On treating subway-pushing by treating mental illness and homelessness

Subway tracks. (Kevin H. via Flickr)
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Subway pushers are often psychotic, homeless, male, and have histories of psychiatric inpatient treatment, or at least that was the case in 1992, when Park Elliott Dietz, a forensic psychiatrist, published "Mentally disordered offenders who push or attempt to push victims onto subway tracks in New York City" in the Archives of General Psychiatry.

"We found that inadequately treated psychosis, homelessness, and living in the subway were risk factors for homicidal subway pushing," Dietz wrote in an email this weekend. "Despite the City's efforts to combat each of these causes, I'd expect to find a similar pattern today. Of course, this is a fairly safe prediction, considering that one recent suspect was reported to be homeless and another to be muttering to herself."

In the past month, two subway riders on platforms have been pushed to their deaths by strangers, prompting a flurry of reports asking what, if anything, can be done to prevent such incidents in the future.

Some transportation experts have suggested the Metropolitan Transportation Authority experiment with platform screen doors, like the kind Paris is installing in its subway system.

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Dietz says, "the cost of platform doors would need to be compared to the costs of alternative measures, such as educational or treatment programs focused on psychosis and depression."

In their report on subway pushers, Dietz and his co-author, Daniel Martell studied the years between 1975 and 1991, when 41 individuals or groups tried to push 52 straphangers onto the tracks, and sometimes succeeded.

Of the 36 offenders who acted alone, 25 of them were subsquently referred for psychiatric evaluation, as was one offender who acted in concert with a gang.

Dietz and Martell were able to get background information on 20 of the 26.

The offenders had a lot in common. They were all unemployed, mostly men, and mostly homeless. The majority had arrest records, and all of them, with one exception, had histories of inpatient psychiatric treatment, including the offender who had been hospitalized three times, starting when he was 19 and "killed his mother's dog by throwing it into an incinerator in response to hallucinations."

In all 20 cases, the victims were complete strangers.

And all but one was "psychotic at the time of the offense."

Of those 19 who were psychotic at the time of the offense, 18 "were experiencing delusions," and 13 were "actively hallucinating."

One man with "grandiose delusions" delivered "an inaudible message from God" to a pregnant transit worker before pushing her onto the tracks. Three men believed they were actually protecting the public by "pushing perceived villains onto the tracks." And one offender "heard voices that told him that he must achieve a 'victorious kill,' a vendetta against the white Europeans who took his family from Africa," an incident which echoes last week's pushing, after which the offender told investigators she was trying to target Muslims as punishment for September 11.

The offenders' behavior post-pushing "varied greatly," according to the study, but there were some recurring patterns: "fleeing the scene," " standing and watching," and "attacking responding police officers." One pusher "rummaged through his victim's duffle bag and tried on the Kentucky Fried Chicken uniform he found inside."

After the study was published in 1992, Dietz said he shared it with policy makers.

"On this topic, as with others (assassination, stalking, and mass murder, to name a few), I naively believed that careful observations that were publicly presented would lead to rational changes in policy," he told me. "I've since noticed that nothing seems to change until a high profile case leads politicians to call for whatever policy fits their political agenda."

What would he recommend policymakers do?

"The most important steps policymakers can take to reduce subway pushing are the same steps that would reduce mass murder and many other forms of violence, could reduce the burden of mental illness on society, and could ameliorate the suffering of large numbers of people: increase the odds that the seriously mentally ill take the right medication," he wrote. 

DJ Jaffe, the executive director of the Mental Illness Policy Org., has been calling for a tightening of Kendra's Law, which as Jaffe wrote in the Albany Times Union, allows "courts to require certain historically dangerous, hospitalized, or incarcerated mentally ill to stay in treatment as a condition of staying in the community."

In the meantime, Dietz said that for riders, "it pays to be alert" and "avoid confrontation with strangers."

"I suggest people comport themselves so as to avoid looking like either predator or prey," said Dietz.

Departing M.T.A. chairman Joe Lhota offered the following comment: "I encourage all of our subway customers to call 911 or use Help Points if they encounter any emotionally disturbed individuals in the system. I also encourage all customers to stand away from the edge."