“Yes, I know. But ADHD is a neurodevelopmental condition, and accordingly, people start to show symptoms as kids or adolescents. You never had any problems with focusing, being attentive, or misplacing anything until you had your fourth baby close to six months ago.”

“So what am I supposed to do?” Rivki asked. “Why do I keep on forgetting where I put the keys, and why is it so hard to get everything together to get out of the house in the morning? I used to get ready for Shabbos by chatzos, and now I’m lucky if I have five minutes to shkiah.”

“Rebbetzin,” I said, delicately balancing the need to be honest with the need to protect her dignity as an idealistic and dedicated frum woman. “What you have is a lot on your plate.”

“Then how come when I took my neighbor’s son’s Ritalin, I was able to stay up until 3 a.m. finishing Shabbos preparations last week?”

Trying to hide my sadness that in the frum community, this kind of thing could be seen as an acceptable method of coping, I was honest when I said, “Stimulant medications like Ritalin are made to keep people focused. That doesn’t mean that you have ADHD. It just means that you took a drug meant to keep folks awake and clear-headed. But you know, there are downsides too.”

“Yeah, yeah, yeah, I get it, Dr. Freedman, but I really need to get this stuff done. I have a lot of responsibilities.”

“You do have a lot of responsibilities,” I agreed. “That’s why you need to be responsible in your decision-making too. True, not everyone who takes these medications will have a cardiovascular side effect or become acutely psychotic, but these are the risks. Let’s also not forget that people get addicted to this stuff, and addiction isn’t a joking matter. I’ve seen more than a few people in our community who fell into it.”

“I guess I also know a lady who abuses the stuff,” Rivki admitted with a nervous laugh. “But what about my neighbor who takes her son’s Ritalin every Erev Shabbos? She has her act together and is a reasonable, intelligent woman. I mean, most people I know don’t really abuse this stuff. It’s a medicine, not a drug.”

I didn’t immediately respond. I wanted her to be honest and find her own truth here.

“Right? I mean, so what if I borrow this stuff from my neighbor? It’s not like I’m paying her for drugs. It’s not like I’m getting addicted to Percocet or morphine and buying it on the black market. I’m not buying it on the street… And I don’t think you should judge me, Dr. Freedman. I don’t think you should judge me at all. I’m just busy and I need this to get me through the day. That’s why I came here! I can’t just keep borrowing it from my neighbor every day. If you’d just give me a prescription then I could pay her back for what I owe her and we could move forward already.”

By now Rivki was nearly in tears from a mix of stress, shame, and frustration.

“Rebbetzin,” I said, taking charge of the conversation again, trying to steer her away from a meltdown, “I think this is a complex situation and I want to help you. I’m not here to judge you.”

“My neighbor’s psychiatrist just writes her a prescription for the medication every month without even thinking about it. It’s a two-minute visit with an 800-shekel copay. That’s it.”

“Well, I’m not your neighbor’s psychiatrist,” I said gently, “and baruch Hashem you aren’t your neighbor. But I think we should talk about what it means to be misusing stimulants.”

Rivki turned defensive and angry.

“Please, I’m not an addict, Dr. Freedman!” she snapped. “Plus, you can’t even get addicted to this stuff unless you snort it or inject it. People don’t need to detox from stimulants — it’s not like painkillers or street drugs. I’m a college-educated woman and my husband is a rav from a prominent family. I’m not just some brainless idiot who would get addicted. I only take a pill or two every day in order to get my work done.”

There were some legitimate thoughts here mixed in with frustrated half-truths, but that wasn’t the crux of the issue and I had to tread carefully.

“Rebbetzin, chas v’shalom — I’m not calling you an addict. I’m just stating the fact that what you’re doing right now is unsafe, and although ‘everyone does it,’ it happens to be illegal. I’d like to try to help you to get through this rough patch without it.”

Rivki thought for a few moments and looked like she’d be ready to make some changes. Then suddenly she jumped up out of her chair and told me she was leaving. I’m not sure if it was her pride or her fear, or perhaps she’d made a plan to try getting a prescription somewhere else — but she was utterly unwilling to discuss anything further, and wished me “a good day” as she walked out of the office.

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 707)