Dr Judith Guedalia

Is Ice Fleishig Or Milchig? Another Case From A Psychologist's Journal

Late one afternoon my secretary, Tova, told me in my office that I really have to take this call now, as the woman on the other end of the phone kept saying, "This is an emergency." I picked up the phone and noticed that as Tova left the room she had an odd smile on her face, not at all in keeping with the word "emergency."


"Please help me; I am not religious but I was told you might be able to help me. Is ice 'dairy' or 'meaty?'"

My first reaction was a muted, "Huh?"

I wasn't sure whether to be sad or glad for this type of referral. Someone felt that, notwithstanding the fact of my being religious, I would help someone who wasn't. How could anyone assume that you have to be of the same religion, let alone level of observance, to ask for or receive help from a professional? I find even the existence of this perception appalling!

Instead of lashing out and (haughtily) listing rabbinic literature, which permits desecrating the Shabbat to save the life of anyone, I just replied, "Maybe you should start from the beginning; on second thought, let's start at the end."

"My daughter is newly religious and when I tried to put ice in my baby grandson's soup to cool it down, she said that I couldn't because I don't have 'separate' meaty and dairy icetrays. Is ice fleishig ormilchig?"

I decided to "handle" this question in the age-old Talmudic fashion, answering a question with another question. "I think this is more complicated than it would appear at first blush. Would your daughter be prepared to come in and speak to me herself?"

Within a few days the daughter called and said she knew her mother spoke to me, and that she is only making an appointment because her mother is so upset and crying all the time.

An intake/first appointment is usually scheduled for between 1½ to 2 hours. In that time we chat and try getting to know one another. A kind of first date, it allows the therapist a chance to get a "feel for the patient." Many "first" appointments can last for four or more visits.

The daughter (I'll call her Dianne) came at the appointed time with her infant son. We started talking and I had the immediate impression that Dianne was a highly intelligent, well-spoken person. She attended to her baby during the course of the meeting, fussing with him, nursing him and checking his diaper when appropriate. She had also brought along a sheaf of papers. "I Googled you," she said proudly. In the years that the Internet and especially Google have become household words and all sorts of information are literally at one's fingertips, I have had many patients who have similarly looked me up.  They have also frequently Googled the information regarding their diagnosis, treatments and everything in-between. 

I know many of my colleagues in the hospital find this, at best, annoying and, at worst, threatening. I know that I would have probably (and have) done the same thing. What most of my previous patients and I would not do is bring the papers − specifically on my research of the doctor − into the office with us. "Hmmm," I thought to myself.

During the course of the interview/meeting, Dianne frequently referred to comments I made in articles I wrote or that were written about me to "punctuate" her points. As if to give further credence to her statements, she quoted me to me! She also noted pointedly personal information that she had culled from the Internet, and asked me if the other people listed with the same last name were my husband or children. As she asked the last question, Dianne looked at me with her eyes lowered, head tilted to one side, and a smile that seemed more like a smirk on her face. My association from her facial expression was, "gotcha."

I frequently teach my students that how we feel during the interview is of the utmost importance to note. My mantra is, "pay attention to your visceral reaction -immediately."

Transference, first described by Sigmund Freud in relationship to psychoanalysis, has been written about ad infinitum. Here it is "just" defined as an unconscious redirection of feelings for one person to another, feelings that probably originated in childhood. And the counter-transference is not only - but also - the psychologist's response to these "redirected feelings."

Patients have a right to know my professional credentials. So what was my visceral reaction? In cases like this, I see their "search" not as a genuine need to have information about the professional to whom they are planning to share their issues. This time I felt stalked and my privacy invaded. She had crossed Internet etiquette. There was something aggressively intrusive about her "hunt" for information about me.

I asked her where most of her friends lived. "That's a funny thing to ask," she replied. She looked at me and said that she "never really had any friends - even before I became a ba'alat teshuvah (newly observant)."

"What about your relationship with your siblings?" I asked. "We still fight like cats and dogs even though we are all in our thirties already. Actually they get along together, they just don't get along with me never did for that matter, and now that I am religious it is more of the same."

I told her that I really respected the fact that she came in to speak to me, when it was her mother who had asked. "Kibud Eim (honor thy mother)," she said. "Still, it speaks well of you." Then she smiled - genuinely - for the first time. I felt relieved that there was some sign of genuine emotional resonance. Her diagnosis, treatment and prognosis might be more optimistic than I had first thought.

Over one hour had gone by, and I was trying to formulate some form of game plan that for me meant trying out a hunch vis-à-vis a preliminary diagnosis. I asked myself what would make someone need to know, to "own" information that was someone else's?  How and why would having information relieve someone's anxiety to such an extent that, in this case for example, it then allowed the person to relax sufficiently in order to accept a compliment?

I went back to my original impression that once Dianne had the info on me, I perceived her looking down her nose and smirking - as if to say, "gotcha." If she "got" me, was that a way of pre-empting my "getting" her? Was she girded/armed with the information about me as a protection against attack?

I turned to Dianne and told her my feelings of her having "gotcha-ed" me, and that I felt she had crossed the line from appropriate to invasive. I said that I am now going to ask her an off-the-wall question that she didn't have to answer if she felt it was too intrusive.  I said, "I am asking myself what happened to you very early on in your life that would make you wary of being attacked?" Quiet for a long time, she then answered, "I have many allergies, starting with Lactose Intolerance that was diagnosed when I was two months old. My whole life I have had to be careful about the food I ate and places I went."

I thought that had I been Sherlock Holmes, I would take out my pipe now and smile contentedly. Her behavior − her "gotcha" with the personal information and the "meaty and milky" ice − spoke of severe anxiety, defensiveness and even paranoia. Instead of dealing with the anxiety as an "internal" experience, I might propose a treatment plan "externalizing" the basis of her anxiety by trying to understand the "siege" she has been under by her Lactose Intolerance and allergies.
            Being Orthodox can mean "separate," but can also be a way of joining and including others without the constant anxiety about being harmed, devalued and embarrassed. I would try to posit that being a new mother might have triggered the fact that she might not be able to protect her son from pain and noxious foods in his environment - as her own mother could - and did not know that while being nurtured with a bottle of milk, her mother may have been perceived by infant Dianne as someone "out to get her." When a child is born with Congenital Lactase Deficiency, a genetic disorder that prevents enzymatic production of lactase, the child may experience severe stomach cramps and gaseous − full but empty − feelings until diagnosed and treated.
            In her seminal book, Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (1994 Guilford Press), Nancy McWilliams writes: "The main polarity in the self-representations of paranoid people is an impotent, humiliated and despised image of self versus an omnipotent, vindicated, triumphant one." Further in the chapter, she states, "They [paranoid individuals] never feel fully safe and spend an inordinate amount of their emotional energy scanning the environment for dangers."
            As she left the office, I asked her if ice is fleishig or milchig. She smiled and said, "I'll tell my Mom ice is pareve."


Originally published in the Jewish Press on September 17, 2008.

Tags: Anxiety | Congenital Lactase Deficiency | Counter-Transference | Defensiveness | Jewish Press | Lactose Intolerance | Paranoia | Redirected Feelings | Transference