| Off the Couch |

Who’s to Blame?

“Your husband is a victim of some very dangerous advice”

 

“I need your help, Reb Yaakov,” said Rav Chayes. “You have to save a marriage.”

Rav Chayes was a special man — a rosh yeshivah who’d also earned a well-deserved reputation for excellence in shalom bayis counseling over the past few decades. “I’m in touch with a yungerman who was formerly a bochur at my yeshivah,” Rav Chayes explained. “Great guy, did some amazing personal avodah, and was blessed with a real winner of a wife. Soon after their marriage though, he experienced his first bipolar episode, but his wife stuck with him until he was stabilized. Frankly, things were going great up until a few months ago when he stopped his medication and ended up in the hospital for the second time in a decade.”

It was an all-too-common cause of rehospitalization, and Rav Chayes’s talmid was no different. It generally happens when the fellow is doing well, feels like he doesn’t need his mood stabilizers anymore, and then stops taking his meds. “Of course,” he tells himself, “the pros of taking those meds outweighed the cons when I was first getting back on my feet after the prior hospitalization, but now things are good and the medicine makes me tired,” or “the meds have a long-term risk for kidney problems” or any number of other good reasons. The ending is usually the same: Someone calls Hatzolah or 911, and the patient ends up back in a locked psychiatric ward.

“So how can I help you, Rav Chayes?”

“I need you to speak with the wife and tell her to give him some more time until he gets back to normal. Right now she’s asking for a divorce — he was completely manic for a few weeks with all sorts of out-of-control and dangerous behaviors before he was finally picked up in an ambulance from the makolet kicking and screaming about a kashrus conspiracy that he’d uncovered. I told her, ‘Give him some time, you weathered the storm once after you first got married. It’ll take him a month but you’ll get your husband back.’ ”

“But she doesn’t want to hear it this time, is that the story?”

“Right. All she can focus on is how irresponsible he was for going off his meds. She’s taken their kids to her mother and she calls me daily to ask him to write her a get. You get the picture, Reb Yaakov.”

“I do, Rav Chayes. But what are you hoping I can do? It sounds like the poor guy needs a few weeks in the hospital to stabilize, and then hopefully we’ll be able to do the work necessary to repair the marriage. I’m not sure I have much more to offer beyond that.”

“Agreed. But she sees me simply as a shalom bayis macher, yet she once heard you speak — so I thought it might help to settle her down a bit if she heard your take on the case.”

“I’ll have to meet her husband first and do a formal consultation, Rav Chayes,” I responded.

“I know, I know. It’s all set up for you.”

Later that week I made my way to the hospital where Rav Chayes’s talmid, Reuven Davis, was being treated. Reuven had signed a consent form to allow me to review his records and speak with the staff, and what emerged was that this recent episode was most likely due to stopping his medication on the advice of his “therapist,” Rabbi Cherlow.

I felt my blood pressure rise as I read the name and was forced to associate yet another unnecessary psychiatric hospitalization with Rabbi Cherlow. A Yerushalmi fellow who had been to just enough psychology seminars to master the language of therapists, Rabbi Cherlow marketed himself in the chareidi sector as “an expert in safely getting people off of their psychiatric medications using the wisdom of the Torah and the body’s own healing mechanisms.”

Rabbi Cherlow was familiar with several alternative healing techniques that have been shown to alleviate certain mild depressive symptoms — but bipolar disorder has no cure and requires managing two distinct categories of extreme dysfunctional behavior, both the manic symptoms and the depressive ones, with nonnegotiable prescription medication.

I’m sure Rabbi Cherlow was a talmid chacham and probably didn’t want to ruin anyone’s life, but he was far out of his league on a case like this one. By weaning his “patients” off their necessary meds, he was literally playing with fire. From what I knew, Rabbi Cherlow had been directly responsible for no less than five hospitalizations, three incarcerations, and two divorces.

But in talking to Reuven, I had to put my personal prejudices aside. Reuven wasn’t too keen on speaking with me because I was a doctor and doctors had “locked him up” to prevent him from disclosing the “kashrus conspiracy that was plaguing Jerusalem.”

It was clear that Reuven was still manic and psychotic, but according to the nursing staff, he was already making big strides, and I encouraged him to continue working with the treatment team and taking his meds, to which he reluctantly agreed. And he was grateful that I’d made up to speak with his wife.

The following day, Rav Chayes and I met Mrs. Davis. I spent some time recounting my understanding of the story, beginning with Reuven’s initial hospitalization and diagnosis shortly after their marriage. I emphasized the success they’d had as a couple in raising three children and shared my optimistic assessment that Reuven was in the early stages of recovery.

But Mrs. Davis interrupted me: “Dr. Freedman, I appreciate your positive approach, but even if Reuven is getting better, I refuse to stay with him. He promised to stay involved in treatment and he broke his promise and stopped his medications in a very selfish and thoughtless move!”

“Mrs. Davis,” I countered, “Reuven did stay in treatment — he just got some really horrendous advice from his new ‘therapist.’ ”

“Rabbi Cherlow?” she asked.

“You got it. Rabbi Cherlow advised him to stop his medications, like he does with all of his patients.”

“Why would he do that?” she questioned in shock. “He came so highly recommended. Didn’t he know that Reuven has incurable bipolar disorder?”

“This is the problem with askanim pretending they’re psychiatrists,” Rav Chayes said, stealing the words right out of my mouth. “And he’s not even a licensed therapist.”

“But he came so highly recommended,” she repeated softly as she slumped in her chair. Here was a woman who was also dealing with the shame and embarrassment of the entire neighborhood having witnessed her husband’s mania. She herself needed support to survive this latest episode, to be able to hold her head high in front of neighbors and friends and to reclaim her dignity.

“You see, Rebbetzin,” I added, “this isn’t Reuven’s fault. In fact, I’d say he’s a victim of some very dangerous advice.”

“He’s a casualty!” she exclaimed as everything suddenly clicked together. “How could that rabbi act so confident?!”

After the shock and the tears, Mrs. Davis collected herself. “I feel so betrayed…. I guess I don’t need a get — but maybe what I do need is patience, more empathy, and to be more vigilant in making sure Reuven’s care isn’t compromised again by impossible promises of salvation.”

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 772)

Tagged: Off the couch