Something was strange about Shachna’s tears, however. It actually looked as though he was crying out of sadness and not laughter.

Rabbi Silver was a special mechanech who ran a great place for mainstream yeshivishe bochurim in Jerusalem.

I’d seen some of his talmidim as patients over the years — no terrible stories of overdoses, violence, or jail time. Rather some isolated cases of anxiety, OCD, and mild-to-moderate depression in “good kids from good families,” as Rabbi Silver described it. And while these conditions often go unnoticed and untreated, Rabbi Silver had his finger on the pulse of each of “his” bochurim and was highly astute when it came to decisions about intervention.

I’d once given a talk at his yeshivah about making sure to avoid “flipping out” — getting far too frum too fast — and then imploding from all the chumros and commitments like memorizing an unrealistic number of Mishnayos while refusing to return to their mothers’ homes in Flatbush over kashrus concerns.

I had ended the talk with an admittedly corny joke that was met by smirks and groans, and by Rabbi Silver urging me to “keep on being a psychiatrist and to give up the dreams of standup comedy.”  We had a good laugh and called it a day.

And then a few months later I got a phone call from Rabbi Silver asking if I could see a special case.

“It’s my brother,” said Rabbi Silver. “He’s a lovely man…”

I waited for the “but” as Rabbi Silver paused for several very long seconds.

“…but it’s strange, Dr. Freedman,” he continued.  “Something strange has happened to him over the past half-year or so and it’s only getting worse. You see, it’s just that… well, I don’t know how to say this, but, I mean…”

“It’s okay to say it,” I said, imagining all sorts of embarrassing, illegal, unsanitary or otherwise uncomfortable things he might reveal.

“Forgive me, Dr. Freedman, for saying it, it’s just that he’s developed an awful sense of humor with all sorts of terrible jokes — a bit like your puns — and I don’t know, I figured he might need a psychiatrist,” Rabbi Silver said, half laughing and half serious.

“I don’t take your swipe at my humor personally,” I smiled. “And everyone can use a good psychiatrist once in a while — after all, even the earth is bipolar.”

Rabbi Silver did me the courtesy of laughing, but hung up before I could ask him how many psychologists it takes to change a lightbulb.

The following week, Rabbi Silver arrived with his brother Shachna, who had a wide smile on his face and stuck out his hand to shake mine. I filed away the lack of vigor in his greeting, not exactly in line with the laughing face.

Shachna told me about how he came to Eretz Yisrael as a bochur with his family, how he learned in Slabodka before he got married, and how, after a few kids, he joined the family business and opened a branch of shatnez testing in his town.

I figured now was as good a time as any to test the waters and told him the story of the new suit I’d bought that was 85 percent wool, 10 percent linen, and 5 percent other fibers. “I tell ya, HaRav, it’s that ‘other fibers’ I’m worried about — who knows, this could be shatnez gamur!”

Rabbi Silver feigned a smile but Shachna was laughing heartily. “That’s a great one, Dr. Freedman.”

“Did you hear about the bull that came to my shul on Shabbos and wanted to be the chazzan, Reb Shachna?” I asked, barely able to hold my laughter back as I led with my most epic set of dumb jokes. “He asked if he could daven moo-saf.”

Shachna was crying by now, as I continued to his brother’s dismay. “I asked if he was serious and you know what the bull told me? ‘I’m shor.’ Get it? He’s a bull. Not bad, huh?”

Something was strange about Shachna’s tears, however. It actually looked as though he was crying out of sadness and not laughter. Not that my jokes were any good, but I had a thought and decided to continue.

“So I asked that bull to come back to my house for lunch and he asks me, ‘Do you mind if I drive?’ and I said, ‘Buddy, it’s Shabbos, you can’t drive,’ and he tells me, ‘I’m a cow, I’ll come ba-kar.’”

Shachna suddenly began laughing again which was further evidence of my suspicion.

“Reb Shachna, do you even like these jokes? Or do you just find yourself laughing anyway?”

He looked at me with an off-grin and said honestly, “A bit of both, Dr. Freedman. I mean, I started getting this crazy love of terrible jokes a few months ago, but I also feel like I started laughing randomly as well.”

“And crying too?”

“You’ve got it,” he confirmed.

I stopped my joking and explained to Shachna and his brother about a bizarre neurological condition called pseudobulbar affect (PBA), the primary signs of which are frequent, involuntary and uncontrollable outbursts of crying or laughing — often in response to a mildly amusing comment or joke which others don’t even see as funny. It usually happens in people who’ve suffered a brain injury or trauma, or certain neurological changes.

Rabbi Silver looked a bit nervous. Shachna smiled but it was hard to tell what he was experiencing internally.

“Does that also explain why I think so many of these ridiculous jokes are funny?  I mean, why would anyone laugh at stuff like ‘Dr. Sheep’s baaaahd puns?’” Shachna asked as he burst into giggles.

“Well, that’s actually a corollary condition, something called ‘Witzelsucht,’ or ‘addiction to wisecracking,’ another odd neurological symptom where someone suddenly finds puns and other not-particularly funny jokes absolutely hilarious.”

“Do you have that problem too, Dr. Freedman?”

“Well, my father loves weird puns and so did my grandfather of blessed memory, so my bad jokes might be hereditary, but that starts at an early age. Reb Shachna, I think here we’re looking at something else.”

“No one in my family thinks my jokes are funny,” laughed Shachna. “I wonder what’s causing this? Do you know, Dr. Freedman?”

I think I did.

“Reb Shachna, I wonder if the weak handshake you gave me suggests that maybe you have some sort of neurological problem that’s affecting your cognitive and motor functioning,” I said gently. “Both of these conditions are most commonly seen in patients with some kind of frontal lobe damage or trauma, and often in people who’ve suffered a stroke or brain hemorrhage. The extreme reactions are related to the complex processing of the brain that lies behind a joke, the hoops the brain jumps through and the incongruity in the punchline. That might be triggering a dopamine kick that makes you collapse into fits of giggles. “Reb Shachna, I think we need to get you to a neurologist for an evaluation and an MRI.”

Shachna began to cry and told his brother, “These are real tears.”

We sat quietly together for a while longer before I provided him with a referral for a top-tier, compassionate neurologist who would be able to do a thorough neurological assessment and find out what was causing these symptoms.

“Sometimes they call it a ‘divine comedy,’ Dr. Freedman,” said Shachna.

“Man tracht und Gott lacht,” I responded. “Man plans and Hashem laughs.”

“Or sometimes, ‘Hashem plans and in the end, we’ll all be laughing,’” added Rabbi Silver.

Shachna smiled and shook my hand as sturdily as he could before leaving me with his parting words. “Honestly, I’m scared. But even so, this smile is a real one, Dr. Freedman.”

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, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills around Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 872)