He refused to leave the house spending days in his room in pajamas and popping out only when hunger pangs overcame him. He’s not a rebellious teen at risk but a shackled young man overcome by social anxiety and depression. Appointments with mental health professionals proved futile. But what if someone could meet him on his own turf?
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don’t know what to do with Danny. He’s been sitting in his room in the dark for weeks. He’s hostile and controlling and we’re all afraid of approaching him because he sometimes flies off the handle. Can you help us?” It was a plea from Danny’s brokenhearted and confused mother to Rabbi Gavriel Hershoff director of Aish Tamid of Los Angeles an organization that helps teens at risk and young adults find themselves and become productive members of society.
Rabbi Hershoff a social worker and substance-abuse counselor braced himself. He had a lot of experience with such holed-up teenagers some of them trapped by their own social anxieties others with at-risk behaviors who’ve dropped out of school and still others hit with all-too-common teenage depression to the extent that they’ve basically hidden themselves away and have bowed out of life raging at the world if provoked. If Danny was embarrassed to be seen in his present state not having showered for weeks and wearing pajamas would he rage at him? Would he slam the door in his face? Would he scream at him angry at being seen as a “project”?
Reb Gavriel always tries to be there for kids who need him and for their families who feel like hostages in their own homes. So he said “I know your son. Would you like me to come over and see what’s going on?”
Danny’s crisis wasn’t a new story just a new episode. His mental health had been shaky for a while but left untreated it began to deteriorate as his baffled parents looked on helplessly — it’s always hard to see a downward slide when you’re in the middle of it. And social phobia — sometimes called a silent disorder because it can affect children for years before being diagnosed is a gateway disorder to depression substance abuse and lifetime impairment.
“Usually there has to be a crisis for a social worker to get involved ” says Reb Gavriel who’s become known as an expert in home visits a sort of first-step intervention when reasonable communication with family fades. “That’s why I prefer to work in a less formal setting so there’s a relationship going before there’s a crisis. But just because a counselor comes on the scene doesn’t mean a kid is going to open up. Besides a lot of kids have been going to therapists for years and by the time they’re old enough to actually do the work therapy demands they’ve already ‘been there done that.’ ”
A Little Different
“When Shauli announced ‘I’m not going to yeshivah tomorrow’ that was okay with me. Sometimes I need a day off too ” says his mother Ita. “But his vacation extended to three days and then two weeks. It took a while for us to realize we had a problem. He’s been home for four years now. He doesn’t talk much and we’re at a loss.
“He’s brilliant and did well in school but we always knew he was a little different” Ita continues. “I took him to speech therapy and OT for years. My friends laughed. ‘You keep finding problems just because you’ve got a degree in special ed’ they said. Even one of his therapists said ‘Sensory issues are just a fad.’ But while other kids hang upside down from the couch for a few minutes Shauli would do it for an hour. Then he became a teenager and refused to keep going saying ‘I’m normal. I don’t need it.’ That’s when it all fell apart.”
Zelda’s description of her son Moish’s withdrawal was similar. “It took us a while to realize that it was as bad as it was ” says his mother who explains that Moish was diagnosed with high-functioning Asperger’s which never seemed to interfere on a drastic level with his everyday life. “At first Moish just stopped going to classes that didn’t interest him. He knew he could pass the English exams with no trouble so he didn’t go to English. Then they started mixing enrichment courses into the school day. He might have gained a lot from the Dale Carnegie course but he had no interest in it. I couldn’t force him to go to the first-aid class either. He was still going to his math tutor and his Gemara rebbi though so in my mind he was still in school just not going to classes.” Moish has been home for three years.
Finding help for these young people can be a huge challenge and wrong diagnoses are common; a child who interacts well with adults in one-on-one situations can get lost between the cracks.
“That’s too bad because there are ways to teach young kids skills even those with anxiety issues ” says Akiva Harrow a social worker and family therapist with Kav L’Noar in Israel who makes home visits to try to reach these broken young people. Some of these kids he says have low-level Asperger’s and although they’ve functioned pretty well until now at a certain point they need help learning social behaviors most of us take for granted — and if they don’t “get” their social environment or feel overwhelmed and unable to grasp behavioral nuances it’s just easier to give up.
“Not everyone is ready to be helped ” Akiva says. “But just because we don’t click in the short term doesn’t mean we can’t lay the groundwork for a relationship at some time in the future when he’s gained the maturity to pull himself together and do something.”
So, what does a boy who’s home when everyone else is in school do all day?
“Moish played on the computer for hours a day,” says Zelda. “He did accept limits though — Shabbos, of course, and no computer after 8:30 p.m. But when the computer was broken, he’d stomp around the house in quiet despair.”
Computer addiction is common in Asperger’s kids, who feel confused by the intricacies of everyday life. Playing video games for hours on end is soothing. A computer lets them control the volume and brightness of their environment, and getting lost in the on-screen world saves them from the complexities of face-to-face interactions.
Ita says that her son Shauli “doesn’t just sit around” either. “He has a schedule built around his favorite sports broadcasts, and he washes dishes and takes out the garbage. His brother was involved in a start-up and taught him some programming, and Shauli was helping him with his work. When I ask if he wants to do something else, he can’t imagine why I’m asking. ‘Why, am I not helping enough?’ he asks. He can’t understand why anyone would think his isn’t a good life. He’s happy with it.”
Life Feels Hopeless
Some young men don’t hide in the house; they just don’t get up in the morning. By the time they roll out of bed, mid-afternoon, there’s no place to go and nothing worth doing. This schedule lets them avoid their problems, which may include social anxieties or a fear of going outdoors.
Family conflict, trauma, bullying, or other experiences can create internal emotional conflicts that lead a child to stop believing in himself and the world around him, which can lead to full-blown depression. Anecdotal evidence suggests that depression is the most common cause of withdrawal, with anxiety a close runner-up. Some of these teenagers suffer from both, a tough double whammy that can send some sufferers to bed permanently, coming out only when they need to eat.
Many can’t even articulate why they don’t want to go to school or to work, and some, ashamed to have problems, would rather take to their rooms than explore what’s making them feel bad. Asperger’s, other social disorders, and even some mild physical limitations such as a hearing impairment can make social integration awkward, the sufferer feeling like it’s insurmountable.
“Human behavior is purposeful,” says Rabbi Simcha Feuerman, senior director of operations for OHEL Children’s Home and Family Services in New York. “Most people want to go out and to achieve. If a young man depends on the safety of his bed, there’s a reason for it. Figuring out what’s going on in his world is the first thing you have to do to help a homebound boy.”
The trick, says Rabbi Feuerman, is to establish a way to communicate. “It’s frustrating when you ask ‘What are you doing?’ and the child is purposefully quiet, or answers, ‘I don’t know’ or ‘nothing.’ Still, something is being communicated. It’s not a verbal statement, but it’s a statement. He’s saying, ‘I don’t want to talk’ or ‘I’m overwhelmed’ or ‘I’m scared.’ If your response lets him know he’s being accepted, he’ll continue to communicate. The more you can show that you understand, the more the child will talk. If you respond, ‘It looks like whatever’s going on is making you so upset you don’t even want to talk about it,’ and that answer is close enough to what he meant — mission accomplished. He communicated and got a response, and that encourages another response, maybe a nod. Every communication should be rewarded with communication. ‘You’re nodding. That shows you agree.’ But go slow. A child’s decision to reach out is like a little fire. Even a splash of gas can put out a little fire if it overwhelms it. So wait and see if he says something else. It’s painstaking work.”
Menachem Engel, a social worker for the Jerusalem Municipality who also makes home visits says the first thing he does is enter the boy’s world. “I find out what interests him and start talking about it. Talking about what he’s watching or reading builds a connection, but it’s a slow process, almost like a waltz — two steps forward and one step back.”
Rabbi Gavriel Hershoff works across the ocean, but the issue, and the healing, is global. “It’s all about building a relationship. If we have a relationship, he’s willing to talk to me. If he likes me as a person, he’ll listen to what I say. So I go to his house, not as a social worker who has to go because it’s my job, but as a friend. And I keep up with him between visits, texting and calling. Then when I go to see him again, we can move forward. I try to take him out for coffee or lunch, to see what he’s capable of, looking for one little step he can take. If I suggest something big, like going to see a therapist, it can sabotage everything. It’s a long process. Remember, he only reached this state after lots of years of being shot down.
“If a kid isn’t ready to make progress,” Reb Gavriel continues, “I’ll spend less time with him. We’ll still be in touch, so I get updates, but I can’t work harder than him, except at the beginning, to create the relationship. Then I back off and let him do more work, let him be the one who comes to me. I won’t accept parents calling for him. The kid has to pick up the phone himself or text me. If he’ll reach out that much, I’ll go to him, but he has to show at least basic interest in meeting with me. If our relationship is important to him, he’ll start to share.”
While texting isn’t the healthiest way to communicate, it’s a good way to keep a relationship warm. Then when meeting face-to-face, communication’s easier.
Finding something these young people can be passionate about helps create connections too. “In our yeshivah, there are other guys who are interested in the same things as our socially isolated chevreh,” says Rabbi Shimshon Jacob, director of the Kemach Institute, a gap-year program for learning-different students in Israel. Some of those students are boys who were stay-at-homes. “They play the same games on their phones as the rest of the guys, and they’ll talk about them. Our most extreme loner won’t initiate any social interaction, but he’ll engage if someone else does. We also help guys get involved in dealing with animals. Animals are easy to relate to, since there’s no expectation of clear communication. One boy, on a hike, crushed some potato chips in his hand and bent down to feed the birds. A whole flock followed him down the mountain. For him, associating with animals is a lot simpler than associating with people. He found it funny that we were all so impressed with his animal following, but he liked the attention it earned him.
“We also create opportunities to be involved with others, because living in your own head is a spur to anxiety. We had one creative guy teach art at a senior center. He walked away happy with himself. Even though he’ll still say that no one thinks he’s worthwhile, that was an opportunity to experience the opposite. And ahavas chinam is essential. I’ll text a guy or phone him to say, ‘Here’s something I learned from you yesterday,’ or, ‘I really appreciate what you did.’ ”
How Am I Feeling?
The main reason kids will say they’re dropping out of school is because they don’t find it satisfying and can’t see why they need it, says Rabbi Yoni Lichtman, a family therapist in Encino, California and program director for Evolve, a Torah-oriented therapy center in the Los Angeles area that has its own section for teens at risk and yeshivah dropouts. “But it’s always much deeper. Sometimes it stems from depression, which makes them feel hopeless about their ever accomplishing anything.”
Usually it helps if these withdrawn teens can label their feelings, Rabbi Lichtman explains. “The first thing a child with anxiety needs to understand is that he’s feeling exaggerated fears. Once he knows that, he can differentiate what’s rational from what’s irrational. Then he can be helped to recognize that ‘my anxiety is telling to be afraid; it’s getting in the way of my going out with friends for coffee and a donut.’ If he can learn to break down his irrational thoughts, he can begin to heal.”
Friends, he says, can be crucial, as can strong positive relationships between a child and his or her parents, teachers, and mentors, which can foster resilience and help struggling students make it through school. “A good friend can give encouragement and even confront his friend’s behavior, attitudes, and life choices, often more effectively than a parent or therapist. But all too often, even if the said friend isn’t a drop out, he might have similar attitudes about school being unimportant.”
Not fitting into a group is unbearably painful, so a kid who still has a sense of self will hang out at the basketball court with other drop outs, but some teens don’t have it within themselves to discover another bunch of friends once they’ve stopped going to school.
“I’m currently working with a boy who wouldn’t go to school, but he would go to the library and play cards with some friends, and he’d play basketball with them after school and hang out at the store — but then his family moved and he couldn’t find a new network,” says Akiva Harrow of Kav L’Noar. “He’s been at home for four years now, since he no longer has a reason to go out.”
Because isolated people are completely self-absorbed and don’t see anything outside their world, the healthiest interactions are those that force them out of their own heads, where the one-way conversation is about self-condemnation and recrimination. Giving such a kid a job to do, maybe to help cook supper for someone in need, gives him a sense of purpose and belonging, which is really oxygen for everyone.
Hanging onto friends though, isn’t always so easy. “People think these kids don’t have friends,” says Ita. “But Shauli was close to his friends when he was in school and he’s still loyal to the ones who are left. Wearing anything nicer than a sweat suit is hard for him, because of his sensory issues, but when his friend from school got married, he put on suit pants and a white button-down shirt, for his friend’s sake. Painful, but a lot of the old chevreh deserted him when he took to the house. Some of them would have visited, but their parents discouraged them. I understand. They were having their own issues and their families worried that a friendship with Shauli wasn’t a good idea.”
House Calls
It’s not simple to find a professional willing to come to the family’s home and try forging a relationship with the troubled young person, to which Ita, Shauli’s mother, can attest. “It’s hard to get services for a kid who won’t leave home,” Ita confirms. “To get government services, we needed a letter from a psychiatrist. One came, but Shauli was confused about who he was and why he was there. He couldn’t see why he should relate to a stranger just because he showed up at the house.”
Reb Gavriel, from his experience, agrees. “A lot of kids won’t see psychologists or psychiatrists. When they were little, their parents forced them to go, even though they were too immature to benefit from therapy. By the time they hit their teens, they’ve already been to five therapists. They feel ‘been there, done that, and you can’t make me do anything anymore.’ So when they most need the help, they’re least likely to ask for it. One of the biggest challenges in connecting with kids who need help is that sometimes they only reach out when they’re doing okay. You’re risking the relationship by invading their privacy when they don’t want to be talked to or seen. I tell them, ‘I want you to call me when you’re doing lousy, also,’ but then they’re too embarrassed.”
People on the outside might confuse anxiety-ridden teens with those who’ve spitefully veered “off the derech,” but for some teenage shut-ins, the predictability of frum life actually provides a feeling of safety. “Some people might think that all kids with Yiddishkeit issues are de facto suffering from mental-health problems and that’s why they toss Yiddishkeit aside, but it’s not so,” says Rabbi Feuerman of OHEL. “We just notice the ones who fit that stereotype. But in our community, there’s not much range to be different. That’s problematic, especially for these boys who are different. The reward for compliance, psychologically, is that you’re part of a community. Social isolation is actually physically painful, and the reward for conformity is social prestige.
“Yet,” he says, “if a child has a disability that doesn’t allow him to enjoy that prestige, the reward just isn’t worth the effort.”
(Originally featured in Mishpacha Issue 656)
