1594 BRIEF COMMUNICATIONS

Management of the College Student with Homicidal Impulses-

The “Whitman Syndrome”

BY JOHN L. KUEHN, M.D., AND JOHN BURTON, M.D.

The authors discuss the management of attendance at a professional meeting of

globally hostile students who have the college health workers where discussion
means to carry out their threats through the broke down and communication was
use of firearms. Three such students and paralyzed when a participant broached the
their treatment are described. Management subject of management of homicidal
of the patients emphasized recognition, students. It is interesting that this subject
consultation, hospitalization, and use of (which seemed to mobilize mass anxiety in
drugs and brief psychotherapy. the group) was a reference to college student
Charles Whitman who, in August, 1966,
T HE FBI and the Dodd Committee have “meaninglessly” killed 15 people and
documented widespread possession and wounded 31(5).
homicidal use of firearms in the United We have now seen three cases of what we
States( 1). In our work in college psychiatric have come to call the “Whitman syndrome.”
counseling, we are becoming increasingly By this we simply mean college students
concerned about management of globally with severe global hostility who have had
hostile students who have the means to the means (usually firearms) to act out their
carry out their threats and fears through the fears and wishes with deadly efficiency.
use of firearms. The conscientious mental
health worker sees murderously angry Case Reports
people every day. That many student
The following are situation vignettes of
patients harbor feelings of intense hatred
three people who diagnostically satisfied the
projected against others (as well as
means and action steps for the assessment
introjected upon themselves) is a clinical
of homicidal risk(7). The focus of our dis-
truism which requires no further validation.
cussion will be management of these homi-
One hopes that most people can learn to
cidal students on the college campus rather
discharge potentially dangerous affect in a
than diagnosis, psychodynamics, etc.1
harmless or even constructive manner if
given opportunity and direction. Indeed, Case 1. A 24-year-old married senior stu-
teaching this is one of the essences of dent arrived in a state of panic, fearing loss
psychotherapy. of control of hostility directed toward “the
world.” The previous day he had observed
Unfortunately, many students still harbor
children torturing a cat and feared he would
these feelings; the management of such
kill the children. He gave a long history of
potentially dangerous individuals is the chronic pan anxiety, gradual school failure,
subject of this paper. Our need to report the and increasing use of alcohol. He had been
cases described below was prompted by seen several times by another psychiatrist and
had been diagnosed as “possible schizophrenic
reaction, paranoid type.”
Read at the 124th annual meeting of the
American Psychiatric Association, Boston, Mass.,
As soon as we received this information
May 13-17, 1968. from the patient, we entered into an active,
Dr. Kuehn is clinical director for counseling and
mental health services, student hospital, and
assistant professor of psychiatry and associate 1 We have begun a homicidal college student
professor of psychology at Louisiana State registry; since the submission of the first draft of
University, Baton Rouge, La. 70803. Dr. Burton is this paper, two more individuals have been seen
director, the Monroe Mental Health Center, and treated. A future report will detail our
Monroe, La. experiences during follow-up studies.

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BRIEF COMMUNICATIONS 1595

detailed search of his present life situation. Case 3. A 24-year-old single part-time
Particular attention was paid to resources student came to the counseling service in a
presently available for him to carry out his distraught state, fearful he would murder a
threats. The means and actions investigation professor who he felt was about to flunk him.
steps were emphatically satisfied by uncovering Because of his huge size and the fear of the
the fact that he was an expert marksman whose staff member assigned, he was initially seen in
initialmotivation to come to the university was a conjoint interview. (The patient weighed 300
to be on the rifleteam! Guns had been a life- pounds and was six feet tall; it was easy to see
long hobby with him, and he slept with a [and feel] how the mental health counselor
loaded revolver under his pillow. had become frightened.)
He conveyed intense resentment of all For a week the student had been having
authority figures. Once a boss had criticized frightening dreams of choking the teacher, but
him, and the next morning he had brought a this was only the latest incident in a long
loaded gun to work with the intention of history of delusions of persecution and
murdering the boss if he “pushes me any fantasies of murdering his many persecutors. It
more.” He had frequently entertained fantasies was of interest that the professor, a mild
of climbing to the top of the university’s mannered gentleman who knew the student
carillon and shooting people “just for the hell only casually, had recently been concerned
of it.” about him and, rather than planning to flunk
him, had decided to offer a make-up exam and
Case 2. A 21-year-old single freshman was referral for tutoring.
encouraged to come for psychiatric counseling The patient reported that he was obsessed
by a friend because he had repeatedly said, “I with hate for all people, particularly those in
can’t stand people and am pissed off at the authority (teachers, bosses). He stated that
world.” In particular, he was enraged at a although he had not acted on his impulses
professor and said that he had an almost before, “I am big enough and strong enough to
uncontrollable urge to “smash him in the kill anybody if I wanted.” He was familiar
mouth.” Shortly before coming to the clinic he with, and had access to, firearms. He was
had been arrested for a traffic violation and on his way to the professor’s office when he
remembered feeling an intense desire to “get “happened” to pass the student health center,
my gun and fill that cop’s ass with bullets.” and remembering that he had read in the
He presented himself in a neat and quiet college newspaper that psychiatric counseling
manner, and, due to his severe tension state, was available, he decided to come in and
with an intense need to overcontrol the inform us of his plan.
interview. He finally mentioned that he had
fantasies of being a “Texas sniper” and, in this
Management
way, “getting even with the world.” Inquiry
revealed that, prior to coming to college, he These individuals, all seen within a short
had been an excellent marksman during his
period of time on one campus (full-time
three years in the Marine Corps. He had no
student population 16,000), reinforce our
guns in his possession at school, but there was
impression that there are numerous severely
a large collection at his parents’ home a few
miles away. On further reflection he said that disturbed and potentially dangerous people
this was probably a good place for the in a large university setting.
guns-an idea we enthusiastically supported. The three students: 1) were paranoid, 2)
Although he was extremely bitter and were globally hostile, 3) were “psychotic”
resentful, his reality testing was considered to in the sense that they were in the process of
be somewhat better than that in the first case losing their controls, and 4) had the means
report. Later in the course of brief to act on their impulses.
psychotherapy he mentioned
several somewhat
It is not a purpose of this paper to discuss
more socially acceptable alternatives if he
or speculate on the complex etiology and
were to flunk out of school (a distinct
possibility)-to become a lighthouse keeper, a dynamics of these situations. That is better
“schizophrenic” (!), or a policeman-”! would left to Dr. John Spiegel and his team of
enjoy giving out tickets and roughing up investigators at Brandeis University and to
people.” He mentioned that he knew a great others. However, from a purely “medical”
deal about schizophrenia because he had been point of view, it is sufficient to point out that
an avid devotee of the television program “The there are now some 19 million mentally ill
Eleventh Hour.” Americans( 3); 50 out of each 10,000

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college students will exhibit grossly dis- confronted with such a situation then has
turbed behavior(2); and there is a initial reponsibility to take whatever action
“population explosion” on campuses that is necessary to safeguard the patient and the
indicates that the “cloistered halls of ivy” environment.
are no longer any more immune to these We feel that the next step should be
phenomena than are any other heteroge- immediate consultation and conjoint inter-
neous and crowded communities drawing view with a member of the college mental
from all walks of life. health clinic senior staff, the university
The question of management in these physician, the dean of students, or, if
cases raises many issues. Satisfactory necessary, even the president of the college.
resolution often involves considerable time After giving initial strong unambiguous
and thought. For purposes of organizing our verbal reassurance to the student, it may be
efforts, we have divided management into critical that the student be “helped” to walk
1) recognition, 2) consultation, 3) hospital- to the office of the “consultant” or that the
ization, and 4) other treatment (drugs and “consultant” interrupt his activities to come
psychotherapy). to the clinic’s offices. Matters of protocol
1. Recognition. We feel that if one takes should be of little concern during such
an adequate history there should be little emergencies.
problem in recognition. This, of course, Our experience has been that these
requires somewhat more activity on the part students were immediately relieved, feeling
of the interviewer than some college mental that somebody really cared about them and
health professionals are accustomed to was interested enough to do something
utilizing during the initial interview with a about their fears. To avoid problems of
student. This means being “directive” and confidentiality, necessary phone calls should
“intrusive” rather than “nondirective” and be made with the student present. We would
“unobtrusive.” In our experience this is not emphasize that “secrecy” here is antithera-
a small point, since some mental health peutic and often only increases the student’s
workers, in an overconscientious effort to be paranoid fears-particularly fears that
“good listeners,” fail to ask crucial police will be called and he will be
questions during the time allotted in their immediately incarcerated, or fears that he
busy schedules for one interview. One really is a terribly dangerous person who
should push for a precise history with regard cannot control his murderous impulses.
to the presence of: a) intense hostile These transactions should of course be
thoughts, b) the capacity to carry out fears handled with calmness and unhurried
and threats, and c) presence of preliminary equanimity.
actions that would lead to the carrying out We feel the conjoint interview format has
of such threats. the therapeutic advantage of including the
In the three cases discussed, two of the patient in deliberations as to how best to be
individuals were excellent marksmen who helpful to him. This not only further
had immediate access to guns and increases his sense of having controls but
ammunition, and a third had overwhelming also his sense of responsibility for his
physical strength at his disposal and was behavior, no matter how motivated.
familiar with guns. We feel that the presence The important point is that responsibility
of at least “thought” and “capacity” for management of these patients should be
represents a de facto psychiatric emergency shared. This alleviates both individual staff
that calls for the next step-immediate anxiety and the patient’s anxiety. Even
“consultation.” though a physician is initially present (and
2. Consultation. These student patients may feel that he has the situation under
will ordinarily precipitate intense staff control), we nevertheless feel that a third
anxiety. It is axiomatic that the well-trained
health professionals on campus. Of 2,252 college
mental health worker will have learned to campuses in this country, only 76 provide
recognize his own anxiety.2 Whoever is counseling by professional mental health personnel
in campus clinics. It is estimated that there are no
more than 75 full-time psychiatrists working in
2 Unfortunately, many colleges have no mental colleges in the United States(6).
[ISO] Amer. J. Psychiat. 125: 11, May 1969
BRIEF COMMUNICATIONS 1597

party should be brought in. (We are also for some discussion-but still with a
aware that some physicians and other movement in “all deliberate speed” to get
workers mobilize unconscious counter- them to bed.
phobic mechanisms which may prove We try to increase the intellectualization
ultimately destructive.) defenses of these students at a time when
3. Hospitalization. The next step in their world is collapsing about them. An
management that we feel is mandatory is example of this would be explaining that
some kind of hospitalization. There is often hospitalization-on a voluntary basis and
considerable resistance to this recommenda- involving their cooperation and collabora-
tion on the patient’s part because of his tion-is as necessary as if they had acute
paranoid fears. Patients frequently verbalize appendicitis. We also give a very strong
the concern that we will ship them off to the suggestion that they will probably improve
nearest state hospital and lock them as quickly as they got “sick”-without the
up-probably on a “back ward.” There necessity of a hospital stay of more than a
is some truth in these statements; college few days. During these initial contacts, we
students as a group are well aware that such also begin discussion of the need for further
things are possible and even probable in individual outpatient psychotherapy. It is
some settings. It has been our experience the therapist’s responsibility to maintain a
that at this point hospitalization in the firm and coherent structure for the patient
general medical setting is to be preferred at all times. He should indeed serve as an
and is usually carried out easily. The “auxiliary ego.”
“typical” college health service with Our students were relieved to find that
inpatient facilities is well suited for this their antisocial ideas would not lead to their
because of the ease of admission proce- being immediately placed in a state hospital
dures, informality and lack of red tape, and closed ward. Of the students described, two
geographic proximity to the psychiatric agreed to hospitalization; however, one did
counseling center. The responsible profes- not. This brings us to the highly charged
sional in college mental health work usually issue of responsibility to a patient vis-#{224}-vis
does not have to “check” with someone or the community. In this case we felt there
arrange further evaluation with a fourth was no basic conflict, since the needs of the
party, as is often necessary in the larger community and the needs of the patient
hospital or university medical center or in coincided. However, we did not feel it was a
state psychiatric facilities. medical responsibility to require involuntary
As a corollary to the above, we feel hospitalization when one of our patients
strongly that every college (even if affiliated refused hospitalization after a long conjoint
with a medical school in the same locality) interview (he did agree to take medicine,
should have assigned or available beds that and one of the staff members immediately
can be utilized quickly without further need gave him an oral dose of 100 mg. of
to justify their use to hospital authorities chlorpromazine).
(departments of psychiatry, etc.). In As a corollary to the above, we do not
particular, when one is working with believe mental health professionals are in a
homicidal people, time and timing are of position to predict, with far greater accuracy
critical importance. than others (parents, teachers, police,
The three students described were in a coroners, and juries), who will attack
severe state of crisis. They were extremely somebody in the future-at least not to the
frightened, not only of what they might do to extent of recommending involuntary con-
others, but of what might happen to them as finement(4). It was of interest that in the
a result of their divulging their fears to us. situation cited above, the college dean’s first
In all cases they were ambivalent about comment was: “Yep, I know him-he is
further treatment-particularly about hos- going to kill somebody someday!”
pitalization. In the initial interview this The procedure we follow, then, when
ambivalence was interpreted for them; such a patient refuses hospitalization, is to
strong was given
reinforcement to the consult with the appropriate dean for
positive side of their ambivalence, allowing student affairs. In addition, in our university
Amer. J. Psychiat. 125: 11, May 1969 [151]
1598 BRIEF COMMUNICATIONS

we have a “mental health advisory council” severe problem in management, provided

in which the deans participate. This seems the follow-up treatment is consistent and
to be an extremely useful task group for adequate. “Psychotherapy,” of course, has
dealing with the administrative complexities already started, but the student, while in the
of such issues. We have achieved agreement hospital, is then seen at least once a day for
that in our setting involuntary hospitaliza- a 30-minute interview. Because of a lack of
tion is not a medical responsibility. This psychiatrists and other college physicians,
does not, however, divest the mental health we do not feel that this aspect of the
worker of the responsibility to advise program need necessarily be in the hands of
university officials of the presence of a a physician. (However, it should be the
“possibly dangerous” situation and to person who initially worked with the
convey in.formation about human behavior student.)
that would further educate the authorities In addition to hospitalization and
and facilitate problem solving for all emergency psychotherapy, use of a major
involved. tranquilizer such as thioridazine, with or
We have found (largely because of these without trifluoperazine, may be given
prior discussions and developing comfort in immediately after admission. Because of
communication) that no difficulty arose frequent fear of needles (with their dynamic
when the appropriate college administrator significance), we do not make an issue of
took charge. For the student who did not the patients having to have a “shot,” and
agree to hospitalization, a temporary medication is given by mouth. We
referral order was obtained from the county recommend an initial dosage of 100 mg. of
coroner on a complaint by the college thiondazine and 5 mg. of trifluoperazine,
operating in loco parentis. repeated every eight to 12 hours. We have
In these situations every effort is made to found that a daily dose of one to two mg. of
contact parents or close relatives. However, benztropine mesylate is of prophylactic use
in our experience in these three cases, this for the drug-induced parkinsonism and
contact was not helpful. (Possibly this was dystonia that are frequent with trifluopera-
part of the patients’ problems.) In the case zine at these doses in young adults attending
cited above, the student was held for two college. Medication may also be given in the
days but was released when the parents were liquid concentrate form.
unwilling and unable to sign the regular It may be necessary for the therapist to sit
referral order. Although we had a long with the patient until the medication takes
telephone discussion with his mother, who effect; sometimes we have personally
promised to take her son to a private “helped” the patient into bed. Incidentally,
psychiatrist in another city, we are our clinical experience is that a great deal of
realistically aware that this student has useful psychotherapeutic work is done
possibly not reached more definite treat- during this hour when the patient is in bed
ment. Such risks must be taken in a free and “safe.” Dephenhydramine hydrochlo-
society. We would again emphasize that ride (Benadryl), 50 mg., may also be given
decisions concerning involuntary hospital- if the patient is unable to sleep at night.
ization should be administrative rather than In our university, as in many, psychiatric
medical. counseling often takes a crisis-centered ap-
The patient was informed of what we felt proach in which the patient is seen frequently
we had to do. He politely disagreed with us for the first several weeks, with sessions
(at this point), thanked us most courteously gradually tapering off. If long-term psycho-
for our help, and then returned to his therapy is considered crucial and is available
lodgings-making sure we had his correct (it often isn’t), the patient is prepared to
address! From another student we later “be a psychotherapy patient.”
learned that the patient felt we had treated Psychotherapy tactics include careful and
him honestly and that his two days in jail intense focusing on the “here-and-now”-the
had actually been “very interesting.” past explored only as it has practical
4. Other Treatment. Those patients who relevance to problem solving in the present.
accept voluntary hospitalization pose no After the initial relationship is established,

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BRIEF COMMUNICATIONS 1599

because of the dependency problem wean- note if he had been coming regularly and
ing is encouraged. A great deal of time staff anxiety is minimal. Another goal of
is usually spent on discussion of alternatives brief therapy is to prepare the students for
to the student’s present college program and group work. In our clinic, as in many college
his vocational identity. clinics, this is the one modality of
After the first few days of hospitalization, psychotherapeutic learning experience that
the students described improved in terms of can be offered to the student over a
an increase in optimism, a decrease in considerable period of time.
anxiety, reinstitution of pre-psychotic de-
fenses (or more useful ones than in the REFERENCES
past), and development of an ability to
consider alternatives to their present mode 1. Committee on the Judiciary, United States
of existence. We continue to see the patients Senate, Eighty-Eighth Congress: Part 15:
twice weekly after discharge from the Interstate Traffic in Mail-Order Firearms,
Hearings before the Subcommittee to Investi-
hospital.
gate Juvenile Delinquency, 1964.
Possibly our most important goal during
2. Farnsworth, D. L.: Psychiatry, Education and
these encounters is the development of a the Young Adult. Springfield, Ill.: Charles C
feeling in the patient that there is some place Thomas, 1966, p. 6.
to go for help. If nothing else, in terms of 3. Joint Commission on Mental Illness and
future impulse control, it is important that Health: Action for Mental Health. New York:
Basic Books, 1961, pp. 86-192.
the patient come away with the feeling that
4. Katz, J., Goldstein, J., and Dershkowitz, A.:
his “cry for help” has been heard. We spend
Psychoanalysis, Psychiatry and Law. New
considerable time directing “where to go York: The Free Press (Macmillan Co.), 1961,
and who to see” if their fears recur. As a pp. 590-598.
matter of routine, we usually continue to see 5. The Madman in the Tower, Time Magazine,
patients with “Whitman’s syndrome” for at August 12, 1966, pp. 14-19.
least six weeks after the initial contact. 6. Shepherd, J.: Why College Students Crack
Up, Look Magazine, June 13, 1967, pp. 23-
If the student misses an appointment, an
25.
effort is made to contact him to find out
7. Solomon, P.: The Burden of Responsibility in
what happened-by telephone if staff Suicide and Homicide, J.A.M.A. 199:321-324,
anxiety is high, and by a “we missed you” 1967.

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