"The daily pressures required so much of us just to stay alive. There was no free moment to worry about what would be"

Meir Elbagdadi was dressed like a thousand other young men from wealthy Israeli Shas-affiliated families whose fathers,

through grit and determination, pulled themselves up from the poverty in which they’d grown up and secured the brachah of parnassah.

Sharp suit? Check. Neatly trimmed peyos tucked behind the ears? Check. Limited exposure to high-quality information about mental health? Unfortunately, that was also a check.

Meir had a classic case of OCD, complete with intrusive, obsessive thoughts about his halachic observance, plus compensatory compulsive behaviors. Some of his most debilitating symptoms included the need to repeat the Shema or to restart his Shemoneh Esreh over and over due to fears of lacking proper kavanos.

After suffering for nearly two years during yeshivah ketanah, Meir eventually found his way to an unlicensed therapist.

“My rebbi had recommended him, and he was known to our community as a good and compassionate person,” Meir described as he sat across from me, relating his generally unsuccessful therapy journey.

The man claimed to be an expert in CBT after having taken a course with a well-known coach in Bnei Brak who offered a popular six-month training program. He probably picked up the rudiments of the methodology, and might have even helped some people with minor issues, but he was totally out of his league when it came to understanding the complexities of full-blown OCD. While this man was intuitive and supporting, spending a full year in whatever therapy he was offering not only didn’t do Meir any good, it cost the family close to 15,000 shekel.

“In the end I saw it wasn’t for me, and all he did was scare me away from therapy,” Meir recalled. “My experience with a ‘real’ psychiatrist wasn’t any better though.”

After obsessive thoughts regarding personal hygiene and compulsive behaviors were keeping Meir in the bathroom for nearly four hours a day, he wasn’t able to maintain the pace or pressure of yeshivah gedolah and had returned home. His parents then contacted a local askan who brought Meir to a famous professor at a big academic hospital in Tel Aviv.

“The appointment lasted 15 minutes, and I’m embarrassed to tell you how much my Abba shelled out for it,” Meir related. “The doctor basically just threw a piece of paper from his prescription pad in my direction.”

Meir took those pills for a month but didn’t feel much real change, so he stopped the medication after it ran out. There was no follow-up appointment scheduled, and given that the family wasn’t particularly impressed, they never returned.

What Meir did have going for him was yichus. His grandfather, Chacham David Elbagdadi, was a highly respected Iraqi rav and dayan. I had actually met Chacham Elbagdadi earlier that year after I’d consulted him on a complicated shalom bayis case that had ended up in his beis din.

Meir’s pedigree, and his father’s financial standing, stood in his favor when it was time to do a shidduch, and the OCD was never brought up as an issue.

“But now,” Meir admitted, “my wife has had it with my OCD, and she even told my Saba about all my weird behaviors. He insisted that I see you, which is how I ended up here.”

I had the utmost respect for Chacham Elbagdadi and was truly honored to help his grandson. But Meir needed to understand that there were no shortcuts on this one.

Classic cases require standardized treatment and therefore recommendations for Meir were pretty straightforward: He’d need to start an SSRI (selective serotonin reuptake inhibitor) medication and steadily increase the dosage with regular follow-ups. He would also need weekly skills-based therapy with an expert, frum psychologist who specialized in OCD and also understood his religious needs.

“Dr. Freedman, do you mind calling my Saba to tell him the plan?” Meir asked. “I’m feeling a little embarrassed. I never even let him know about my challenges, and here he’s the one who’s putting me on the right path.”

I was honored to help the Chacham’s family any way I could, and apparently the feeling of respect was mutual: He asked me to come over later when he’d be going to Maariv and made me an offer I couldn’t refuse — his wife’s famous sambusak.

I swung by Chacham Elbagdadi’s apartment near the Moussayoff beit knesset on my way home that evening. Fresh and crispy sambusak held the kind of pull on my stomach that made it easy to go a bit out of my way. Chacham Elbagdadi’s wife opened the door and handed me an aromatic paper bag filled with traditional Iraqi Jewish delicacies and let me know that her husband was getting ready to walk to Maariv.

I waited in the doorway for the Rav to come, escorted by his shamash whose arm the elderly Chacham held as he slowly walked from his study through the kitchen and into my view. The Rav was dressed in the long coat of a dayan, and it was clear from his gait that merely walking to tefillah required assistance.

“I see my wife gave you your present, Doctor. I hope you enjoy it, and thank you for your help,” he said. “I am honored if you will walk with me so that I can ask you a question that has been on my mind.”

I nodded and followed the Rav out into the street.

“I wonder if you might tell me why there is so much mental illness in today’s generation,” he began. “It was not the same a generation ago when I was a younger man, nachon?”

As we walked through the starlit and winding streets, we discussed many things that were already quite evident to us both: the clear presence of mental illness in prior generations irrespective of a proper diagnosis, the lack of understanding and referrals to professionals that was only slowly being addressed in many populations, and particular stressors new to the current times. Chacham Elbagdadi would walk a few feet and then stop, sometimes nodding his head in agreement and other times simply saying nachon.

“I wonder if perhaps there is another reason, Doctor. Perhaps it is the tremendous brachah of gashmiyut in this generation that has become a pitfall for so many, nachon?”

This time I nodded my head in interest.

“I remember as a child that we did not have electricity or even running water. If you wanted to see at night, you had to build a fire or light a candle. If you wanted a shower, you had to heat the water that you had drawn from a well in the shared courtyard outside of the house,” he recalled. “Even for people who were sad or anxious, the daily pressures required so much of us just to stay alive. There was no free moment to worry about what would be.”

“Wealth can be a double-edged sword,” I said in agreement.

“Nachon. I am grateful to live in an age where we have refrigerators to hold amounts of food that I never could have imagined as a child, Doctor. Todah l’Hashem. But I wonder if all of this has made us soft and rebellious and opened us up to new sorts of problems.”

We had arrived at the gate of Beit Knesset Moussayoff and Chacham Elbagdadi reached up, together with the steadying hand of his shamash, to kiss the mezuzah.

As we walked in, he looked at me and said, “Dr. Freedman, when I was young dayan in Baghdad, I’d watched children starve to death. And I prayed fervently for parnassah of our community. Hashem heard my tefillot, but now I pray for something else: the seichel to use it properly.”

There was only one word for me to say: Nachon.

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.  His new children’s book — Me and Uncle Baruch — is available through Menucha Publishers.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 909)