My younger brothers weren’t born until I was 8. So I was a lonely child. Not only didn’t I have siblings with whom I could relate, there were no other children in my neighborhood with a similar background.
I was a short, weak kid, but I loved baseball. When it came to choosing sides, however, I was never chosen because I couldn’t hit or catch the ball if I tried. Eventually, I thought, “I’m not going to make it athletically. I might as well do something that I can do.” So I became studious.
My father had a large library, and I read everything I could get my hands on. I went to high school in Milwaukee but was specially promoted twice and graduated at 16, then went off to yeshiva and trained to be a rabbi, like my dad. He was a natural therapist and people flocked to him, Jewish and non-Jewish alike. He was so good that the courts would send him cases to adjudicate. They would say, “Take this case to Twerski. If that doesn’t work, then bring it to court.”
I got married and was ordained at 21, and my father took me in as assistant rabbi in his congregation. This was about 1951. In the years following World War II, psychiatry and psychology had a meteoric rise. After being a rabbi for several years, I noticed that people weren’t flocking to me for counseling the way they had to my father. They were not going to rabbis for that. They were seeing professionals. I decided that if I wanted to be the kind of rabbi my father was, I had to become a professional. So I went for broke, going to medical school to become a psychiatrist.
By that time, I had several children, so my dad and some members of the congregation helped me to pay for school. I applied for a scholarship through a foundation, but it didn’t come through, so in my third year, I fell two trimesters behind on tuition. One day, I called my wife at lunch as always, and she asked, “What would you do if you had $4,000?” I said, “I’m too busy to talk about fantasies.” She said, “But you really do have $4,000!” I said, “From where?” She said, “From Danny Thomas.” “Who’s Danny Thomas?” She said, “The TV star.” Then she read me an article from The Chicago Sun. Local officials had told Mr. Thomas about a young rabbi who was struggling to get through medical school. Thomas asked, “How much does your rabbi need?” They said, “Four thousand dollars.” He said, “Tell your rabbi he’s got it.” So I did my internship in general medicine, went to the University of Pittsburgh Psychiatric Institute for three years, and then worked two more years for a state hospital.
At that time, one of our rotations was to serve two months at the Psychiatric Division of St. Francis General Hospital in Pittsburgh. St. Francis was an unusual hospital. It had 750 beds, of which 300 were psychiatric. And it was the only emergency-receiving center for the whole tri-state area. All the while, I had an understanding with the chief of the department at Pitt that, after I finished my two years at the state hospital, I would get a teaching position at the university. When I returned, he said, “St. Francis has done a great deal for the community. We have to help them. They haven’t been able to keep a medical director for very long, and they’re without one now. Please go and talk to Sister Adele.” So I did. This was in June of 1965. I told Sister that I was working at the state hospital until the end of the month and planned to take my family to Israel for two months thereafter, so I wouldn’t even be in the area again until fall. She said, “We’ll wait for you.” So I agreed to take the job for a year. I stayed on for 20.
In those days, if you called to make an appointment with a psychiatrist, you had to wait three weeks. God help you if you were suicidal. But Congress passed the Mental Health Act, offering grants for communities to develop mental health centers. So I applied, won a five-year grant and opened up St. Francis Community Mental Health Center, the first of its kind in Pittsburgh.
One of the things that characterized St. Francis was that it had a large alcoholic service. Why? Pittsburgh, by city charter, couldn’t have a public hospital, like Bellevue or Philadelphia General. And that’s still true today. In larger communities, undesirable patients were not accepted into private hospitals. They were sent “to the county.” In virtually every other city, the “drunk tank” was the county hospital. But in Pittsburgh, alcoholics were picked up and put into jail. The sisters thought this was terrible, which it was, so they opened an alcoholism unit.
When I got to St. Francis, drug addiction wasn’t what it is today, so there weren’t too many drug addicts. But on any given day, we had 30 or 35 alcoholics. They would come in, get dried out in three or four days and then were discharged. Next month, they’d be back. So I said to Sister, “We’re not really doing these people a service. We must build a place they can go for a few weeks after they’ve dried out to give them a head start on sobriety.” Sister thought this was a good idea. Thank God that she had no concept of reality, because she never would have done it had she known better.
The first thing I did was to organize a committee to foster community support and then looked around for a place to convert into an alcohol treatment center. There were a few places that could have served this purpose, but nobody wanted “drunks” in their back yard. We had to build out in the sticks, but where were we going to get money? After a lot of machinations with Harrisburg and Washington, we ended up building a great facility. Then it dawned on me: “Who’s going to pay for the care?”
We opened on Jan. 3, 1972, and I went around from foundation to foundation, industry to industry, getting $10,000 here and $20,000 there to keep the place afloat. Meanwhile, we started working with insurance companies. They promised that we would have coverage within three months. We didn’t get coverage for three years, so I kept panhandling to keep the doors open. At one point, our administrator called me up and said, “Dr. Twerski, we can’t make next week’s payroll.” I said that I just couldn’t go back to the same organizations for more money. She asked, “What are we going to do?” I said, “You know how we tell our patients that they have to live one day at a time? That’s what we’re going to do. We’re going to stay open — one day at a time. If we have to close next Thursday, we’ll close next Thursday.”
Well, Thursday came and went, and we stayed open. In a few months, insurance payments started coming through, so we were able to function. But I never knew how we met that payroll. Many years later, at the facility’s 50th anniversary, I found out. Way back when, we had a bookkeeper, a retired accountant, who served more or less as a favor. He was a recovering alcoholic and had been sober for a number of years. When he found out we couldn’t meet payroll, this old man took a mortgage out on his house to keep us going. That’s what the loyalty of a recovering alcoholic can be. Ultimately, we did pay him back. But it was that kind of attitude that went into St. Francis, that kind of devotion to recovery.
By 1976, it became evident the insurance industry was going to take a market turn for the worse and bring in managed care, which would prescribe how long patients were allowed to stay in the hospital and for what. So we started developing outpatient clinics. We opened our first clinic around 1978, then another, and another. We also started some outreach programs to prisons and such. So the Gateway Rehabilitation Center you know today started off as a 100-percent inpatient facility. We now see 1,500 patients every week at all of our locations. That’s how Gateway came to be — because of my involvement with St. Francis and alcoholism.
Somewhere along the line, I decided to write a book about self-esteem titled, Like Yourself and Others Will, Too. The idea of writing appealed to me, so I wrote another book called Caution: Kindness Can Be Dangerous to the Alcoholic. After that, I started writing on Jewish themes. Then something wonderful happened. I had always been impressed by the insights of Charles Schulz, the man who created the Peanuts comic strip. I used to clip out meaningful strips and put them on the bulletin board for our residents to see. Then I stumbled upon what I thought was a good book idea. I called Mr. Schulz’s publishers and told them about it. Schulz thought it was a good idea, so I wrote the first book with his Peanuts insights titled, When Do the Good Things Start? That was followed by Waking Up Just In Time. Next came It’s Not a Fault, It’s a Character Trait, which was followed by I Didn’t Ask To Be In This Family. These books were popular in the U.S., but they sold like wildfire in Japan, where they’re crazy about Charlie Brown and Snoopy.
I’ve kept writing. You could call it an addiction. I have an advice column in one of the Jewish papers, which resulted in two books called Dear Rabbi and Dear Doctor. I’m now working on three other books that will one day be published — numbers 56, 57 and 58. And because my e-mail address is pretty well known, I get questions from all over, and I try to respond. I receive three or four e-mail messages and three or four phone calls every day about all kinds of problems. I’m a free consultant. And my days are still pretty long. But I’m really just doing what my father did.Jeff Sewald is a writer and independent filmmaker based in Pittsburgh.