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The brutal murder of Iryna Zarutska began a national conversation on mental illness — a problem every one of us, in every city in this country, is intimately acquainted with because tens of thousands of violent lunatics roam our streets today more or less unchecked. There is no cure for most of what we see out there, there is no longer any easy path to conservatorship, and the problem is now sufficiently bad there is no tolerating the status quo. It's time to bring back asylums.
Obviously, the subject is fraught. Civil libertarians believe the chaos on our streets is just the cost of freedom, while many well-meaning liberals believe the problem just a matter of our government refusing to fund treatments for mental illness that literally do not exist. The big missing piece of the conversation is, I think, a history. How did we get here? What has been tried? What is the reality on the ground? And how do we move forward.
Today, G. B. Rango lays out the definitive piece on the problem of our violent lunatics, and the way forward.
—Solana
Iryna Zarutska was stabbed three times on August 22nd of 2025 while sitting quietly on Charlotte's LYNX Blue Line, an integral part of the state's light-rail commuter system. Decarlos Dejuan Brown Jr., unprovoked, plunged a folding knife into her throat. He did this two more times in rapid succession. Zarutska looked up at him in terror, visibly petrified and confused, blood spilling out of her neck. She then covered her face with her hands, remaining conscious for nearly a minute before sliding off of her chair and onto the floor of the train. Brown wrapped his hand in a sweater and walked away. Iryna was pronounced dead at the scene. All of this was captured on security cameras.
A particular still from this footage has become central in the story's coverage. It shows Zarutska looking down at her phone and making herself very small in her chair. Her arms are pulled close across her body, her knees are touching. She is in the sort of physical position that one now tends to assume when in unavoidable public proximity with a person whom one senses to be mentally unstable. Whose attention is easily drawn, and whose unpredictable set of potential reactions ranges from silent shuffling to incoherent and aggressive yelling to spontaneous, life-threatening violence. Brown is looming behind her in this image, arm raised, knife in hand, midway through the swing of his first stabbing motion.
Brown walked off the scene unimpeded, a dotted trail of blood following behind him, through two train cars filled with bystanders. No one came to Zarutska's aid until one minute and thirty-six seconds after the attack. Some have attributed these facts to a growing collective callousness toward the suffering of others. I believe, however, that they originate not from a place of indifference, but of practiced inattention, one that is a logical consequence of public policy. These bystanders were instinctually aware of Brown's mental instability, accustomed to dealing with the presence of such people, and engaging in the rational set of avoidant behaviors. The purposeful staring at nothing, metaphorical blinders on, body language signaling non-confrontational dispositions. Iryna was making herself very small in her chair.
It is now routine in American cities to come into contact with folks who are some combination of severely mentally ill, homeless, perennially criminal, and substance-abusing. Most of these people are not dangerous. Some of them are. The almost limitless tolerance of their disruptive presence in common society is a choice that we have made, one that hides behind the nebulous defense of "empathy as policy"¹ while fomenting destructive conditions. We have largely failed to engage with this problem for several decades.
Brown's case highlights this negligence in striking fashion. He had been arrested fourteen times for a litany of violent and nonviolent offenses before murdering Zarutska. This is one of the most-reported-on facts of the story, a source of understandable outrage, and a primary representation of the failure of "empathy as policy" in the criminal justice system — a pattern of imaginary thinking in which endless second chances and empty hand-waving about transformative reformation dominate. Anyone with Brown's sort of track record should, quite obviously, be removed from society for the preemptive good of all parties involved. This requires long-term incarceration or institutionalization, neither of which were demanded of or granted to Decarlos Brown. (With the caveat that he previously served a six-year prison sentence for armed robbery from 2015 to 2020, which is in many senses "long-term," though clearly neither sufficiently long nor reformative.)
I use the term "granted" here, in reference to long-term institutionalization, because of a number of lesser-known facts about Decarlos Brown. Michelle Dewitt, his mother, with whom he had been living after his 2020 prison release, had attempted multiple times to get her son committed to a mental institution. He is a diagnosed paranoid schizophrenic, was growing increasingly aggressive at home, and would pace the room while having heated conversations with invisible participants. Dewitt took her son to a mental hospital, but they did not have space for Brown, who was, in any case, refusing voluntary commitment. The hospital informed Dewitt that if he was not "trying to kill himself or someone else," she would need a court order to have him committed.
Dewitt then went through the legal process of petitioning the court, demonstrating successfully that her son met the criteria for involuntary commitment. The civil order was granted, and Brown was remanded to a mental health facility for the stunningly meager duration of 14 days. He stopped taking his medication soon after returning to his mother's house. Dewitt and her husband eventually dropped him off at the Roof Above Lucille Giles Men's Shelter, no longer able to abide him in their home, and Decarlos began living on the streets. In January of 2025, he went to Novant Hospital, seeking help and claiming that he was afflicted with some "man-made material that controlled when he ate, walked, and talked." The hospital was unable to accommodate him, and the police became involved. Officers told Brown that there was nothing they could do, which greatly upset Brown, who proceeded to call 911 to request further assistance. He was arrested for "misuse of the 911 system" before being released without bond back into the general public.
After killing Zarutska, Brown called his sister from jail. "The material did it… whoever was working the materials, they lashed out on her," he said. "They just lashed out on her, that's what happened." He then added, "I never said not one word to the lady at all. That's scary, ain't it. Why would somebody stab somebody for no reason?"
Brown's murder of Zarutska is, of course, not the only such case of severely mentally ill wanderers unleashing unprovoked violence on unsuspecting members of the general public. On October 4th, 2021, Anthonia Egegbara — a 29-year-old homeless and schizophrenic woman whose family had tried repeatedly to get her professional help — pushed Lenny Javier into an oncoming Times Square subway train. On January 15th, 2022, at 9:30 in the morning, Michelle Go was pushed in front of an oncoming R train at a New York City subway stop by Martial Simon, a 61-year-old homeless man and diagnosed schizophrenic who had been in and out of various institutions for 20 years (and who, notably, told a psychiatrist in 2017 that it was "only a matter of time" before he shoved a woman onto the tracks).
May 21st, 2023, at the Lexington Avenue and 63rd Street stop, Kamal Semrade grabbed the head of Emine Ozsoy with two hands and, according to a witness account, "mushed her head — not her body — into the train. She just tumbled, just kept spinning because the train kept hitting her. You could see the white inside [the flesh in her face], that's how bad it was." March 25th, 2024, Carlton McPherson snuck up behind Jason Volz and pushed him onto the subway tracks at 125th Street and Lexington Avenue. McPherson had been hospitalized several times in two years before this incident, for artifacts of severe mental illness, and his brother Daquan insisted their family had "repeatedly tried to ensure he remained in psychiatric care." Daquan "begged them to keep him, but they said he wasn't a threat to himself or others… and they let him go." McPherson was released two weeks before killing Jason Volz.
This cohort of examples consists only of New York City subway-pushings that occurred in the last five years, were perpetrated by homeless people with evidence of severe mental illness, and were entirely unprovoked. Even within this limited scope, I am unable to cover the list comprehensively for fear of turning this piece into a morose droning-on — at least 25 people were pushed onto NYC subway tracks in 2024 alone. (Obviously, many of these do not fit the precise shape pertinent to this discussion, but the point has been made.)
This is also just one city's subset of extreme examples: any person who has spent meaningful time in a major American metropolis has had, at minimum, one nontrivially unnerving encounter with someone who is aggressively mentally unstable. The consequences of tolerating free-range lunatics, a colorful phrase which I invoke here with no pejorative ill-will, reach far beyond the hyper-acute hazard of being literally murdered. Why do we accept the ubiquity of this on-edge, unsafe feeling, the ceding of the character of public spaces to a small minority of profoundly suffering individuals who lack the wherewithal to operate safely in society?
This incredible systemic failure is institutional and cultural: the mid-20th-century demolition of American insane asylums, whose initial construction and eventual destruction were both functions of ill-fated empathy, left us without a viable option for the preemptive and humane isolation of these disturbed individuals. We then filled this institutional void with coping mechanisms, namely a persistent delusion that our secular powers of criminal and psychiatric reform were limitless, sparing ourselves the difficult work of dealing with reality (at the expense of allowing the festering of this proverbial rat's nest). Endless strings of repetitive catch-and-release prison stints. Short-term, and therefore futile, psychiatric confinements, limited by infrastructural capacity. Permanent, rampant, inhumane homelessness.
It is not that we are refusing to cure the severely mentally ill out of disdain, or apathy, but that we lack the medical ability to do so. Anti-psychotic pills, even if taken religiously, which they rarely are, fall far short of being reason-restoring. They also come with a laundry list of brutal, and common, side effects: painful muscle contractions, severe weight gain, new-onset diabetes, nausea, insomnia, chronic involuntary movements. A refusal to grant these individuals long-term institutionalization, therefore, amounts to nothing less than a surrendering of the public to insanity.
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In 2023, as part of his larger Agenda 47, Trump vowed to "open large parcels of inexpensive land, bring in doctors, psychiatrists, social workers, and drug rehab specialists, and create tent cities where the homeless can be relocated and their problems identified." For those deemed "severely mentally ill and deeply disturbed," he planned to "bring them back to mental institutions, where they belong, with the goal of reintegrating them back into society once they are well enough to manage."
Then, in July of 2025, Trump signed an executive order entitled "Ending Crime and Disorder on America's Streets" that, among other things, directed the Attorney General to expand the use of involuntary non-criminal commitment for those who are homeless and suffering from severe mental illness — to make it legally easier to preemptively isolate them.
Most recently, when asked in a September 2025 interview if he would be amenable to the idea of "the government reopening insane asylums for people with serious mental illness," Trump replied, "Yeah, I would… they used to have them, and you never saw people like we had… they released them all into society because they couldn't afford it… you can't have these people walking around."
Slippery-slope-fearers are naturally, and perhaps fairly, wary of this proposed pro-reinstitutionalization trajectory. There are obvious due process and civil rights concerns associated with the forcible removal of people from society based not on criminal convictions, but on potentially subjective evaluations of their mental states. This is a heated conversation even in the case of modern conservatorships established and led by family members, Ã la the Britney Spears situation, let alone hypothetical widespread, state-initiated asylum lockups. A preemptive assumption that this person will harm themselves or others has to be made with enough certainty to strip them of their autonomy. The hairiness of this territory, however, rather than discouraging us from searching for potential solutions, should be seen as a call to continue (and retrospectively learn from) a conversation that has been happening in America since our prenatal days.
Francis Fauquier, the Lieutenant Governor of Virginia from 1758 until his death in 1768, wrote the following a decade before the Declaration of Independence was signed: "It is expedient that I should also recommend to your Consideration and Humanity a poor unhappy Set of People who are deprived of their Senses, and wander about the Country, terrifying the Rest of their Fellow Creatures. A legal Confinement, and proper Provision, ought to be appointed for these miserable Objects… to endeavour to restore to them their lost Reason." A year later, he expressed concern that, given the lack of progress on resolving this issue, he was "compelled to the daily commission of an illegal act, by confining, without any authority, a poor lunatick who, if set at liberty, would be mischievous to society." Nine years later, America was born, the "unalienable rights" phrase was printed, and the unsolved problem of these wanderers remained.
In the late 1700s and early 1800s, confinement of the severely mentally ill was widespread and unofficial, driven by social and carceral forces. Families would hide their mentally ill relatives away out of shame, and those without accommodating families would be subject to imprisonment in local jails (crimeless or otherwise, as Fauquier noted). Still others were relegated to workhouses and almshouses, many of which had designated sections for insane occupants.
Enlightenment ideals of the moral restoration of Reason to the Reasonless began making their way into the American psyche, birthing early insane asylums like the 1813 Friends Asylum in Philadelphia. These institutions remained small and rare, however, through the 1840s, at which time activist Dorothea Dix began documenting the horrific conditions of informal confinement facing the severely mentally ill. Dix wrote of people in cages, naked and chained, packed into cells without regard for their well-being. She was the most prominent torch-bearer of this new wave of public empathy for the disavowed.
Dix, in 1843, petitioned the Massachusetts legislature to expand the Worcester State Lunatic Hospital. Having toured the pertinent jails and almshouses, witnessing the torturous and immoral treatment of the severely mentally ill in informal confinement, and believing in the promise of formal asylums, she wrote the following: "I come to place before the Legislature of Massachusetts the condition of the miserable, the desolate, the outcast. I come as the advocate of helpless, forgotten, insane men and women; of beings sunk to a condition from which the unconcerned world would start with real horror."
As it turns out, Dix's calls for society to "restore the outcast" and "defend the helpless" spread like cultural wildfire. By the end of the 1840s, eleven of the original thirteen states had built asylums. In the 1850s came the "Kirkbride Plan," developed by Dr. Thomas Story Kirkbride, which outlined a standardized approach to asylum construction — natural light, maximal air circulation, well-maintained grounds, and a patient limit to prevent overcrowding. This directly led to the construction of an additional seventy-eight American insane asylums; the plight of the insane had been heard. There was great optimism that these institutions would end the terrors of informal confinement, cure the disturbed with moral treatment — a regimen of kindness, dignity, structured routine, and open spaces — and reintegrate many of them back into society. Progressive empathy would be backed by effective institutions and transformative collective action.
That is, unfortunately, not what happened. Moral treatment did not work, and viable medical approaches were nonexistent. By the 1870s, overcrowding was rampant. It was apparent by 1900 that our powers of psychiatric restoration had been greatly overestimated, and that these asylums looked a lot like rebranded versions of the informal confinements which had horrified Dix and her public 50 years prior. Beatings, restraints, cruel and inhumane conditions. Our eyes (empathetic passions) were proven much larger than our stomachs (pragmatic capacity to enact lasting change), and society once again turned against lunatics.
Accordingly, the 20th century pre-1950s was largely characterized by "custodial care" — the begrudged warehousing of severely mentally ill patients in brutal conditions, in grossly underfunded asylums — and the emergence of overtly violent medical "treatments." One asylum in Buffalo, designed to hold 600 patients, was housing 3,600. Insulin shock therapy, deliberately inducing comas in mental patients via insulin overdosing, was widespread. Metrazol shock therapy used pharmaceuticals to cause seizure-like convulsions of such intensity that 43 percent of patients undergoing the treatment suffered vertebral fractures. Walter Freeman developed the transorbital lobotomy, in which a picklike instrument is forced through the back of the eye socket to sever parts of the brain and enfeeble patients, a procedure so efficient that he was able to personally lobotomize 228 patients over one 12-day span. Nearly 19,000 lobotomies were performed in the United States by 1951. Treatments like these were often used as a means of control, to make overcrowded asylums more manageable.
100-plus years after Dorothea Dix's crusade, cyclical empathy having made its rounds, the plight of the severely mentally ill once again took center-stage. An early turning point was Albert Maisel's "Bedlam 1946," a written exposé of two insane asylums — one in Pennsylvania and one in Ohio — that detailed horrific conditions, much like Dix had done before him, and was coupled with grueling photographic evidence.
But history is linear and does not "repeat itself" as such. This brings us to the 1950s. Institutionalization, in the form of insane asylums, had failed miserably. Informal confinement had proven inhumane, as had formal confinement, and no moral or medical cure for the deeply deranged had been produced. Where was left for a troubled society to turn?
Thus began the multi-decade process of deinstitutionalization, which would lead to the end of insane asylums, the mass release of severely mentally ill individuals into society, and today's commensurate end-state of public disarray.
In 1954, an anti-psychotic drug called Thorazine received FDA approval. Within eight months of hitting the market, it was administered to two million patients, and became widely available for use at asylums. The existence of an anti-psychotic pill that was even marginally effective was revolutionary, and it made appealing the concept of outpatient treatment for the severely mentally ill. The 1950s, an age of futuristic optimism, had yielded the beginnings of a cure for insanity! Common conception was that, of course, progress on the clinical restoration of Reason would continue, if not accelerate. How could it not? The insane asylum population peaked in 1955 at around 559,000 patients.
Remember the aforementioned Dr. Walter Freeman, notorious purveyor of lobotomies? Rosemary Kennedy, the sister of future president John F. Kennedy, was lobotomized in 1941 by that very same Dr. Freeman. The operation resulted in Rosemary, then 23, having the diminished mental capacity of a two-year-old child. This greatly affected JFK, who, in 1963, delivered a "Special Message to the Congress on Mental Illness and Mental Retardation," asserting that the "reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability." This marked, quite directly, an empathy-driven return to placing this major societal burden of the severely mentally ill on imaginary empathic "community" shoulders.
Kennedy signed the Community Mental Health Act of 1963 23 days before he was assassinated. The plan called for 1,500 community mental health centers which, no doubt inspired by the promise of drugs like Thorazine, would provide outpatient care and begin to replace custodial asylums. Federal grants funded the construction, but not the operation, of these community centers. Fewer than half were ever built.
The civil rights movement served to intensify this anti-institutionalization surge. These patients were seen as unfairly oppressed, their rights clearly violated. Ken Kesey's One Flew Over the Cuckoo's Nest (1962) further contributed to (rightful) negative perceptions around asylum conditions. (The 1975 movie had significantly wider reach and later contributed even further to a culture of deinstitutionalization.)
Medicaid, established in 1965, included something called the "Institutions for Mental Diseases" (IMD) exclusion. This, in line with the spirit of the Community Mental Health Act, prohibited federal Medicaid funding for care provided to adults in psychiatric facilities with more than 16 beds, a fatal blow to insane asylums. These facilities were insanely expensive to operate, even understaffed and overcrowded, were facing major cultural headwinds, and would need to be financially supported exclusively by state governments. (Who, by the way, were promised financial incentives in the other direction for transitioning to community-centric, outpatient-led, non-custodial care models via Kennedy's 1963 legislation). The IMD exclusion remains active today, fundamentally unchanged from its original wording. (As of a March 2024 revision, Medicaid covers up to 30 days per year of substance use disorder treatment, specifically, in qualifying mental institutions.)
In 1955, there were 166 million people in the United States and at least 559,000 patients in long-term psychiatric institutions. Today, there are nearly 350 million people in the United States and only 37,000 patients in state psychiatric hospitals. (There are an additional 60,000 private psychiatric beds, but they are occupied predominantly by voluntary patients whose health insurance covers the costs of their brief stays, as nearly all civil and criminal court-mandated patients are sent to state facilities.) If we were to institutionalize, proportionally, the same number of people today as we did in 1955, that would translate to 1.2 million patients. We have 37,000 state beds. Of these, more than half are occupied by "forensic patients" — individuals who have already been charged with crimes and are either undergoing evaluation or have been dubbed Incompetent to Stand Trial (IST), Not Guilty by Reason of Insanity (NGRI), or Guilty but Mentally Ill (GBMI). The other 48 percent of patients, civil patients, are held on average for fewer than two weeks.
Decarlos Dejuan Brown Jr. is currently being held for evaluation in one of these state facilities as a "forensic patient." Before the stabbing, when his mother's legal petition was granted and he was remanded to one of these facilities for 14 days, he was on the long end of a civil stay. Not only do we not have room for the preemptive isolation of the potentially dangerous severely mentally ill people among us, we, in fact, don't even have room for the criminally insane. Those inmates, e.g. those who are NGRI, spend a median of two months in jail before there is even a psychiatric bed available for them. This pressure, of course, necessitates the rapid discharge of civil patients from state psychiatric facilities, many of whom will inevitably return as forensic patients.
We, as a country, completely lack the institutional infrastructure needed to deal with the particular brand of severe mental illness — and its natural comorbidities — with which we are afflicted. Nontrivially unnerving encounters with horrifyingly unstable people are routine in American cities because we, by our own series of choices, have abandoned these folks to a repetitive pinballing between homelessness, short-term psychiatric holds, and jail. This is an inhumanity which puts innocents at risk and unacceptably deteriorates our social fabric. Frighteningly, our best solution, barring the invention of a miracle panacea for mental derangement or the construction of additional infrastructure, seems to be indefinitely jailing these people once some yet-to-be-formalized threshold of pertinent convictions has been met. A version of our early 19th-century approach. Because, again, we do not yet have a cure for the severely, violently mentally ill.
That is not an aspirational enough end-game for the United States of America, the wealthiest and most powerful country on earth, in 2025.
Hard problems are always messy. Dealing with them inevitably involves taking on risk and making difficult, calculated tradeoffs. The only definitively wrong answer here, which appears to be our chosen solution, is to not engage. To act on empathy with one hand and to cover our eyes with the other, so as to imagine a better result than the one we have actually wrought.
Much of the failure to address this elephant in the room, I fear, is a sense that we lack the governmental competence to build much of anything — let alone a new network of modern insane asylums that will avoid the sprawling pitfalls of its 19th and 20th-century predecessors. Instead, it is easier to foolishly pretend that someone like Decarlos Brown will be magically healed by an outpatient psychiatric pill prescription, or to believe that our carceral system will miraculously reform him after his fourteenth arrest-and-release, or to imagine that his fractured familial support network will come together and eventually be able to manage him safely without meaningful aid from the state.
Rebuild the insane asylums. Call them "Psychiatric Institutes," but know what they are. Isolate those who need to be isolated, and find a way to do it humanely. Continue to strive to understand the spiritual and chemical concoctions whose balances separate Reason from Reasonless, sanity from insanity, and aim to cure as many afflicted souls as possible. What looks now like a surrendering of the public to the whims of deeply disturbed wanderers can become an opportunity for change, a testament to our ability to construct incredible institutions, a credit not to just our moral sense, but to our ability to follow through on the pragmatic machinations of turning visions into reality. Admitting that a problem is beyond the reach of our resolve has never been the American modus operandi, and a situation as important as this one must not remain neglected for craven fear of failure.
—G. B. Rango
FOOTNOTES
¹ This is a scarcely preexisting term without clear origin which I am, while likely not "coining," choosing to co-opt for the purposes of this piece and recontextualize for future use in the public vernacular.
