New York City’s Mayor Eric Adams released his Subway Safe Plan on February 18, but it will do little to address the growing violence on subway platforms and stations unless he is willing to mandate treatment for the violent mentally ill.

Three days after his plan was released, the New York Post reported that a “sicko” perpetrator slapped a bag filled with human excrement into an unsuspecting 43-year-old woman’s face—and then rubbed it on the back of her head. He then spit on her as she sat on a bench waiting for the subway. Arrested the following day for attempted robbery, the subway attacker has over 20 arrests for violent crimes since 1999. 

Responding to the vile subway attack, Mayor Adams pointed to “mental-health issues” as the cause: “Human waste or someone spitting in your face, those are real signs of mental-health issues and we really must dig into how we’re dealing with these mental-health issues.” 

That is the problem—New York City has failed to deal with mental-health issues on its streets and subways for several decades now. Unprovoked subway slashings and knife attacks have increased by 35 percent in the past year.

For more than 50 years, New York City—and other major cities like San Francisco, Los Angeles, and Portland—have been defining down the risks posed by the violent mentally ill living on their streets. To be sure, society should not stigmatize mental illness the way it did in the 18th century, when aristocratic elites visited the “mad” in London’s Bedlam Hospital and called it “entertainment.” But minimizing the risks associated with serious mental illness has a cost, as New York City residents know well.  

To understand how the mentally ill homeless population went from being considered deviant to viewed as making an “alternative lifestyle choice,” it is helpful to look back at the efforts of the 1960s mental-health advocates. Inspired by sociologist Erving Goffman’s book Asylums, progressives in the 1960s claimed that coercive treatment for mental illness exacerbated the supposedly deviant behaviors of those labeled mentally ill. This view was reinforced by Michel Foucault, who asserted in Madness and Civilization that modern conceptions of mental illness were socially constructed by the bourgeoisie to enforce conformity. 

To Foucault, notions of madness and institutionalization were the result of the elite’s intolerance for “difference.” Psychiatrist Thomas Szasz, one of the most prominent figures in the anti-psychiatry movement, began writing about the “myth of mental illness” at this time. Likewise, R.D. Laing drew upon existentialist philosophy to reject what he called the “absurdity of the normal.” By the time Ken Kesey’s book One Flew Over the Cuckoo’s Nest was released in 1975, audiences were primed to accept the idea of the mental institution as the ultimate agent of social control, and the parallel notion that insanity is the sane response to an insane world. 

It was in this cultural climate that the Supreme Court in 1975 declared in O’Connor v Donaldson that mentally ill individuals who pose no obvious danger to themselves or others cannot be confined against their will. And for the past five decades—rather than focusing on the wellbeing of the mentally ill and their neighbors, family, and friends—policymakers and activists have focused instead on reducing the stigma associated with mental illness. 

These decisions have had significant human costs, especially in big cities. Recent incidents have reminded New Yorkers of the epidemic of subway-pushers of the past. The last cycle of subway attacks began in 1995, when Reuben Harris, a paranoid schizophrenic with 12 previous state-hospital admissions, simply walked out of the Manhattan Psychiatric Center on Wards Island and pushed a 63-year-old woman to her death from a Manhattan subway platform. Witnesses said Harris appeared to wait until the train approached the station before shoving the unsuspecting woman onto the tracks. Afterward, Harris was described by New York Times reporter James Barron as “laughing and babbling gibberish” when he walked away from the subway stop. The Times also reported that Harris had been convicted of slashing a subway panhandler in the face with a razor six years earlier.

Similarly, in 1999, Edgar Rivera was pushed to the tracks by a mentally ill homeless man just as a train entered the Lexington Avenue station at 51st Street. Julio Perez, the perpetrator, was living in a shelter for the homeless in Washington Heights and being treated for a 20-year history of schizophrenia at a program run by New York Presbyterian Hospital. Rivera, a 37-year-old father of three young children, survived the attack, but sued the hospital in civil court, contending that they failed to take adequate steps to protect others from an obviously unstable mental patient. 

This type of civil litigation is designed to hold hospitals and psychiatrists accountable. Patricia Webdale, whose daughter Kendra was killed when she was pushed in front of a train in January 1999, sued seven institutions for their negligence in releasing Andrew Goldstein, the man who committed the crime. Webdale filed a $70 million lawsuit against psychiatric staff members of the various Manhattan- and Long Island-area hospitals that had repeatedly sent Goldstein home—even though they knew he was dangerous and unlikely to take the medication that stabilized him. Goldstein had been hospitalized 13 times in 1997 and 1998, and had committed more than a dozen assaults, many on hospital staff, during the two-year span. 

The Goldstein case led the New York State legislature to pass “Kendra’s Law,” allowing courts to require the involuntary treatment of mentally ill individuals who are found to have stopped taking their prescribed medications. But the law pertains only to those who have been mandated by the court to take medication. It does not apply to people like Paul O’Dwyer, another violent mentally ill man, who in 2000 tried to push three women and a man onto the tracks of the West Fourth Street and Broadway Lafayette stations. 

There was a time—two decades ago—when even the New York Times acknowledged the need to change the progressive policies that failed to protect the vulnerable. In an investigative research piece published in 2000, the Times documented more than 100 rampage-type killings in the city and concluded that “warning signs were missed by a tattered mental health care system; by families unable to face the evidence of serious mental turmoil in their children or siblings…by the police who when alerted to the danger…were incapable of intervening.” They concluded that these individuals do not just “snap” and commit these violent acts. 

Despite the prevalence of violence among people with serious untreated mental illness, advocates from the National Alliance for the Mentally Ill’s “Stigma Alert” and the National Institute of Mental Health’s “Stigma Watch” seem more concerned with people’s perceptions and attitudes than the underlying criminal behavior to which they are reacting. Anti-stigma advocates pay careful attention to the way the mentally ill are presented in media reports. When Kendra Webdale’s attacker was identified, the National Alliance for the Mentally Ill rallied to his defense, saying that he too was a victim. Laurie Flynn, the group’s executive director, wrote in a media release that “we grieve for Andrew Goldstein whose promise was stolen by schizophrenia over a decade ago.”  

In the wake of the recent rash of subway violence, there are plans to revive and expand Kendra’s Law by requiring mandatory treatment for the violent mentally ill. But there is already resistance to this. The Gotham Gazette reports that Harvey Rosenthal, CEO of New York Association of Psychiatric Rehabilitation Services, opposes the law because “coercion is really not the answer to this.” 

Until New York lawmakers are convinced that coercive treatment is, in some cases, necessary to protect all citizens, Mayor Eric Adams’ Subway Safe program will fail.

Anne Hendershott is professor of sociology and director of the Veritas Center for Ethics in Public Life at Franciscan University of Steubenville, Ohio. This New Urbanism series is supported by the Richard H. Driehaus Foundation. Follow New Urbs on Twitter for a feed dedicated to TAC’s coverage of cities, urbanism, and place.