by E. Fuller Torrey, M.D.
In a recent article in Psychiatric Services, Michael Allen, J.D., of the Bazelon Center for Mental Health Law, claimed that Andrew Goldstein and Russell Weston were "actively seeking treatment and services, and each was repeatedly turned away." (52 Psychiatric Services 342,343 (2001)) Mr. Allen is either seriously misinformed or consciously misrepresenting the facts.
Bazelon's assertion that Russell Weston, who shot and killed two Capitol Hill police officers, was actively seeking treatment is absurd. A videotape of Weston's competency evaluation for trial by a forensic psychiatrist reveals just how seriously delusional he is. He calmly explains that the primary significance of his trial is to provide a forum to expose the conspiracy of murder and cannibalism in this country. When asked if he is aware of the possibility that the death penalty could be imposed in his case, he answers affirmatively. As soon as the death penalty is carried out, Weston explains, he will end up in the Great Safe of the U.S. Senate where the ruby satellite control is hidden. That is what he was after the day he shot and killed Officers Chestnut and Gibson. Weston believes that the ruby satellite's time reversal system will "sweep him away" to a time when he is not deceased. But when asked if he has a mental illness, he adamantly denies it. For that reason, he rejects the possibility of asserting an insanity defense, even in the face of a possible death penalty.
Why would someone who goes to such lengths to deny that he has a mental illness seek treatment and services? The truth is, there is no evidence that he sought treatment for his mental illness, but rather that he consistently refused treatment. The Washington Post reported that Weston showed up at St. Peter's Community Hospital in Helena, complaining that a man in a field had pointed a gun at him and that a dentist had implanted a chip in his tooth that allowed communication with the Russian ambassador. He declined medication and follow-up treatment. On another occasion he went to an emergency room and threatened a lab worker he believed had injected him with a needle contaminated with feces and Rohypnol. That time he was involuntarily admitted to a state psychiatric hospital in Montana. Again he refused medication, but doctors administered medication over his objection. He responded to treatment and subsequently continued to take it voluntarily while in the hospital.
The Washington Post also reported that after Weston was discharged from the hospital, he appeared for a follow-up appointment at a clinic near his parents' home in Illinois. He was obviously delusional, and it appeared he was not taking his medication. He told clinic workers that a judge had ordered him to attend the clinic. When clinic staff told him that follow-up treatment had not been court ordered, he immediately left and never returned.
Contrary to Bazelon's fiction, Russell Weston's case is the paradigm for assisted treatment. He has no insight into his illness. Not only did he not seek treatment and services, he refused them unless he thought they were court ordered. But, when he was treated, he responded.
Portraying Andrew Goldstein as a person who begged for services and was refused is no closer to the truth. In 1998 alone, the State of New York and the federal government expended $95,075 for his mental health and residential care. The New York State Commission on Quality of Care for the Mentally Disabled and the Mental Hygiene Review Board investigated and issued a report on the history of services and treatment for Andrew Goldstein (pseudonym David Dix). (A copy of the report can be found at http://www.cqcapd.state.ny.us/publications/dix.htm).
The Commission reported that in the two years prior to pushing Kendra Webdale to her death in front of a New York City subway train, Goldstein received 199 days of inpatient and emergency room services, on 15 different occasions, in six different hospitals from1997 to 1999. Four different clinics provided outpatient services in this time period.
This is hardly the profile of a patient who was refused services. In fact, it was Goldstein who often refused services. He consistently stopped taking his medication after discharge from a hospital unless he was closely monitored. When he wasn't taking medication, he exhibited hallucinations, delusions, and unprovoked acts of aggression. On some occasions, when his untreated symptoms deteriorated to the point where he suffered anxiety, insomnia, or other unpleasant conditions, he went to an emergency room seeking relief. Other times, he was brought to the emergency room following a violent outburst.
For a period of approximately four years, while living in supervised residential programs, Goldstein remained medication-compliant and participated in treatment. He chose to leave the program to live on his own. Shortly after leaving, he was picked up by police after he acted aggressively in a supermarket. He returned to the supervised residence but, within months, chose to leave again. Subsequently, he refused placements offered to him in supervised residences, even though it was obvious to hospital social workers and Goldstein's mother that he needed structure, support, and medication monitoring to stay well.
Instead, the two years prior to Kendra Webdale's death were characterized by repeated emergency room visits, medication noncompliance after discharge, and at least eight incidents of unprovoked violence against others. Whenever he requested services, he either changed his mind before arrangements could be made or failed to follow through. On two occasions when he was willing to accept placement in a supervised residence, the system did not respond quickly enough before he changed his mind and opted to be discharged to his apartment instead. At no point during this time did he appear to take his medication regularly.
There is no question that the system failed Andrew Goldstein and consequently Kendra Webdale. Since New York State had no assisted treatment law at that time, there was little that could be done for someone like Mr. Goldstein who failed to stay in treatment, opted to live independently, refused services, and was medication noncomplaint. That is, until Kendra's Law was passed.
It is ironic that the Bazelon Center cites these two men as archetypes for their arguments against assisted treatment. In fact, these two men are excellent examples of why assisted treatment is necessary. Andrew Goldstein and Russell Weston had long histories of medication noncompliance, refused needed services, and had documented aggressive histories. When required to do so, both took medication and responded well. But, when they were left to their own devices, the course of their untreated illness led to violence that ravaged many lives, including their own. Goldstein and Weston strongly make the case for assisted treatment.