May 21st, 2019

Inspired Living

When your shrink is NOT a god

Jacob L. Freedman, MD

By Jacob L. Freedman, MD

Published March 13, 2019

When your shrink is NOT a god 'You need to get him off G od and into treatment already!' demanded the voice on the phone.

"Boruch the Breslover” was the name he’d chosen for himself. From my perspective, it was a whole lot better than Bernie Fishbogen, but apparently this wasn’t unanimous.

Boruch’s brother wasn’t a big fan of the Breslover Chassidic sect. In fact, he wasn’t even religious, and wasn’t too happy that Boruch had “found himself a new rebbe to work with.”

As Boruch’s psychiatrist following his recent hospitalization for bipolar disorder, that was the message I received one afternoon.

Actually, I was quite pleased with Boruch’s progress and felt things were on the right track. Here was a young man who was finally addressing his serious mental illness.

Boruch was a baal teshuvah, a returnee to the faith, from an academic American family. And after a few years with Chabad on his college campus, he’d headed to Israel and became a Breslover chassid.

That was shortly before his first psychiatric hospitalization.

And while he’d subsequently recovered, married a fine young woman, and was learning well in kollel, he’d had a second hospitalization a few months back, following the birth of his first daughter and the inevitable first-time parent pressure and lack of sleep.

He’d been doing well since his discharge, and we’d done some important work together in terms of helping his wife to understand his illness and to support him with the necessary treatment.

Boruch the Breslover himself was taking everything with emunah (faith) and was thankfully on the right track.

But based on the tone of the message I’d received, I had the feeling that his brother wasn’t too interested in talking about these positive developments.

Boruch had told me that his brother would call, but wished he would have warned me what I’d be up against.

“Who the heck are you?” boomed the aggressive voice from overseas. “We don’t need another rebbe messing up Bernie’s head. One rebbe is enough.”

“Err… I’m not a rebbe, Mr. Fishbogen,” I responded, a bit taken aback.

“It’s Dr. Fishbogen,” came the reflexive retort. “Actually, it’s Professor Fishbogen. I’m a full professor of biostatistics at Columbia. And if you aren’t a rebbe, then I’ll just call you Mr. Freedman.”

“Professor Fishbogen, you can call me whatever you’d like,” I said with as much equanimity as I could muster.

“Mr. Freedman, if you’re not a rebbe, why does my brother Bernie call you Rebbe Freedman?”

“Professor Fishbogen, he calls everyone ‘Rebbe.’ It’s a term of endearment for him so I let him call me Rebbe Freedman in the same way that I let other people call me ‘Dr. Jacob,’ or the same way I let you call me ‘Mr. Freedman’ — whatever makes people comfortable.”

Professor Fishbogen was a little taken aback. “What, you’re a doctor? What kind of doctor?”

“I’m a psychiatrist. I trained in Boston and now practice within the religious community of Jerusalem and its environs.”

“Well, if you’re a psychiatrist, then how do we get Bernie to understand that he needs medications for his bipolar disorder and not some religious fanatic beliefs?”

“He does understand, Professor Fishbogen,” I explained. “He’s been treatment-compliant with his Lithium for nearly a month now since his last hospitalization, and thank G od he’s moving toward a steady place.”

“Then why does he keep on telling me that medications don’t do anything for him and that only G od provides him with healing? What do you have to say to that, Dr. Freedman? Are you still sure that he’s taking his medications?” he jabbed.

Luckily, lithium required regular blood tests and I was able to provide objective evidence that Boruch the Breslover was treatment-adherent. “Your brother’s monthly blood tests suggest unequivocally that he’s been taking his medications exactly as prescribed. I’d be happy to e-mail you a copy of the report.”

Unwilling to bend, Professor Fishbogen changed his tactics slightly. “Well then, why doesn’t he think the meds are helping? It’s just G od, G od, G od all the time when you talk to Bernie these days. ‘Only G od helps me,’ is all you get from him. You need to get him off of G od and into treatment already.”

I was in no mood to enter into an angry theological debate with the professor, so I decided to win him over with some solid scientific research he’d hopefully respect. “Professor Fishbogen,” I began, “you’re surely familiar with the research of Dr. Martin Seligman on positive psychology — how the power of optimism and of positive thinking leads to improved outcomes.”

“Yes, of course Dr. Freedman, but what does this have to do with Bernie?”

“Well, we have to keep in mind that believing in a treatment’s success is a powerful predictor of treatment response. Look at the research of Dr. Ted Kaptchuk on the placebo response,” I suggested, mentioning a well-known researcher who happened to be a Sabbath -observant Jew I’d met back at Harvard Medical School. “Dr. Kaptchuk’s research shows that a patient’s own expectations in the experience of treatment are extremely powerful. Even when an individual is receiving a fake-treatment like a sugar pill, the placebo response — their subjective experience of symptoms — is significant and the patient will show true improvement. There was one study regarding treatment for irritable bowel syndrome using real acupuncture as well as treatment by some Asian fellow using fake needles. Dr. Kaptchuk’s research showed that both groups showed decreased symptoms of their irritable bowel syndrome — because believing in the treatment is a key factor in its success.”

“I’m writing all this down in order to do my own research, Dr. Freedman,” Professor Fishbogen responded somewhat more pleasantly. “But what does this have to do with my brother and his hyper-religious ‘faith’ that only G od will cure him?”

“Professor Fishbogen, every time your brother takes his medicine, he also says a little prayer, something to the effect of ‘Please G od help this medicine to be effective so that I can be a healthy and a productive person to serve You to the best of my ability.’ Now tell me, isn’t that an optimistic, powerful expression of positive psychology?

“You know,” I continued, “your zeide [grandather] used to call it tracht gut vet zein gut  — think good and it will be good.”

“How do you know that?” Professor Fishbogen asked.

“Because mine did too. Everyone’s zeide said it.”

“Well, it better work. You know what, I’ll pray for your success and my brother’s recovery.”

The professor didn’t miss my surprise at his comment, and clarified: “Hey, you told me to think positively, so here I am telling you I’ll pray for the two of you with a positive, hopeful attitude. Like you said, Dr. Freedman, research shows it won’t go to waste.”

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

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Keeping Your Head -- and Bases -- Covered

Jacob L. Freedman is a columnist at Mishpacha magazine, an international glossy, from where this article is reprinted. 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.