R av Shoham is one of those people you can never turn down,

because as much as you can do for him, he’s doing even more for everyone else. He runs a number of chesed programs in the city, coordinates Shabbos meals for needy families, finds donors to fund weddings for orphans, and has started several kollels for baalei teshuvah from broken homes. He also has a great sense of humor, and in true Breslov fashion, this chassid of Rebbe Nachman always has a smile on his face no matter the circumstances, and seems to be on a direct mission to find the best in every situation. After doing teshuvah himself a few decades back, his assignment has been to fix the world, one Yid at a time, and I’ve been glad to help any time I can.

I got to know Rav Shoham over the past year, as he’d sent a number of young men in my direction. Baruch Hashem, we were able to wean some of those kids off drugs, and we’re still hopeful regarding many others. Rav Shoham is a walking kiddush Hashem, so I’m always more than willing to pick up the phone when I see it’s him calling, even if the question wasn’t clinical. Like the last time he called, letting me know about a bochur from his kollel who was getting married the following week and didn’t have a shekel to his name. So when I saw his number on the caller ID this time, I was curious about his newest project. I didn’t have long to wait.

“Reb Yaakov, we’ve got a guy here who needs you,” he said. “A bit of a wacky story — maybe you can help.”

Rav Shoham proceeded to tell me the story of a young man who’d done far too many psychedelic drugs a few years back on his travels to India following his discharge from the Israeli army. Ofek had returned with some delusional ideas and had spent a number of months in a local psychiatric hospital for what ended up being his first episode of schizophrenia. He’d subsequently become religious and had been off drugs for some time, but the combination of a genetic predisposition to mental illness and his reckless substance abuse had left the young man with a chronic psychotic illness that had proven largely resistant to medication.

“And now he thinks he’s the Kohein Gadol or something like that?” I asked Rav Shoham innocently.

“How’d you know?” he asked moderately flabbergasted.

“Just a hunch,” I answered nonchalantly. “Actually,” I told Rav Shoham, “I think I already met him.” I’d already met a guy named Ofek with the same story. How many of them could there be? I had had contact with this particular fellow during my stint at a wonderful clinic in Jerusalem shortly after making aliyah. Ofek was a longtime patient of Dr. Z, one of the best psychiatrists in the country, and Dr. Z took exceptional care of him.

But Ofek was probably not going to get much better, as he had a very severe and treatment-resistant form of schizophrenia that was further complicated by the fact that he had experienced horrible side effects from his antipsychotic medications. I remember hearing from Dr. Z about the discussions he’d had with Ofek and his sister (his legal guardian) about the risks and benefits of treatment with medications, and their eventual decision to use only a low dose of meds to minimize the chance of further complications. Of course this resulted in Ofek’s inability to achieve a complete remission from symptoms and from the fantasy world he lived in, including the belief that he was the Kohein Gadol.

“So what do we do then, Reb Yaakov?” Rav Shoham asked. “He’s really quite delusional. Every day he stands up with the rest of the Kohanim at Shacharis to duchan. Plus, he spends all day learning Kodshim.”

“Tell me, Rav Shoham, is he safe and happy as the Kohein Gadol? I mean, he’s not hurting himself or anyone else, correct?”

Rav Shoham was somewhat skeptical, so I tried to explain.

“Ofek is a super lucky guy,” I said encouragingly. “He has an exceptional psychiatrist who takes great care of him. Unfortunately, he’s probably in as good a shape as he’ll get — but look, it’s infinitely better than it could be. I mean, he’s learning in kollel, and there are plenty of yeshivos where all they learn is Kodshim.… Brisk has avreichim doing it three sedorim a day,” I said.

“Nice, Reb Yaakov. But he’s still delusional.”

“I know, Rav Shoham. But Dr. Z is a very good doctor and has discussed all of the treatment options both with Ofek and with his sister. These are the decisions they all made as a team. That’s the thing with mental illness, navigating that space between the patient’s ability to heal, whether he’s a danger to himself or society, and how bad his life really is — according to his comfort level, not ours.”

“Okay, I hear. But what about his duchaning thing? Truthfully, I guess it’s not hurting anyone, but how can we be complicit in his delusions about being the Kohein Gadol?”

“Rav Shoham, I want to share a story with you about a woman I knew when I was training in a mental health clinic back in Boston. She was Abraham Lincoln’s wife. Not his real wife, but the other one: She was a homeless woman with chronic schizophrenia, who used to come to the clinic for the free coffee. After years of building a relationship with her, one of my mentors finally convinced her to take a certain medication for her condition, thinking that with treatment she’d be able to return to a more normal life. Well, let me tell you what happened — a week later, the woman wound up in the emergency room after a suicide attempt. When she finally woke up and my mentor visited her to ask what happened, she told him, ‘Your medications made the voices go away. I went from being the First Lady of the greatest president in the history of the United States to being just another crazy homeless person.’ ”

“So what are you saying, Reb Yaakov, that we just let him continue to be the Kohein Gadol?”

“Well, the world is a pretty challenging place, and we could all use a few more brachos, no?”

“True what you’re saying. Okay then, Reb Yaakov, I guess we should all be waiting eagerly for the time when the real Kohein Gadol comes to take his job back.”

“I’m sure that when Mashiach comes, Ofek will defer to the recommendation of returning to being a stam Yisrael,” I told Rav Shoham. “In the meantime keep up your amazing work — you’re the one bringing the Geulah closer every day!”

Originally featured in Mishpacha, Issue 691. 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.