It was the sort of grisly serendipity book publicists may only take covert satisfaction in. Jordan Neely’s death in a Manhattan subway car last year occurred just two weeks after the release of a book with considerable relevance to the controversy it provoked: Jonathan Rosen’s The Best Minds: A Story of Friendship, Madness, and the Tragedy of Good Intentions.
The book concerns the tragic life of Rosen’s childhood best friend Michael Laudor, an intellectual prodigy who graduated from Yale Law School despite struggling with paranoid schizophrenia, and went on to become a prominent advocate for the mentally ill. But Laudor’s remarkable trajectory ended in catastrophe when he murdered his pregnant fiancée, Caroline Costello, in 1998.
The Best Minds focuses on the same questions that were hotly debated after Neely’s death, which also overshadowed the trial of Daniel Penny: What should society do with those suffering from severe psychosis? Is there an obligation to forcibly confine them for their own safety and that of others? Or on the contrary, do they deserve the same freedom from involuntary confinement the rest of us take to be our right? Now that Penny has been acquitted, there is an opportunity to revisit these questions, which the outcome of the trial on its own does little to resolve.
Regardless of our views on the Penny verdict, most of us likely agree on a few things. First, it is undesirable, for everyone involved, for people in Neely’s condition—severely mentally ill, drug-addicted, menacing to strangers—to be a constant public presence in our cities. Second, it is also undesirable to need to rely on citizen intervention to maintain basic public order. Third, Neely’s death was a regrettable outcome, symptomatic of profound dysfunction.
In spite of this consensus, there remains a fundamental disagreement about the forcible confinement and medication of the mentally ill. Progressives have mostly dodged this question by claiming that if Neely had simply been provided with shelter, sustenance, and healthcare, he wouldn’t have behaved as he did. “Why,” as The New York Times’s Jamelle Bouie asked shortly after the fatal encounter on the F train, “in one of the wealthiest places in the history of the world, did Neely lack for a proper place to sleep and adequate mental health care?”
But a cursory glance at reporting published in Bouie’s own newspaper provides a simple answer to that question. In the most immediate sense, Neely lacked shelter and treatment not because society had failed to provide it, but because he had left the treatment facility in the Bronx where, after being tried for assault, he was sent by a judge and prosecutor—very much in line with the sort of “restorative” and “decarceral” approaches progressives often advocate. The state had, in fact, provided Neely with shelter and treatment; but it had also granted him the freedom to refuse those things.
Lisa Miller’s detailed account of Neely’s life and death for New York magazine further put the lie to the claim that the free provision of basic resources would have saved him. The clear takeaway of the profile is that the legal impossibility of confining him for treatment practically guaranteed his life would end badly. Even a clinician at the psych ward at Rikers who identifies as an “abolitionist” is quoted in the article saying that Neely “did better in jail than on the streets.” Neely’s best friend also tells Miller that locking him up “could have saved him.”
The debate prompted by the increasing visibility of mental illness in public spaces in the post-Covid years is the pale shadow of a debate that raged far more widely, and more consequentially, over several decades in the late 20th century. Michael Laudor, Rosen’s friend and the subject of his book, was a participant in this debate as well as emblematic of its stakes.
Unlike Neely, who had a horrifically traumatic childhood, Laudor grew up in a happy middle-class family, was academically successful, and had many resources at his disposal as he contended with full-blown psychosis beginning in his 20s. Despite all that, his life took a disastrous turn. Having, like Neely, refused confinement and medication, he attempted to lead a normal life. Laudor is now forcibly institutionalized and medicated for the rest of his life—but only because first he committed a monstrous murder. In line with his own political demands as a writer and activist, he couldn’t be confined in advance of that act, simply on the basis of his condition.
The broader significance of Laudor’s life derives from the historical period in which it unfolded. Between the 1960s and the 1980s, America ended the mass involuntary confinement of the mentally ill in state institutions—often in scandalously dire conditions—and shifted to a model of “community care” that often turned out to be a euphemism for little or no care at all, in part because it was implemented in an era when communities of all sorts were breaking down.
In this de facto abandonment of the severely mentally ill, left-wing idealism, which viewed the mentally ill as an oppressed class in need of liberation, converged with conservative fiscal austerity, which hoped to liberate the state from the onerous obligation of paying for their costly, lifelong care. “Left and right often met at the gates of the asylum,” as Rosen puts it.
The 20th-century antipsychiatry movement—in which Laudor was a participant, publicly advocating for the right of people with conditions like his to be fully integrated into society—took the position that mental illness was a social construct, a means of stigmatizing and excluding people who were merely different. Antipsychiatry advocates also often claimed that what might seem like insanity could in fact be a justified form of protest against an insane society. (This message found its most popular vehicle in One Flew Over the Cuckoo’s Nest, the cultural influence of which Rosen explores at length.)
“Antipsychiatric opposition to forcible confinement and medication still guides policy.”
In retrospect, it is easy to dismiss such views as an excess of the countercultural left. Especially after psychotropic medications were widely embraced beginning with the 1990s Prozac boom, the notion of psychiatrists as sadistic enforcers of societal norms lost popular traction as many more people began turning to them for help in managing stress and depression. Nonetheless, antipsychiatric opposition to forcible confinement and medication still guides policy as well as collective attitudes, as Neely’s death and the reaction to it made apparent.
Discomfort with the idea of medical authorities depriving citizens of their freedom isn’t confined to the left, nor is it always unreasonable. Just a few years ago, refusal of state-mandated quarantines and pharmaceuticals became a rallying cry on the right. This set of concerns abruptly made conservatives receptive to the ideas of a thinker they had previously reviled: Michel Foucault. Not coincidentally, Foucault was involved in antipsychiatric activism, and his first book, History of Madness, was one of the movement’s canonical texts.
In Foucault’s account, the exercise of power by medical and psychiatric authorities always threatens to become a permanent state of exception within liberal political regimes whose power is nominally circumscribed by individual rights. To declare someone insane—or a vector of infectious disease, or another sort of expert-defined menace—provides a basis for suspending these rights. Once someone is classified in this manner, the coercive force of the state can bypass the protections afforded by citizenship and operate directly on the “bare life” of the medicalized body. This threat, for Foucault, was always implicit in the institutional project of public health.
In the Covid era, many progressives found themselves in the strange position of arguing the state must not forcibly confine and medicate the Jordan Neelys of the world, but should be able to exclude the unvaccinated from public life. Conservatives have mostly claimed the reverse. I’m of the opinion that the latter position is more reasonable, but I also don’t think questions about the proper relationship between rights, public order, and public health have easy answers. Revisiting the debates that led us to our current impasse, detailed by Rosen, might offer a way to restart the conversation.