How do you tell a disturbed person from a dangerous one?

Seventeen-year-old Robert Butler Jr. was escorted out of his Omaha high school after being suspended. Hours later, he returned with a handgun and shot the principal and assistant principal. The assistant principal died, the principal lived, and Butler himself was found dead in his car of a self-inflicted gunshot wound.

That was three days before Jared Loughner allegedly shot 19 people in Tucson, killing six and wounding 13, among them Congresswoman Gabrielle Giffords, who was shot in the head at close range.

These incidents join an ever-growing list of mass shootings in this country. In the media - social or otherwise - the murderers have been described as lunatics, monsters, cold-blooded killers. Loughner's friends and acquaintances, including students and staff at the community college he attended, have described him as an outcast and a "troubled" individual. Fingers are being pointed - at his parents, at Sarah Palin, at our political climate and our schools. "How could this have been prevented?" people ask. "How could no one have known?"

I work as a psychologist, both in college counseling and other settings. Over the last several years, college psychologists have been receiving more and more calls expressing concern -- from professors who see student papers with disturbing content, or parents worried about their child, or residence advisers dealing with difficult behavior. They are seeking definite answers, and I share their frustration when I am unable to provide them.

Determining risk and proper intervention is a tricky issue in any setting, but especially at colleges and schools. Legal definitions of risk and psychological definitions of risk do not always line up neatly with what seems to be common sense. The frequent request for us at the college counseling center- - and for psychologists more generally -- is to intervene. But it's difficult to know how. Assessments and strategies for predicting risk are far from foolproof.

One of the best predictors of future violence is a history of violence. However, mental illness often is just revealing itself for the first time in late adolescence and early adulthood. Many of these young perpetrators aren't old enough to have significant histories.

Demanding that a "person of concern" receive treatment is also fraught with difficulties. Mandated counseling or treatment is not especially effective. True change requires personal desire and the will to change. How open would you be to therapy if someone was forcing you into it? The roles of therapist and of safety officer are not often complimentary. People may not establish the trust needed for therapy if they think a therapist might use their words against them.

Psychologists must adhere to ethical guidelines that include respecting the rights to privacy, confidentiality and self-determination. In addition, the counseling relationship has special legal privileges of confidentiality. This often places us in a difficult bind. A professor may call me concerned about a student, but I cannot reassure that professor that I am already seeing that student - or even reveal that the student is not seeking help at our center.

Obviously, there are exceptions to confidentiality and limits to respecting self-determination. If a person in therapy presents an imminent threat to self or others, we are allowed to break confidentiality and notify police or potential victims. However, threats are often masked in ambiguous language and risk is unclear.

Some people's odd or disturbing thoughts or behaviors don't result in outward violence. Eyebrows were surely raised when Stephen King turned in creative writing assignments in high school, but should he have been placed in therapy? When do we respect people's right to not seek treatment, and at what point do they lose that privilege? Clearly, Jared Loughner's disturbing thoughts and behaviors appear to have resulted in tragic consequences. But how do we know the difference between a Stephen King and a Jared Loughner?

Psychologists have much to offer in the prevention of violence, but we also have limitations. This is a societal-level problem that is going to require societal-level efforts that go beyond dropping off "persons of concern" at a psychologist's door. We are stronger when we can each use our unique roles and knowledge to contribute to prevention. Our best chance will come from a communitywide effort in which we all contribute eyes, ears and caring outreach.

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Lindsey Hammond Teigland is a licensed psychologist who has worked in a variety of college counseling centers. She also has a private practice in Eden Prairie.

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