When the frum community began to face the need for help with mental-health issues, Dr. Ronen Hizami was there to welcome them
The photographer has arrived before me, and by the time I come through the front door of Dr. Ronen Hizami’s office, they’re already laughing like old friends. Dr. Hizami emerges, looking like the friendly proprietor of a children’s shoe-store, the type who knows what to say when your child has a tantrum because he wants to keep his old, too-tight shoes and hates what you chose. I promised I would never use this phrase, because it’s clichéd and overused, but Dr. Hizami leaves me little choice: His eyes twinkle, if there is such a thing. He takes off his shoes and puts his feet up, like his office is a living room.
He also quarterbacks treatment for hundreds of Jewish kids, helping their over-stressed, frantic, devoted parents understand why their child behaves the way he or she does, mapping out a course of treatment, following up to see how the medication has affected them, shifting, adapting, listening.
It’s a journey, the trail that starts at PTA or with a phone call from a concerned rebbi — nothing major, a small issue, speak to him, exactly, thanks for your time. If you’re a parent, maybe you shove it on top of your closet with the sweater that doesn’t fit and your Tishah B’Av shoes, but then another teacher mentions it, and maybe you and your spouse exchange glances because, yes, there it is, in full view on the couch in your living room, this very behavior. Then to the menahel’s office for another meeting — we get it, the school will work with you, no worries. It’s a pattern, now, and you’re all out of denial. You square your shoulders and say, “Okay, we’re good parents, we deal with things,” but you’re going to face a million more walls that will challenge your resolve and good intentions.
But maybe not.
Sometimes, with a bit of Divine grace, you find your way to the right shaliach.
There are professionals in every school and community who can guide you. The good people at Relief, for example, have been doing this for years, like a signpost with the arrows pointing you down the road that’s right for you.
And in many cases, that road leads right here, to the nondescript office in a nondescript low building in nondescript New City — a hamlet east of New Square in Rockland County — to a man from a Yemenite background who makes gefilte fish jokes and wears quirky ties and also, who knows not only how to talk to parents about their child, but how to talk to the child about the child.
“There is a culture we’re trying to create here, we want people to feel at ease. No one is being helped if they’re tense.” He waves a hand down the hall to where Sharleen, his longtime receptionist, sits near the front door. “Many doctors consider a full-time receptionist an unnecessary investment and so instead they use an answering machine to make appointments. But if you want people to feel comfortable, then someone’s got to answer their calls, someone’s got to greet them pleasantly when they come in.”
For Dr. Hizami, that “real feel,” the human touch, didn’t start at Sharleen’s desk, but well before.
If there was one childhood figure who would affect the course of his life, it was his Aunt Susie.
“She was what they then referred to as ‘retarded,’ and she spent her life in a series of institutions. My parents always made it a priority to visit her and took us along. Later in life, I learned that the field of autism attracts two types of doctors, those who have passion for the subject and those who are inept, who simply can’t work with anyone else so they gravitate to the defenseless, the ones who won’t complain.”
Dr. Hizami says his passion comes from those visits to Aunt Susie.
One of Ronen Hizami’s claims to fame is that his Yemenite grandparents opened the first chalav Yisrael pizza shop in Boro Park; his mother, a child of Vizhnitzer chassidim, was born in a postwar Displaced Persons camp.
Any presidential candidate would pay real money for the next little bit of trivia. “My father was a custodian. That was his job, and he did it with dignity and respect.”
The Hizami family lived in Albany, where little Ronen went to nursery school in the basement of a local church. “But one winter day, we were at the mall and I asked if I could sit on Santa’s lap. My parents immediately switched me over to the local Chabad Day School, and Rabbi Rubin at Chabad brought our whole family closer to frum life.”
The Hizami family moved to Brooklyn, where Ronen attended Yeshivah of Flatbush.
After high school, Hizami was admitted to an exclusive seven-year BA/MD program at Brooklyn College and SUNY Downstate medical school — just 20 high school students each year were invited to apply. After three years at Brooklyn College and four years at SUNY, he was ready to take on the future.
“Originally, I hadn’t been sure what sort of medicine I would practice,” Dr. Hizami says. “I had two close friends in college, and one day, we each predicted where the others would end up. They were both convinced that I would be a psychiatrist. I was offended, but by the third year of medical school, I knew they were right.”
Dr. Hizami looks down at his hands. “I don’t have the hands of a surgeon. I wouldn’t want to be operated on by these hands. So this path made sense for me.”
He was vacillating between pediatrics and psychiatry when he came to a realization. Anyone can write a prescription for penicillin and help a child, “but the field of psychiatry would allow me to use the actual relationships I’d develop with people in order to help them.”
But at the same time, the newly minted doctor was developing a different kind of connection, one that would become his first love.
“My grandfather had a Teimani shul in his house in Boro Park, and the rav there, Rabbi Chaim Yaakovi, introduced me to Rav Shlomo Korach, the Sephardic av beit din of Bnei Brak for close to 40 years and the leader of worldwide Yemenite Jewry. He was a tremendous talmid chacham, and once I met him, I had a rebbi. He was niftar a year ago, and I miss him greatly. From the beginning, I was captivated by him; his power, his calm, his dignity, his incredible knowledge… I had never really gone to yeshivah, but I wished I could learn from him.”
And so, from long distance in Bnei Brak, Rav Korach arranged for a chavrusa for his young charge. Rav Chanoch Admoni was a talmid of Torah Vodaath, who’d started semichah under Rav Pam and completed the course of study under Rav Belsky. Rav Admoni was studying to be a shochet and he’d become an expert on treifos. Rav Belsky trusted Rav Admoni to do shechitah for his own talmidim, and then he would do the bedikah.
“We sat in the basement of the Bobover beis medrash, and I offered my knowledge of anatomy to his Torah knowledge,” says Dr. Hizami of that special time.
Beyond the Torah of first seder, Rav Korach became a mentor in the Torah of life itself, essentially spelling out his mission statement.
Early on in his career, Dr. Hizami had to attend the levayah of a close friend. He planned to cancel all his appointments, but then he hesitated. He phoned his rebbi in Bnei Brak, asking which took precedence. “Your mission is to help the living, to do chesed with them,” Rav Korach answered. “Unless it’s a case of meis mitzvah, you cannot cancel an appointment.”
Dr. Hizami looks toward the window, beyond New City. “I would love to learn seriously, to spend hours in the beis medrash, but I got my marching orders.”
It’s a rule he follows until today. Earlier this year, his grandfather took ill and it was clear that the end was near. Dr. Hizami wanted to pay respects to his beloved grandfather, but he had a backed-up waiting list of patients.
“I called Rav Chaim Schabbes, with a question: I could take off a day or two from work and fly to Eretz Yisrael for the levayah and shivah, or I could go right away and simply sit by his bedside, since it was a legal holiday and the office was closed. He told me the patients came first, so I went while my grandfather was still alive, getting the chance to say goodbye.” Having married and settled in Brooklyn and raising a growing family (sons Refael Shlomo, Gavriel, Meechael, and Uriel, and daughter Hodayah), he’d been working at the Long Island Jewish Medical Center, but was ready to open his own practice. Home prices in Brooklyn kept rising and he was ready move out.
“In 2002, I had an idea. I called Rabbi Binyamin Babad of Relief Resources and asked him where I was needed. He told me I would be useful in either Monsey or Lakewood.”
Relief was itself in its infancy at that time, but Dr. Hizami intuited that the demand and clientele for an Orthodox referral network was there, and he wanted to be ready.
The Hizami family moved north, settling in Monsey. (Today, Dr. Hizami maintains offices in New City, Brooklyn, and Lakewood, treating patients from age 3 to 65.)
At the time, Relief was new. The frum community’s readiness to confront its own mental health was new. And the informal network of frum mechanchim and clinicians working hand-in-hand was still a few years away.
The man who wishes he had more time to learn leans forward in his chair. “When the pasuk in Kohelet says, ‘Ein kol chadash tachat hashemesh,’ it’s also referring to this — there aren’t new illnesses. Depression isn’t new. ADHD isn’t new. Schizophrenia isn’t new. In Chazal, you can see evidence of various mental illnesses, and more recently, this has been borne out by research showing cases of ADHD from a thousand years ago. People really suffered.”
The frum community woke up by necessity and Dr. Hizami, who’s not just a psychiatrist but a psychopharmacologist, which means that he’s an expert on the use of medication in treating mental disorders, was there to welcome them.
“One Shabbos, I went for a long walk with my Monsey neighbor, Rabbi Ronnie Greenwald, alav hashalom, and he explained to me that I wasn’t signing up for a 9-to-5 job, but for a calling, that I didn’t have the luxury of saying ‘I can’t’ to a patient in need.” Ronnie Greenwald was a tireless educator, political activist, hostage negotiator, and ambassador, but despite his worldwide activities, he was also the go-to man for the local Jewish community and was on the front lines when it came to crisis intervention and kids at risk. “Ronnie was my teacher in his dedication to the Klal and the dignity with which he dealt with others.”
But engaging patients with respect and dignity doesn’t mean he lets them take the lead or self-diagnose. “You can’t come in here and dictate treatment, what you’re hoping for, you know, a touch of ADHD, a little anxiety,” he says. “Mental illness isn’t pistachio nuts and caramels and you can’t create the package that works for you.
“Today ADHD is considered cool,” he continues. “We’ve done a good job of removing the stigma, and kids think that ADHD means they’re smart and creative, but the first thing to realize is that there’s a painful flip side to it, and additionally, not everyone who thinks they have ADHD is right.”
He points to his tie, which looks like it might have been a Chanukah present from a well-meaning, clueless child, and he laughs. “I like art, but my art isn’t fashion or paintings. My art is medication, that’s where I get to be creative, trying to figure it all out.”
But Dr. Hizami is no pill-pusher. “Make no mistake,” he stresses. “The best medication is no medication, then you have no side effects. Sometimes we get to take a patient off medication and that’s great. That’s the best case.”
He lowers his voice. “I’ll tell you a secret. Within the entire field of psychopharmacology — other than in a few exceptional cases — medications don’t heal, they just alleviate the symptoms. When it comes to anxiety or bipolar or depression, the meds don’t take care of the problem, they just help control it.”
So when a patient comes in, within that first hour, Dr. Hizami is not just carrying on a conversation and asking questions, he’s also trying to asses the right course of action, which does not always include medication. He’s looking for clues in places that you don’t even know exist. (At one point, he tells me something shockingly accurate about myself. I ask him how he could know this, and he explained to me how obvious it was from the way I was sitting.)
“Research shows that CBT (Cognitive Behavior Therapy), for example, can be effective in treating OCD, but it’s not for everyone. In some cases, identifying an untreated medical or nutritional problem can actually help depression. So we’re trying to evaluate the patient from the first moment to see if we need medication at all.”
He stands up and picks up a thick textbook from a side table. It’s called Complementary Treatments for Mental Disorders. “If you would have told me ten years ago that I would be reading something like this, I would have laughed at you. What happens is that today’s alternative becomes tomorrow’s mainstream.”
We Missed It
My interview with Dr. Hizami takes place over several meetings: I try to come early, before the workday starts, but in one case, he’s sitting with a patient as I wait in the side room. There is some shouting, and he is delayed by a few minutes.
When he comes in to speak with me, he looks unruffled, as if he just got off for lunch from a job answering phones at a spa.
But what was going on inside was a full-blown tantrum, with the patient getting violent. I ask how he dealt with it, and the he looks at me, the eyes that twinkle, telling me gently to mind my own business.
“When I was starting out,” he says, “I was part of a team evaluating a young girl — she was rocking back and forth on the floor and aggressively biting and hitting herself. She had come with a diagnosis of autism and we concurred.”
A few years later, Dr. Hizami was at the school play of one of his children, and the lead actress was a dynamic, confident girl. After the play, the girl’s father approached him. “Dr. Hizami,” he said sweetly, “do you remember me? You said that my daughter was autistic. Everybody missed the boat. It was really a seizure disorder, and another doctor figured that out and we corrected it. Tonight, she was the star.”
He doesn’t remember the plot of the play, but that line always remains with him. “We got it wrong. Gaavah has no place in medicine and I try to remember that girl every day. You know, some of my best professors sat where you’re sitting now — they’re the patients who come and speak honestly, who share what they’re really feeling and give clues to their own best course of treatment.”
Dr. Hizami is the first mental health address for many schools, educators, and community rabbanim, and he’s grateful for their trust and cooperation. “The rabbanim of 2019 are exceptional in their dedication — they get what we do and work so well with us. I can’t tell you how many times I’ve called rabbanim to discuss a particular sh’eilah before suggesting a course of treatment, and they always make these calls a priority.”
Still, there are times when working within the system involves an uncomfortable back and forth. “I was dealing with a young man who was being medicated to prevent certain destructive behaviors, and I didn’t think the meds were necessary. The medication wasn’t simple and I thought medicating him was taking the easy way out and that it could pose long-term problems. I asked to speak to his rebbi.”
In theory, someone could take sleeping pills before Shabbos and wake up after Shabbos, Dr. Hizami told the rebbi. “Wouldn’t this be a great way to prevent chillul Shabbos?” Dr. Hizami asked. The rebbi heard the argument and conceded.
“Occasionally, the school will diagnose a child and then send him here for treatment. They expect me to concur with them, but that doesn’t always happen — I do my own evaluation. I’ll be honest — I’m not for the schools or even the parents: I’m here to help the children, so of course I sometimes lose friends.”
Sometimes, however, it gains him new friends.
In one case, Dr. Hizami felt that the school was being harsh with a particular student and he had several tense meetings with the rebbi. “At one point, we argued and he walked out, upset at me. I was sure I would never see him again.”
A few days later, the rebbi returned — as a patient. “We diagnosed him and were able to help. If he was a good rebbi before, he’s a superstar now.”
Dr. Hizami walks a proverbial tightrope, with those who eschew medication on one side, those who think it will fix all their problems on the other.
“Look, there is a common misconception about medication,” he explains. “Take Ritalin, for example. It can be helpful for someone who has no ADHD at all — they give it to fighter pilots to help them focus. You have college students loading up on it to prepare for exams, but they don’t really need it. So what happens is, people come in to me, certain that they have ADHD because they tried Ritalin and yes, it made them hyper-focused. But that doesn’t mean you have ADHD.”
On the other hand, he had a case where a teenager-at-risk was at home while his parents were away. The boy decided to snoop around the medicine cabinet and found Adderall. “He came to me and said, ‘Dr. Hizami, it was the first time in my life that I felt normal.’ That was ironic and very sad.”
The photographer asks Dr. Hizami to talk to the camera. He knows what the photographer means, but he chooses to take it literally, leaning toward the camera lens and saying, “How do you feel today? What made you come in here?”
Even as he enjoys his own joke, there’s also a layer of seriousness there. “You know what brings people in here, more than anything else? Emunah.”
What he means it that there are too many suffering people out there who pretend there’s nothing wrong. “They’re in denial because they worry about shidduchim, about getting their child into the best high school or seminary.”
He’s had patients who’ve told him that no, there was no family history of whatever disorder he’d diagnosed. “The parents look me straight in the eye, when I know that I’m treating several first cousins for the same issue — that’s also a form of denial.
“You know what happens to problems that aren’t addressed? They come out in sheva brachos — suddenly a new husband or wife is sitting here and saying, ‘Help, my new spouse is saying that my behavior isn’t normal,’ or worse, ‘What am I supposed to do now? My new spouse is really crazy!’”
Dr. Hizami has mastered the art of always maintaining an even tone, and our conversation is no exception. There’s no banging the table, no getting up, or gesticulating to make a point. Now, however, there’s a note of passion in his voice, a faint wind brushing the water’s surface as he continues. “If you’re a maamin, you know that He makes shidduchim and He decides who will go where. Getting help is your mitzvah.”
Open any frum magazine and you’ll see articles arguing that we, as a community, are taking too many pills, that we’re not taking enough pills, that we’re taking the wrong pills at the wrong times — and Dr. Ronen Hizami hears it all. He smiles at the comment, a kind smile, one that reaches his eyes and probably goes deep into his soul.
“Ronnie Greenwald told me, ‘Ronen, we all have problems. Some people handle them and others don’t, but we all have them.’
“But the people who come here,” Dr. Hizami looks around the office, the children’s toys and pile of books he’s waiting to read, the mediocre art on the wall and his own pair of shoes, sitting devoid of feet near his chair, “the people who come here are the ones who want to learn how to handle them.”
The Best Defense
Dr. Hizami says there are a few things every parent should know, in order to give it your best shot when navigating the complex world of growing children:
The strongest safeguard your child can have against any problem that comes his way is to have a close relationship with you, his parents.
Remember: Our kids do what we do, not what we say. What kind of example are we setting?
Don’t assume that no news is good news from the school. Develop a good relationship with your children’s teachers and speak with them frequently. Get to know their styles and prejudices. Do they refrain from complaining to parents because they fear the parents will have the children put on meds? Or, do they expect every child having any difficulty to be put on medication?
Don’t ignore changes in your child’s mood, academic performance, or behavior. It can take years for people going through difficulty or trauma to open up.
Be extremely careful from whom you take advice. Take advantage of your pediatrician. He/she is trained to help decide when help is needed. Get advice from a rav who is experienced in dealing with chinuch and mental health issues.
Mommies — dont ignore your binah yeseirah.
Don’t let concerns about your child’s future shidduch prevent you from getting him/her the appropriate care now.
Remember, the job of every parent is to help guide their child into becoming a productive member of society.
There is mental illness in every family. The difference is that some people take care of their problems, while others just ignore them and hope they’ll eventually disappear.
(Originally featured in Mishpacha, Issue 792)