"I don’t care if my hands are shaking as long as I have my mind"

Rabbi Kalman Shneider was already a tremendous talmid chacham even as a bochur, having studied in some of America’s finest yeshivos  before moving to Eretz Yisrael to continue learning.

“You have to understand something,” said his older brother Shloime, who scheduled the initial appointment. “Have you ever met a gadol who knows the entire Gemara like you know the back of your hand? Well, Kalman knows Shas Yerushalmi like they know Shas Bavli. This is the ikar of understanding him.”

Reb Kalman had grown up in a family where talmud Torah was truly k’neged kulam and had dedicated his life to learning. At the age of 22 he came to Yerushalayim and was married to the daughter of a prominent rosh kollel. Within a year they’d had their first children — a pair of twin girls — and he’d already established himself as a true masmid within the upper crust of top yungeleit.

But then came the first signs of a problem. Kalman was suddenly mistrustful of neighbors and claimed that another yungerman on his bench “was placing ayin haras on me.” And while his rosh kollel was generally not interested in psychiatry or medications, he recognized the signs and referred him to a psychiatrist to treat his “anxiety.”

The doctor had made the correct diagnosis and had started Kalman on an antipsychotic medication for his first episode of schizophrenia. Kalman’s paranoid delusions miraculously disappeared and he was able to return to learning without any difficulties. After a year, Kalman’s psychiatrist was willing to decrease the dosage of his meds, and things stayed stable for a solid six months — until the fears of ayin hara from his fellow yungeleit began creeping back.

Kalman’s wife had called Shloime to help her convince him to restart the previous dosage of his meds. It took an intervention with his rosh kollel, but Kalman also realized that his learning was suffering and wasn’t willing to risk his ability to study Gemara. He returned to his antipsychotic regimen and his daas returned as well.

A year later though, the same story occurred. Kalman was doing well, but when his psychiatrist went back to live in the US, he decided on his own to reduce the  medication a second time. That’s when I came into the picture. Luckily, the painful delusions taking over his mind again convinced Kalman: “I’m staying on this stuff for good, because having my daas back trumps everything.”

Things had pretty much returned to normal and Kalman was happy in kollel. His rebbetzin had just had their fourth child and he was preparing to be mesayem Shas Yerushalmi b’iyun. It was at this point that Kalman began experiencing a shaking sensation in his hands. At first it didn’t really bother him, nor did he think too much of it. The siyum came and went, and soon his wife was expecting their fifth child. His medication regimen was stable, there were no fears of ayin hara, and he was ascending to great heights in his learning.

But soon the shaking in his right hand was significant enough that he had difficulty keeping his index finger on the right spot in the Gemara. His wife noted that his lips seemed to move in a strange way as well, and Reb Shloime was called to weigh in.

Actually, this was pretty straightforward. Kalman was having a classic side effect from his antipsychotic: a tremor that was a common result of being treated with this class of medication for multiple years.

Kalman’s case was one of risks and benefits, as I explained to him along with his wife and brother. On one hand, the mediation was a veritable miracle drug in terms of controlling his paranoia, meaning he was able to return to his learning without any interference. On the other hand, his tremors would get worse with time and would soon be quite noticeable even to the untrained eye.

“Not a big deal, Dr. Freedman,” Kalman said as a matter of fact, accepting his lot with equanimity. “I know that I can’t change this dosage or I’ll lose my learning. So my hands are shaking — it’s my sacrifice for the Torah, and if this is what Hashem has decreed, then it’s up to me to accept it.”

I was impressed by his pure emunah. There was another option however — a different type of antipsychotic medication that didn’t cause any tremors.

“That sounds interesting,” Shloime suggested.

“Well, it carries its own set of risks,” I clarified. “But we can give it a try and see how it works — at least that way we’ll know for sure.”

Kalman, however, was skeptical. “Torah learning is all I have, Dr. Freedman. Believe me when I tell you that I don’t want to mess that up. I frankly don’t care if my hands are shaking as long as I have my mind. What if I try this other medication and it doesn’t work, and then I become too paranoid to learn again? Let’s just leave it be.”

His wife and brother accepted his decision and I felt compelled to join them, leaving the door open for reconsideration. Still, I was somewhat surprised when he returned a few months later.

“My wife thinks it’s gotten worse,” Kalman told me. “I told her I don’t care if my lips are always moving, but it’s important to her, so I want to try the other medication. Maybe it will work and I won’t have such a bad shake in my hands while still being able to learn?”

“It’s worth a try,” I said. “And I respect your decision.”

We discussed the benefits and risks of the alternative treatment and I wrote out a medication plan for Kalman on the back of his new prescription.

But it wasn’t meant to be. Kalman developed a terrible rash within a week — an allergic reaction that would make continuing on this medication impossible.

The trio returned to my office and Kalman was resolute: “Hashem has blessed me with a medication that works to control my symptoms and lets me continue to learn Torah. Yes, I have a bad side effect, but this is Hashem’s ratzon, part and parcel with His brachah. How can I be a kafui tov and stop taking it just because it makes my hands shake and my lips twitch?”

I began to tell Kalman about a growing body of research that suggested there might be ways of mitigating the tremors that his medication regimen would continue to cause in an increasingly permanent manner. Shloime looked relieved and hopeful, but then Kalman took the floor.

“Shloime,” he said, “I know my shaking hands look strange, but baruch Hashem I’m a learner and not an electrician who would be crippled by this kind of thing. And you know what? If I were an electrician, then it would be a brachah too, because I’d be forced to retire and go to the beis medrash. Hashem gave monkeys hands, but he didn’t give them daas. I think, at least for now, I’ve made my decision pretty clear.”

I couldn’t have summed it up better myself.

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 774)