Dr. Reishman was a well-known pulmonologist in the Jerusalem area who was revered for his clinical expertise as well as his bedside manner. I had initially heard of him from a chassidish social-worker colleague with whom I’d been working for the past few years. Dr. Reishman was well known by the medical askanim, who cited him as an example of “a real Rambam-type doctor who is a both a talmid chacham and a great physician.” He even gave a daily daf yomi shiur for the Anglo community at the local shtiblach every evening after Maariv.

So when I was dealing with a yeshivah bochur who, in addition to some emotional issues, wasn’t getting great care for his cystic fibrosis, I figured I’d introduce myself to Dr. Reishman. Baruch Hashem, Dr. Reishman was just as good as his reputation, and both my patient and I were grateful for the consultation.

About a month later, I was pleased to hear Dr. Reishman’s voice on the other end of the phone line.

“Shalom aleichem Dr. Reishman!” I picked up. “What can I do for you?”

“I’d like you to see a consult for me, Dr. Freedman,” he began. “A nice young man, tough case of depression that just isn’t getting better.”

“I’d be happy to return the favor,” I responded. “Maybe tell me a bit about the patient — how long have you known him?”

“About 19 years now,” Dr. Reishman said and then paused somewhat awkwardly. “You’d see my son for a consultation?”

And why not? I’d worked with dozens of doctors, their spouses, and their children. “I’d be honored to work with your son, Dr. Reishman,” I answered.

And with that he proceeded to tell me the story of his son, a former superstar who’d been pretty much stuck for the past half year. Akiva Reishman was the fourth son of his parents and had done well in the chareidi Talmud Torah system. He’d hit all of his developmental markers on time, had plenty of friends, and excelled as a baal korei.

“But now Akiva is stuck — he needs to pick himself up and get his act together,” described Dr. Reishman.

Apparently something had happened around last Succos, when Akiva lost some of his trademark cheishek for yeshivah and began to sleep in through davening. Dr. Reishman knew his son would get over “this little speed bump” and didn’t pay it too much attention beyond a mussar derashah on Isru Chag.

Dr. Reishman and his wife assumed the struggles were yeshivah- related, until they began to notice certain behaviors at home as well when he’d return for Shabbos. Something just wasn’t right — Akiva even stopped eating schnitzel with his normal appetite. And try as he might with his trademark motivational speeches, Dr. Reishman couldn’t get Akiva to snap out of it.

Akiva was feeling particularly blue one Motzaei Shabbos and Dr. Reishman approached him with the idea of going for some kind of intervention. Although he certainly believed that Akiva could plow through whatever was getting him on his own, Dr. Reisher finally conceded that it might be time for therapy. Within a few days, Akiva had begun to work with a psychologist and Dr. Reishman had high hopes that he’d soon be back to his old superstar self.

But therapy clearly wasn’t enough for Akiva — he was drowning in an ocean of depression and couldn’t extricate himself.

“I feel like every day is torture,” Akiva told me when we met. “I have no energy, I’m sad as can be, I feel like I’m wading through a swamp, like I’m trying to climb out of a jar of peanut butter. I mean it’s weird, my body feels heavy and I’m just a mess.”

It presented like a classic case of depression and Akiva was more than willing to follow my recommendations to take an antidepressant in addition to working on a more aggressive therapy regimen. We made up to meet again and Akiva was all right with me speaking with his father.

“You should just know that he thinks I’m a whiner and that if I put my mind to it, I can just ‘snap out of it,’ ” Akiva warned me.

That was actually a bit of a surprise — I would have thought differently as Dr. Reishman was a tremendous clinician and surely understood the biological basis of depression. But Akiva knew his father a lot better than I did.

“He probably convinced you that he’s suffering from severe depression,” Dr. Reishman told me when we spoke afterward. “But I’m telling you, he can snap out of it. Hey, I know my children. This kid is a top bochur, and I’m sure there’s a way out of the self-pity he’s been wallowing in for the past half year.”

“Dr. Reishman,” I told him, weighing my words carefully, “you’re obviously a caring, hands-on father and probably the first to intuit if something were wrong with one of your children. I’m sure you checked his labs to make sure he’s medically healthy?”

“I did, and his iron, thyroid, and other hormonal functions are fine,” replied Dr. Reishman.

“Baruch Hashem,” I agreed. “But you know, he has a number of telltale symptoms of depression including the lack of energy, appetite, and focus as well as the increased need for sleep. These things don’t show up in lab work. And it’s not just a rut he can pull himself out of if he tries hard enough. Akiva is mamash suffering. Enough so that his mental health is taking a toll on his body. The poor guy looks like a wreck and feels even worse. I know your son seems like he’s just stuck in a rut, but here’s a kid who was doing great and then began to slide into a profound dysfunction. The kid is depressed and suffering from a serious medical condition that needs evidence-based treatment just like any patient you have in your office. Tell me, have your pep talks helped at all?”

Dr. Reishman was silent and clearly taking a moment to think about his next move. His medical credentials were tops, surpassed only by his Torah scholarship, but here was the tricky thing — when it came to his own child, he just couldn’t seem to come to terms with a mental health diagnosis. He eventually tried to counter me: “In my field we have pulmonary function tests, radiology, physical examinations, and other tools to make a diagnosis—”

I felt bad cutting him off before he finished but I knew where this was going and wanted to save him his breath. “Dr. Reishman, you’re an excellent clinician, you have decades of experience and can diagnose a case of obstructive pulmonary disease from the sound of the cough even before the patient walks in the door. True, while the diagnostic tests behind psychiatry are still a few years away from prime time, your son has a classic case of depression and trying to get him to ‘snap out of it’ is like asking a patient with pneumonia to ‘breathe through it.’ ”

I heard a long sigh on the other end of the line and waited for Dr. Reishman to answer me.

It eventually came. “Dr. Freedman, I love my son and want to help him. But I admit, mental health pathology is way out of my purview…. So tell me, with my black-and-white attitude about medicine, how can I be supportive of my son in getting him the kind of help he really needs?”

“Dr. Reishman, you’re already halfway there.”

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

Originally featured in Mishpacha, Issue 751. 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