The aquarium. Vocational rehab. The best thing Israel has to offer. The spinning wheels in my head finally clicked

My patient Yonasan Goldberg, an adult male with treatment-resistant chronic schizophrenia, believes that I’m Eliyahu Hanavi and was ecstatic when I “vanquished” his bully of a neighbor, “wicked King Achav” (it turns out that really was his name, although Yonasan has a penchant for making up words and terms). I still haven’t discovered a sure-fire treatment protocol, but Yonasan is a nice guy and deserves a measure of happiness, even if the lines between delusion and reality are blurred.

PART III

After several weeks, I found myself getting lost in the various characters of dubious existence that graced Yonasan’s inner world, but interestingly, it was a phone call from his mother that helped clarify things in my own head.

“Dr. Freedman,” she gushed, “I must tell you that Yonasan can’t stop talking about how much you’ve helped him!”  I wanted to accept her compliment graciously, but truthfully, I wasn’t sure how much I’d really done.

“He told me how you vanquished wicked King Achav! What a wonderful thing you did telling our nasty neighbor to leave him alone,” she continued. “In the week since that happened, they both basically ignore each other, which is frankly perfect from my perspective. And Yonasan is having so much fun going back to the aquarium on his daily visits. But you know, those cuttlefish used to really undo him and ruin the experience. Now all he does is talk about how they’re friends again, and it’s all thanks to you, Dr. Freedman.

“And you know what I think?” she went on in that hopeful, almost conspiratorial tone I’ve gotten used to hearing from parents, “Maybe he’s really getting cured!”

Mrs. Goldberg elaborated on her son’s history: She mentioned withdrawal from his friendships and the strange beliefs that had been filling his head since beginning yeshivah gedolah. How he wound up in a private “frum” facility whose managers claimed they were accredited and in the end gave him a dangerous cocktail of medications that caused oversedation and landed him in the Intensive Care Unit. His subsequent trials with different medications that never quite did the trick of bringing him back to 100 percent rehospitalizations here and there, and his inability to hold any job no matter how hard they tried to find him a good daily structure.

“And you see, now he kind of has a job,” she chuckled. “If going to the aquarium and being the number one fan of the cephalopods counts?”

I had to break it to her that he was functioning well in a safe and organized framework but that he wasn’t, and — based on his psychiatric history and non-responsiveness to medication — would likely never be “cured.” And then it became clear to me in that comforting way when you know you’ve stopped fighting the truth: We can’t always cure, but we can find ways to help make people like Yonasan productive, keep them safe, and frame their lives with a semblance of “normal.”

Mrs. Goldberg herself had the answer: The aquarium. Vocational rehab. The best thing Israel has to offer. The spinning wheels in my head finally clicked. “Mrs. Goldberg, he’s an Israeli citizen, correct? And he has Bituach Leumi? National disability recognition for his mental illness?”

“Yes, to all the above, Dr. Freedman.”

“Then why don’t we get him a real job at the aquarium? Something where they pay him a small stipend, provide him with structure and support, make him feel as though he’s part of the team there?”

“That would be amazing, Dr. Freedman, but how do we go about it? I wouldn’t know where to start.”

“Eliyahu Hanavi knows how to make it happen.”

Mrs. Goldberg laughed, but I was serious. And so, I set up a meeting for the three of us — Mrs. Goldberg, her son, and my dear colleague Reb Zechariah, a social worker with the city’s welfare department who specializes in connecting patients with vocational rehabilitation resources. Often with this treatment-resistance condition, even small changes in family, occupation, or social functioning can be highly significant for the patient. For Yonasan, I suspected the key was integration. The goals of treatment for incompletely recovered patients should generally be slanted toward integration, if at all possible.

Yonasan was thrilled to come back to my place and was smiling in the waiting room, singing a niggun about “Smushing Wicked King Ahav.” I brought him into my office and offered him and his mother a seat.

I then introduced them to my friend. “Yonasan, Mrs. Goldberg, meet my friend Reb Zechariah. He’s a social worker with the Revacha, and he works hard in connecting young men with governmental benefits including vocational rehabilitation.”

“You’re not firing me, are you, Dr. Eliyahu?” Yonasan looked wounded.

“Of course not, Yonasan,” I said reassuringly. “I just want to make sure you get all the resources you qualify for. My friend Reb Zechariah is going to help you get your dream job at the aquarium!”

Yonasan was overjoyed at the idea and shook my colleague’s hand enthusiastically after handing him one of his bizarre business cards — but Reb Zechariah didn’t flinch. He’d seen his share of the underbelly of humanity — his own story is a long and winding one, and although we never discussed all the sordid details of his past, from taking a nosedive out the window of yeshivah and falling to the depths of society’s netherworld, Reb Zechariah emerged as one of the most intuitive, compassionate therapists I’ve ever met.

For him, it doesn’t really matter if you’re a Nobel Prize winner or a totally delusional schizophrenic unresponsive to the most powerful meds, because underneath the layers of illness and dysfunction, Zechariah sees the holy neshamah. And if he could help a broken young man be happy, that was the biggest reward for his effort.

And so, Reb Zechariah tackled necessary paperwork to apply for rehabilitation services. He could then link Yonasan’s supported employment benefits with an existing program at the aquarium.

Yonasan, for his part, was thrilled. “I’ll get a shirt that says I’m part of the team!”

“And you’ll have a regular daily job to help keep you from getting into trouble with any of your pesky neighbors, Yonasan,” I added.

“You’re the real Eliyahu Hanavi,” I told my colleague once the papers were signed. “You’re going to provide this fellow with meaning that I never could.”

Prior to our next meeting, I got a message from Mrs. Goldberg that they needed to change the date of our appointment as it didn’t fit with Yonasan’s new work schedule. I couldn’t have been happier for them.

It was a few weeks later when we were all able to reconvene. Yonasan had arrived in uniform — wearing a hat and a shirt bearing the aquarium’s logo. He was as proud as could be as he handed me a stack of business cards that read: “Dr. Eliyahu — Squasher of Bad Guys.”

I was honored to accept them although I wasn’t sure what to do with them.

“Keep them for when you need them, Dr. Eliyahu,” he told me. “It will help the nogoodnikim to know when to run.”

That was a word I knew without Yonasan having to explain himself.

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 871)