"It’s up to you,” I told Rami. “You’ve got all of the skills to make it happen.”

“I know you’re right, Dr. Freedman, and I also know exactly what you’re going to say next.”

“And what’s that?” I asked.

“That I should call you when I’m ready to buckle down and do the real work.”

“You got it, Rami.” And with that, he gave me his patented goodbye handshake that was some kind of a high-five-clap-clap-hug-snap.

“I won’t let you down,” Rami told me as he walked out the door.

“Don’t let yourself down!” I yelled after him.

But it was complex. And he’d already let us both down for what would be the seventh time. I suspected it would be a while before he’d call me again, which was truly unfortunate as there was so much potential and good work to be done in therapy.

This was a young man who let the tough background he came from hijack his natural potential and doom him to be a serial failure. His father had spent time in prison, although he’d been out of the picture for much of Rami’s formative years after his parents’ acrimonious divorce. As Rami was her only child, Mom wanted to be involved in his life, but their relationship wasn’t simple due to her own unstable personality and her inability to separate her son’s future from his dad’s past. He moved to Israel several years ago to escape the pressure of being incessantly chided “You’ll end up like your father.”

Rami had spent much of his school-age years being told by both his parents and his teachers that he was a failure, although he was talented in so many spheres: He was a natural athlete, a true people-person, and had a solid mind for business. But Rami always seemed to be shooting himself in the foot — whether it was the sixth grade math test that he aced but was accused of cheating on, the professional soccer tryout he missed because he was hungover, or the great internship he never showed up to sign the contract for, Rami could never get it together.

He’d tried a range of stimulants for ADHD that never helped his focus or gave him anything more than problems with getting to bed on time. He’d been on most antidepressants without any response beyond an upset stomach. He’d tried some homeopathic remedies, which only ended up draining his wallet. In the end, Rami had been unofficially labeled “destined to fail” and was dismissed by his previous therapist for missing too many appointments.

I got the referral after his former therapist was burned out. After hearing more details, it was clear to me that he didn’t need psychiatric medications or have some hopeless mental illness. Whatever it was that was disrupting Rami’s functioning, I was happy to meet him and hear his version of inappropriate diagnoses and failed treatments.

“Nothing’s worked so far, so I’m willing to try any pill you’ve got,” Rami offered half-heartedly back in our first meeting. “Not that it will help. I’m pretty sure I’m basically healthy — I just keep messing up.”

“I don’t even think I have a pill for you that you haven’t tried,” I told him, “and even if I did, I don’t think that’s your answer, so let’s not waste each other’s time by going in that direction.”

And I didn’t. He lacked the profound dysfunction of someone with mental illness; rather here was a fellow who just couldn’t get it together. He’d start a new business but then get into an argument with his partner, meet a great girl but then stand her up for a date, or find his way into drinking a few more beers than appropriate in an inopportune situation.

During our first meeting, when I asked him why he thought he was always sabotaging himself, Rami shrugged and didn’t seem like he was ready to open up. But sometimes psychiatry can be more invasive than thoracic surgery so I sent out a hook.

“You’re afraid of failure?”

Rami took the bait. “Maybe. But the truth is I’m just sick and tired of being told by my mother that I’m just a bum like my father. If I’m a bum then let me be a bum.”

“But you’re not a bum, Rami. I’m not here to cheer you up. It’s just that you’ve clearly got the skills to be successful, even though you’ve programmed yourself to fail. So what we’re going to work on is figuring out your feelings and what thoughts, conscious or subconscious, are driving those feelings and beliefs that are making you feel so bad about yourself. You’re not defined by your past, nor by the negative feelings evoked when you think of your parents. You don’t have to be a self-fulfilling prophecy regarding what your mom thinks of you. Think you’re ready for the journey?”

“It’s not that simple, Dr. Freedman,” Rami said, looking at the clock. And with our time up for the day, we left it as we would for the next seven times we met. He was ambivalent about doing the tough personal growth and the psychotherapy that would help him to break through. “If I think I want to meet again or if I’m still not better in a few weeks, I’ll give you a call.” Then he gave me his high-five-clap-clap-hug-snap and we wished each other the best.

Now, on our eighth meeting, Rami was a bit embarrassed to tell me that he had parted ways with his most recent business partner and that he was trying to avoid a legal dispute.

“Rami, you’re ‘The Man!’ ” I told him emphatically.

“What are you talking about, Dr. Freedman? I’m just messing up again!”

“I know, Rami. You’re not ‘The Man’ because of this new problem. You’re ‘The Man’ despite this new problem.” He laughed, but I was serious. “Rami, this is the whole point. You can do it. A tzaddik can fall seven times but he keeps getting up. You have the skills and G-d-given talents to make this happen. You just need to actually do it already.”

“Dr. Freedman, every time we’ve met you keep telling me I can keep it together. But why? I haven’t done it yet! My dad is a complete failure, my mom is a mess, I’ve never followed through — why am I suddenly going to start being successful after 27 years of utter disappointments?”

“Listen Rami,” I told him, bringing out the heavy artillery, “I once heard a story from a colleague who had gone to visit the Baba Elazar ztz”l. The Baba Elazar told him he had to do something tough, but not to worry, he could make it happen. My colleague tried to tell the Rav that it was too hard, too complicated, too unrealistic. The Baba Elazar wasn’t interested in his excuses and told him, ‘You’re saying it’s impossible and I’m saying you can do it. This means that one of us is wrong and one of us is right. But you’re the one who came to me for advice, so just do it.’ And you know what? My colleague was naturally successful in his endeavor. Not only did he have the tzaddik’s brachah, he was also empowered to believe in himself. Once he realized that it was possible, he was able to make it happen.”

Rami looked at the clock and got up to leave. “You know what? I’ll call you—”

“…if I’m ready to do the work,” I finished his sentence for him.

For the eighth time, I accepted his high-five-clap-clap-hug-snap and wished him a good day, eagerly awaiting the message that he was ready to schedule his ninth appointment.

Originally featured in Mishpacha, Issue 711. 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