“Dr. Freedman, I’m willing to do whatever you tell me to do. I’m your talmid! A frum doctor — what mazel!”

Gedalya was a gentle British fellow and Brisker talmid who had been learning in a serious kollel for a number of years. He and his wife were happy living in Jerusalem and especially grateful that they could raise their own children near his elderly grandparents, who had moved to Eretz Yisrael nearly two decades before.

For this G-d-fearing yungerman, life was good when he was sure he was doing the right thing — giving honor to his bubby and zeidy, being makpid on the chumros he’d established for himself and his family, not wasting time in kollel so that there was no issue of not deserving his stipend. Yet even his compulsive need to say “bli neder,” his chronic fear of throwing magazines with divrei Torah in the trash, and his obsessive thoughts regarding kavanos while reciting Shemoneh Esreh were all things I’d seen before.

Gedalya’s attribution of his symptoms to chumros and to his need to work on bitachon had helped him dig himself quite a hole. He was simply unwilling to commit to help for too many years and his obsessions and compulsions had gotten progressively more debilitating. Sure, he’d tried meeting with a psychiatrist a few times at the urging of his rosh kollel, but he was frightened off by the doctors — especially the bareheaded ones. Even a meeting with a highly acclaimed OCD therapist that his wife had scheduled was canceled when Gedalya found out that the fellow’s name was Edward.

“How could I sit with someone who calls himself Edward instead of Ephraim?” he asked his wife sincerely, because for a Yid like Gedalya, this was a deal-breaker.

Gedalya’s OCD was impacting his ability to trust a therapist, as he was plagued by intrusive thoughts that the therapist “wouldn’t be frum enough” to understand a Brisker patient.

Finally, things came to a head when a neighbor saw Gedalya looking through the dumpster for sheimos he was worried he might have mistakenly thrown out. This neighbor, who happened to be a social worker for the municipality, discreetly approached Gedalya’s wife to let her know that, in her opinion at least, the poor fellow digging through the dumpster needed help.

Desperate not to end up with another mental-health clinician who didn’t understand the frum velt, Reb Gedalya and his wife called Relief for a confidential referral, and the next day, Gedalya landed in my office for a consultation.

And while he was initially skittish, Gedalya was overjoyed to meet a fellow frum Yid who was also a psychiatrist.

“Baruch Hashem, it’s you and not some great professor who doesn’t know anything about Yiddishkeit,” he said, genuinely relieved. “I mean, I’m sure you’re also smart like a great professor, but I just can’t sit with someone who doesn’t understand where I’m coming from.”

I knew Gedalya was the sort of patient who never would have been able to hear my assessment or listen to my advice if I didn’t look familiar in one way or another. My diplomas were fine, the letters from rabbanim were better, but it was my beard and peyos that helped Gedalya to feel at home — and really, I couldn’t blame him.

“And you even have a shtender in your office with a Bava Metzia sitting on it —gevaldig!” he enthused. “Dr. Freedman, I’m willing to do whatever you tell me to do. I’m your talmid! A frum doctor — what mazel!”

This precious avreich, who had resisted entering treatment for far too long, was tremendously motivated to get better. The sheer horror of having had a local social worker intervene to tell his own wife that he needed help was more than enough to make him a true chassid when it came to getting psychiatric treatment.

Just as his diagnosis was clear-cut, so was the treatment regimen. Gedalya began regular therapy, learning how to ignore his obsessive thoughts while simultaneously resisting the urge to act on his compulsive desires. At the same time, we started a low dose of an antidepressant medication that was slowly increased.

A great breakthrough moment came three months into treatment, when Gedalya, my first appointment of the day, ran into the office to tell me how he’d walked past every trash dumpster without thinking about misplaced sheimos, hadn’t said “bli neder” all day, and was able to daven an eight-minute Shemoneh Esreh without any fears of mistakes.

I too had just walked in, and was still busy taking off my hat and raincoat, while Gedalya was excitedly providing me with an update.

“It was really incredible, Dr. Freedman, and it’s all thanks to this great frum psychiatrist shaliach that Hashem sent me!” he exclaimed. “Not having to worry about all this stuff is like being in shamayim.”

Gedalya was still talking about how amazing the experience of freedom was and how he’d conquered his OCD yetzer hara when he suddenly stopped.

I looked up and saw him staring at the hooks on the back of my door where my baseball cap rested peacefully.

“Everything okay, Gedalya?” I asked. “What happened to shamayim?”

“Nothing, I mean, nothing, Dr. Freedman,” he mumbled quietly and looked away. “It’s just, I mean, nothing, it’s okay.”

But it wasn’t, so I prodded him, having a hunch I knew what was up. “Is my baseball hat bothering you, Reb Gedalya?”

He smiled nervously and refused to make eye contact. “It’s not that it bothers me… I just thought, I mean, I don’t know… I guess, I mean…”

I cut him off to avoid an unnecessary conflict. “You’re afraid this means I’m not so frum and don’t really understand you, Gedalya? That’s kind of an obsessive thought by you, isn’t it?”

He giggled anxiously as he nodded.

“Luckily, I learn Bava Metzia and have a good beard, otherwise we never would have made it through the initial consultation,” I said, as we laughed together.

“Let me explain to you why I have this hat, Gedalya, as it’ll make things easier. Even though it’s cold and rainy, I walk three miles back and forth to the office to get in some extra exercise. In the summer I can’t wear a black hat because I shvitz straight through it and it gets ruined within a week. In the winter, the rain would kill it,” I said as I pointed to his soaking wet hat on my coat rack and my own dripping baseball cap.

“Okay, Dr. Freeman, but you’re wearing these very un-yeshivish hiking boots, and that hat — it says ‘Hospital Security’ on it,” Gedalya half-laughed as he knew he was losing this battle.

I smiled as I answered. “Yeah, that hat’s a whole other story for next time — assuming you don’t fire me for being too goyish to help you through your OCD.”

“Chas v’shalom, Dr. Freedman, you’ve helped me so much! You’ve been a great shaliach. I just needed you to, you know—”

“You needed me to be super frum in order to avoid the intrusive obsessive thought that your doctor wouldn’t understand you unless he’s a frummie and has never worn a baseball cap in this gilgul….”

He actually thanked me for giving him the words.

“Reb Gedalya, part of your treatment is working on the flexibility to know that everything will be okay, that Hashem is in charge, even if it doesn’t happen exactly as you hoped it would.”

Gedalya nodded. It was hard, but he was starting to understand. After all, he really did want to make progress. Still, I wanted to give him a bit more gentle assurance before we started the session.

“Don’t worry, Gedalya, I still have a tish beketshe for the Shabbos seudah after I take my hat off.”

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

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills around Jerusalem.

Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com

(Originally featured in Mishpacha, Issue 850)