Elazar was a big mensch who spent his entire adult life balancing dozens of different things. He still kept his daily Gemara chavrusa, managed a team of six tech guys for his brother-in-law’s business back in the States, and was a loving husband, father, zeidy, brother, and son.

But there was a strong family history of depression, although Elazar did his best to protect his mental health, maintaining a strong regimen of healthy eating and sleeping, daily exercise, and harnessing the power of positive thinking.

Elazar had been to his share of psych wards with his mother and older brother Yehudah, both of whom suffered from serious mental illness. He’d witnessed nissim too, watching as his mom bounced back time and again with psychopharmacology. He’d also seen the horrors of psychotic depression, and how even electroconvulsive therapy wasn’t enough to save Yehudah from his eventual passing in a single tragic leap.

Elazar had been a stalwart force of stability in his otherwise unstable family. He’d worked throughout yeshivah to support his younger siblings after his father passed away, served as the medical guardian for his mother, and had successfully married off his sisters into good families.

And yet, as much as he tried to keep things stable for his family, life had become full of unforeseen challenges. First came his brother-in-law’s diagnosis of lymphoma and the added financial stressor of supporting his sister’s family during the costly treatments. Then came the difficulties that his second son was having in yeshivah. “Nothing a bit of tefillah can’t fix,” he told himself and set to work tutoring Yossi every night after Maariv before he headed off to the moonlighting consulting work he’d taken on to meet the additional expenses that landed in his lap.

With a few extra gam zu letovah’s each day, Elazar managed to stay afloat, but a tough quarter for the business led to some downsizing at work, and the 10 percent pay cut for supervisors hit him harder than he thought when he realized he couldn’t afford to purchase a new car after his sedan’s transmission died. Around this time, he found that his stomach started to bother him and wondered if it was due to the brisk walk to work right after breakfast. But when it persisted even on the days when he got a hitch with a neighbor, Elazar began to get a bit nervous.

He’d had a normal colonoscopy at age 50 but was scared enough that he headed back to his family doctor, who sent him to a gastroenterologist. In the absence of any clear physiological symptoms, the gastroenterologist was quick to recognize the connection between Elazar’s stress and his upset stomach. Put together with his difficulty sleeping, lack of energy, and all of the challenges that seemed to slam Elazar at once, his physician had no question that a referral for psychiatric treatment was necessary: The man was suffering from acute anxiety.

Elazar, though, didn’t appreciate the diagnosis. “I know what depression is, Dr. Freedman, and I’m telling you, this is not depression,” he told me right off the bat.

“So how about telling me what’s going on then, Elazar.”

“Well, baruch Hashem, I guess I don’t have stomach cancer, but I have to run to the bathroom about 15 times a day. I cut out caffeine, started eating more fiber. I did all of the things that the gastroenterologist asked me to do,” Elazar insisted, “but nothing’s really worked. Still, I’m telling you, it’s not depression.”

“So what do you think it is?” I prodded.

“I don’t know, I guess I’m stressed.”

“Elazar, I would say that this is more than just stress. You’re really suffering and it’s taking a toll on your body. I mean, I’m the third doctor you’re seeing because of how stressed out you are.”

“My whole family suffers from depression: grandparents, mother, brother, everyone. But believe me, I’m not like them,” he said as tears began to roll down his face. “I’ve always been the strong one. I’m the ‘gam zu letovah’ guy who stays positive and figures out how to get through everything…. Oy, this is the first time I’ve cried since I fell riding a bike back in third grade.”

I felt for Elazar. He was clearly overwhelmed with a bad case of anxiety. He built a career out of a being the bulwark of strength for his family and now he was snapping under the pressure.

“Elazar,” I said as I took his hand, “just because you’re struggling now doesn’t mean that this nisayon is what defines you!”

“Okay, so what do I do — take Prozac and call it a day? Am I just a psych patient now? Fifty-two years of being a baal yiras Shamayim, father, brother, son, husband, zeidy, and now I’m a psych patient?”

In his mind, he had a good point. It would be easy to call this slide into clinical anxiety a “failure.” But this was also the story of a man who’d done an amazing job of keeping his family together and had finally shown his mortality, which is a very human thing to do.

“Prozac or no Prozac, you’re not a ‘psych patient,’ Elazar. You’re a family man, a baal chesed, and a good Yid. Coming to see a psychiatrist doesn’t make you a ‘psych patient,’ it makes you a human being — and who doesn’t need help at some point?”

I saw that Elazar needed a little cheering up, so I figured I’d tell him a story. “I remember going to L.A. as a kid and seeing a famous street performer there — a guy who used to juggle a bowling ball, a watermelon, and a chain saw. Probably a bad idea, but he did it expertly and in the end he even added a tennis ball or two before the finale, where he’d throw up the chain saw, which cut the melon in half, and then sell slices for ten bucks apiece. That was one expensive piece of watermelon.”

“What’s pshat on this, Dr. Freedman?”

“The guy was an expert, the best out there, but he could add two tennis balls and not three. Even Mr. Chain Saw-juggler had his limits and breaking point.”

“So I pushed passed my limit?” Elazar asked.

“Look, not that Prozac would help you juggle those extra tennis balls anyway, but you need to find some ways to decrease stress in your life and get back on your feet. After all, you’ve got a classic case of anxiety overload. Would therapy help? Absolutely. Would medication help? Probably, given your family history of positive response to treatment.”

Elazar calmed down, and finally felt open enough to make an appointment to discuss and map out a treatment protocol. And as I closed the door behind him, I sat down to ponder what happened to the chain saw-juggler — and whether or not he’d retired before realizing that adding three tennis balls was too much.

Originally featured in Mishpacha, Issue 732. 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.