agreed to an appointment.

“Look, I’ll need you to bring me a few letters of recommendation from colleagues,” I told her. “Your résumé.  A trusted friend or neighbor.  And be prepared for me to ask a lot of questions.”

When Dr. Appelbaum arrived with a stack of papers and a good friend to keep her company, I began reviewing the documents she handed me, while she waited outside. A history of volunteering for the community, fine marks in university and medical school, and a current letter of good standing from her state’s medical board. While there were certainly high-functioning people who were capable of terrifying horrors, the woman in my waiting room certainly didn’t look like one of them. Her neighbor confirmed that this was a good woman and she had no idea why the police had become involved. With this information in hand, I was ready to meet my patient.

And her story unfolded in a surprising fashion as she described her life. The only child of a pair of physicians, Dr. Appelbaum had surprised them both by becoming shomer Shabbos through an Aish HaTorah campus outreach program back in medical school. After finishing her residency in pediatrics at Columbia’s flagship academic hospital, she’d met an older bochur from a Monsey family who was happy to have their son married off to a woman who would support his Torah learning. No one asked too many questions, but it wasn’t long before some abnormalities began to surface — like his extreme basar b’chalav stringency of scrubbing the entire kitchen with bleach, or the way he personally scrutinized the mezuzos multiple times even after having them checked by a respected sofer.

“Looking back, I guess I should have said something, but I was a baalas teshuvah and he was a kollel man,” Dr. Appelbaum admitted. “There was definitely an OCD red flag there, but what could I say? I didn’t grow up with any understanding of halachah, and his family was well-respected. I know this is going to sound crazy, but—”

I finished her sentence to make it easier. “But you didn’t want to speak lashon hara, so you didn’t tell anyone.”

“Exactly,” she said, reaching for the box of tissues. “And then at age 34, I finally had the baby I was waiting my whole life for. It was an easy pregnancy, but my husband was so nervous the whole time. ‘Don’t do anything dangerous!’ he’d shout at me out of nowhere. ‘Don’t drink too much caffeine! Don’t drink any kiddush!’ The list was endless. He was so nervous about the baby that no matter what I told him, he just couldn’t calm down.”

The story of spousal OCD was a story I’d heard many times, but here the stakes were even higher, as the legal system was involved.

Dr. Appelbaum continued to describe her husband’s extreme behavior, which only got worse after she gave birth.

“After the baby was born, I told him he’d have to stop smoking cigarettes in the house, and he developed this crazy idea that I was going to burn the baby,” she said.

This was an unusual twist. Even though harm obsessions classically exist when a person is nervous he will hurt the child himself, sometimes these thoughts will transfer to the other person in the relationship. Rabbi Appelbaum’s obsessive fears that his wife would hurt the baby weren’t the most common type of OCD, but nor was such a harm-obsession undocumented.

“So one day the thoughts he was having got bad enough that he called the police to tell them you were burning the baby?” I asked.

“It sounds crazy, but yes, Dr. Freedman.”

“And they did their due diligence and filed an emergency restraining order and now here we are?”

She nodded, and I gave her a few moments to regain her composure.

I waited a minute before asking the obvious question. “You’re a physician, Dr. Appelbaum. You saw this behavior early on from his obsessions over certain practices and crazy chumros. Why did you wait so long to address it?”

“I don’t know. Fears about criticizing my husband? Denial? Wanting things to be right?”

“You know, there’s nothing to fear about disclosing your husband’s symptoms. Not addressing them has landed the wrong person in my office, it seems. We’re not talking about lashon hara l’toeles here — this is a situation of pikuach nefesh for the family! Dr. Appelbaum, I’ll write you the letter, but you know it’s much deeper than this.  A letter won’t fix your family. We need to get to the root problem by making sure your husband gets the help he needs.”

“So then what do we do?”

“We call Rabbi Appelbaum in and set him up with his own psychiatrist to do a full assessment of the situation and make recommendations for his treatment. Baruch Hashem, OCD is a very treatable condition, and with high-quality help, we can hope that he’ll be healthy and functional.”

“Wait — how do you know he’ll even be willing to come in for an evaluation?”

“That one is easy,” I responded. “I’ll have a letter written up for the courts in a few minutes. You’ll bring that in and the judge will order an emergency evaluation to ensure that the baby is in a safe place.”

“The baby is with my in-laws,” she responded. “I’m sure he’s safe.”

“I’m glad to hear it, but — and I’m assuming that you do want to keep your family intact — we need to make sure that your son’s Tatty will get the help he needs to be the kind of dedicated parent he really wants to be.”

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

(Originally featured in Mishpacha, Issue 797)

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