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No X-Rays Here

“We’re fighting all the time. This just isn’t the woman I married”

Dr. Yedidya Levy, an American radiologist living in Jerusalem’s Katamon neighborhood, contacted me to help him with a rough spot in his marriage.

“We’re fighting all the time. This just isn’t the woman I married,” Dr. Levy told me during our first visit.

He described what sounded like a standard story: They grew up together in Woodmere and had begun dating while he was a senior medical student at Albert Einstein College of Medicine. They got married during his residency while she finished her degree as a physical therapist.

“We had an amazing beginning to our marriage,” he told me, “Shabbos with our parents, Yamim Tovim with my whole family at a hotel in Miami, and even though I was working all the time because of my training, her sister was in the same building so she was always busy with her family.”

He described how they had always wanted to make aliyah. “We had two daughters, I finished my training, and now we’re in a great community with our own home — our dream come true.”

Life looked great on paper but it was clear that Dr. Levy was suffering. He described his wife as cold, short-fused, and “completely without any hakarat hatov.” When I asked him if there was anything he might be doing to contribute to the situation, he looked like a befuddled radiologist intern who couldn’t read the scan.

“I guess I get a bit frustrated when all she does is tell me how miserable she is, but Dr. Freedman, I honestly have no clue what I’m doing to torture her to the point where she tells me she’d be better off dead.”

Hearing a few more details, I had a gnawing suspicion that Mrs. Levy might need more than marital therapy.

“Does she suffer from any mental illness?”

“Of course not, Dr. Freedman. I mean, she’s not a crazy person like the ones I treated at a prison hospital back on my psych rotation in med school. She’s a great girl from a great family. What we need is couples’ therapy.”

I wasn’t sold, and requested that Mrs. Levy come in separately. When she arrived, it didn’t take more than a few seconds before she burst into tears, telling me how unhappy she was, to the point of considering taking her life. As it turned out, my hunch was correct — Mrs. Levy, it appeared, was suffering from severe depression as well as ongoing anxiety attacks. It turns out this wasn’t her first bout either, having been in therapy previously with a milder episode after the birth of their second child.

Mrs. Levy felt liberated when I gave her sadness a name. She loved her husband and felt terrible for the yelling, crying, and blaming that came with her depression. The more we talked, the more it became clear that she didn’t really want to die, she was a dedicated wife and mother, but was suffering from a serious mental condition. She knew her husband was supportive and dedicated and it seemed the only crime he was guilty of was mistaking his wife’s depression for “a lack of hakarat hatov.”

I called up Dr. Levy and put him on speaker as I discussed the plan: His wife would begin treatment with an antidepressant and I would refer her to a colleague for cognitive behavioral therapy. We’d make sure she was getting enough sleep and cardiovascular exercise and she’d check back if there were any questions.

“The enemy is the illness, not your wife,” I told him. “You wouldn’t blame her if she got cancer, chas v’shalom, and you can’t blame her if she developed a mental illness. Your job now is to help her tackle this depression, and not let it kill your marriage.”

We agreed to follow up in another three weeks. At that appointment, Mrs. Levy appeared to have had a limited improvement, so we increased the dose of her medication.

Baruch Hashem, things improved significantly by the third visit. Dr. Levy was overjoyed — Mrs. Levy had joined a gym, was going to a daily aerobics class, and was volunteering as a physical therapist at a local geriatric clinic. She was comfortable with her CBT therapist, and most important, things at home were much calmer. We planned to meet again in another month.

At our fourth visit, the good news continued.

“I’m back to my old self,” Mrs. Levy declared, smiling expansively at her husband.

“She’s certainly not crazy!” he exclaimed and then caught himself, “I mean, she’s great. She’s definitely ready to come off the medication now that she better.”

I didn’t want to crash the party, but here was a woman who had been in a deep depression less than two months ago and would be at a significant risk of symptomatic relapse if she stopped treatment.

“Baruch Hashem, you’re doing fantastic, Mrs. Levy. It’s really been a miraculous recovery,” I responded. “And that’s why it’s so important to keep up with the treatment that’s helped you so much.”

“But I’m feeling better now, Dr. Freedman.”

I understood completely. As a general rule, no one wants to take a psychiatric medication — certainly not someone who’s feeling good. Mrs. Levy had experienced an exceptional recovery and the dark times of her depression had become an unwanted memory. And yet the scientific research was clear: Patients who continue their antidepressant medications for a significant time period after symptom remission are less likely to experience another episode of their depression. On the flip side, patients who stop their meds prematurely — and don’t slowly decrease the dose of their medicine with the help of a psychiatrist — are more likely to have a subsequent bout of depression. Even more concerning is the risk that a relapse can be more difficult to treat.

Dr. Levy laughed nervously as he tried to dismiss my explanation.

“Dr. Levy, two months ago your wife was suffering to the point where she couldn’t go more than a few minutes without feeling she’d be better off dead. Recovery takes time.”

“Yes, but now she’s fine.”

“Dr. Levy, there are no X-rays in psychiatry. Three months ago, you missed the diagnosis of severe depression and were convinced you had a shalom bayis problem. Don’t blame yourself, though — doctors make great advocates for their loved ones but aren’t always the best diagnosticians. So trust me when I tell you that the treatment of depression must continue for months even after the symptoms have resolved.”

Dr. Levy heard what I was saying but was still torn. He obviously didn’t like the idea of a wife on psychiatric meds.

“Dr. Levy, mental illness isn’t a curse or something to be embarrassed about. One in three people will experience some type of psychiatric or substance-abuse issue at some point in their life. With all of the research supporting evidence-based treatment, the main thing is to fight our own personal stigmas and to make sure that we focus on recovery.”

“Yedidya,” Mrs. Levy gently told her husband, “it’s just like your wealthy zeide always says: ‘Invest, invest, invest.’ Let’s invest in my health now so that we can live a happy life together. I’m fine with it.”

I couldn’t have phrased it better myself. Mrs. Levy was certainly not someone suffering from a lack of hakarat hatov. She was an eishet chayil and a 401k. From the rejuvenated look on Dr. Levy’s face, it seemed he felt the same way.

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 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

(Originally featured in Mishpacha, Issue 777)

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