D ov the medical student who’d been observing me was back for another visit.

“So how are your studies going?” I asked the obligatory question as he sat down in my office.

“Studies? Well I’ve got the med-school basketball tournament and looking for a new apartment before the end of the summer.”

“I hear you Dov. It’s good to have your priorities straight.” I smirked.

“Yeah well… one more reason not to have to memorize every single artery in the lower extremity the exact genetic mutation that causes Hurler’s syndrome and the 12 most common causes of pancreatitis.”

“Scorpion stings ” I told Dov.

“Scorpion stings? What are you talking about?”

“I think they’re the 11th most common cause of pancreatitis ” I said.

Dov smiled and turned his iPhone to vibrate mode in anticipation of our first patient.

“No Dov — ‘off-off.’ ” I grinned sternly. We’d already done this the last time he came.

“I know I remember. It’s just that I’m expecting a call about a shidduch so I’m a little nervous about it and want to make sure I pick up when they call.”

“Patience Dov. You can check your messages when we’re done. We need a clear head and an objective mind when we’re in the office. The first appointment is already waiting.”

Our morning together was pretty much routine. The appointments were primarily follow-ups with patients who were largely stable but around noon our last and most challenging patient of the day arrived. Rivky was a young woman and first-time mother who had come in with her husband Yudi a seventh-generation Sephardic Yerushalmi who was versed in Zohar and attracted to Breslov chassidus to discuss treatment options for her symptoms. She had begun to feel postpartum blues after the baby was born and quickly doubted her ability as a mother. Within a few weeks strange thoughts about “thinking they’d be better off without me” began to creep into her mind.

Luckily Rivky and Yudi had sought advice from a rav who was knowledgeable on the subject and told them to come in for a psychiatric evaluation. Rivky was willing — even relieved that they could put a label on what she was going through. But Yudi — an idealistic scholar who toiled in the realms of the spirit — had his reservations fearing that “they’d just pump her with medication ” which he adamantly felt went against Breslov teachings based on the writings of Rebbe Nachman and his disciple Rav Nosson. They waited another week but the situation deteriorated so Yudi upped the ante tuned his emunah up to full throttle and went to Meron to daven at the kever of Rashbi. But things still got worse and now he’d finally acquiesced to meet a psychiatrist.

Rivky was keen to tell us her story while Yudi sat quietly in the corner jotting down notes. I tried to include him in the conversation but he remained aloof.

After I heard Rivky’s history her current symptoms and clarifying details it was pretty clear to me that she was suffering from postpartum depression. Yudi practically rolled his eyes as I recommended a multidimensional treatment plan including psychotherapy strategies for maintaining a regular sleep schedule daily exercise Omega-3 fatty-acid supplementation and a low dose of a common antidepressant medication.

Rivky seemed appreciative but Yudi preempted her. “I knew he’d just make you take a bunch of medication Rivky. Don’t be fooled that he looks like a frum guy and has a beard. Psychiatrists are all the same.”

“Yudi ” I replied calmly making a reasonable effort to ignore the slight “a low dose of a medication was one of the multiple recommendations I made. I’m not forcing anyone to do anything. I’m just offering recommendations based on the available medical research and my own clinical experience.”

“Yudi ” said Rivky finding her voice “he’s right that he’s not forcing me to do anything. And he’s also right that a particular medication might be helpful. Things have been really hard for me.” She started crying and continued “Things have been really really hard for us and I need to get better.”

“But what about emunah?” responded Yudi. “Didn’t Rebbe Nachman warn against medicine and didn’t Reb Nosson take those warnings literally even as it affected his personal physical suffering? Isn’t it our job to build ourselves to such exalted spiritual levels that we don’t need doctors and their medications as Hashem is the True Healer? How can you cop out with Prozac when you have personal prayer and hisbodedus when you can ask Hashem to set you straight? Hashem can make miracles and turn everything around. Rivky we are religious G-d-fearing people aren’t we?”

“Of course we are ” Rivky sobbed “but I’m struggling! Yudi we need more than just tefillah now. I was feeling suicidal last week — how much worse does it have to get?”

“I know Rivky I know I’m sorry — I just want to make sure that we’re doing our part before running for medications ” Yudi said soothingly in an attempt to comfort his wife.

At this point it became clear to me that Yudi wasn’t an abusive husband who wanted to control his wife. Rather we were engaging in a fundamental philosophical dilemma on the role of emunah within one’s life.

I tried my best to outline the situation: I believed that Rivky would benefit from taking a medication for postpartum depression Rivky was interested in taking the medication and Yudi was adamantly opposed. Rivky sat quietly at this point as Yudi sought to engage me in a serious discussion about the balance between hishtadlus and emunah.

Whereas he was convinced that taking medications represented a crack in emunah (when Rebbe Nachman was ill he instructed his disciples not to call a doctor even if his situation worsened and he himself called out for a doctor) I countered that it was the bare minimum of hishtadlus given the circumstances and that Hashem Who empowers doctors to heal would want his wife to try the medications and have faith that they would help her to recover.

“Yudi ” I told him “your own rav was the one who recommended you come to a psychiatrist. True there’s nothing like going to Rabi Shimon’s kever — I was there last Erev Rosh Chodesh — but we need to do our hishtadlus as well. In fact I’ve discussed Rebbe Nachman’s teachings on medications at length with prominent Breslover rabbanim. In cases of pikuach nefesh for regular folk like us pshat is there’s a chiyuv to take medications.”

“With all due respect Doctor I think you’re missing the point. As soon as you choose a pill you’re throwing emunah out the window.”

Dov who had been sitting quietly for most of the morning couldn’t control himself and against protocol blurted out “Didn’t you ever learn Chovos Halevovos Yudi? Doing a reasonable amount of hishtadlus doesn’t represent a lack of emunah. That’s the point of Shaar Habitachon!”

The room went silent. Everyone stared at Dov and I was about to apologize for my student’s inappropriate outburst when Yudi looked at Dov and told him “My saba’s rosh yeshivah Harav Ezra Attia ztz”l always carried a copy of Hovot Halevavot in his pocket. My saba did the same and I still have his copy in my own pocket.” Yudi took a small beaten old sefer from his jacket to show us.

Dov took it from his hand and opened it up to the fourth perek and started reading aloud through Rabbeinu Bechaye’s treatise on the delicate balance between emunah and hishtadlus. I motioned for him to stop but Yudi asked him to continue. The seconds that followed seemed to stretch and eventually Yudi turned to his wife and apologized.

He then turned to me. “Kavod HaDoctor I see that you and your student have yirat Shamayim. If you think that my wife will benefit from an antidepressant medication then you should prescribe it to her.”

“It looks like the beit din has made its psak ” I said still a bit shocked.

After they left Dov let me know he’d gotten a message from the shadchan he was hoping he could return and as he headed out the door he asked if he could come again.

“Sure Dov ” I told him “but only after you win the med-school basketball tournament.”

“You make it sound so simple. How do you know I’ll win?”

“You’ve got the winning formula ” I said. “Emunah and a little bit of ’shtadlus.”

(Originally featured in Mishpacha Issue 673. Jacob L. Freedman is a psychiatrist and business consultant based in Jerusalem. He serves as the medical director of services for English-speakers at Bayit Cham a national leader providing mental health treatment and outreach within the religious community. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.)