She may not have been a psychiatrist but she sure knew the right thing to say

I’d been working with Leiba for close to three yearsand thank G-d, she was stabilized and functioning after a roller coaster of hospitalizations and meds. 

Leiba, the oldest in the family and the only girl among six younger brothers, comes from a well-respected chassidic family in Bnei Brak, where she went through the local Bais Yaakov system and was always the center of fun and creativity, weaving stories for her friends that never failed to entertain. Her father, Shneur, provided solidly for his family as a senior kashrus administrator, and once Leiba turned 18, the family began to consider shidduch suggestions for their sparkly, talented daughter. 

Until the day she returned early from seminary and something in her personality shifted.

“I’m not a psychiatrist,” Shneur told me as he recalled the catastrophic feeling, “but immediately I knew that things weren’t good.” Leiba came into the house talking about how the Mossad had come to her seminary and planted a number of cameras in the rooms to help recruit new spies. Rather than “join up with the agency,” Leiba had rushed home.

“I didn’t waste any time,” Shneur related. “I brought her to a local psychiatrist to make sure that she was alright.”

But she wasn’t alright, and it soon became clear that the paranoid delusions were the onset of schizophrenia. Her family was open to treatment, but a week later Leiba was hospitalized due to an overdose of her antipsychotic medication, the beginning of a three-year spiral of psychiatric hospitalizations until she was finally stabilized.

I met Leiba after she’d experienced a rare complication of her medication regimen and the family sought a second opinion to determine the right course of action. Leiba was a sweet, charming, and intelligent young woman who was motivated to engage in her treatment. 

“I’m not a psychiatrist,” Shneur said, “but I know that any new medication might also have its risks.”

It was a very reasonable assessment so I made sure to honor their concern. But I also shared my opinion that without antipsychotic meds, she would be at a very high risk of redeveloping the same paranoid delusions that had landed her in the hospital so many times. Baruch Hashem, we found a treatment that worked for Leiba and was remarkably well-tolerated. 

She returned to her supportive employment in Bnei Brak, and we’d meet every few months to monitor her treatment. I was therefore surprised to get a message that her father had scheduled an emergency appointment, and I didn’t know exactly what to expect, when Reb Shneur walked in with a young man who looked very much like his younger self.

Shulem, a middle brother, shrugged his father’s loving hand off of his shoulder as they sat opposite me and Shneur began talking. Shulem had apparently had a tough run the past few years and had left — or been kicked out of — his yeshivah. He spent his days on the streets, sometimes working odd jobs and sometimes not, but always smoking marijuana. Shneur described his fears as Shulem shrugged and looked into the distance.

“I’m not a psychiatrist,” Shneur let me know, “but forgetting everything else about smoking, even I know that marijuana is terrible for people with mental illness in the family.”

For someone who wasn’t a psychiatrist, he hit the nail on the head: because for a person like Shulem who had a close relative with schizophrenia, marijuana abuse significantly increases the risk of developing the illness himself. Recent studies have indicated that young people who smoked marijuana even occasionally were twice as likely to develop psychosis over the next ten years as those who didn’t smoke, and those with a parent or sibling affected by psychosis have a one in five chance of becoming psychotic themselves. 

And Shulem wasn’t just smoking marijuana on a daily basis, he had also been experimenting with other substances that were even more dangerous. As he himself would tell me later, the whole experience of his sister’s illness had been crushing for him, and he’d found some solace using coping skills that weren’t particularly safe.

“Tatty! I’m not frum like you! Yiddishkeit isn’t for me, I hate yeshivah and I hate all of this!”

Shneur nodded toward his son and stood up to leave so that I could speak with Shulem alone.

“I hate you,” Shulem muttered as his father left the room.

“What?” He glared at me. “What do you want from me? Yeah, I get it! My sister’s crazy and so you’re worried I’ll become crazy too. But hey, isn’t it true that my sister is still sick even though she takes her pills? Plus taking those meds almost killed her at least twice — so what do you care if I smoke a little grass?”

“Shulem,” I told him, “everything has its pros and cons. Psychiatric medications, eating pizza, even crossing the street. But we need to be honest here — the stuff you’re putting into your body carries a very real risk that you’ll develop schizophrenia.”

“And that I’ll become crazy like my sister? You know that the meds did that! If psychiatry is so great, why is she still so sick?!” Shulem began to sob. “Do you know what it’s been like for me that everyone in the neighborhood has been making fun of my sister since before my bar mitzvah? Do you know how that makes me feel? My big sister was the best. She was incredible. And now she’s just crazy. All they ever did in yeshivah was laugh at her, so I was outta there.”

I opened my mouth to speak, but Shulem stood up and was already halfway out the door. 

“Shulem,” I called, “I have an idea.”

“Me, too.” He looked back at me. “Leave my family alone.”

But my idea was a good one and I couldn’t really leave it alone, so Shneur and I discussed a plan to meet once more.

But Shulem was unwilling to come back: He didn’t trust psychiatrists, he was angry at his father, and the drugs he was putting in his body were doing a decent job of dulling any motivation or desire to move forward. Still, everyone has his price, and he eventually agreed to meet me once more, on condition that his father would buy him tickets to Switzerland for a weekend of skiing. And so, after some negotiation, the two of them walked into my office together, Shulem sitting down defiantly in the chair opposite me. 

After a few minutes of dancing in circles, I got up and went to the door. “Just give me one minute, I need to get something,” I said as I closed the door behind me with one hand and beckoned to my next patient with the other. 

I returned a few seconds later with Leiba at my side.

“What is this?!” Shulem shouted, nearly falling off his chair. 

“I’m not a psychiatrist,” Leiba said, “but I think it’s called an intervention. Shulem, I know how hard it’s been for you to be a part of this family while I’ve been ill. But now you need to listen to your big sister who’s telling you that it’s time to make a change if you want to live the life you want instead of repeating my life’s challenges.”

Shulem was stunned and sat frozen as tears welled up in his eyes.

“Shulem,” she continued, “it’s not about frumkeit or Tatty or Bnei Brak. It’s about your brain and doing everything you can to avoid becoming so sick that you need a psychiatrist in the same way that I do.”

She may not have been a psychiatrist but she sure knew the right thing to say.

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 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

(Originally featured in Mishpacha, Issue 803)