First published JULY 21, 2015 - Times of Israel.

He is just 12 years old. He is a  healthy pre-teen with a  serious problem. He is afraid that he has lost his “olam habah” his portion in the world to come, a concern people four times his age rarely have. He says things like “I look at all those other people, the ones who spend their time playing or reading secular books I am so glad that I am not like them. At least I still have a chance to make it into the world to come.”

His very concerned mother, father and pediatrician asked him to see a therapist. He has been to three therapists. He rejected all of them. None of them were good enough for him because he judged them as irreligious. He consented to see me, albeit briefly.

After introductions I asked him what his plans were for the summer vacation. His response was quick and chilling:  “I will learn at least six hours but probably more every day with my rabbi.”

I asked him if he enjoyed sports. His response was terse. “That’s for people who don’t care about the next world.”

I asked him if he ever played any sports or even board games. “I used to play basketball but I can’t waste my time on that now. If I want to be successful in what I want I can’t spend more than a few minutes wasting time.”

“But, you need physical exercise to stay healthy,” I told him. He just scoffed.

He is so scrupulous that he often refuses to eat at home. He doesn’t always trust that his mother will serve him food that is kosher despite the fact that the home is completely kosher.

I ask him about friends. He reassures me that he has many. Does he spend any time with them? “Yes, in learning.” He replies.  He goes on to say “But they learn about two hours I spend much more time. Sometimes I play basketball with them for a few minutes.”

He admits to me that he is “very anxious inside” and attributes that exclusively to a concern about being a religiously pure person.

“Does your rabbi know that you have such anxieties?” I ask.

“Sure he does. He gave me a book to read and a video to watch.” He responds.

“What type of book?”

“A book of mussar.” He goes on to describe what he has read there, clearly misinterpreting large parts to fit his very scrupulous worldview.

“Tell me about the video.”

“It teaches that all the cures come from god and the more you learn the more god will help you.” He is energetic in his narrative.

I notice that he is secretly texting while we speak. I ask him who he is writing to. “My rabbi.”

“May I speak with him?” I ask.

“Sure.”

I obtain a release from him and his parents and the next day I call his rabbi.

The rabbi seems affable,  happy to communicate with me. He says he is concerned about the boy and is attempting to work with him to help calm his fears. He also tells me that despite the young man’s many hours at learning he seems stuck. He repeats what he learns for many hours and has a hard time moving on. I get the impression that the rabbi is withholding but it is not immediately clear what it could be.

After speaking with the rabbi, I phoned the young man’s mother. I asked her about the rabbi. She says she was trying to reach him for over three months to ask him to help her get help for her son. She said he never called her back.

At our next session, the session that would be our last, the boy starts off in an angry, agitated attack at me for not understanding him. He is crying. I ask him what is so hard for him. He raises his voice and tells me he will never make it to the world to come and it is because of me. I tell him that it is an article of faith that it is possible for someone to acquire the world to come in an instant. I tell him that it is a mitzvah to take care of one’s health. He is increasingly agitated and begins flailing his arms.  I am suddenly aware – I ask if I can call his rabbi right then and there. He says “Please call him.”

I get the rabbi on the phone and explain what is going on, asking him to be an ally in helping me treat this young man. The rabbi raises his voice telling me it is unprofessional for me to call him. We hang up. I ask the boy if the rabbi wants him to be in therapy. He replies “No!”

Scrupulosity is a disorder characterized by severe religious and moral guilt. It is often accompanied by acute anxiety, poor social functioning, and can even include what appears to be paranoid thought patterns.

This boy’s rabbi thinks intense devotion is healthy and is encouraging it in this boy. His parents object as do I and every other health and mental health professional he has seen. The boy has a severe anxiety disorder that is made worse by obsessive devotion. Many clerical leaders understand the problem and the correct way to interact with health care providers to treat the issue. Some not. While this rabbi sees the anxiety in the boy he is unaware of the pathological side of it.

Abuse can come in many different forms. The tenacity of religious fervor accompanied by a disregard for normal, healthy development can cause one to lose their health, well-being even their religion.

Or perhaps just lose their belief in those few who misrepresent religion.

Significant personal details have been altered.