I first met Avi following a hospitalization around Pesach.

He was convinced that his medicines weren’t kosher l’Pesach and had stopped them. By the fourth night of Chol Hamoed he’d stopped sleeping and was engaged in a project to write what he called “The World’s Largest Mezuzah” even though he’d never been trained as a sofer.

Once Avi was restarted on his mood stabilizer, we began working together and all seemed well — until Shavuos when he told me that he was going to have to miss a few doses.

“You see, I need to stay up, Dr. Freedman,” he explained as he noticed my obvious concern. “Learning all night on Shavuos is a mitzvah. Would you rather I just didn’t tell you that I’d skipped?”

“Avi, you know this isn’t a great plan, and you know what staying up all night does to you, even if you take your meds in the morning.”

Avi wasn’t interested in my little speech and promptly fired me. I called to speak with his father but it was to no avail. While Avi might have been living in his parents’ machsan, they had limited control of their 24-year-old son, even though they would have loved to see him back in my office.

“I suppose it was worth a try to have him meet you a few times, but we don’t have the koach for this fight,” his father said. “Avi is just going to do whatever he wants to do anyway.”

Avi did follow through with his plan… and was rehospitalized after trying to fly to Crown Heights for Isru Chag without a ticket. Eight days later he was back on his mood stabilizer and ready to come back to my office.

We had a few good weeks but Avi was very persistent in finding excuses. “You can’t even really explain how your medications work, Dr. Freedman,” he told me.

The truth is, Avi had highlighted an interesting aspect of the psychiatric field. While neuroscience has come a long way, explaining how antipsychotic medications work by blocking dopamine receptors often sounds quite abstract or disconnected for many patients.

And after doing a bit of research online and deciding that his medicine could theoretically cause fulminant liver failure, Avi told me he was stopping again.

We danced back and forth and I tried to enlist the help of Mom and Dad once more, but soon Avi had had it with sleeping and decided to paint a neighbor’s car with a Na Nach fire. And as fast as he was gone, 12 days later Avi was back in my office.

We schmoozed for a little while before I decided to try something different.

“Aren’t you sick of this, Avi? Missing minyan for two weeks every time you get hospitalized?”

“They have a minyan at the hospital,” he countered.

“Being stuck in a hospital during Shabbos?”

“They have a Satmar guy who comes to make a leibedig Shabbos in the unit,” he said somewhat less emphatically.

“Living in your parents’ machsan because you can’t get a stable job, get married and start a family, or get your life on track because you’re always getting hospitalized?”

“Okay, you got me. Right, the hospital isn’t too good for me. But I don’t like taking your meds either. Why should I?”

“Because something wacky happens every time you miss them for even a day or two and then you end up hospitalized. Avi, I have an idea. What if we try a shot, an injection that you’d take once a month and that way you wouldn’t have to fight the yetzer hara every day to stop your medicine.”

“I’d still find an excuse,” he said — and I knew he wasn’t kidding.

“Avi, I know you’ll try to weasel your way out of it, but we’d have enough time to talk about it and you wouldn’t need to go to war with yourself on a nightly basis.”

Avi agreed, and we began a new, more stable phase of his treatment. Of course, every month before the injection he threw me a slew of halachic teirutzim and reasons he couldn’t continue his monthly injections.

We almost lost him again when he planned a trip to the Negev for the week of his monthly injection around Chanukah time. He admitted that he “sort of” did it on purpose, but luckily there was no problem with administering the treatment three days early. As hard as he fought it, Avi was able to remain treatment compliant.

But soon Purim was coming, and Avi wanted to avoid his injection since “alcohol and medicines don’t mix.”

But he was able to hear that the injection led to a less-sedating steady blood level and that celebrating in moderation was okay.

“I’ll tell you Dr. Freedman, being out of the hospital is a pretty good simchah this Adar,” he quipped as he took his injection somewhat reluctantly.

And then Pesach was around the corner and I knew I’d be up against a fiercely determined Avi who wouldn’t want to take his medicine during the festival.

“You know I really don’t need this,” he began.

“Avi!” I said perhaps a bit too loudly. “Can’t you see how much better your life is without having been hospitalized for the past eight months? Pesach is about freedom, and stopping your medicine and being locked up in a hospital is the antithesis of that.”

“I know, Dr. Freedman. That’s why I was going to tell you that although ‘I don’t really need this,’ you’ve been honest and have really helped me. It’s been a year since we’ve met and although it started off rocky, I’ve been doing great and I’m less against just taking the shot right now. But it’s probably not kosher l’Pesach?”

My stomach fell. This was such a common discussion that I knew all the angles baal peh. But if Avi was in fact determined, I didn’t have too much hope that we wouldn’t end up being back where we started the year before.

But while I was busy catastrophizing, Avi was laughing hysterically. “Oh man, Dr. Freedman,” he chuckled. “You should have seen the look on your face. Ha! You think I’m really going back to the hospital? I’m taking these shots and I’m doing great! Plus what’s the problem with a medicine during Pesach if it’s pikuach nefesh — isn’t that what you taught me?”

As he rolled up his sleeve, he told me with conviction, “Dr. Freedman, I think I finally figured out what real freedom looks like. And being locked up in a hospital just because I want to do things my way isn’t it.”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties. 

Originally featured in Mishpacha, Issue 755. 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