Joel Rabinowitz looks back wistfully on his high school and college days. Fourteen years ago, his classmates at T.C. Williams High School in Alexandria elected him a student senator, and he spent happy hours preparing for team debates and playing baseball. At George Mason University he did well enough in his studies to graduate magna cum laude.
But not long before college graduation, his life began to fall apart.
Found to have schizophrenia on April 17, 1976 -- the day, Rabinowitz said, "I began hallucinating . . . . I felt terribly confused" -- he spent painful years receiving psychiatric treatment before appearing to gain some control over his chronic thought and mood disorder.
Then last January, feeling he needed more help than the outpatient care he had been receiving, Rabinowitz walked into Alexandria Hospital. But after spending one night in the psychiatric ward, he was discharged, his attorney Patricia Ryan said, apparently because his condition was not acute enough to warrant hospitalization.
It was just the first of many moves for Rabinowitz, according to Ryan, as mental health authorities in Alexandria tried unsuccessfully to find a place for him to live.
By this week, according to his count and that of his lawyer, he had been moved 14 times and still had not found a permanent home.
The constant shuttling is the result of a severe shortage of housing in Alexandria for men and women such as Rabinowitz who suffer from mental illness and need to live in a supervised environment but are not ill enough to be hospitalized. The shortage of such facilities in Alexandria and elsewhere has been a major source of criticism of deinstitutionalization, the policy begun in the '60s and '70s that emphasized treatment of the mentally ill outside of state hospitals.
Peter T. Straub, chairman of the Alexandria Community Mental Health Center Governing Board, said that Rabinowitz's case shows how the city mental health system cannot possibly serve all the people who need help because of limited funds and facilities.
"It is our job to take care of him," Straub said of Rabinowitz. "But we are overwhelmed." Straub said he thinks Rabinowitz would be best served by being in a supervised group home, but at the moment there is no such place in the city.
Instead, Rabinowitz has spent time in a jail cell and five months at Western State Hospital after assaulting a nurse at Alexandria Hospital when he was told he could not be readmitted.
He has also been placed with recovering alcoholics in a detoxification center -- although he has never had a drinking problem -- and was moved there again recently when no alternative was available.
According to Ryan, her client's condition has worsened in recent months, and she attributes it to his frequent moves.
"My client seemed to be on the road to recovery until mental health officials began moving him abruptly," said Ryan. "He's regressed since then. To have 14 different homes for anyone is stressful, but to have a chemical imbalance and the added burden of not knowing where and how long you were going to be at a given place -- especially during the holidays -- is unfair."
Rabinowitz, 32, says he feels frustrated much of the time. "I enjoy learning," he said. "I used to browse in bookstores. Now I can't do anything. I feel panicky. I can't read. It's like I'm in pain inside all the time."
While there is no cure for schizophrenia, Alexandria mental health officials agree Rabinowitz could gain better control over the condition, which affects an estimated 2 million Americans. It has often been controlled in others, they say, with potent tranquilizers, personal determination, and medical, family and community support.
Rabinowitz's elderly parents say they are unable to take care of their son. The lack of community programs has thus been particularly harmful, according to Straub.
With not a single long-term group home for the mentally ill in Alexandria, city officials say they are often forced to send discharged patients to ill-equipped family members, the Christ House shelter funded by Catholic Charities, unsupervised boarding rooms, and the YMCA.
"If a person is not in crisis, there are limited places to go," said Judith Krasnow, director of Alexandria's Community Mental Health Center.
In June, Krasnow and other city mental health officials signed a tentative contract to purchase the city's first permanent residence for the mentally ill. But an avalanche of letters and telephone calls from angry neighbors to City Council members appeared to kill that plan. Amid all the opposition, the council postponed approving the required special use permit for the home about a mile west of the King Street Metro station, and because the home purchase agreement expired, the delay in action effectively killed the project.
Another group home for the mentally ill is now scheduled to be reviewed by the City Council in January, but already North Ridge residents are organizing their opposition, citing danger to their children and devalued property.
The shortage of homes is not limited to Alexandria. In the entire state of Virginia, there are only seven licensed group homes to serve an estimated 43,000 to 61,000 chronically mentally ill, according to the Virginia Department of Mental Health and Mental Retardation.
Most cities and communities have some short-term residences for the mentally ill. Alexandria's New Hope home houses seven persons, and four city-leased apartments provide temporary homes to 12 mentally ill patients. But health officials acknowledge that that is far from enough.
Until people realize that a medicated schizophrenic is "not a danger to society; he may just think he's Napoleon," and until politicians have "the backbone" to approve group homes, said Straub, people like Rabinowitz will have less hope of rejoining society.
When Rabinowitz was discharged from Western State in August, he was placed in a city-supervised apartment, where patients usually live for about a year until they are independent enough to live on their own or go to homes outside Alexandria. His stay, however, lasted only two months.
On Oct. 20, Rabinowitz accidentally dropped a lighted cigarette in a chair. Although the fire burned only the chair, neighbors complained to the mayor and the City Council that the fire could have been devastating.
Almost immediately, Rabinowitz was told to leave the apartment and sent to Arlington Community Residence Inc., the first of eight places where he has lived in the last two months.
Straub and Ryan said that they believe "politics" has aggravated Rabinowitz's situation and that city officials bowed to neighborhood opposition in moving Rabinowitz out of the apartment even though the fire was an accident and he had no suitable place to go.
Since being discharged from Arlington Community Residence, a private facility for the mentally ill that Alexandria uses for temporary housing, Rabinowitz has stayed at Alexandria Hospital, Alexandria Jail, the city detoxification center and the YMCA.
After a 14-day stay at the hospital and a conference with a doctor and city mental health worker, it was decided that Rabinowitz should leave the hospital. Rabinowitz's family and attorney say he was handed a list of rooming houses and told to find himself a place to live.
He then went to his parents' house, but after a week, his parents said he began methodically rocking and crouching in a fetal position. They said that after calling the Mental Health Crisis Center, they were advised to call the police and have their son arrested for trespassing to get him immediate attention.
Rabinowitz then stayed at the city jail for three days, before being transferred to the detoxification center, back to Arlington Community Residence and the YMCA.
"He never should have been let out of the home" the city-run apartment, said Straub. "Maybe that's where the political process didn't react the right way."
Alexandria Mayor James P. Moran Jr. and City Manager Vola Lawson said they did not know Rabinowitz was removed from the apartment after the fire until a reporter inquired. William Claiborn, executive director of the city's Mental Health, Mental Retardation and Substance Abuse Department, said that "the staff immediately involved" made the decision to move Rabinowitz.
"It sounds like a horrible situation, an inexcusable one," Moran said of Rabinowitz's recent accommodations. Moran said after learning that Rabinowitz was in the YMCA, he made sure that on Dec. 20 he was placed back in the detoxification center, where Claiborn said the staff is trained to deal with the mentally ill. Moran and Claiborn said the city is doing its best to find him a permanent home.
Lawson said Rabinowitz's housing problem was not caused by poor judgment or management, but "illustrates the difficulty of finding a group home." In early 1986, Lawson said, the city hopes to renew the process of purchasing a long-term residence.
But Claiborn emphasized that there are as many as 200 Alexandrians with acute cases of schizophrenia and that the need for housing some of these patients was so great that the city was now asking residents to consider opening their homes on a foster care basis to ease the crisis.
Now back at the detoxification center, where, Ryan said, Rabinowitz was recently promised he could stay until permanent housing could be found, Rabinowitz has been spending his days going to outpatient therapy at the Community Mental Health Center and walking around the city.
He says he is agitated and confused most of the time, and longs for the time he can again sit down and read and study and work. "Holidays don't mean much to me," he said. "I just want to get better."