COLIN (8) was a remarkably brilliant boy residing in a small city in a neighboring state. He was referred by his pediatrician due to severely disruptive behavior in his public school 3rd grade.  He had been diagnosed as having ADHD by the pediatrician and treated with reasonable doses of stimulant medication, but improvement was modest at best and frequent outbursts of defiant, angry comments and refusal to do  assigned work persisted. He lived with both biological parents: pleasant, responsible, and caring middle class people.  He had a “perfectly well-behaved” 6 y/o brother whom he teased whenever an opportunity presented. 


Reviewing the problems with his parents and teachers revealed some vital diagnostic clues.  It wasn't quite true that he refused to complete assigned work.  He always wrote down answers.  When a problem might be:  “Read the story about a boy having trouble training his pony.  What do you think the boy should try next based on how well the pony responded to his efforts?”  (Pictures accompanying the story showed the boy offering the pony sugar cubes, then offering a carrot, then brushing his back.


A typical answer Colin wrote might be: “Get a big whip and beat the snot out of the stupid pony.”  


Another question might be a math problem such as:  “Jennie has 25 pennies she wants to divide equally among her five friends.  How many pennies should she give each friend?”  Colin's response was:  “Keep them all for herself and buy candy for lunch.”  On many other questions, especially math, he would just write the correct answer but refuse to show how he deduced that was the correct score.  He generally finished all assigned class work within 5 minutes and spent the remainder of the period insulting other kids for being so stupid.  Psychological testing performed later that year revealed he had an IQ of 148, well into the genius range.


By 4th grade he became steadily more obnoxious, acting like The Great Genius Professor talking down to a classroom of “morons.”  Finally one of the older female “morons” sat down in front of him at a lunch table and launched into nasty, insulting critique about his offensive behavior.  Colin's response was to reach into his backpack and pull out a round object which he kept disguised by cupping his hand around it.   He then told the girl:  “You're such a fat, ugly bitch so when I stuff this hand grenade down into your slimy panties and pull the plug its going to blow your fat ass and all   your guts and blood and poop all over the lunchroom walls!”  He reached forward as if to insert the object into her waistband.  The girl screamed and ran to the Principal's office. 


*** I first heard about the case when one of my staff interrupted me and told me Colin's Mom had called in great agitation because she was on her way to the Sheriff's office because Colin brought a bomb to school.  Then she clicked off.  30 minutes later  I received an urgent call from the town sheriff, who sounded very agitated.  He said:  “Doctor, we have that Colin kid in custody here!  He's in a strip and search cell and the deputy just told me doesn't have bombs or other weapons in any cavities.  We're doing the best we can to manage the case. We evacuated the school and parents are taking their kids home from the front lawn area.  We have the bomb squad at the site now and they're searching for the main bomb or grenade or whatever it word yet, and we can't keep all the media out much longer.  Mom is out in the hall screaming something like he has Ambergurs, and wants me to let him out!  She says you're his doctor.  Can you help us with this?”             


*** I then did my very best to resist saying something like “Do people like you get promoted to sheriff because you have shit for brains?”  I succeeded in resisting, and told him Colin would certainly not have any kind of bomb or weapon, and further stated I suspected the potentially “lethal object” was a vinyl ball wrapped with rubber bands his parents and I had given to him to take to school so he could have something to play with when he was bored in class (Colin loved to make bigger and bigger rubber band balls by using a semi-mathematical strategy to increase their size.)   The sheriff asked if I could vouch for that and guarantee he was not a danger to himself or others. I told him I could vouch for all these issues and suggested he be let of the strip cell (where I could hear him and his mother screaming in the background).  I gather the sheriff let him go immediately after the bomb squad returned and reported the campus was “clean.”


I couldn't figure out why the incident got that far!  Colin was on an IEP by then, and the school principal knew him well.  He knew all about the rubber band balls Colin was making and had endorsed the idea.  And he was supposedly on duty on campus that lunch hour.  Eventually it came to light the only person in the administrative office at lunch hour was the school secretary, since the principal had retired to a remote staff bathroom facility to cope with an uncomfortable “constitutional.”  So with nobody else to help her the school secretary called the police merely upon hearing the girl run into the office screaming “Colin has a bomb!”


Since Colin's IEP covered “offensive threats” no administrative action could be taken against him, and the Principal arranged for a conference the next morning with both kids and their parents wherein both kids apologized to each other.  Unfortunately, local media misused the incident to unfairly criticize school personnel, and then the sheriff.  Colin learned a useful lesson and went on to behave better and better that year.


VINCENT (55) held advanced degrees in Physics, but had never been able to work in his chosen field.  He invariably found horrible defects in any office or research project to which he was assigned, and typically was terminated within 3 or 4 days on every job.  This pattern started as soon as he joined the Army.  He immediately found the barracks were not being properly managed, and demanded miscreant soldiers be punished for even the most trivial offenses, such as using more than 6 squares of toilet paper wiping themselves in the bathrooms.  The bunks were never properly “made” with the precise arrangement of sheets and blankets he felt required by regulations, and he carried his complaints about “slipshod” management and discipline up the chain of command to the point of insulting the company captain.  He was summarily discharged as unfit for duty for psychiatric reasons. 


Many years later he finally became despondent enough to request my help for severe depression.  It took a great deal of patience for my office staff and me to cope with the constant criticism about how we (mis)managed our Clinic!  But he slowly improved and became less fixated and inflexible given 200 mg Zoloft per day and therapy with a psychologist colleague.  He and I were finally able to arrange for Vincent to receive VA benefits due to a connection between his pathology upon being discharged from active duty and his current symptoms.  At long last he had a service-connected disability and a modest income!


Upon receipt of the disability papers, Vincent indignantly burst into my office and told me he could not accept this “terribly flawed” settlement.  His reasons why were:

  A clerk had misspelled my name as “Carydon Clark” under my signature;

  A clerk used an incorrect diagnosis code for ADHD, 314.10 instead of 314.01.

So he insisted on rejecting the settlement and almost succeeded in returning these papers.  The psychologist and I stopped him in the nick of time. 


A year later Vincent burst into my office again, this time bearing a 9-page, single – spaced, rambling letter he had already, and very proudly, e-mailed to Sen. John Kerry, Pres. Bush, VP Chaney, Homeland Security, and a dozen or so other federal officials.  He was furious:  presidential candidate Sen. John Kerry had called Pres. Bush a “liar” after an interview when he (Mr. Kerry) thought the microphone recording him was off.  Vincent insisted I read his message right away.  I got to it an hour or so later.  Midway down page 2 he wrote his only “honorable recourse” was to challenge Sen. Kerry to a duel, generously allowing him the choice of weapons.  Midway down page 5 he wrote  “if you are unwilling to face me on the field of honor I shall be forced to deal with you as I see fit.”   


It was my professional duty * to call the Secret Service immediately, and their agents took Vincent into custody 25 minutes later.  He was taken to a federal detention center and charged with threatening to kill a federal officer.  Fortunately, the prosecutor soon realized this was an empty threat (he had never owned a weapon) by a seriously mentally disturbed man, and after further consultation with me and others, agreed to let him plead to a lesser charge and serve an 18-month sentence at a federal psychiatric facility. 


·          Any explicit threat to kill a president, vice-president, or nominated candidate for the presidency is an automatic exemption to confidentiality statutes in my profession.


Treatment in the federal psychiatric facility did not work well for Vincent.  I only saw him twice after discharge, and on both occasions he insisted he was right and it indeed was his duty to challenge Sen. Kerry to a duel


Further “post-mortem” analysis of this catastrophe revealed Vincent had stopped taking Zoloft one month before he wrote the threatening e-mail because he felt guilty about using the free medication samples I was giving him.  He was angry VA physicians would not prescribe this for him. 


There is one final irony about this crazy-making case:  I had several discussions with the prosecutor, and she stated it was extremely unlikely anyone in our government would have ever read the document he e-mailed!  


Chapter 4 will follow, probably during or after the Christmas holidays.