Joseph, a thin man with a delicate bearing and soft gray eyes, has a mellifluous accent that is hard to place — evidence of growing up in the United States but in a world apart. Until 2009, he was living in a religious enclave of upstate New York as a Belzer Hasidic Jew. He worked as a travel agent, spending his days arranging flights to far flung places, often for people with more freedom than he could ever dream of.

Like many Hasidim, Joseph (who, like several of the people interviewed for this article, requested that his real name not be used here) married at twenty. His wife was the first woman he had ever touched, and she got pregnant soon after their wedding. But their sex life left much to be desired for both partners, and then petered out altogether.

Joseph says his wife would sometimes decide not to go to the mikvah, the ritual bath required of Hasidic women after they menstruate to "purify" them, making them once again sexually available to their husbands. According to Jewish law, if Joseph's wife had not gone to the baths, he was forbidden from touching her, much less having sex with her. After their fourth child was born, Joseph says she stopped going altogether. Joseph grew desperate for intimacy. After two years of celibacy, he finally went to a strip club, Stiletto, on Route 59. A stripper asked him if he wanted a dance and a confused Joseph told her he didn't know how to dance — was she going to teach him? "She meant a lap dance," he told me when we met in his Brooklyn apartment, shaking his head with an embarrassed smile. "I had no clue."

Joseph at home in Brooklyn, New York | (Pearl Gabel/Courtesy Narratively)

About once a month, Joseph would go back to the strip club. Sometimes there would be other Hasidic men there. Fearful of being recognized, he learned to ask the bouncer before entering if there were others like him inside, and if the bouncer said yes, Joseph would go to Lace Gentleman's Club, on Route 303.

One day Joseph sold a ticket over email to a Hasidic woman planning a family trip. A mild flirtation developed when she got her ticket and made a throwaway comment about the airport code listed at the bottom of the itinerary — something most customers never noticed. Joseph remembered their first interaction fondly: "I was like, 'Wow, a chassidishe woman, you know airport codes? You go, girl!' And she was like, 'You bet I know!'" The woman, who I'll call Dini, managed a store. She had an open-mindedness and a brassy confidence that Joseph found intriguing; her curiosity about the world mirrored his own. "I liked her power," he remembered, and for her part, Dini was drawn to Joseph's gentleness.

After a week of email flirting, they arranged to meet at a movie theater. When Joseph saw Dini, he was very attracted to her. "Her face was a raving beauty, and still is," he told me. But he was struck by something else, too. "There was a presence," he remembered. "She's not someone who gets lost in a crowd," a unique quality in their little village. For someone like Joseph, who had always struggled to stand up for himself, struggled to identify his needs and desires, this quality of Dini's was intoxicating. The two continued to see each other, and fell in love.

But two Hasidim married to other people don't just get a divorce and start a new life together. The community got involved. A rabbi and what's known as an askan, a person of influence in the Hasidic community, were given Joseph's "case." The role of an askan — collectively called askanim — is part politician, part good Samaritan, and part busybody. Together, Joseph's rabbi and the askan appointed by the community to his case staged an intervention. Joseph says they got involved in every level of his life, in order to prevent him from leaving his family and starting a new one. They took away Joseph's BlackBerry. The askan started monitoring Joseph's computer, a mirror image of Joseph's screen under surveillance at all times. Joseph's brother-in-law started tracking Joseph's car, where he went and whom he saw.

Joseph was faced with a choice: surrender to the will of his community's leaders, or risk public shaming, and worse — losing his children and friends. He capitulated, and promised never to see Dini again. But that was not enough. The askan chose a psychologist to provide Joseph with talk therapy, and then a psychiatrist for medication, who started Joseph on a course of chemical treatment for sex addiction.

The Hasidic movement began in the 18th century in Western Ukraine. Legend has it that the founder, Rabbi Yisroel ben Eliezer, known as the Baal Shem Tov or Master of the Good Name, performed miracles — that he cured the incurable. He urged his disciples to develop a personal relationship with God through mystical teachings. Today, there are about a quarter of a million Hasidim in the U.S., up to 95 percent of whom live in the New York area, according to population consultant Jonathan Comenetz's 2006 "Census-Based Estimation of the Hasidic Jewish Population."

There are nine major sects, each named for the town in Eastern Europe from which its adherents came — Satmar, Bobov, Belz, Munkatch. After the Holocaust, the remnants of these communities made their way to the United States, where they began to flourish, exhorted by their leaders to repopulate the Jewish people and to radically separate from the secular world that had caused them so much loss. Many of these communities are now all but self-sufficient; they have their own ambulances, police forces, businesses and Yiddish-speaking schools. They have internal economies based on deluges of charity that cascade from the richest to the poorest. In each sect, fealty is paid to the leader — the "Rebbe" — whose position is inherited.

The focus of these communities is on securing the collective good. Conformity is strictly enforced. There is also strict separation of the sexes: Men and women, who typically marry between 18 and 20, are kept apart before and after their arranged marriages. While sex is a taboo subject, masturbation is often discussed, absolutely verboten, and rigorously policed. A man from the Satmar community in Williamsburg, Brooklyn, told me that he knew of two rabbis with cabinets full of medications that they dispensed to boys who had been caught or confessed to masturbating, as well as to couples having marital difficulties. "Listen, a boy who masturbates is depressed," he explained, "because he knows he's not following God's commandments."

Religious deviation — especially of a philosophical or sexual nature — may be interpreted as a sign of mental illness, which, for many years, has carried a serious stigma among Hasidim. Perceived aberrations are punished in the arena that matters most — the marriage market. If word got out that someone were on medication, that information could hurt her chances of making a good match, and those of her immediate and even extended family members.

But recently, non-Hasidic psychologists and psychiatrists have been making inroads on topics like post-partum depression and trauma therapy through workshops and ultra-Orthodox publications. Dr. Ayala Fader, an anthropologist at Fordham University and author of Mitzvah Girls: Bringing Up the Next Generation of Hasidic Jews in Brooklyn, told me in an email, "Over the past 15 years or so, there has been a shift in perceptions and uses of therapy among Hasidic Jews. When I did research in the 1990s, many were reluctant to go to therapists and prescription drugs were stigmatized. These days, therapy is more accepted. Therapists and rabbis may work together, and like for so many in the secular world as well, prescription drugs for certain diagnoses are not uncommon."

With the increased acceptance of those subjects has come a recognition that psychiatric medications might have off-label uses that serve the community's goals. Joseph is one of many Hasidic Jews in the United States and Israel who are taken by community operatives like askanim to see psychiatrists for what are essentially religious, rather than psychiatric, difficulties. I spoke to twenty individuals in the New York area who had all been sent to the same five or six psychiatrists (and all knew others who had been through the same thing, often cycling between them), where they say they were prescribed anti-psychotics, hormones, or anti-depressants for masturbating, questioning the tenets of the community's faith principles, experimenting with or even fantasizing about same-sex partners, or displaying "too high" a sex drive.

The "symptoms" that psychiatrists take as evidence of disorders can vary, according to their patients. One woman told me that, when she confessed to an askan and later to a psychiatrist that the strictures of her life made her feel stuck, she was prescribed anti-depressants. When that didn't solve anything, her askan took her to a second psychiatrist, who told her that she was getting a sexual high from her job, where she interacted with men, and diagnosed her with bipolar disorder. She was prescribed Abilify, an anti-psychotic medication. Another young woman, who had kissed a girl at school, was compelled by the principal to see the same psychiatrist. She was prescribed anti-psychotic medications, "to make you feel better and to decrease your temptations," the doctor told her. "You're not going to want to misbehave as much."

This may sound shocking. But taken in a different light, these off-label uses are consistent with a current American mentality that uses medical interventions as technologies for optimization. Think for example of the use of growth hormones to enhance height, or Ritalin to optimize concentration, or plastic surgery to enhance beauty, or even amputations to optimize expressions of sexual identity. Are the uses of psychiatric medications to enhance religious performance so different from these practices? And are they necessarily unethical?

"The very idea of what we call a psychiatric disorder is strongly influenced by different norms," Dr. Jonathan M. Metzl, a professor of psychiatry and the director of the Center for Medicine, Health and Society at Vanderbilt University, told me. Doctors over-prescribe anti-anxiety medications to women, and they over-diagnose African-American males with schizophrenia, he explained, because doctors themselves live with cultural biases. "If the psychiatrists are Orthodox, they may share some of the same belief systems," he went on. "Is the critique of the doctor, or is the critique of a culture that doesn't have an outlet for talking about different kinds of sexuality and calls everything deviance?"

In the course of their affair, Joseph and Dini never had intercourse. According to Jewish law, a woman who commits adultery is barred from marrying the man with whom she cheats on her husband, and Joseph and Dini wanted a future together. When a psychologist diagnosed Joseph with sex addiction, he tried to correct him. "I said, 'It wasn't just about sex! It was love, it was passion, it was fun, it was a different lifestyle, it was everything else,'" Joseph recalled. "But I was at the point of surrendering, so I said, 'OK, I'm a sex addict.'"

The askan sent Joseph to Sexaholics Anonymous meetings in nearby White Plains every Wednesday and Sunday. His sponsor, a Christian, confessed to Joseph that he didn't really see the manifestations of Joseph's sexual addiction. The askan also made Joseph an appointment with a psychiatrist named Dr. Richard Price. Before they went to the appointment, Joseph says that the askan coached him in what to say and how to say it in order to procure the treatment that the askan thought was appropriate. According to Joseph, the plan in mind was that Dr. Price would prescribe Lupron Depot, a hormonal shot used to treat prostrate cancer by lowering the patient's testosterone; it's also a controversial treatment for sex offenders. Perhaps this would lower Joseph's desire for Dini. (When I reached the askan by phone, and asked him if he had arranged for a man having an affair to get Lupron Depot shots, he interrupted me. "No, no, I don't speak about such things," he said. "No, no, it's a mistake," and he hung up.)

Dr. Richard Price in his Monsey, New York, office | (Pearl Gabel/Courtesy Narratively)

Joseph's medical records name the askan who brought him to Dr. Price's office, where Joseph told Dr. Price that he could not stop thinking about sex and running after women. Joseph said that he was "addicted" to his Blackberry and to the internet. He told Dr. Price that, since being married, he had had sex with five women, including prostitutes, and that he was seeking help "by all means necessary." Dr. Price initially prescribed a small dose of Risperdal, an anti-psychotic medicine, and recommended that Joseph go back to talk therapy. After that, he prescribed Lupron Depot. Joseph got the shot four times over a period of three months. "Patient here Lupron injection," read the nurse's scrawled notes. "Administered R buttocks."

"This askan took me to a psychiatrist and coerced me into saying that 'yes, I am a sex addict,' and that I need Lupron Depot," Joseph told me, sitting hunched over on a couch in his Brooklyn apartment and staring at the floor. He paused, shook his head, and went on, "Thinking back on it now, it was very humiliating to me."

Read the rest of this story at Narratively.

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