“Dr. Freedman, what is the point of this story?”

T

 his was round two, and Tzippi had already been in the hospital for the better part of two months. Her first stint was for about two weeks, after which she was discharged to go home — but less than 24 hours later, she jumped off the porch of their apartment, broke a leg in the process, and was promptly readmitted to the psychiatric ward.

At a loss for how to proceed, Tzippi’s family reached out to their cousin, a physician and a good friend of mine. While it’s not the general practice of private psychiatrists to perform initial consultations for hospitalized patients, I owed my friend a favor and told him I’d be happy to help.

Tzippi’s father — a prominent rosh kollel in Jerusalem — told me the all-too-familiar story. Tzippi had been abused repeatedly by a family member when she was younger, and over the years had been tagged with the gamut of diagnoses: trauma, bulimia, bipolar disorder, panic, ADHD. And yet at age 18, her latest diagnosis was obvious: The chronic emptiness, unstable emotions, and the never-ending urges to hurt herself were characteristic of borderline personality disorder. This diagnosis was further confirmed by the fact that no combination of antidepressants, anxiolytics, or antipsychotics had done much to control the profound hatred she felt toward her own body.

We agreed that I’d meet Tzippi the following afternoon and would then be able to share my thoughts on how to move forward. Tzippi’s tough-as-nails Israeli nurse arranged for me to review the chart before our appointment and reserved a place for us to speak. “You know she’s a stale cookie,” said the nurse, practicing her English as she showed me to the room where I’d be meeting the patient.

“I think you meant ‘tough cookie,’ ” I responded with a smile.

“She’s difficult, is what I meant. Happy luck.”

Tzippi was sitting at a desk, squeezing the life out of two stress balls. Her forearms were covered in bandages that suggested she’d been either scratching or cutting herself enough to require treatment with an antibiotic cream, and her left leg was still in a cast from when she had jumped. This was in sharp contrast to her fashionable, obviously invested outer appearance — a reflection of the raging inner conflict she must have been experiencing.

“What do you want from me?” she scowled.

“Aren’t you going to offer me to sit down?” I said with the warmest smile I could muster under the circumstances.

Tzippi didn’t smile back. “Sit down and ruin my life, I don’t care.”

To break her angry silence, I figured I’d introduce myself, “I’m Dr. Freedman. And my goal isn’t to ruin your life.”

“You couldn’t,” she retorted swiftly. “The damage is already done.” Tzipi scowled. “If they discharge me now, I’ll kill myself. I promise I’ll do it, too.”

“I have no doubt you will.” And I didn’t. I’d been around for long enough to know that a young woman with a history of abuse, borderline personality disorder, and prior suicide attempts should be taken seriously when she says she’s suicidal.

“So why are you here, then? To diagnose me? They say I have borderline personality disorder, but I just want you to know I’m not crazy and I don’t need all of these medications. I just hate my life and everything about it. What do you care if I kill myself, anyway? You’re not my doctor or my relative.”

“Too many questions at once, Tzippi, so I’ll just answer the last one: Every Jew is my family.”

“Hmm… okay, so how are you going to suggest they fix me?”

“I’m not going to suggest how they should fix you.”

“Then what are you here for?”

“I’m here because I have an old friend that I owed a favor to and he’s related to your father. So, are we ready to talk?”

“Well, I guess. What do you want to know? I don’t need to tell you about what happened when I was a girl, do I? Please, I’ve talked about it enough in this place.”

“I’m not sure opening up those old wounds will help, Tzippi. All you’ve done is focus on the past. Let’s talk instead about moving you into the future.”

“Good.” Tzippi took a deep sigh of relief and squeezed her stress balls a few times in succession. “It’s not that I like it here, it’s just that I’m still so angry, and I’m nervous I’ll hurt myself for real if I leave now. They’re always telling me I’m about to be discharged and then I have to do something like cut myself with a staple or a scratch or open an old scar to show them that I’m serious.”

“When do you think you’ll be ready to leave?” I asked. It was an honest question.

“When I’m ready. Not yet. But maybe soon, if I knew I had a team of people I could trust. A doctor who won’t just put me on a bunch of meds until I’m too drugged out of my mind to even spell my own name. A therapist who won’t ask stupid questions and instead will give me some practical advice about what to do when I feel like I want to hurt myself.”

“Sounds reasonable.”

“So, you’re going to tell them I’m ready for discharge today? Don’t push me!” she threatened as she flipped back into a rage.

“I won’t push you and here’s why. Back when I was a junior resident at a psych hospital, I was working with a young woman much like you. The medical director decided it was time to discharge her in spite of the fact that she told us she wasn’t ready. There was a lot of back and forth, and I was pretty unimpressed with how the senior psychiatrist was yelling even louder than the patient. In the end he brought her a trash bag to pack her clothes, and she tried to end her life.”

“What? What happened then?”

“She was rushed to emergency surgery, and after about three weeks she came back to our unit with a bunch of stitches.”

“So, what happened to that dumb doctor?”

“He retired and moved to Arizona. I think he plays a lot of golf these days.”

“Dr. Freedman, what is the point of this story?”

“I’m not sure about that, either. Maybe that even stale cookies are better than trying to end one’s life?”

“What?”

“I don’t know. Maybe that young women like you are in charge of their own destiny?”

“Okay. I guess that makes sense. I don’t really want to end my life or hurt myself too much anymore. I just want someone to listen to me.”

“My friend Dr. Harris is exactly the doctor you’re looking for. He’s got a great team of therapists and is a huge mensch.”

“Okay. If you trust him, and I trust you, then I guess I’ll trust him too.”

“What makes you trust me, Tzippi?” I thought this was a fair question.

“You told me a ridiculous story and then forgot the point of it to begin with. That’s why I trust you. You aren’t a baal gaavah. You aren’t telling me what to do. You’re telling me that I’m in charge and you mean it.”

“Of course, Hashem is really the One in charge, but you can absolutely take achrayus and control your own destiny.”

“Thanks,” she said and then paused. “Maybe I’ll be ready to go home next week.”

 Originally featured in Mishpacha, Issue 697. 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.