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Gemara Detective

Jacob L. Freedman

“Tell me a bit about the bochur behind the medication”

Wednesday, December 12, 2018

Shmulik was from an upstanding chassidishe family in Monsey. His father ran a kollel and his mother ran a house of 13 children, kein ayin hara.

With siblings who included an older brother who was a dayan in Eretz Yisrael, another who was a maggid shiur in Brooklyn, and a sister who was married to a popular community rav, Shmulik was poised for greatness as he headed off to yeshivah gedolah in Jerusalem, where he’d been studying for the last two years.

One afternoon, the mother called me to schedule a phone call with the father. He didn’t own a cell phone and would only be available to speak between 2–3 p.m. when he was back at home between morning and afternoon seder, even though that would be between 9–10 at night for me.

But I’m a nice guy and happy to help. Anyway, it was all pretty straightforward and simple: Shmulik had run out of his ADHD meds and needed a refill. No drugs, no depression or anxiety, no legal problems, no trauma history. Simple. Just refill his ADHD medication. Okay, I said. Tell Shmulik to come in at 10:30 tomorrow morning and we’ll take care of it.

And then Shmulik showed up 25 minutes late for our appointment. He seemed surprised, caught off guard, when I asked him why he had missed the first half of our appointment, as if it were somehow expected behavior.

“Because I dunno,” he said. “Can you refill my medication, Doc?”

“Sure I can,” I replied. “But first you’ve got to tell me a bit about the bochur behind the medication.”

“What do you mean?”

“I mean that I’m not a drug dealer who gives meds with a potential for abuse to everyone who asks for them without some kind of background check.”

Shmulik smirked with epic sarcasm. “I gotcha, Doc. So what do you want to know? Who I think is going to win the Oscars this year?”

Hmm, interesting. What does a boy from chassidishe Monsey know about the Oscars?

“Basic stuff, Shmulik, like who are you, what do you like to do, those kind of things.”

“I like to schmooze,” he responded flippantly.

“Schmooze with me a bit then,” I countered.

“I like to schmooze with the guys, not with some shrink that I had to shlep out to,” he clarified, looking a bit annoyed.

“Fine,” I said. “No schmoozing. But I do get to ask you what medication you’re taking and why you’re taking it.”

Shmulik described a very atypical story for ADHD. No problems sitting still. Good zitsfleish and no shpilkes in grade school whatsoever. No forgetting stuff, no issues waiting his turn.

“Okay, I never had any problems learning a Gemara until I came to Eretz Yisrael,” he conceded.

This was certainly not the norm, given that ADHD was a neuro-developmental condition that — with very few exceptions — begins in childhood and not all of a sudden when bochurim leave their parents’ homes for yeshivah.

“But to tell the truth,” Shmulik continued, “I don’t even know that I need it. I don’t take it too often and when I do, it never really helps anyway.”

“So why did you start taking it in the first place, Shmulik?”

“Some mechanech told me to take it, I guess. I dunno, I was having trouble paying attention in shiur and then the mechanech took me to a doctor for 15 minutes and I walked out with a prescription. You know how it goes.”

Unfortunately I did. The art of the 15-minute psychiatric consultation was one that I was never interested in mastering. I have no doubt that this mechanech was trying to help Shmulik, but clearly something was missing here. This bochur didn’t have a history of ADHD, and it was therefore not surprising that he didn’t get better with the first-line medication treatment for the condition. It seemed to me that this boy was a casualty of a multipronged system that pushes stimulant medications in the absence of a proper diagnostic evaluation.

After taking a thorough psychiatric history, it was pretty clear that Shmulik didn’t have any other mental illness or clinical issue. In fact, the more questions I asked, it seemed as though his problem was one of ruchniyus as opposed to a neurochemical dysfunction.

I couldn’t put my finger on it, but here was a kid who knew a lot more pop culture than I would have imagined for someone from his background, and he didn’t seem to have too much cheishek for his Gemara either.

But Shmulik wasn’t ready to divulge anything, and answered most of my questions with a “yes” or a “no” until I finally caught him.

“So, what masechta are you doing these days, Shmulik?”

“Chagigah.”

“That’s an interesting masechta for a yeshivah bochur, but it happens to be one of my favorites,” I responded. “All of the halachos about being oleh regel three times a year, tumah and taharah, all the aggadetas about Acher, the Merkavah, Brias Ha’olam — it’s mamash one of my favorites.”

Shmulik started to squirm as I continued, “So what daf are you guys on?”

Shmulik mumbled something and I pushed him again. “I didn’t catch that one Shmulik. What daf are you on?”

“Daf 42, amud beis,” he said squeamishly.

“That’s so interesting, because Chagigah ends on daf 27 alef, if I remember correctly.”

Shmulik blushed and then laughed. “Okay, you got me.”

“You’re right,” I said without trying to sound too victorious. “Like I told you, that’s one of my favorite mesechtos. So tell me, Shmulik, when was the last time you went to shiur?”

“Elul zeman,” Shmulik answered.

“Appreciate your honesty, Shmulik,” I said. “So what is it? Drugs? Girls? Phone? Or something else?”

“Uh… phone. Pretty much all day,” he admitted.

“Gotcha. I figured as much when you mentioned the Oscars. They don’t have that narishkeit in the beis medrash.”

We sat in a shared silence until I spoke again. “So Shmulik... is this where you really want to be, or do you want to try to have a shot at getting back to your other self? If you want, I can put you in contact with some people who will really ‘get’ you, and we can work with that.”

“You can? I mean, I’m not hopeless?” he said, surprisingly positive about the newest option, which he probably knew would help more than any Ritalin, Concerta, or Adderal. “I think I could connect to that. But one question — how’d you catch me?”

“Easy,” I said, “I’m the Gemara Detective.”

*Names and identifying details have been changed to protect the privacy of patients, their families, and any other involved parties.

Originally featured in Mishpacha, Issue 739. 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

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