Sury Silverstein called me after hearing a talk I had given a few months earlier in Har Nof about decreasing the stigma of mental illness. Apparently she wanted to book an appointment, but there was one important condition.

“Promise me you won’t force me to take any medications and I’m happy to come meet with you. I don’t want anything interfering with my brain — I’ve been warned about what meds can do.”

“I don’t force anyone to do anything,” I responded honestly.

“Good… so no medications then, Dr. Freedman?”

“Well, I can’t really promise what I’ll recommend to you, as I don’t know anything about your case right now.”

Click.

An hour later she called back and told me, “I’d really like to schedule an appointment but I don’t want to take any medications and I’m afraid you’ll tell me that I have to take them.”

“Mrs. Silverstein,” I said, “I don’t force anyone to do anything. I don’t ram medications into their stomachs, I don’t do shots, and I don’t do hypnosis to force folks to do my dirty work.”

“Good… so no meds then?” she asked, obviously anxious and repeating her plea from earlier in the day.

“Mrs. Silverstein, I’m not known as a reckless over-prescribing slave to the pharmaceutical industry. But I do a thorough evaluation and it’s not impossible that I’d recommend a medication as part of your treatment plan depending on your situation, which I haven’t yet evaluated.”

Click.

And then another call two minutes later.

“Let’s just book the appointment and you’ll try your best not to prescribe me anything?”

“Sure, Mrs. Silverstein.” And I meant it. Different people have different treatment preferences and it’s my job as a physician to guide them through their recovery journey according to their wishes, and according to the relevant up-to-date standards of clinical care. Some folks are interested in medication therapy and others aren’t. My goal is to help my patients find the appropriate mix of what they want and what they need in order to get better. Most of the time we can find a happy medium. In fact, I’d say that more often than not it’s the other way around — I might have a complicated case where psychopharmacology isn’t going to be the answer, and it’s my job to set the realistic expectations that medications aren’t a silver bullet or some kabbalistic cure.

Sury Silverstein came in together with her husband, who immediately identified himself as a “psychologist who specialized in the treatment of anxiety disorders.”

Whoa. That was a surprise. Was this part of the puzzle in her adamant anti-meds stand? “Pleased to meet you, Dr. Silverstein,” I said as I stuck out my hand.

“Actually, I’m not a doctor,” he responded. “But I do have a master’s degree in psychology and completed a few courses in CBT.”

“Fantastic. So why don’t the two of you tell me what’s going on.”

Sury proceeded to tell me about her history. A mother of two young kids initially from Cleveland, she’d always been on the anxious side and was a serial perfectionist. Apparently things had reached a head when she began waking up to wash down the entire house at 3 a.m. shortly after their last baby was born.

She’d been evaluated by a top psychiatrist who recommended treatment with an antidepressant — and apparently her husband had really let the fellow have it.

“I told him that the evidence-based approach suggests that medications are not a cure-all for OCD,” Mr. Silverstein explained. “Cognitive behavioral therapy is the cure and that’s why we told him to stop being a pill-pusher and to start helping people the right way.”

Sury looked down at her feet.

“Did it work?” I asked.

“Kind of,” she answered a bit sheepishly. “I mean I’m a little better, but it’s been a few months now and I’m still a nervous wreck and waking up to start sponja way before dawn.”

“Some people with more significant OCD need a mix of medication and psychotherapy treatment,” I explained. “In fact, the research shows that this is the best and most effective treatment strategy.”
“I’m familiar with the data, Dr. Freedman,” Mr. Silverstein interjected.

“Then it sounds like this is the right plan, to try a mix of medication and therapy,” I responded.

“Dr. Freedman, with all due respect,” he continued, “my wife doesn’t need treatment with any chemicals.”

“Mr. Silverstein, it’s very clear to me that you’re well versed in the field and want the best for your wife,” I said, doing my best to avoid an argument, which wouldn’t help either of them. “Let me tell you a quick story. I’ll never forget back when I was in Boston and a young couple came to me for marital therapy. Given that they were close to my own rebbi, Rabbi Naftoly Bier, and members of his kollel community, I had no idea what they were doing in my office. ‘Shalom bayis is Rabbi Bier’s forte,’ I told them, to which the husband responded that they needed a ‘professional, not a rabbi. He doesn’t have a degree and you were trained at Harvard.’ I politely let them know that Rabbi Bier was the best man for the job, and I told him to take the check he had written for me and to give it as a donation to the kollel. ‘I’ve been doing this for a couple of years and Rabbi Bier’s been doing it for four decades,’ I said, ‘plus the fact that all the psych professors at Harvard are on their third or fourth wives by now. Rabbi Bier is tocho kevaro.’ ”

Mr. Silverstein looked back at me and then at the floor. “You know how much I love my wife, Dr. Freedman.”

“Of course I do, Mr. Silverstein. Baruch Hashem, she has such an amazing husband who has scoured all the research to help her as much as possible.”

“It’s my job,” he said proudly.

“Wrong,” I said firmly and then paused as they both looked at me, shocked.

Before I could speak, Sury lowered her voice and said to her husband through her tears, “I need you to be my husband. That’s your job and you’re the only one who can do it. Picking the right treatment is Dr. Freedman’s job.”

Mr. Silverstein wiped away his own tears and looked at his wife, nodding his head in tacit agreement.
I had no doubt that we were finally on the right track.

Originally featured in Mishpacha, Issue 734. 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.