Distinguishing the killers among us

When I was in high school, one of my friends told me he intended to kill another one of my friends. It was a different day and age back then, and with more than 4,000 students, my high school was rather large and impersonal – it was easy to get lost in the crowd.

"Juan" (not his real name) confided in me that he wanted to kill "Joe" (also not his real name), which I found a bit odd. Joe was well liked but not did really stand out. Juan was perhaps quieter and more studious, but he also did not stand out. Both boys had friends, did well in school, and were not obviously troubled. When I asked Juan why he wanted to kill Joe, he responded, "Because he’s the all-American boy."

I worried about this. I told my mother, and I told a teacher I trusted. No one knew what to do, and Juan’s plan did not sound feasible. He was going to bring a knife to school in a folder, and when Joe was walking in a crowded hallway, Juan would walk behind him and thrust out the folder to sent the knife flying. The physics of this just didn’t make sense to me, and I didn’t see how the knife would gain enough momentum to travel very far, much less penetrate a person through their clothes. Feasible, or not, however, the equation changed on a day that Juan and I were sitting together in the back row of Latin class. Juan opened his calculus book and showed me the butcher knife.

I excused myself from class, went to a pay phone, and called my mother. She called the school, the principal called the police, and Juan was quietly removed from school when the period ended. It would be hard to imagine that a teenager who plotted the murder of another student, by illogical means for an illogical reason, wasn’t emotionally disturbed. I don’t know what happens to someone like Juan in 2014 – I’m thinking nothing good – but let me tell you what happened to Juan in the late 1970s.

Juan was out of high school for 6 weeks. I heard he had psychological testing, but aside from that, I have no idea what transpired. One of his friends told me it was a joke. He returned to high school, never said another word to me, graduated, and attended an Ivy League university – one of several prestigious schools to which he gained admission. A Google search reveals that Juan later earned a graduate degree and works as an executive making a six-figure salary. (Isn’t Google great?) He’s an adjunct professor at a college where he gets glowing reviews on RateMyProfessors.com. He was elected to serve on a local government committee. He’s married and has children. Compliments of Facebook, I know that he continues to have contact with high school friends.

From what I can tell, Juan’s brief period of being a disturbed adolescent did not progress to a life defined by chronic mental illness, and he did not go on to become a violent felon. I have no idea if I did Juan a favor, prevented a murder, got him much-needed treatment, or simply added an embarrassing diversion to his life. I don’t know if he ever really would have harmed Joe, or if it was in fact a joke designed to yank my chain.

Apparently, my threshold is on the low side, and not long ago I called a friend late one night and insisted she check on her teenager when a Facebook post struck me as alarming and a bit too final. The response I got was, "They were lyrics from a song and you’re overreacting." So be it. I called the mother and not the National Guard, and if the teen had become a statistic, I would have regretted not reacting.

I did wonder, while writing this article, how it would be received if I were to contact Juan and ask his thoughts on those events decades ago. Somehow, it seemed best not to uncover old wounds.

The media talk about the dangerously mentally ill as though they are a separate breed of humans, ones who can be easily distinguished by simply assessing who stands on which side of a well-marked "us-versus-them" line. Human beings, especially young human beings, may go through phases, and they may struggle with controlling their emotions, behaviors, and impulses and with finding their identity at a time in life when fitting in has undue importance. Some of them, no doubt, have these crises in the throes of an acute episode of mental distress – illness, if you’d prefer – and others do so at the genesis of what will prove to be a chronic and persistent psychiatric disorder. It may not be clear at any given moment who is going through a phase, who is suffering from an acute episode of mental illness, and who is beginning their course of a severe and persistent disorder.

Still, there are those who want to neatly categorize those with "serious" mental illness so that we can focus more of our resources on their needs and not on those who they deem to be the "worried well." Juan, it appears, did not fall into that category of chronically or persistently mentally ill. Similarly, all of us know chaotic, misbehaving, and even suicidal teenagers who go on to live productive lives. Does that designation matter if those not-so-seriously (or not-so-obviously) mentally ill individuals kill someone or die during their brief moments of emotional turbulence?

It seems to me that the goal is to keep people safe and help usher them through difficult periods in their lives, regardless of any diagnostic certainty or severity. I would contend that the mentally healthy among us also are subject to impulsive, distressed, and dangerous moments and that the world does not always neatly divide people into proper categorical entities.

Dr. Miller is a coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011).

When I was in high school, one of my friends told me he intended to kill another one of my friends. It was a different day and age back then, and with more than 4,000 students, my high school was rather large and impersonal – it was easy to get lost in the crowd.

"Juan" (not his real name) confided in me that he wanted to kill "Joe" (also not his real name), which I found a bit odd. Joe was well liked but not did really stand out. Juan was perhaps quieter and more studious, but he also did not stand out. Both boys had friends, did well in school, and were not obviously troubled. When I asked Juan why he wanted to kill Joe, he responded, "Because he’s the all-American boy."

I worried about this. I told my mother, and I told a teacher I trusted. No one knew what to do, and Juan’s plan did not sound feasible. He was going to bring a knife to school in a folder, and when Joe was walking in a crowded hallway, Juan would walk behind him and thrust out the folder to sent the knife flying. The physics of this just didn’t make sense to me, and I didn’t see how the knife would gain enough momentum to travel very far, much less penetrate a person through their clothes. Feasible, or not, however, the equation changed on a day that Juan and I were sitting together in the back row of Latin class. Juan opened his calculus book and showed me the butcher knife.

I excused myself from class, went to a pay phone, and called my mother. She called the school, the principal called the police, and Juan was quietly removed from school when the period ended. It would be hard to imagine that a teenager who plotted the murder of another student, by illogical means for an illogical reason, wasn’t emotionally disturbed. I don’t know what happens to someone like Juan in 2014 – I’m thinking nothing good – but let me tell you what happened to Juan in the late 1970s.

Juan was out of high school for 6 weeks. I heard he had psychological testing, but aside from that, I have no idea what transpired. One of his friends told me it was a joke. He returned to high school, never said another word to me, graduated, and attended an Ivy League university – one of several prestigious schools to which he gained admission. A Google search reveals that Juan later earned a graduate degree and works as an executive making a six-figure salary. (Isn’t Google great?) He’s an adjunct professor at a college where he gets glowing reviews on RateMyProfessors.com. He was elected to serve on a local government committee. He’s married and has children. Compliments of Facebook, I know that he continues to have contact with high school friends.

From what I can tell, Juan’s brief period of being a disturbed adolescent did not progress to a life defined by chronic mental illness, and he did not go on to become a violent felon. I have no idea if I did Juan a favor, prevented a murder, got him much-needed treatment, or simply added an embarrassing diversion to his life. I don’t know if he ever really would have harmed Joe, or if it was in fact a joke designed to yank my chain.

Apparently, my threshold is on the low side, and not long ago I called a friend late one night and insisted she check on her teenager when a Facebook post struck me as alarming and a bit too final. The response I got was, "They were lyrics from a song and you’re overreacting." So be it. I called the mother and not the National Guard, and if the teen had become a statistic, I would have regretted not reacting.

I did wonder, while writing this article, how it would be received if I were to contact Juan and ask his thoughts on those events decades ago. Somehow, it seemed best not to uncover old wounds.

The media talk about the dangerously mentally ill as though they are a separate breed of humans, ones who can be easily distinguished by simply assessing who stands on which side of a well-marked "us-versus-them" line. Human beings, especially young human beings, may go through phases, and they may struggle with controlling their emotions, behaviors, and impulses and with finding their identity at a time in life when fitting in has undue importance. Some of them, no doubt, have these crises in the throes of an acute episode of mental distress – illness, if you’d prefer – and others do so at the genesis of what will prove to be a chronic and persistent psychiatric disorder. It may not be clear at any given moment who is going through a phase, who is suffering from an acute episode of mental illness, and who is beginning their course of a severe and persistent disorder.

Still, there are those who want to neatly categorize those with "serious" mental illness so that we can focus more of our resources on their needs and not on those who they deem to be the "worried well." Juan, it appears, did not fall into that category of chronically or persistently mentally ill. Similarly, all of us know chaotic, misbehaving, and even suicidal teenagers who go on to live productive lives. Does that designation matter if those not-so-seriously (or not-so-obviously) mentally ill individuals kill someone or die during their brief moments of emotional turbulence?

It seems to me that the goal is to keep people safe and help usher them through difficult periods in their lives, regardless of any diagnostic certainty or severity. I would contend that the mentally healthy among us also are subject to impulsive, distressed, and dangerous moments and that the world does not always neatly divide people into proper categorical entities.

Dr. Miller is a coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011).

When I was in high school, one of my friends told me he intended to kill another one of my friends. It was a different day and age back then, and with more than 4,000 students, my high school was rather large and impersonal – it was easy to get lost in the crowd.

"Juan" (not his real name) confided in me that he wanted to kill "Joe" (also not his real name), which I found a bit odd. Joe was well liked but not did really stand out. Juan was perhaps quieter and more studious, but he also did not stand out. Both boys had friends, did well in school, and were not obviously troubled. When I asked Juan why he wanted to kill Joe, he responded, "Because he’s the all-American boy."

I worried about this. I told my mother, and I told a teacher I trusted. No one knew what to do, and Juan’s plan did not sound feasible. He was going to bring a knife to school in a folder, and when Joe was walking in a crowded hallway, Juan would walk behind him and thrust out the folder to sent the knife flying. The physics of this just didn’t make sense to me, and I didn’t see how the knife would gain enough momentum to travel very far, much less penetrate a person through their clothes. Feasible, or not, however, the equation changed on a day that Juan and I were sitting together in the back row of Latin class. Juan opened his calculus book and showed me the butcher knife.

I excused myself from class, went to a pay phone, and called my mother. She called the school, the principal called the police, and Juan was quietly removed from school when the period ended. It would be hard to imagine that a teenager who plotted the murder of another student, by illogical means for an illogical reason, wasn’t emotionally disturbed. I don’t know what happens to someone like Juan in 2014 – I’m thinking nothing good – but let me tell you what happened to Juan in the late 1970s.

Juan was out of high school for 6 weeks. I heard he had psychological testing, but aside from that, I have no idea what transpired. One of his friends told me it was a joke. He returned to high school, never said another word to me, graduated, and attended an Ivy League university – one of several prestigious schools to which he gained admission. A Google search reveals that Juan later earned a graduate degree and works as an executive making a six-figure salary. (Isn’t Google great?) He’s an adjunct professor at a college where he gets glowing reviews on RateMyProfessors.com. He was elected to serve on a local government committee. He’s married and has children. Compliments of Facebook, I know that he continues to have contact with high school friends.

From what I can tell, Juan’s brief period of being a disturbed adolescent did not progress to a life defined by chronic mental illness, and he did not go on to become a violent felon. I have no idea if I did Juan a favor, prevented a murder, got him much-needed treatment, or simply added an embarrassing diversion to his life. I don’t know if he ever really would have harmed Joe, or if it was in fact a joke designed to yank my chain.

Apparently, my threshold is on the low side, and not long ago I called a friend late one night and insisted she check on her teenager when a Facebook post struck me as alarming and a bit too final. The response I got was, "They were lyrics from a song and you’re overreacting." So be it. I called the mother and not the National Guard, and if the teen had become a statistic, I would have regretted not reacting.

I did wonder, while writing this article, how it would be received if I were to contact Juan and ask his thoughts on those events decades ago. Somehow, it seemed best not to uncover old wounds.

The media talk about the dangerously mentally ill as though they are a separate breed of humans, ones who can be easily distinguished by simply assessing who stands on which side of a well-marked "us-versus-them" line. Human beings, especially young human beings, may go through phases, and they may struggle with controlling their emotions, behaviors, and impulses and with finding their identity at a time in life when fitting in has undue importance. Some of them, no doubt, have these crises in the throes of an acute episode of mental distress – illness, if you’d prefer – and others do so at the genesis of what will prove to be a chronic and persistent psychiatric disorder. It may not be clear at any given moment who is going through a phase, who is suffering from an acute episode of mental illness, and who is beginning their course of a severe and persistent disorder.

Still, there are those who want to neatly categorize those with "serious" mental illness so that we can focus more of our resources on their needs and not on those who they deem to be the "worried well." Juan, it appears, did not fall into that category of chronically or persistently mentally ill. Similarly, all of us know chaotic, misbehaving, and even suicidal teenagers who go on to live productive lives. Does that designation matter if those not-so-seriously (or not-so-obviously) mentally ill individuals kill someone or die during their brief moments of emotional turbulence?

It seems to me that the goal is to keep people safe and help usher them through difficult periods in their lives, regardless of any diagnostic certainty or severity. I would contend that the mentally healthy among us also are subject to impulsive, distressed, and dangerous moments and that the world does not always neatly divide people into proper categorical entities.

Dr. Miller is a coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011).