Jacob is just past 30 by a year or two. He is, as I like to describe him, a little boy trapped inside a man’s body and very much mentally ill. He started off with fetal alcohol syndrome, which means his mother drank heavily when she was pregnant. I am not sure I believe that diagnosis is correct, by the way. Fetal alcohol syndrome is a much more complicated condition than what I see going on with Jacob.

Jacob can be a lot of work for a person like me in my social work role. He is, for example, in our office each and every day for medication. And lately, supervising his getting medication has become part of my job description as his case manager. It shouldn’t be this way.

I go into the rooming house where Jacob lives on Camp Street. It is little more than a hovel full of crack cocaine addicts. Jacob lives on the first floor in the rear. I have been in his room before, where I found a single bed and an open closet (no door) and a tiny dresser. There were no sheets on the bed. Nothing at all, not even a blanket. That was the first time I was there. The next day I brought him a set of sheets from my home and a blanket. Today, I showed him how to put on a fitted sheet and a top sheet, explaining to him how he will sleep between those two sheets. He didn’t seem to know this. I have put the pillowcase on the new pillow we just bought at Value City.

I know with first-hand familiarity all the psyche units in the city and county, and of course, the main state hospital — Central State — plus all the shelters with names like “The Healing Place.” It should be no news by now that the mentally ill who are poor (the two often go together) inhabit pretty much full time halfway houses, shelters, hospitals and, of course, the jails.

Because of my job, I also know quite a lot about medicines, psychiatric medicines, anyway. Those with names like Zyprexa and Seroquel, Risperdal and Depakote, and many more. Some work pretty well. Very few exist without substantial side effects, and serious ones at that. Others are an expensive joke. One very costly antipsychotic is in my view, little more than a good but costly sleeping pill.

Jacob is a small man, rather gaunt, with longish blond hair, which is very dirty most of the time, as is the rest of him. He is, in a way, a handsome young man, or he could be but is so mentally ill.

I guess schizophrenia is his diagnosis — I should know, but I don’t often look up the diagnoses. Or maybe it is what is called “schizoaffective.” I won’t try to explain the difference (not sure I could).

He is depressed a lot and gets Lexapro medicine for that. He is also delusional, as well as very unhappy all the time. I won’t say he is suicidal, not yet.

He will become suicidal in time, I believe. Suicidal thoughts clearly will develop in his future. There are religious references in his speech — this is common with the severely mentally ill, I notice — and talk about Germany and the Nazis, and sometimes mention of Israel and Jews. But not too much of his talk adds up to much of anything.

Yet there is a sort of gentleness about Jacob that I see. Others don’t see it so much. As a matter of fact, his silence scares some people with whom I work.

They are guarded around Jacob as if they expect him to strike out at any moment. I suppose that is possible, but I don’t expect it will happen.
There is also a generosity about him, and many take advantage of that spirit of giving he possesses.

Some days he walks around with rosary beads, even though I don’t think he is Catholic. Today the beads are missing. The red strap I got for his house keys and had him put around his neck has worked out pretty well so far. He still has his keys — and he has had them now for about two weeks. After he lost the third set of keys, I decided upon the necklace of keys. It was a simple solution to a big problem. Most of the solutions I effect are simple like this one, and nothing very revolutionary.

Jacob is not very animated, as I have said. You don’t get much expression of emotion out of him. But I sense he knows quite well who means him no harm. Or put another way, which means for him better things, if only in a small way.

On the ride to Value City, I said to him, “You know, I try to make life a little better for you?” I seldom talk this way with clients. The question just popped out of me this day. After a long pause as it sinks in, he acknowledges that he knows this is true.

“Well,” I continue. “I want you to do something for me.”

“What’s that?” he asks a little more quickly, his curiosity piqued, I suppose.

“Take the friggin medicine I give you at night before you go to bed!” He laughed … a rare response. He seldom laughs.

“OK,” he said. He is not good at taking his evening medicines.

Jacob can be funny, although maybe not deliberately so, but funny just the same.

He was at Central State Hospital recently, the state mental facility, for about a month. I visited him about once a week. I always make it a point to see my clients when they land at Central State for a spell.

We were sitting in a large visitors’ room and were just about alone in that space. You could see the corridor outside through the glass windows. I said to him, “Do you have any friends here?” I no sooner got those words out of my mouth when in the outside corridor, a patient went by our line of vision screaming and waving his hands and just about doing cartwheels down the corridor. We both saw the fellow at the same moment. Jacob paused before he spoke as if he was considering what he had just witnessed, and he quipped, “Oh, yes. There goes one of my best friends now.” We both laughed.

I have to lecture Jacob on locking the door to his room at Camp Street. I remind him of what he already knows, and that is, the other roomers will steal anything they can get their hands on. He wants a small TV. And so later in the week, we go back to Value City to get one. We buy one for a hundred bucks.

Surprisingly, one hundred dollars buys quite a lot of TV these days. We get a color set, brand new of course, 13″ size with a built-in DVD player. As I say, not bad for a hundred bucks. I pay for this out of his funds. We handle his disability checks. We parcel out spending money to him every day and pay his rent and other expenses, like buying a TV.

But I have to keep reminding him the drug users in the building will lift that TV in a heartbeat, even if he merely goes down the hall to use the bathroom. There is no bathroom in his room — cooking facilities, either, although in the corridor there is sort of a cooking area for everyone. Curiously, though, this room does get him cable, with lots of channels. I don’t see Jacob as much of a TV person, but it is there if he wants it.

I don’t wish to sound cynical or make predictions, but I will do both. The TV I expect will last about two weeks before someone gets in and steals it.

Sometimes Jacob talks and acts tough, but he isn’t very tough. I’ve seen the marks on his face from assaults, probably muggings on the street, or even in the rooming house on Camp Street. He doesn’t have a lot to say about the bruises when I ask him what happened to him. “Got attacked,” he might say, but not much more. He doesn’t laugh, though.

Some days he will come in and rant about his father, who lives in Lexington, about a hundred miles away. His father is divorced from his mother and has had nothing to do with Jacob for many years.

When Jacob speaks of his dad, the words are angry and threatening. Death threats sometimes spill out of him — or, if not precisely death threats, then a wish that his father was dead. I pretty much ignore these rantings. I don’t know what I could do about it anyway. I suppose I could do a mental inquest warrant (we do quite a lot of those), and the police would quickly pick up Jacob take him to University Hospital (psyche unit). He’d likely be released the next day or possibly sent back to Central for a few weeks. Nothing would change, though.

His father lives someplace in Lexington, and Jacob does not know exactly where. There is no relationship whatsoever. I doubt if they have seen each other in 10 years, maybe longer. There is only the knowledge that a person he calls his father exists. There is a little more of a relationship with his mother.

He sometimes visits with her, and she occasionally calls me and feigns interest in his welfare. I believe there is little real interest. I am certain she is a bit of an actress when she is speaking to me. I suppose she has her troubles. She is probably under 50, and I am told she requires an oxygen tank wherever she goes.

The latest with Jacob’s his anger is this:

Other clients around our office have started to ask him if he is straight. He is highly offended by the question, and tells me the next person to ask that is going to get punched out. I counsel restraint with Jacob, but I don’t believe that he is really going to punch out anyone.

About as close to violence that I have heard concerning Jacob — violence that he may have initiated — occurred last year when he was arrested and spent about two weeks in jail for pounding on the hood of a police car with his fists while the two officers were sitting in the vehicle.

When he got out of jail that time, he was as clear-thinking and normal-acting as I have ever seen him. I know in the local jail that they are good about seeing that detainees get their medicines on time. And he is made to bathe, and his hair is trimmed. Even when he is at the state hospital, I don’t believe the medicine compliance is as good as when he is in jail. I don’t know why that should be so, but it is.

Jail — hospital — the streets. It is one giant circle for persons like Jacob. It goes on and on.

Right now he is pretty healthy physically. But he is young. I have seen his lab work, and it is normal for a man his age. Not even pre-diabetic. That will likely change by age 40 when he will be not just older, but probably obese. The weight gain is caused some of the time by medicines, but also from a very poor diet of soda pop and candy and other junk foods.

Years of heavy smoking won’t have helped, either. Heavy use of tobacco goes with mental illness. Why? I am not sure I know why. It isn’t 100 percent, but it comes very close.

So for now, Jacob stands out a bit. I guess it is because of his youth and boyish good looks and manner. But when he becomes more drab, more like those around him, a few years older, and a person like me — my replacement, I suppose — looks at him, they will just see another hopeless soul who looks older than his years. He will be plodding on, going no place special, and you can bet, no place great. You can make book on that, as a matter of fact.

Raymond Abbott is a social worker and novelist.

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