“Yes, sir, yikes!” responds Andrew.
“Who’s your daddy, A-Train — you love your daddy?” taunts a prisoner.
“Yes, sir, yes, sir — you’re my daddy!”
Andrew, now 48, hasn’t seen or spoken to his mother in 18 years. His stepmother and father, a retired radiologist, used to visit, sometimes bringing one of Andrew’s two older brothers, an optometrist and an accountant-lawyer. But as his father got older, they stopped coming. Andrew remembers the last family reunion with precision: “Yes, sir, November 2nd, 2015, at Sullivan, was my last visit.”
His father sends him $50 money orders for commissary, which he spends mostly on pouches of Top roll-up tobacco, and they talk occasionally by phone.
Curious about the new arrival, I had friends send me clippings. Andrew spots them poking out of a notebook I carry to the computer lab and asks for a look.
I hand him the stack. The one on top has a full-page photo of Kendra Webdale sitting at her desk, eyebrows done, beauty mark on her left cheek, blonde bangs framing her face, hands on her keyboard. He stares at her beaming face, blinks several times, and, with cigarette-burned fingers, turns the page and begins reading.
“Must be difficult stuff to read?” I venture.
“Yes, sir, yes, sir,” he says. “It stirs my emotions. A perfect woman. I know,
I don’t know. To destroy a perfect life like that is a horrible thing. I don’t know why I did that …”
I begin stopping by Andrew’s cell each morning. He tells me about his childhood in Queens, his studies at the Bronx High School of Science — a high-achieving student, he recalls, although by the time he was 16, his disease was already manifesting itself. He retreated to his room, watched TV for days on end, didn’t sleep, didn’t eat, didn’t shower, and dropped to 120 pounds. He still managed to graduate and even took two semesters at Stony Brook.
I would sometimes catch him in a meditative state, sitting on his bed in his state-issued greens and sneakers, legs crossed, back against the wall, head hung down, grungy sheets untucked on a green plastic mattress. My cell has soft sheets, shelves of books, TV and radio. His was bare.
“I miss having a radio,” he tells me. Andrew’s radio broke in 2008, and he never bothered to order a new one. “Sometimes, I’d listen to rock and doodle. You know, like a mind’s-eye view of what the music looks like, ha ha.”
Andrew seems lucid and lively at first. Mid-conversation, he fades out, eyes downward, mumbling.
“It’s like a computer that doesn’t have enough memory and shuts down,” he explains when his attention returns. “I know, I know, I don’t know,” he adds — as if to say “I’m doing the best I can here.”
At 19, he tells me, he had his first psychotic outburst. His father took Andrew and his brothers to Catalina Island, off the coast of California. One evening, Andrew bolted out of the hotel room and turned over a table where two women were sitting. Then he hurried back to the room. His father quickly got wind of the commotion, defused it with the hotel staff, then went back to the room, punched Andrew on the arm, and demanded, “Why did you do that?”
Andrew didn’t know what to say.
—J.J.L.
II.
Shortly after Webdale’s death, Michael Winerip, a reporter for the New York Times, obtained Andrew Goldstein’s 3,500-page psychiatric file—“Given to me by people who see his treatment record as a harrowing testament to the failures of the mental-health system.” In the two years before Webdale died on the tracks, Goldstein had attacked at least 13 other people, including two psychiatrists, a nurse, a social worker, and a therapy aide. In other words, everyone knew. “Maybe,” Winerip wrote, “they should have just stenciled it in large letters on Andrew Goldstein’s forehead: TICKING TIME BOMB. SUFFERS SCHIZOPRENIA. IF OFF MEDICATION, RUN FOR COVER!”
Goldstein had been hospitalized 13 times — voluntarily—and each time he was medicated and discharged to live alone in a squalid basement apartment. Social workers assigned to his case tried to place him in state hospitals, in state-financed group homes, in single-room-occupancy hotels staffed by counselors, in the care of intensive-case managers. Always they encountered long waiting lists, lengthened by severe budget cuts under Governor George Pataki.
The article, published in The New York Times Magazine four months after the attack, was meant to shame, and it did. A few months later, Pataki earmarked an extra $125 million for the care of the mentally ill. He also signed Kendra’s Law. Officially known by the euphemism Assisted Outpatient Treatment (AOT), the law establishes a stringent outpatient regimen for those who are mentally ill and have a history of resisting therapy and a record of violent behavior. A treatment plan is imposed by court order and monitored by a case manager or “Assertive Community Team.” A patient who refuses to follow the program can be committed to a hospital for up to 72 hours. More than 16,000 New Yorkers have passed through AOT since the law took effect, and some 3,000 New Yorkers are currently living under AOT court orders.
—B.K.
III.
Around the same age that schizophrenia started showing up in teenage Andrew, I was drawn to the allure of the gangster lifestyle in Hell’s Kitchen.
In 2001, as a drug dealer looking to defend my turf and boost my rep, I committed murder. Andrew’s illness is a brain disease backed by hard science; my issues — father blew his head off, mother was a bit wacky — were not clinical. Like Andrew, I had two trials, but unlike Andrew, I didn’t commute to court in a medicated fog from a Bellevue psych ward. I was culpable as hell; I belonged in prison. Which is where they sent me after the second jury found me guilty of murder: 25-to-life plus three more years for drug sales and gun possession.
Andrew’s case wasn’t about whether he did it; the jury had to try to figure out what was going on in his mind when he pushed Kendra off the platform. The first trial ended in a hung jury. The second rested on the opposing narratives of two forensic psychiatrists. The defense witness, Dr. Spencer Eth, was straightforward: When Andrew pushed Kendra, he was having an “acute exacerbation … of severe psychotic symptoms” because he had failed to take his antipsychotic meds. His actions, Eth testified, weren’t planned, and he didn’t know that what he was doing was wrong.
The prosecution’s expert, Dr. Angela Hegarty, argued that Andrew was a “relatively mild” schizophrenic and his symptoms were “substantially in remission.” A psychopath with a resentment of women — that was the real Andrew, a conclusion that Hegarty reached, she told the jury, by conducting interviews with people who had firsthand knowledge of him.
As a writer, I’ve come to appreciate the power of story. The prosecutor worked Hegerty’s testimony into a thriller-worthy narrative: A calculating predator, Andrew was reminded when he saw Kendra of a woman who, weeks before, had teased him, leaving him frustrated. On the subway platform, to distract her, he asked Kendra for the time, then waited until he heard the train and pushed. The prosecutor’s last words to the jury mocked Andrew for seeking help: “He’s counting on you to buy ‘I am sick, take me to a hospital.’ ”
The story was a little too good. An appeals court threw out the murder conviction on the grounds that the prosecution expert’s testimony had been all hearsay. Andrew says his Legal Aid attorney told him he could go back to trial and try again to plead not guilty by reason of insanity, but if he succeeded he’d be walking back and forth in a hospital psych ward for 30 years — or even more, since in New York, an NGRI commitment has no limit. If he pleaded guilty to manslaughter, he could be out in a few years. Andrew agreed to plead guilty.
Judge Carol Berkman, who blessed the deal from prison, had earlier handed down a verdict on the system itself: “I have no doubt that someday,” she said, “probably after we are all gone, people will look back at our treatment of mental illness under the law and be shocked and appalled.”
—J.J.L.
IV.
Studies by the Duke University School of Medicine indicate that patients like Goldstein, when following the provisions of Kendra’s Law, are far more likely to stay on their medication and far less likely to be homeless, hospitalized, arrested, or incarcerated. The law does not make up for the dire shortages of hospital beds and supervised housing, but Kendra’s Law has been a godsend for some of the most tormented among us.
Marvin Swartz, a Duke professor of psychiatry and behavioral sciences who has co-authored many of those studies, attributes the success to two things: First, the law not only requires compliance by the patient; it requires the government to do its part, arranging housing, supervision, and rehabilitation. So Kendra’s Law patients go to the head of the line. The law was not just a statement of good intentions. It came with $32 million a year for personnel and drugs to handle the AOT population and $125 million for enhanced community services. The second reason for its success, Swartz says, is that the involvement of a court seems to make everyone—patients, government, families — take the treatment more seriously.
All but three states — Connecticut, Maryland, and Massachusetts — offer AOT as an option for county mental-health authorities, but only New York mandates it as a statewide policy. Most other states have not invested in the therapeutic infrastructure or created the judicial oversight to make it most effective.
It is impossible to know if Kendra’s Law has reduced extreme acts of violence. “Fortunately, acts of serious violence are rare,” Swartz says. “And so it’s hard to design a study that would adequately assess that.” People still push strangers onto subway tracks — 14 times so far this year, according to the NYPD. On January 3, Edward Cordero, an 18-year-old reportedly off his medication for schizophrenia and bipolar disorder, was charged with manslaughter for punching Jacinto Suarez, 65, onto the subway tracks in Brooklyn. Suarez survived the fall but died of a heart attack in the hospital.
One outspoken supporter of AOT is Kendra’s mother, Patricia Webdale, who endorsed the original law and became an improbable champion of families like Goldstein’s, bonding with them over a shared experience of calamitous loss. In a 2005 Buffalo News op-ed, she pleaded with lawmakers to renew the law and suggested that if a Kendra’s Law had been in place in January 1999, her daughter would be alive.
“Kendra died because of purposefully ineffectual laws and policies that prevent treatment for those with severe mental illnesses, many of whom are too ill to make informed treatment decisions,” she wrote. “Some commit violent crimes, many more are victimized, incarcerated, homeless — or commit suicide.”
I spoke to a Westchester County mother whose schizophrenic son put the family through an eight-year ordeal of psychotic delusions, hospitalizations, and bank-account-draining visits to professionals. “It was very scary,” she told me. “He would take my car in the middle of the night and drive until he ran out of gas and call and say, ‘I don’t know where I am.’ ” She phoned the county crisis hotline, which eventually assigned a “crisis team” — “hardworking people that were completely overwhelmed.”
Finally, two years ago, a doctor told her about AOT, accompanied her to court, and got a judge’s order. After six months in a residential facility and a prescription change, her son came home. Now he takes his meds and volunteers at a local food pantry. (“His fear of the court order was all we needed,” his mother said.) Most patients live under AOT for just a year or two before graduating to less stringent requirements, though judges can renew AOT indefinitely. Medicaid covers the costs for those who can’t afford to pay. Two years in, said the Westchester mother, her son, now 26, has not had a psychotic episode. “He’s back. He has a long way to go, but the person that was in there is back.”
The strongest opposition to the law has come from civil-liberties groups, which fought the original legislation as coercive and succeeded in excising a provision that would have allowed the forcible administration of medication. The civil-liberties concerns have not been entirely assuaged, but they have been tempered. “It’s still compulsion,” says Beth Haroules, senior staff attorney of the New York Civil Liberties Union, which has unsuccessfully challenged the law on constitutional grounds. But she acknowledges that it’s better to be compelled to follow a treatment plan than to face homelessness or incarceration or hospitalization.
Another source of opposition is mental-health service providers who would rather spend their energy on compliant patients, or at least not reward noncompliance. Kendra’s Law has been renewed periodically since it first passed. In March, Catharine Young, a state senator who has become friendly with Kendra’s mother, won a State Senate vote to make Kendra’s Law permanent. But the State Assembly insisted on a five-year sunset. AOT supporters attribute the defeat to Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, which lobbies on behalf of local service providers who want more money to flow to “voluntary approaches.” (Governor Andrew Cuomo has avoided the issue.)
Kendra’s Law has had no more passionate advocate than D. J. Jaffe, a ponytailed former advertising executive, who encountered the world of extreme disorders when he and his wife became guardians of a schizophrenic family member. He helped persuade Kendra’s parents to support the original passage of the law and now sees himself as AOT’s fiercest defender. Jaffe contends that too much mental-health funding is siphoned off in service of “wellness for the masses,” at the expense of those most in pain and most dangerous to themselves and others. He summed up his complaint in a ted Talk earlier this year: “We wrap everything that makes you sad in a mental-health narrative, whether it’s poverty, bad grades, unemployment, angst about sexual identity. These are all now either mental-illness conditions or they’re risk factors for mental illness. If we start spending our money on all the things that make people sad, what’s left for the seriously ill?”
Jaffe told me opponents of AOT treat the sickest as a public-relations liability. “If you’re a mental-health advocate, you want to teach the public the mentally ill are no more violent than others. You don’t want to teach the public that the untreated, seriously mentally ill are more violent,” he said. “You want to teach the public that everyone can live in the community, not that some people do need institutional care. So the mental-health groups have kind of disengaged themselves from the seriously ill.”
—B.K.
V.
In the late 1990s, when Andrew Goldstein was banging on hospital doors, begging to be admitted, there were 200,000 people with mental illness in jails and prisons and 61,700 in state hospitals across the country. Today, there are twice as many, 400,000, incarcerated with mental illness — but only 38,000 in hospital beds. That jails and prisons have become our default mental facilities is a cliché, because it is true.
Behind bars, the mentally ill are frequently victimized by other prisoners, drugged into zombielike submission or denied the medications they need, and confined in solitary units that have a maddening effect on even healthy prisoners. Jails, which are designed for relatively short stays, are particularly ill-equipped to manage psychotic prisoners. In August, the Virginian-Pilot, a Norfolk daily, documented 404 deaths of mentally ill prisoners since 2010 in the nation’s jails — surely only a fraction of the real number.
One reason so many of the desperately ill are in prisons is that prosecutors exercise their immense discretion in pursuit of victories, not treatment. If prosecutors had agreed to accept a plea of not guilty by reason of insanity, Andrew would have been sent to a psychiatric facility instead of Sullivan, but prosecutors wanted a conviction. In any case, Andrew had a Hobson’s choice — prison with a chance of freedom, or a more appropriate setting possibly for the rest of his life.
Despite the V in SMI-V, Andrew has kept his violent impulses in check for nearly two decades. He attributes this in large part to a series of antipsychotic drugs — Haldol, Cogentin, Abilify, and now 20 daily milligrams of Zyprexa. At 8 p.m. every day, a psych nurse hands him two white pills. He pops them in his mouth, drinks some water, then opens wide to show he has swallowed them. “It makes me feel like a jigsaw puzzle that patterns out,” he says of the drug.
Once, in April 2015, Andrew was eating breakfast when he saw officers take a man out of his cell block into the sally port. “I heard a slight resistance,” he tells me. “The next thing I heard, the guy was dead.” Another time, a fellow prisoners in the SMI program tried to choke him for no apparent reason. Andrew, though, has had no violent-misbehavior reports in 19 years. He did tell me of an incident in 2003, when he hit a facilitator who was urging him to clean his cell. Andrew apologized and nothing much came of it. The last fit he felt coming on was around the same time; he was walking up the stairs with cleaning supplies, and he felt an urge to push or kick the man in front of him, but he controlled it.
Andrew’s prison medical records portray a man beset by commonplace miseries of poor hygiene, bad diet, and what one report describes as “inability to provide adequate self-care” — painful calluses on his feet, conjunctivitis, diabetes, obesity, and burned lips and fingers from his addiction to roll-your-own cigarettes. On several occasions in the last few years, he was marked as “noncompliant” for not taking his meds, but that appears to refer to his diabetes and cholesterol medication, not his antipsychotics.
A health-screening report in 2016 asked: “Does inmate exhibit aggressive behavior?” The screener checked “Yes.” The file includes no details.
These days, medicated Andrew can’t quite wrap his head around what psychotic Andrew did. “It’s a horrible thing, what happened in that station,” he tells me. “But if I would have taken my meds, I would have been in the right frame of mind … yikes.”
I ask about the prosecution claim that Andrew nursed a resentment of women.
He tells me a girl rebuffed him in high school, saying she didn’t date guys from Queens. It was one of his last lucid memories, the kind most boys have about the girl who got away. He once went to a peep show and saw an Asian woman’s breasts. The slot opened and closed. “It didn’t really turn me on,” he says. “I’m not really a sexual person.”
Then two weeks before he pushed Kendra onto the tracks, his roommate, in an it’ll-be-fun-to-see-Andrew-have-fun sort of way, offered up his girlfriend, who worked as a stripper. Andrew felt her breasts but did not have sex with her. The woman had blonde hair, so the prosecution surmised that Andrew was thinking of the stripper when he saw Kendra and that brought on a fit.
“Turns out, I’m still a virgin at 48,” he says.
We sit quietly for a while. Andrew blinks several times, then palms his head. “I don’t know what to say,” he tells me. “I was going to go with that girl from high school, go to film school, but then everything came crashing down.”
Andrew clings to Kendra’s Law as a small bit of redemption in a horrifying saga. “You know, it’s a really good law — not like some totalitarian law where they could just throw you in a mental hospital. They have legal requirements, a hearing, yes, sir …”
A couple of weeks ago I asked Andrew what he’s going to do when he gets out. He said he wants to put a wreath on Kendra’s grave. One of his fears, though, is that a crowd will surround him, beating him and yelling, “You killed Kendra! You killed Kendra!”
I told him that everyone wanted to know if he was still dangerous. He placed his burnt-brown fingers on his head. “I know, I know. I think I have a routine pattern ingrained,” he told me, “sort of like a monkey walking a maze, taking my meds; any symptoms I feel I tell the person helping me. I’ll never do that again. Yes, sir.”
Then he told me about his idea for a short story that he wanted me to pitch to my editor friends. It was about a mother and two brothers who go to school in a van, leaving a third brother behind. Then a band of energy strikes Earth, and everyone except the abandoned brother reincarnates in another galaxy. Civilization has left him. He’s all alone.
—J.J.L.
VI.
The state has not disclosed its plan for Goldstein, even to Goldstein, but the drill is well established. Before he is released to the community, he will be moved to a hospital while his future is considered — first by a clinical team, then by a psychiatrist specializing in outpatient treatment, and ultimately by a judge. The options range from complete independence (highly improbable, especially given the notoriety of the case) to commitment in a mental ward (unlikely given his behavior in prison).
According to the state Office of Mental Health, “All inmate-patients who are approaching release to the community are reviewed for consideration for AOT.” The criteria include at least two episodes of refusing treatment or one act of serious violent behavior within the last 36 months. (His 19 years of prison time are taken out of the equation, so only his pre-arrest behavior counts.) If he meets the test, he would be assigned an outpatient case manager and be given priority for one of the state’s 40,000 housing units. Thus the man who unwittingly inspired Kendra’s Law may be the latest to experience it.
—B.K.
John J. Lennon is an inmate of Sing Sing and a contributing writer for the Marshall Project. Bill Keller is the editor-in-chief of the Marshall Project. With additional reporting by Mustafa Mirza and Simone Weichselbaum.
*This article appears in the September 3, 2018, issue of New York Magazine. Subscribe Now!
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