"Who told you to stop taking your meds, Moish?"

H

is name was Yekusiel Shemaya Tuvia Moshe Wein.

“But you can call me Moish,” he said, with an air of someone who’s been through it enough times that he reflexively explained, “I’m named for a few different elter zeides, and I was also born on Zayin Adar, so my father shlita thought it was a good name. But like I said, just call me Moish.”

And so I got to meet Moish, an older bochur with a history of OCD who had been at the same chassidishe yeshivah for the past seven years. Moish had come for a consultation regarding his medication regimen, and his story was pretty straightforward: He was a “checker,” and a slave to his fears of missing something when it came to kavanos or halachos. His was a textbook case of the bochur who was still adjusting his tefillin for Shacharis three hours later, and would miserably repeat the same tefillah over and over to ensure he’d pronounced Hashem’s Name correctly. He hated his life and was on his way to hating Yiddishkeit.

And who could blame him? The poor guy could barely get through Shacharis before 2 p.m.! How could he possibly feel any connection to a supremely loving Eibeshter?

But Moish had a history of good response to treatment and had seen top clinicians in the past. So it was a bit of a puzzle as to why he hadn’t been able to successfully move on, given his success in some exceptional treatment programs. And yet here he was in my office, asking what sounded like a first-time question.

“So what medication should I take?”

“Well, according to the medical history I have in front of me, I’d say the same one that worked for you when you tried it last year, Moish,” I answered.

“Oh,” he nodded sheepishly. “I guess that makes sense. There’s nothing new out there in the past year or so?”

“Why would you need anything new, Moish? You’ve had a good response to this in the past.”

“Yeah. I guess you’re right.”

Apparently Moish had taken the same medication on and off for years. The high-dose antidepressant had been excellent for him. The mystery of Moish’s case wasn’t “what medicine should I use?” rather it was “why do you stop taking it as soon as you’re doing well?”

And so I asked him point-blank: “Moish, it seems like every time you take your meds and start doing better, something happens and then you stop. The worrying and checking come back and then things are a disaster all over again. How many times has this happened? By my count it seems like at least three separate times since you started yeshivah gedolah. Why, Moish?”

Moish blushed and looked at the floor. “Four times, Dr. Freedman. I know it seems crazy. But, well, it’s complicated.”

“How about we bring in your family to discuss it? I’m sure that having them on board to support you can help break this pattern and give you a chance to maintain some serious success once and for all.”

Moish was palpably embarrassed. “My mother passed away a few years ago. Shprintza bas Tuvia—”

“Oy, I’m so sorry, Moish. But what about your father then?” I asked.

“He’s very busy. He’s not coming in.”

I let it be for the time being and filed it away as something to be explored later. But after a few months of treatment and significant improvement, it looked like we were headed for crash number five when Moish came in to tell me that he had “forgotten” his medication for a few days.

When I sought to clarify, Moish admitted to having stopped his medication again two weeks previously. Remembering previous conversations, it suddenly hit me. “Moish, who told you to stop the medications now that you were doing better, and it looked like you could start shidduchim?”

“Hey, how’d you know?” Moish asked with notable surprise.

“Was it your father who told you to stop the meds, Moish?” I asked gently.

Moish was quiet.

“Your father, he doesn’t believe in treatment?”

“He’s not some sort of idiot, Dr. Freedman. He’s actually a choshuve dayan in our chassidus.”

“So what makes him think that stopping your medication is such a chiyuv, Moish?”

“He thinks that this is all because my mother died, that it’s just ‘nerves’ and not OCD. I keep telling him that it’s not, but he made up his mind that I started having these episodes after she passed away, even though I remind him that I had these symptoms even before the car crash.”

“I’d like to talk to him.”

“Well, he’s pretty busy. All appointments go through the gabbai.”

“Moish, as your doctor, I have an achrayus to make sure you get healthy and stay healthy. If you think your father is a major roadblock in you conquering your OCD, then I need to get this through to him. How about I go pay him a visit?”

“You’d do that?” Moish looked like a ton of bricks had just been lifted off his shoulders.

Moish let me know where I could find his father and what times he was available for sh’eilos. I found a night that worked for me, and waited my turn in the beis medrash outside the Dayan’s Bnei Brak office, until I was summoned inside.

“What can I help you with?” Dayan Wein asked with the brevity I might have expected from a chassidishe dayan surely surprised to find an American-looking fellow sitting across from him at the end of receiving hours.

“Kevod Dayan Wein,” I began, “my name is Yaakov Freedman and I’m a physician in Yerushalayim.”

“Nice to meet you, Dr. Freedman. It’s pretty late for someone who has to work in the morning, so what can I do for an American doctor from Yerushalayim at midnight in Bnei Brak?” he said through a warm smile.

I first asked him a sh’eilah that had actually been on my mind regarding patients who are too fatigued to daven Maariv and regularly fall asleep before sunset in the summer. Dayan Wein offered a sensitive response, including some thoughts about the concept of “onus patur min hamitzvah,” when a person is “forced” or trapped by circumstances, and then gave me a brachah that I should always have koach to daven Maariv b’zeman.

“Amen. Thank you, Dayan Wein,” I said as I prepared to ask the more uncomfortable question: “And what about someone who doesn’t manage to daven on time because his illness sidetracks him? Someone who could clearly benefit from treatment but his parents don’t feel it’s the right derech for him? Is he also considered an onus who is patur min hamitzvah?”

Dayan Wein closed his eyes for a moment as he sought to mentally access the relevant sugyos. Moments later he asked, “But why does it have to be a conflict? Can’t there just be an open discussion with his family on how to best help the patient? Clearly a doctor who is a baal yiras Shamayim like yourself should be able to speak with the parents to help them understand why you’ve made the treatment recommendations that they are opposing.”

“Dayan Wein, may I give you the name of a patient who needs a refuah?”

“Certainly, Dr. Freedman.”

“His name is Yekusiel Shemaya Tuvia Moshe ben Shprintza.”

Dayan Wein looked up in shock, then began to stroke his beard silently, while I waited for his response.

“Okay, Dr. Freedman, you win. If it’s this important that you’re willing to schlep out to see me on your own time, then I’m willing to listen to how you want me to help my son.”

At that point, I knew we’d all win.

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

Originally featured in Mishpacha, Issue 768. 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