“But he’s my brother, and he’s a psychologist!”

I

was surprised to hear that Etty had relapsed.

Six months ago she was in a rough spot, but that was back around Succos, before the first rains had fallen and cleaned out the air. Things had gotten so much better since.

Etty had first come in for treatment with her husband Yossi at her side. A young kollel wife with a few kids and a degree in occupational therapy, Etty described her life as “just about as normal as can be.” If I’d been involved a few years earlier, I probably would have noticed her preference for symmetry, family history of OCD in a brother, and penchant for keeping their apartment impractically immaculate as risk factors and perhaps early signs of Obsessive-Compulsive Disorder. But I wasn’t.

Things started to get a bit out of hand when she began throwing out fleishig dishes that had been “contaminated,” and insisting that Yossi re-toivel much of the silverware.

But I didn’t become involved until things were really unraveling and Yossi had a sit-down with his rosh kollel. Rav Weingrad had been answering Yossi’s increasingly frequent basar v’chalav queries for a few months and finally decided to get to the root of the problem. The struggling yet ever-patient yungerman recalled how his rav had told him, “Yossi, you know the answers to these questions. You learned them back in yeshivah ketanah. Either you or your wife should see someone — this sounds like OCD.”

Clearly Rav Weingrad had been around long enough to recognize the telltale signs of escalating chumros and the subsequent family dysfunction wrought by OCD. Wise in realms far beyond Gemara and halachah, Rav Weingrad referred the young couple in my direction and told Yossi, “I’m not a doctor, but my guess is that your wife is going to need some medication as well as a form of treatment called Cognitive Behavioral Therapy.”

I was impressed with Rav Weingrad’s assessment, and he was certainly on the ball. Etty had a classic case of OCD with cleanliness obsessions and compulsions to “check the relevant halachos” with her husband and their rav. By the time they made it into my office, Etty was sleeping only four hours per night and the word “divorce” had entered Yossi’s vocabulary. Luckily I was able to stop things in their tracks by explaining OCD as a brain disease with behavioral symptoms as opposed to an untreatable character defect. Baruch Hashem, they were both interested in treatment and willing to try the recommended plan for a low dose of an antidepressant medication, daily exercise and meditation, and a course of CBT.

And it worked. Within a few months, Etty was her old self again, still with some ongoing issues about cleanliness and perfection, but nothing too serious or disabling. She had finished working with her therapist and had graduated from CBT, although she continued to do the therapy exercises, take her medication, and attend a yoga class most evenings. Etty was back at work, being a great mother to her kids, and Yossi was thrilled to have his wife back. At our last follow-up visit, I was overjoyed with Etty’s recovery and certainly didn’t expect to see a fully symptomatic woman less than six weeks later.

Yet here we were — less than a week before Pesach — and Etty was in tears as Yossi recounted how she was scrubbing the children raw in the bathtub to “prevent them from spreading chometz in their beds” after eating cookies one evening. This was after she’d thrown out their Seder plate and had forced Yossi to wake up Rav Weingrad at 2 a.m. to ask him about kashering the sink for the third night straight.

“What happened?” I asked. I was truly shocked. “Things were going so well.”

Both Yossi and Etty stared at the floor. It was the stare I’d seen a million and a half times.

Before she even answered me, I knew that Etty had stopped taking her medications.

“What made you stop treatment, Etty?” I asked in about as nonconfrontational a manner as I could muster.

“How’d you know?” Yossi and Etty asked simultaneously.

I took off my kippah for a moment to show that my head was pretty much bald as could be. “You see this?” I said pointing to my head. “I don’t have any hair left, which means that I’ve been doing this for a while now.”

They both laughed enough to break the awkwardness. Yossi proceeded to tell me that Etty’s brother is a psychologist and he’s the one who had encouraged her to stop taking medications at a Shabbos table a month ago. “He said that psychiatric medications are overprescribed and that they can cause all sorts of addictions and side effects.”

I was more than a little upset, but kept my cool, as it wouldn’t help anyone to have an angry doctor at the meeting. But there were many things wrong with this story. First off, Etty’s brother might be a mental health professional, but he wasn’t her treatment provider, and encouraging her to make medical decisions without knowing her full story was frankly reckless. Secondly, he wasn’t a physician, and had no business telling her what to do about her medications. Would I have been happy to speak with him? With Etty’s permission, certainly. Would I have been happy to include him in a treatment discussion? Of course. Was I downright incensed that he had given my patient — his own sister — terrible advice? Absolutely.

“Etty,” I said. “Your brother is certainly right that some medications are overprescribed and can cause side effects as well as addiction. That being said, I’ve been as honest and open as could be, and I never forced you to do anything you didn’t think made sense. We discussed the benefits and risks of treatment, and you’ve been tolerating your medication very well.”

“I know, but he’s my brother, and he’s a psychologist,” Etty replied somewhat sheepishly.

As I sat there, I thought for a moment about the wisdom of my own rav, Rabbi Naftoly Bier of the Boston Kollel, and what he once told me about the stages of bochurim as they grow. “At first they don’t know too much, so they aren’t so strict. Once they start learning, everything becomes assur because they don’t know enough. When a person really knows HaKadosh Baruch Hu’s Torah, he can relax and know that he was wrong, that not everything is assur, and it’s okay to be reasonable in one’s approach to halachah.”

I then thought about Etty’s well-meaning brother who had some reasonable concerns and clearly wasn’t trying to destabilize his sister’s mental health. True, he knew a bit about psychiatry, but clearly had more to learn before he was ready to give a psychiatric psak.

“Look, we’ve got to restart the meds ASAP to get you back in shape before Pesach comes,” I explained.

Etty and Yossi nodded in unison.

“But we’ve also got to make sure that everyone is on board. Yetzias Mitzrayim means No Yid Left Behind. So let’s go ahead and call your brother to help him understand the situation, so that he too can feel comfortable moving forward and understand that I’m not a pill-pushing slave to the pharmaceutical industry.”

And we did.

Originally featured in Mishpacha, Issue 704. 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.