A s a practicing psychiatrist in the US, I would get a few phone calls every week from people who needed a “letter.” Some people want one for social security in order to be recognized for state benefits. Other people want a letter to aid with their appeal for public housing. I was once asked to write a letter to the airlines in support of a patient who likes to bring her “therapy poodle” on the flight between Miami and LaGuardia.

Sometimes the requests were straightforward and legitimate, and then I had no problem supporting my patients. A young woman with treatment-resistant schizophrenia who can’t make a living and would benefit from supportive housing is certainly deserving of these services to allow her to live independently in the community. On the other hand, a young man who doesn’t want to work because of “anxiety” — when he’s really spending most of his time and resources growing and smoking nonmedical marijuana — likely doesn’t meet criteria for “disability” beyond having bad judgment and a lack of personal responsibility.

Living in Israel comes with all sorts of new complexities as far as writing letters for my patients. Beyond becoming familiar with the ins and outs of Bituach Leumi, the Israeli version of Social Security, and Diur Mugan, sheltered housing, there was a whole new type of letter that I’d be asked to write for my patients: a letter to the army regarding capacity for military service.

This issue was certainly a sensitive one. There are those who say that mandatory service means mandatory service irrespective of religious practices. There are others who say that a yeshivah deferment is legitimate and should be guaranteed according to the goals and laws in the State of Israel. Then there are differences between all-chareidi units and hesder units. And what about issues related to kashrus, Shabbos, and mixed-gender units? Furthermore, there have been a number of well-publicized stories of psychiatrists providing illegitimate exemption letters for individuals seeking to escape their mandatory military service. This had resulted in legal consequences including suspended medical licenses.

That being said, sometimes the issues related to writing such a letter are straightforward. A young bochur with a history of schizophrenia and paranoid delusions had no business serving in the army. Another young man who wanted to “shoot a lot of missiles” and also happened to be taking lithium for bipolar disorder certainly required a letter recommending exemption. A third fellow who was in the midst of his fourth detoxification treatment in one year would be a terrible candidate for military service.

Yehudah was also a clear-cut case, but for a different reason. An 18-year-old kid from a national-religious family in Jerusalem, Yehudah was from a long line of dedicated military men. His father had been in a commando unit and still participated in miluim — reserve duty — every year as an officer. Yehudah’s older brothers were both serving as paratroopers — tzanchanim — and his cousins, uncles, and grandfathers were decorated soldiers — reconnaissance scouts and fighter pilots. Yehudah wore the big knitted kippah and sandals of a young kid from the settlements, and looked like he’d be headed straight to a hesder yeshivah — a five-year program mixing army services with three-plus years of Torah study. And yet he had come to the office complaining of OCD and blindsided me with a request for a letter exempting him from military service.

“I’m not cut out for the army, Dr. Freedman,” he said. “I have bad OCD, I’m just not cut out for it.”

I asked Yehudah about his symptoms and he responded in an odd fashion. “Symptoms? I told you, I have OCD, that’s my symptoms, it’s been going on for a few weeks now.”

But there was no previous history of formal treatment in his very normal upbringing in his Bnei Akiva community. “You were basically okay until a few weeks ago, Yehudah?” I asked him. “OCD doesn’t normally start suddenly and most people have issues related to cleanliness, checking behaviors, compulsive religious rituals, or other symptoms.”

“I just have basic OCD, nothing special, but it’s still pretty bad,” he responded defensively.

“Listen, Yehudah, I’m not telling you that you don’t have OCD, I’m just not sure what your symptoms are or what sort of dysfunction they’re causing. All you’ve done is say the letters ‘OCD’ so far.”

“I have religious things and cleanliness things too. I have compulsive things and obsessive things. You know, like OCD stuff. That’s why I can’t go to the army.”

Hmm, I’d heard this type of thing before. Often it was back in my days covering the ER when criminals with antisocial personality disorder would be brought in by the cops faking schizophrenia to avoid an arrest: Yeah doc, I got a bad case of schizophrenia, I hear voices telling me to kill everyone. I talk to Big Bird and Oscar the Grouch and they told me to rob that gas station. There’s a word for it and it’s called “malingering” — faking it for the sake of secondary gain. The treatment for these guys was easy: discharge them back into police custody.

But sitting here with Yehudah was more complex. He clearly didn’t have OCD but was dedicated to telling me that he did for the sake of getting a letter of exemption from the army. The question was why?

“Yehudah? Why don’t you want to go to the army?”

“Because I have OCD, Dr. Freedman. That’s why I came to a psychiatrist.”

“Yehudah,” I said in my most no-nonsense tone, “lying is assur and you’re a religious guy. Let’s have some honesty. Why don’t you want to go to the army?”

He looked away from me and sat quietly. I waited for a few minutes but it was clear he couldn’t answer this one without some prompting.

“Are you scared to serve in the army?” I asked. “Are you nervous about it being dangerous?”

“No,” he answered clearly.

“Why then, Yehudah?”

“You’re chareidi… don’t you get it? Why can’t I just study Torah? Isn’t that why Hashem put us here anyways? Why do I need to go and hold a gun at a checkpoint near Ramallah? How is that going to fix the world, and isn’t there someone else who wants to do it instead of me? Why do they need to pull me out from yeshivah when I’m finally learning how to crack the Gemara? I’m doing Tosafot and Rishonim and Tur and Shulchan Aruch! I’m doing great! Why do they need me at a checkpoint searching taxis?”

Well, I certainly didn’t see this one coming. Here was a kid who looked like the pride of the national-religious camp telling me that he didn’t want to serve in the army because he wanted a yeshivah deferment. He didn’t want a letter for mental illness at all.

“Why don’t you just ask for a yeshivah deferment, then, so you can continue to study Torah?” I asked.

“In my family, Dr. Freedman? Everyone is basically a decorated war hero.… My saba was one of the first fighter pilots in the country, my uncle is a general, and my father is so proud of my older brothers in the paratroopers. How can I let them down?”

“Studying Torah is letting them down, Yehudah?”

“I… I don’t know… I guess it is?”

I sat for a moment to let him think before asking again: “Studying Torah is letting your family down? Even if it is, do you really think that they’ll buy an excuse of OCD? I can’t imagine they’d fall for that one, Yehudah,” I said. “I certainly didn’t fall for it.”

“So what should I do then, Dr. Freedman?”

“You should tell the truth. Baruch Hashem you don’t have OCD! Baruch Hashem you love the Torah. Baruch Hashem you have brothers who are willing to go to the front lines as paratroopers so that you can study Torah. Baruch Hashem you have the zechut to study Torah in the merit of your brothers.”

Yehudah smiled and then said, “Like Yoav and David. One was always studying and davening in the zechut of the other to ensure that they’d be successful on the battlefield.”

“It’s a winning combination, Yehudah.”

Yehudah was quiet again but not in a sad way. Eventually he asked, “So what should I do, Dr. Freedman… just tell them?”

I nodded and said, “And tell them just like that… and you can even quote the Gemara about Yoav and David.”

“Okay,” said Yehudah as he built himself up and said in an increasingly confident tone, “I can do this.”

“Of course you can, Yehudah,” I told him. “Just make sure you are as serious in the beit medrash as your brothers are on the front lines.” 

Originally featured in Mishpacha, Issue 669. Jacob L. Freedman is a psychiatrist and business consultant based in Jerusalem. He serves as the medical director of services for English-speakers at Bayit Cham, a national leader providing mental health treatment and outreach within the religious community. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.