Oct 31, 2010

Homeless Veterans Not "Details" to Retiring Dallas Dr.

- For Dr. Joel Feiner, homeless veterans are "not details" as some politicians say, they're human beings. Over the years, as many as 200 homeless veterans visited Dr. Joel Feiner's cluttered office at the Dallas Veterans Affairs Medical Center -

By Kim Horner at The Dallas Morning News — They came from cardboard boxes under bridges and from shelters.

They suffered from severe depression, bipolar disorder, post-traumatic stress disorder and addictions.

[Above photo by KHAMPHA BOUAPHANH - Dr. Joel Feiner, flanked by his wife, Dr. Gail Alexander, gets a hug from Helen Sorrells during a retirement party at the VA Medical Center in Dallas, where he was medical director of the Comprehensive Homeless Center. "]

One in five homeless people is a veteran, according to a count by the Metro Dallas Homeless Alliance. Dallas has an estimated 5,750 homeless residents on any given night – with more than 1,200 of them veterans.

And the outspoken, award-winning Dallas psychiatrist helped transform many of their lives.

Feiner recently retired as medical director of the VA's Comprehensive Homeless Center and as a professor at UT Southwestern Medical Center, making for some tearful goodbyes.

Patients and mental health advocates credit him with changing the lives of people often written off as hopeless cases.

Terrence Lewis said he already misses his doctor. But he said that Feiner's lessons will always be with him.

"It's like he's a little conscience and he's guiding me," the 50-year-old Gulf War veteran said.

Lewis is recovering after spending 16 years on the streets because of depression, an anxiety disorder and an addiction to crack cocaine. He has been sober nearly three years.

At a June retirement event, Lewis spoke about the psychiatrist's emphasis on not treating patients as the "thems" of society. Instead, Feiner emphasized that patients are working as a team with mental health professionals.

"As one of the 'thems,' you really made me feel like a 'we,' " Lewis said.

Patient Juan Torres said he didn't have the words to thank Feiner. In fact, he was too emotional to say more.

"This man is truly a hero," Feiner said, and then he saluted Torres.


Feiner came to Dallas in 1992 after treating patients and teaching at Albert Einstein College of Medicine in the Bronx. He moved to Dallas to teach at UT Southwestern and run an inpatient program for people with mental illnesses and addictions.

The doctor with the New York accent and collection of aphorisms – called "Feinerisms" by some – became known as the psychiatrist who chatted with patients on his way out each night and who invited them to call him at home if needed. The program, Mental Health Connections, was lauded as a success.

Feiner drew praise and criticism when he fought further budget cuts in 1999. Texas ranks 49th in per capita spending for public mental health, and the poorly funded system still suffers from budget cuts.

Mental Health Connections closed in 2001 because of a lack of funding, to the dismay of many.

"There are people who spent 15 and 25 years in and out of state hospitals and jail until Dr. Feiner got a hold of them," said Janie Metzinger, public policy director of the local chapter of Mental Health America.

At the VA, Feiner served as medical director of a program with long-term treatment that included psychiatrists, psychologists, a dorm, transitional housing, job training and work programs.

Drawn to the margins

Feiner did not originally plan to become a psychiatrist to the homeless. The Yale undergrad originally set out to work with children.

But he took a different direction after traveling to Louisiana in 1965 with a civil rights group.

As a volunteer for the Medical Committee for Human Rights, he had to have a guard while assisting black patients who had been denied care, seeing the threats of the Ku Klux Klan firsthand.

"When I came home, I was changed," Feiner said. He became committed to working with people on the margins of society.

Since then, Feiner has trained generations of psychiatrists with his unique perspective.

"The part of him that's been unique is, he really has insisted on connecting with other people," said former student Dr. Kenneth S. Thompson, now medical director at the Center for Mental Health Services at the federal Substance Abuse and Mental Health Services Administration.

'Quiet heroes'

Feiner is more humble about his influence, emphasizing that he was part of a team that included psychologists, nurses and other professionals.

He also noted that in handling some of the toughest cases, they didn't always succeed.

Feiner said he has worked with veterans who probably experienced post-traumatic stress disorder from abuse and abandonment long before they served their country. And some formed addictions as they looked to drugs and alcohol to relieve those symptoms.

Despite Feiner's emphasis on connecting, he and Gulf War vet Lewis got off to a rocky start.

Lewis said he approached Feiner one day asking for an evaluation so he could apply to become a peer counselor. He said Feiner snapped at him.

Lewis got mad. "I wanted to beat him up," he said.

Feiner, recalling the episode, said patients with addictions are used to quick fixes – and can have quick tempers when those are not available. But he did approach Lewis later and apologize.

"I gave him medication for the anxiety he experienced because of cocaine withdrawal. We started to meet regularly," Feiner said. "He continued and told me about his hopes and dreams."

Relieving Lewis' symptoms was only the beginning of his work, Feiner said.

Next, he focused on removing obstacles in the way of education and employment.

It was a long road, but Lewis now has his own apartment and a 4.0 grade-point average at El Centro College, where he studies speech communication. He teaches a children's Bible study and hopes to become a teacher – but he worries that his drug criminal record could hold him back.

Still, Lewis said he has never been happier.

"I was literally under a bridge in a cardboard box," he said. "I'm surprised I'm alive. It's really a miracle."

At his retirement party, Feiner said it's been his privilege to work with patients like Lewis.

"We have some very quiet heroes and heroines here – the veterans themselves," Feiner said. "Some have been clobbered by conditions they had, through no fault of their own. It's their ability to keep on that I am in awe of."

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