Mental health

The American penchant for noting records marked the Virginia Tech shootings in Blacksburg as the “single worst massacre on an American campus.” Having survived the previous record-setting event, that awful day in 1966 at the University of Texas, I understand the demarcation, but the label doesn’t tell the whole story. In particular, it runs the risk of following Stalin’s cynical comment that “A single death is a tragedy; a million deaths is a statistic.” We know better. Each and every death at Virginia Tech was a tragedy.

The question remains: What will we learn from the experience?

At noon on August 1, 1966, I was in my car at a stoplight in front of the University Co-Op Bookstore, just across the street from the University of Texas campus. By that time Charles Whitman had already begun his assault on innocence from the Texas Tower. Barely 10 feet away from me a paperboy had been felled by a single, incredibly accurate shot just minutes before. Others had died or were dying on the street, across the campus, and at points nearby. That I was not a statistic that day is either a coincidence or a miracle. That I was among the hundreds, maybe thousands, deeply and personally affected by this tragedy is an undeniable fact.

In truth, I had more or less seen it coming. Over the previous few months I had numerous encounters with Charles Whitman, and I had long been fearful of him. Twice a week my senior year I had seen or heard him as he sat on a windowsill or stood in the hallway outside his upcoming class in the Architecture Building. I had a political history class at the same time in the same building, and the windowsill where I waited for class was next to his. The persistent nervous habit of chewing his fingernails with a vengeance had earned him the nickname “Charley Fingernails” in my household. His military bravado and occasional flashes of anger worried me so much that I had confessed to others, “If this guy ever does anything violent, no one had better say, ‘he doesn’t seem the type of person who’d do something like that.’ ” In retrospect, we know now without question that at some point, perhaps during spring semester, Whitman had confessed to the university psychiatrist, “sometimes I feel like going up to the Tower with a deer rifle and killing people.”

That summer of ’66 my wife and I also had reason to worry about another troubled young man in our world, someone whose name I have never learned. We called him simply the “Mystery Man.” He was a squatter in an abandoned Victorian home adjacent to the apartment complex that my wife and I managed. He stole things, harassed young women, and frankly raised more red flags than the Soviet navy. Assuming he was a UT student or recent drop-out, we addressed our concerns to the university psychiatrist, as well as to the Austin police, to our church minister, or to anyone we thought would listen. No one would. The young man was clearly lost and disturbed. We knew the latter because my wife had discovered hundreds of mutilated pictures of women when she bravely investigated his hideout in the abandoned building during one of his absences.

No one thought the Mystery Man’s behavior rose to a sufficient level of concern to intervene, however. Only the pictures had been cut up, we were reminded, and not the women. His menacing and scary habits were a frightful part of our daily routine that summer, so much so that before we learned that the Tower sniper was Charley Fingernails, we speculated that it almost certainly had to be our Mystery Man.

Were the authorities correct in ignoring the antics of the Mystery Man, while simultaneously wrongheaded in ignoring those of Charles Whitman?

Forty-one years and a long career of college teaching later, I wrote a book about all this. Tragically, Summer of ’66 came out the Friday before the fateful Monday at Virginia Tech. In those pages I do not condemn UT authorities, the Austin police, or the campus psychiatrist; in fact, I agree with the recent comments of A Sniper in the Tower author Gary Lavergne that Charles Whitman bears full responsibility for his actions at UT and Seung-Hui Cho carries that heavy weight for Virginia Tech. Both individuals were determined to kill themselves and to take others with them. Such heinous decisions cannot be guarded against even with the heavy security found in Baghdad. How can it be different on an open American campus?

My concern in the aftermath of Blacksburg is for the victims and all others touched by these tragedies: the dead, the wounded, the relatives, the faculty, students and staff. Equally, I fear how they all face the future. The impact of these events is deeply personal and profoundly individual. Their timeframe is infinite. The sense of loss, the disappearance of trust, and the incredible sense of personal vulnerability will not soon or easily disappear.

Meanwhile, as a parent, a friend, and a survivor of August 1, 1966, I say that when confronted with the troubling presence of a Mystery Man, a Charles Whitman, or a Seung-Hui Cho, for God’s sake do something. Intervene. Like Nikki Giovanni, Cho’s courageous English professor, alert someone.

As a professor on a college campus for 36 years, I appreciate the privacy rules that govern our interactions with students and parents. Still, I believe that these laws and strictures must be reviewed. Parents of students under 21 do have a right to know when their child is in a personal crisis, especially one that potentially threatens the lives of others. The privacy strictures regarding financial issues and grades, however, do not seem to apply. I empathize with colleagues who cite not only limitations in their professional training to deal with mental disorders among students but also the roadblocks they face when alerting those better prepared.

Alas, universities must now address these limitations.

The recent suicides of college students at Yale and Cornell Universities are rightfully cause for shock and sadness, but also a call to action. No doubt, we wonder how young people with so much talent and promise could end their own lives. In struggling to make sense of these tragic events, it is all too appealing – and unhelpful – to resort to simple explanations and casting of blame. In fact, the science of suicide is highly complex, and suicide prediction and prevention present mental health clinicians, and college administrators, with formidable challenges. Even institutions with quality prevention services, like Cornell and Yale, are not immune from these calamities.

Consider that, after accident, suicide is the second leading cause of death among college students. It is estimated that in any given year approximately 7.5 suicides occur for every 100,000 college students, a figure that translates into some 1,400 suicides. Nevertheless, while any death of a young person is heartbreaking, suicides are numerically rare.

At the same time, we know from our own work and much other research that each year about 10 to 15 percent of college students seriously think about suicide, and approximately 2 to 4 percent will make an attempt. This means that for every college student who dies by suicide, there are hundreds who have tried and thousands who have thought about it. Yet, we still have no overarching psychological theory to explain exactly what moves someone from thinking about suicide to taking action.

We do know that most young people who die by suicide have a diagnosable, and often treatable, psychiatric condition, and, frequently, they have told someone of their plan. Regrettably, numerous studies have found that less than 50 percent of depressed college students seek help. And not all manifest obvious signs of their depression.

Recent research has shown that the brain continues to mature throughout one’s 20s, with the area most responsible for decision-making developing last. Some young people, therefore, may act impulsively, without fully appreciating the real consequences of their actions. As a result, suicide in young people sometimes occurs without any apparent warning, either in a setting in which the young person -- most often a young man -- has hidden his despair from others, or as the result of an abrupt and intense impulse, often in the context of judgment-blurring intoxication.

Despite this, it is important to keep the issues in perspective. While universities are seeing larger numbers of students with psychiatric difficulties -- in part because improvements in treatment make it possible for more students with such problems to successfully attend college – the number of suicides on campuses has remained stable over the past 10 years. This suggests that we may be doing a better job at identifying and treating the underlying causes of suicide, such as depression, bipolar disorder, schizophrenia and substance abuse.

We also know that elite colleges do not have higher rates of suicide than others. Academic competition and pressures are not frequent precipitants of suicide in undergraduates. More often, suicide is precipitated by family or relationship problems, often in the context of substance use.

Moreover, we have learned quite a bit about college suicide prevention in the past 15 years. We know that keeping the means used for self-harm out of the hands of potentially suicidal people will save lives. College students have about half the rate of suicide of non-college-attending young people, in part, it appears, because few guns are allowed on college campuses. And there are definitive measures that can prevent an impulsive young person from taking tragic action. The securing and alarming of windows and roofs have been helpful deterrents. Actions such as Cornell’s adding barriers on its bridges are therefore prudent and sensible.

Educational outreach programs are also effective in assisting students, faculty and administrators to identify psychological problems and decreasing the stigma often associated with seeking treatment. Preparing entering students with previously treated disorders to establish a system of continuing care while on campus is vital, as is communication with parents on the importance of such care.

Interestingly, we have learned that we don’t prevent suicides by focusing solely or even too intensively on suicide prevention. Rather, it is essential that colleges offer comprehensive, accessible and affordable systems of general physical and mental health care, and that they utilize community and public health approaches to educate parents, students, faculty and administrators about the need to communicate, support and care for each other. Steps such as "gatekeeper training," in which people most likely to have direct contact with troubled students (resident assistants, writing instructors, academic advisers, athletic coaches and chaplains, among others) are taught to identify and refer such students for counseling and peer education programs, have a proven track record. For example, the award-winning Active Minds on Campus, with chapters across the country, provides a forum in which students present programs focused on promoting acceptance and understanding of people with mental illness.

Many colleges employ online surveys to help students identify problems and utilize other technology-based modes of support, including appointment and medication reminders, to engage troubled students in a way they feel comfortable.

Among all key members of the college community, communication focused on the support and care of students in distress, while respecting the students' privacy, is also essential. Finally, we know that whenever possible, it is best for troubled students to remain in school among their friends and working toward a positive future. At the same time, colleges and universities must allow for students who temporarily cannot function to return home for more intensive assistance and treatment.

In fact, it turns out that when it comes to suicide prevention, students, faculty, administrators and parents are all in this together.