The mental health impact of coronavirus often seemed equally disastrous — if not worse — than the growing body count

Ruchy was a European-born chassidish young mother with OCD who had come to me for an evaluation after the birth of her second child. She experienced a relapse toward the beginning of her third pregnancy, and with the encouragement of their rebbe, restarted her medication therapy.

Part III

Baruch Hashem, Ruchy had delivered a healthy baby back in the pre-coronavirus world that was the start of chodesh Adar, when a crowd could still attend a bris. I couldn’t have been happier for Ruchy, who’d been a real trooper throughout her pregnancy, and for Heshy, who’d been a true mensch in supporting his wife. Although I usually don’t attend simchahs of my patients in order to preserve discretion and maintain their privacy, because their rebbe would be the sandek, many people unconnected to the family knew that this was an opportunity to have a quick audience with the Rebbe, and so I was able to break my rule and attend as well.

I was honored to meet with the Rebbe again — we’d actually met on a previous occasion. I kissed the Rebbe’s hand (something you could still do then), while he bentshed me, “You should be zocheh to keep giving good eitzos, Dr. Freedman. And your patients should be zocheh to follow them.”

We had a follow-up appointment the following week, where we discussed that, given Ruchy’s history of worsening symptoms during the postpartum period, we planned to slightly increase the dose of her current medication. Naturally, she was concerned about the safety of the meds during nursing, especially since some medications have been found to appear in significant concentrations in mother’s milk. That was why we chose this specific medication in the first place — found to be safe for both pregnant and nursing mothers.

“But,” I reminded them both, “we still need to make sure that the rebbetzin gets the sleep and the support she needs.”

Luckily Heshy was on the ball and had already scheduled extra help in the house — he’d just flown his younger sister in from Antwerp to stay through Pesach.

And then Hashem flipped the world upside down and locked us all inside our houses with both everything we needed to keep us sane and everything we needed to drive us mad.

I’d scheduled a follow-up talk with Ruchy and Heshy via Zoom, and was happy to hear that the baby was healthy, Ruchy’s anxiety was in check, and Heshy’s sister was a big help around the apartment with their other children.

With the lockdown in full swing and leaving home was for essential trips only, there was certainly the potential for added tension at home. Ruchy, Heshy, and I talked about the need to stay ahead of the stress by maintaining a healthy schedule even during the nationwide quarantine. Ruchy would need to build a daily routine that involved regular cardiovascular exercise, mindfulness and relaxation practice, time for tefillos and Torah learning, as well as some personal time to relax. Heshy even ordered a treadmill so they could both stay physically fit.

They would take turns with the kids to allow each other to have some personal time, and even scheduled in a date night where Heshy’s sister would watch the kids while they’d go to the supermarket together. It wasn’t particularly romantic but it would allow them to have some alone time together, and much like everything else during the quarantine, it was making the most of a tough situation.

Ruchy and Heshy were in touch again around Shavuos and I was happy to hear that things were still going well. Ruchy’s anxiety was under control, their baby was growing, and the chassidish neighbors in the building began eyeing Heshy’s sweet, dedicated, helpful sister for shidduchim. The country was opening up again, Heshy returned to the beis medrash, and their two older kids returned to preschool.

Which is why I was surprised to hear from Ruchy that she wanted to set a time to discuss her medication treatment.

I had been meeting with certain patients in my office for a few weeks already, under specific guidelines. I let Ruchy know that as long as she was asymptomatic, no family members had recently been exposed to anyone with the virus, and she’d wear a mask to the appointment, I’d be happy to meet with her face-to-face.

“That’s a big part of the problem, Doctor Freedman,” Ruchy said, and I couldn’t tell if she sounded more irritated than anxious. “I have a child in quarantine for the third time since Shavuos and I feel like I’m losing my mind!”

We scheduled a Zoom meeting and Ruchy told me all about her current situation. They’d all been quite resilient since the beginning, but now she felt everything was starting to unravel. Heshy’s grandfather has passed away in Belgium and he felt terrible not being able to attend the levayah and shivah due to travel restrictions. And then their oldest son’s preschool teacher tested positive for coronavirus.

“Baruch Hashem none of us caught it, but we all had to be tested and the stress of it was horrendous,” she told me. “And then my husband’s chavrusa tested positive a week after my son got out of his two-week quarantine so that meant my husband had to lock himself up, and we all had to be tested again. When that was over — baruch Hashem we tested negative again — we just found out that a kid in my toddler’s preschool tested positive and now we’re back in jail!”

I could only imagine how frustrating this must be for Ruchy and Heshy, and while it was a mitzvah to follow the Health Ministry’s guidelines, I thought about all the people who’d lost their parnassah, all of the young men and women who had relapsed on drugs and alcohol, and how much domestic violence there had been over the past few months. The mental health impact of the coronavirus pandemic often seemed equally disastrous — if not worse — than the growing body count.

But as I spoke with Ruchy, it became clear that she hadn’t experienced any change in her obsessive and compulsive symptoms. She wasn’t running to ask unnecessary sh’eilos, there weren’t any intrusive and obsessive thoughts of hurting her kids like there had been when we first started working together, and her compulsive cleaning so there shouldn’t be any basar v’chalav contact was a thing of the past. Ruchy was admittedly stressed, but this wasn’t OCD.

“This isn’t the kind of stress that would get better with a medication change,” I explained, much to her dismay. “The current situation might feel very uncomfortable, but you’re already taking a high dose of an antidepressant and I’m not going to give you another medication with a whole new set of side effects.”

I explained to Ruchy that while the number of prescriptions for Klonopin, Valium, Xanax, and other benzodiazepines has skyrocketed around the world over the past few months, these potentially addictive medications weren’t a good solution at all for the kind of stress that she was experiencing.

With unsurprising wisdom, Heshy summarized even better than I could have myself. “I guess what you’re saying is that we need to go back to following a daily schedule, exercising on the treadmill, creating personal time for each other as well as shared time together, and everything else that we did in the beginning to stay calm?

That and the bitachon that we’ll survive this and Hashem will bring us through?”

“Correct,” I nodded. “You two will weather this storm the same way you’ve always done it, the same way Am Yisrael has always done it, with a prescription for daily tefillah and extra Tehillim as needed.”

(Originally featured in Mishpacha, Issue 823)