On the night of June 17, 1998, a Cornell campus police officer named Ellen Brewer had just begun her shift when she noticed a tall, silhouetted figure moving slowly across the engineering quad. The man appeared to be dressed all in black. Brewer felt a whisper of danger. She slowed her car, and the shrouded figure began loping toward her. He raised a hand and hailed her as if she were a taxi driver. As he drew closer, she thought he must have been the victim of an assault, perhaps in need of medical assistance.

Suddenly, as if in a single stride, the man was at her window. He lowered his face, shiny with sweat, close to hers. He was muttering incoherently; his rust-colored beard and hair were wildly matted. He seemed to be saying that he might have killed someone, his girlfriend or perhaps a windup doll. Brewer radioed in the strange encounter, requested backup, and got out of her car.

She thought again that the disoriented man, whose clothes were bloody, had been attacked or maybe had fallen into one of the steep gorges that famously intersect the campus, but when she tried to steer him out of the road, he leaped back, a large hand clenched into a fist.

The police station was all of 100 yards away, on Campus Road, and officers were already coming toward them, some on foot, others in cars. They escorted the man, whose name was Michael Laudor, to Barton Hall, the looming stone fortress that the campus police shared with the athletics department.

Once inside, Michael didn’t need much prodding to answer questions, but whenever he mentioned possibly harming his girlfriend, whom he sometimes referred to as his fiancée, he added, “or a windup doll.”

When Sergeant Philip Mospan, the officer in charge that night, asked Michael if he was hurt, he received a simple no. In that case, “where did the blood all over your person come from?” Michael told him it was Caroline’s blood.

“Who is Caroline?” the sergeant asked.

“She’s my girlfriend,” Michael said. “I hurt her. I think I killed her.”

Was Michael sure about that?

He thought so, but asked, “Can we check on her?”

His concern seemed urgent and genuine, though puzzlingly he said this had happened in Hastings-on-Hudson, New York, 220 miles away.

Mospan prefaced his request to the Hastings-on-Hudson dispatcher by saying, “This may sound off the wall …” Because who kills someone in Westchester County, drives to Binghamton, and takes a bus to Ithaca, as Michael said he had done, only to surrender to campus police? The dispatcher asked him to wait a moment, and then a detective came on the line. “Hold him!” the detective said. “He did just what he said he did.” They had people at the apartment. The woman was dead, the scene ghastly.

And so it was that my best friend from childhood, who had grown up on the same street as me; gone to the same sleepaway camp, the same schools, the same college; competed for the same prizes and dreamed the same dream of becoming a writer, was arrested for murdering the person he loved most in the world.

When police officers from Hastings-on-Hudson showed up the next morning to bring Michael back there, they were surprised to find reporters, photographers, and TV cameras waiting outside the Ithaca jail. Jeanine Pirro, then the Westchester district attorney, who charged Michael with second-degree murder, would call him “the most famous schizophrenic in America,” a perverse designation, though strangely in tune with the aura of specialness that had characterized so much of his life, and that had shaped the expectations we’d grown up with. Michael was famous for brilliance. He’d gone to Yale Law School after developing schizophrenia, and was called a genius in The New York Times, which led to book and movie deals. Brad Pitt was attached to star.

Michael’s friends and family and his supporters at Yale had thought intelligence could save him, allow him to transcend the terrible disease that was causing his mind to detach from reality. Michael was arrested on a campus where he’d spent six happy weeks at an elite program for high-school kids in the summer of 1980, when we were 16. I sometimes wondered if he was trying to get back to a time when his mind was his friend and not his enemy, but a forensic psychiatrist who examined Michael for the prosecution set me straight: Michael thought his fiancée was a “nonhuman impostor” bent on his torture and death, and in his terrified delusional state, he had fled hours to Cornell hoping to evade destruction and call the police. In other words, he was seeking asylum.

Asylum was also what Michael needed in the months before he killed Carrie. Not “an asylum” in the defunct manner of the vast compounds whose ruins still dot the American landscape like collapsing Scottish castles, but a respite from tormenting delusions—that his fiancée was an alien, that his medication was poison. Because he was very sick but did not always know it, Michael had refused the psychiatric care that his family and friends desperately wanted for him but could not require him to get.

Thomas Insel: What American mental-health care is missing

Michael needed a version of what New York City Mayor Eric Adams called for in November, when announcing an initiative to assess homeless individuals so incapacitated by severe mental illness that they cannot recognize their own impairment or meet basic survival needs—even if that means bringing them to a hospital for evaluation against their will. “For too long,” Adams proclaimed, “there’s been a gray area where policy, law, and accountability have not been clear, and this has allowed people in need to slip through the cracks. This culture of uncertainty has led to untold suffering and deep frustration. It cannot continue.”

Though 89 percent of recently surveyed New York City residents favored “making it easier to admit those who are dangerous to the public, or themselves, to mental-health facilities,” attacks on the mayor’s modest adjustments to city policy began immediately. News stories suggested that a great roundup of mentally ill homeless people was in the offing. “Just because someone smells, because they haven’t had a shower for weeks,” Norman Siegel, a former head of the New York Civil Liberties Union, told the Times, “because they’re mumbling, because their clothes are disheveled, that doesn’t mean they’re a danger to themselves or others.”

Never mind that these were not the criteria outlined in the Adams plan. Paul Appelbaum, the director of the Division of Law, Ethics, and Psychiatry at Columbia, says that the government has an interest in protecting people who are unable to meet their basic needs, and that he believes the mayor’s proposal has been largely misunderstood. “There’s an intrinsic humanitarian imperative not to stand by idly while these people waste away,” Appelbaum recently told Psychiatric News.

The people Adams is trying to help have been failed by the same legal and psychiatric systems that failed Michael. They all came of age amid the wreckage of deinstitutionalization, a movement born out of a belief in the 1950s and ’60s that new medication along with outpatient care could empty the sprawling state hospitals. Built in the 19th century to provide asylum and “moral care” to people chained in basements or abandoned to life on the streets, these monuments of civic pride had deteriorated over time, becoming overcrowded and understaffed “snake pits,” where patients were neglected and sometimes abused. Walter Freeman, notorious for the ice-pick lobotomy (which is exactly what it sounds like), was so horrified by the naked patients crammed into state hospitals, shockingly featured in a famous 1946 Life article, that he developed a new slogan: “Lobotomy gets them home.”

Read: The truth about deinstitutionalization

But getting people home was never going to be a one-step process. This would have been true even if the first antipsychotic medications, developed in the ’50s, had proved to be a pharmaceutical panacea. And it would have been true even if the neighborhood mental-health clinics that psychiatrists had promised could replace state hospitals had been adequately funded. During the revolutions of the ’60s, institutions were easier to tear down than to reform, and the idea of asylum for the most afflicted got lost along with the idea that severe psychiatric disorders are biological conditions requiring medical care. For many psychiatrists of the era, mental illness was caused by environmental disturbances that could be repaired by treating society itself as the patient.

The questions that should have been asked in the ’60s, and that might have saved Michael and Carrie, are relevant to Mayor Adams’s policies now: Will there be follow-up care, protocols for complying with treatment, housing options with supportive services and a way to fund them? Will there be psychiatrists and hospital beds for those who need them? But it would be ironic if all of the past failures at the federal, state, and local levels became an argument against making a first small step toward repair.

If I had known Michael only as he appeared grimly on the front pages of the tabloids 25 years ago, or Caroline Costello as half of a smiling picture all the more tragic for being so full of innocence and hope, I would not have understood how much is at stake in the current efforts to improve the care given to people with severe mental illness. Neither Adams’s policies—nor the more comprehensive measures advanced by Governor Gavin Newsom, in California—will bring about a sweeping transformation; only incremental changes, and many accompanying efforts at all levels of government, will make a difference. And these will not be possible without a shift in the way people think about the problem.

Now when I think about the frenzied moments before Michael killed Carrie, when violence was imminent and intervention was necessary but impossible, I understand that it isn’t on the brink of crisis but earlier that something can be done—though only by a culture that is capable of making difficult choices and devoting the resources to implement them.

But I knew Michael before he thought Nazis were gunning for him. I knew him before the lurid headlines, the Hollywood deal, the publishing contract, and the New York Times profile that proclaimed him a genius. I knew him as a 10-year-old boy, when I was also 10 and he was my best friend.

The Cuckoo’s Nest

I met Michael as I was examining a heap of junk that the previous owners of the house we had just moved into in New Rochelle had left in a neat pile at the edge of our lawn. It was 1973. A boy with shaggy red-brown hair and large, tinted aviator glasses walked over to welcome me to the neighborhood. He was tall and gawky but with a lilting stride that was oddly purposeful for a kid our age, as if he actually had someplace to go.

His habit of launching himself up and forward with every step, gathering height to achieve distance, was so distinctive that it earned him the nickname “Toes.” He was also called “Big,” which is less imaginative than “Toes,” but how many kids get two nicknames? And Michael was big. Not big like our classmate Hal, who appeared to be attending fifth grade on the GI Bill, but big through some subtle combination of height, intelligence, posture, and willpower.

Even standing still, he would rock forward and rise up on the balls of his feet, trying to meet his growth spurt halfway. He stood beside me on Mereland Road in that unsteady but self‑assured posture, rising and falling like a wave. He was socially effective in the same way he was good at basketball—through uncowed persistence. I often heard in later years that people found him intimidating, but for me it was the opposite. Despite my shyness—or because of it—Michael’s self‑confidence put me at ease. I fed off his belief in himself.

Was Michael bouncing a basketball the day I met him? He often had one with him, the way you might take a dog out for a walk. I’d hear the ball halfway down the block, knocking before he knocked.

Even today, when I hear the taut report of a basketball on an empty street, the muffled echo thrown back a split second later like the after-pulse of a heartbeat, I have a visceral memory of Michael coming to fetch me for one‑on‑one or H‑O‑R‑S‑E, or simply to shoot around if we were too deep in conversation for a game or if I was tired of losing.

Michael might just as easily have had a book the day he introduced himself. He often had several tucked under one arm, and he would dump them unceremoniously at the base of the schoolyard basketball hoop. It was always an eclectic pile: Ray Bradbury, Hermann Hesse, Zane Grey Westerns, books his father assigned him—To Kill a Mockingbird or a prose translation of Beowulf—stirred in with the Dune trilogy and Doc Savage adventures.

Our fathers were both college professors, but Michael’s father, who taught economics, sported a leather bomber jacket and spoke in a booming Brooklyn manner. My father, who taught German literature, wore tweed jackets from Brooks Brothers, spoke with a soft Viennese accent, and named me and my sister for his parents, who had been murdered by the Nazis.

Michael had all four grandparents, something I’d seen only in Charlie and the Chocolate Factory. They did not all sleep in one bed, like Charlie’s grandparents, but he saw a lot of them. His Russian-born grandparents still lived in Brighton Beach, Brooklyn, where his father had grown up and his grandmother Frieda had stuffed money into a hole in the bathroom wall until a plumber came and stole it one day. Michael recounted stories about “crazy” Frieda with such amused affection that it was a shock when he told me, years later, that she had schizophrenia.

Every weekday morning during the school year, I’d walk to the bottom of our one‑block street, ring Michael’s bell, and wait for him to step groggily out from the household chaos. We’d hike up the hidden steps behind his house that led to the basketball court, climb a second flight of outdoor stairs, and slip into the school through a side door that felt like a private entrance.

Thanks to Michael, I became a big fan of Doc Savage, originally published in pulp-fiction magazines in the 1930s but reissued as cheap paperbacks starting in the ’60s. We joked about the archaic language and dated futurisms—long‑distance phone calls!—but Doc Savage, charged with righteous adrenaline, formed an important part of the archive of manly virtues that I received secondhand from Michael, who got them wholesale from his father, his grandfathers, old movies, and assorted dime novels.

Like Doc Savage, Michael had a photographic memory. He also read at breakneck speed. I was a fast talker but a slow reader; Michael burned through the assigned reading with such robotic swiftness that he was allowed to read whatever he wanted to, even during regular class time.

He kept stacks of paperbacks on his desk at school, working his way through fresh piles every day. He didn’t just read the books; he read them all at the same time, like Bobby Fischer playing chess with multiple opponents. After a few chapters of one, he’d reach for another and read for a while before grabbing a third without losing focus, as if they all contained pieces of a single, connected story.

I was a direct beneficiary of all that reading. He seemed to have almost as much of a compulsion to tell me about the books as he did to read them, and I acquired a phantom bookshelf entirely populated by twice-told tales I heard while we were shooting baskets, going for pizza, or walking around the neighborhood.

Michael’s precocity made him seem like someone who had lived a full life span already and was just slumming it in childhood, or living backwards like Benjamin Button or Merlyn. My parents were amused by the speed with which he took to calling them Bob and Norma, and the ease with which he held forth on politics while I waited for him to finish so we could play Mille Bornes or go outside. I knew that the president was a crook—but Michael knew who Liddy, Haldeman, and Ehrlichman were and what they had done, matters he expounded as if Deep Throat had whispered to him personally in the schoolyard.

Michael also saw more R-rated movies than I did. In 1976, One Flew Over the Cuckoo’s Nest, which was about a sane wiseass named Randle McMurphy locked in a mental hospital by a crazy culture, won the Academy Award for Best Picture. Michael explained that the hospital tries drugging McMurphy into submission and shocking his brain until his body writhes, then finishes him off with a lobotomy, all because he won’t behave.

I’d never heard of a lobotomy, but Michael assured me it was real; they stuck an ice pick in your head and wiggled it until you went slack like a pithed frog, docile enough to be dissected alive. This was a far cry from the “delicate brain operation” that Doc Savage performed on criminals to make them good so they would not have to rot in prison.

The lobotomy in Cuckoo’s Nest reduces McMurphy to zombie helplessness. His friend Chief Bromden smothers him to death with a pillow and escapes out a window so the other inmates will still have a hero to believe in. Like a lot of things in the ’70s, the movie sent a mixed message, exposing the abuses of psychiatric hospitals while justifying the killing of a mentally impaired person.

The summer before college, I found myself filled with optimism. I’d always been the tortoise to Michael’s hare, but we both got into Yale, and for the ninth year in a row we would be going to the same school. I was surprised when Michael told me one afternoon, as we lounged on my parents’ patio, that he did not think we would see much of each other at Yale. When I asked him why, he told me that I was simply too slow.

We did see less of each other in college, but when I’d run into Michael on Metro-North, heading home for vacation, we’d talk in the old way, nonstop until New Rochelle.

Impatient as always, Michael decided to graduate in three years. He also informed me that he had decided to become rich, as if that were something you could declare like a major. He had been recruited by a Boston-based management consulting firm called Bain & Company, a place, he explained, where the supersmart became the superrich.

He was ironic about his choice to join the ranks of the young, upwardly mobile philistines the media had taken to calling yuppies, but wanted me to know that he was not abandoning intellectual or artistic aspirations: His plan was to spend a decade making gold bricks for Pharaoh, after which he would buy his freedom and become a writer.

I lost track of Michael during his time at Bain, though once or twice I’d hear my name on Mereland Road while home for a visit. Turning, I’d see him loping up the hill, grinning as if we were still fifth graders and his fancy trench coat was a costume.

But I learned later that he was having a rough time. The pressure at Bain was constant. Michael began complaining that his heart raced, his digestion was bad, and Machiavellian higher‑ups were “out to get him” but would never let him go because of his value to the firm, which seemed unlikely even for a place known as “the KGB of the consulting world.” He quit Bain in 1985 and began writing in earnest—the 10-year plan had become a one-year plan. Even after he quit, Michael thought his phone was being tapped and Bainies were spying on him.

Still, his life sounded like the fulfillment of a dream. He was living in the attic of a grand house with a private beach at the south end of New Rochelle owned by the parents of a friend. The mansion might have drifted north and west from the gilded north shore of Long Island. Michael called it “the Gatsby House” and claimed that he could see a green light glinting far out on the water as he stayed up late, writing stories and staring into the night. He wanted to be Fitzgerald and Gatsby both, the drea