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Pick Your Battles

"He’s like a goy... he has this picture of an animal on his neck!”

 

 

Ahrele was a young man from a chassidish family who’d suffered abuse at the hands of a relative, dropped out of the frum world, stumbled on the idea of psychedelic drugs to self-medicate, and ended up in the locked ward of a psychiatric hospital. Part III

 

It was a year since Ahrele’s release from the psychiatric hospital, where he’d found himself after taking psychedelic mushrooms and experiencing a psychotic episode. The week he spent on the ward was a nightmare no one wanted to remember.

But anniversaries can be hard to forget, and while I had the dates right in front of me as I looked over his medical chart during out appointment, Ahrele was the one to bring it up.

“So, Dr. Freedman, you know it’s been a full year since I was at the hospital?” he said matter-of-factly as he sat across from me. “What a wild experience that was.”

He wasn’t kidding. He was the one who suffered as a patient, but I was right there with him in the trenches, managing his treatment alongside the inpatient team of doctors, nurses, and therapists. It was a tough week but we eventually found the right antipsychotic medication to control his agitation and facilitate a discharge plan. His prognosis was uncertain given the intensity of his delusions, disorganization, and violence, but Ahrele slowly returned to himself in the weeks that followed his discharge and we were able to slowly reduce his medication.

Given the lack of persistent psychotic and mood indicators, Ahrele’s symptoms appeared to be strictly a result of his hallucinogen use, and not an indication of an underlying psychotic condition. Whereas someone who had the genes for schizophrenia or bipolar disorder might have had more persistent symptoms, Ahrele’s delusions were gone relatively quickly, it was a purely drug-induced psychosis as opposed to a primary mental illness. And yet the fact that he had such a severe, ongoing reaction wasn’t a good sign: many people — including his friend Tamir who had supplied the drug — don’t end up in a psychiatric hospital when they trip out.

We therefore continued his antipsychotic meds at a low dose for the next few months before tapering off slowly, following a discussion with his father, Reb Leibush, about the benefits and risks of the decision. It was certainly a move that required caution and ongoing monitoring, but baruch Hashem Ahrele did well. There were no signs of the paranoid delusions and disorganization that would suggest an underlying mental illness, and as time went on, Ahrele began to recreate a life for himself.

It might not have been the life the people in his parents’ chassidish kloiz would have expected from a fellow in his early twenties who’d grown up among them, but given where Ahrele had been, I would say he was doing great. He had gotten rid of his old friends — including that fellow Tamir who had given him psychedelic drugs to begin with — and had surrounded himself with an interesting group of ex-chassidish young men who at this point weren’t particularly serious about Yiddishkeit but happened to be quite dedicated to their own personal wellbeing.

Ahrele had returned to the gym, where he dedicated himself to a three-hour daily workout with weights and had also added martial arts, yoga, and a healthy vegetarian cooking class to his schedule. A young man with a gutte kop and an entrepreneurial streak, Ahrele began to pick up others like himself who were hanging around the gym, and started a business as a personal trainer. He developed a reputation for demanding strict discipline and sobriety and was respected by his new chevreh, drawing clients from across Eretz Yisrael to the gym in Jerusalem where he worked out with and mentored the young men.

I was happy to see Ahrele pull himself together so well over the course of the year and expected a similar assessment from Reb Leibush when he booked an appointment to discuss his son. But I’ve been surprised before and Reb Leibush wasn’t one to let me off easy.

“You call this good? He’s still a mess!” Reb Leibush seemed both hurt and angry. “Have you seen him? No Shabbos, no kashrus, no—”

I cut him off because I didn’t need to give him any more momentum. “Well, at least he can’t mix milchig and fleishig because he’s a vegetarian.”

“This isn’t funny, Dr. Freedman. He’s like a goy... he has this picture of an animal on his neck.”

I needed to find compassion for Reb Leibush, even though I felt he’d clearly missed the boat on this one and needed a bit of a perspective jolt. “Reb Leibush, I agree that his Yiddishkeit isn’t where we hoped it would be. And while he still has that tattoo of a lion on his neck, Ahrele is no longer a wild beast — he’s achieved a level of yishuv hadaas and internal calm that’s quite impressive for a young man who went through what he did. He’s sober, he’s working—”

“And he’s basically a shegetz!” Now it was Reb Leibush’s turn to cut me off.

We were both quiet for one of the longest moments I can remember, until Reb Leibush broke his silence with barely a whisper. “He’s a goy because I didn’t stop my brother from hurting him — what did I know? No one knew back then about this stuff. We didn’t talk about it.”

I couldn’t absolve a sobbing Reb Leibush of the guilt he felt because I didn’t know the specifics of the inter-family dynamics. Instead I responded honestly, “If you had known about what was happening you would have handled things differently.”

“I would have done anything to protect my son,” he cried softly.

“Then protect him now, Reb Leibush,” I offered. “Don’t break him further by having this sort of conflict with him over Yiddishkeit. Be happy that he didn’t fry his brain with psychedelic drugs, be grateful that he doesn’t have schizophrenia, thank Hashem that he’s doing the best he can do right now.”

Reb Leibush heard me for the moment and thanked me for my time. A bit of perspective can go a long way, and whether or not Ahrele had a ponytail or peyos was, in my opinion, a far better issue to wrestle with than questions of mental illness, suicide, and drug addiction that could have just as easily been the topic had things gone slightly different. This was easily a young man who could have ended up with chronic schizophrenia, heavy substance abuse, and other challenges beyond Shabbos and kashrus. We definitely had work to do, but it was work that we’d be able to handle without the added complexity of serious psychiatric interventions or psychopharmacology.

“I’m not giving up on his neshamah so easily, Dr. Freedman,” Reb Leibush added resolutely as he left my office. And neither was I.

To be continued…

 

 

 

(Originally featured in Mishpacha, Issue 826)

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