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Threat Assessment and
Management Strategies
Identifying the Howlers and Hunters
Second Edition
Frederick S. Calhoun | Stephen W. Weston
With a Summary of the Research on the Intimacy Effect by Debra M. Jenkins
Second Edition

Second Edition

Frederick S. Calhoun
Stephen W. Weston
Boca Raton London New York
CRC Press is an imprint of the

Taylor & Francis Group, an informa business
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© 2016 by Taylor & Francis Group, LLC
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Version Date: 20160210
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To Austin James Calhoun (1918–2006)
and John Wayne Weston (1926–1992)
Contents
Preface to the First Edition xiii

Preface to the Second Edition xvii
About the Authors xix
Section I
THREAT ASSESSMENT
AND MANAGEMENT STRATEGIES
1 Establishing Threat Management Processes 3

Recognize the Need for Threat Management Processes 4
Assign Responsibility to Manage Inappropriate Situations to Trained Threat
Managers 5
Provide Training and Liaison with Potential Targets and Administrative Staff 6
Create an Incident Tracking System with Well-Documented Files 7
Establish Liaison with Other Agencies, Neighboring Organizations,
and Institutions with Shared Interests 9
Conduct Thorough Fact Finding 10
Use Consistent and Valid Threat Assessment Methods 10
Apply Threat Management Strategies Flexibly and Intelligently 11
Communicate with Potential Targets Professionally, Confidently,
and Competently 11
Manage Inappropriate Situations Appropriately 15
When Is When? 17
Summary 18
Situation Analysis: When Physical Protection Fails 18
Issues of Interest 21
2 Identifying Problem Individuals 25

Understanding Violence 25
Identifying Problem Individuals 29
Protective Fact Finding Compared to Criminal Investigations 31
Conducting Protective Fact Finding 33
Using the Need to Knows 33
Need to Knows on the Situation Circumstances and Context 34
Need to Knows on Subject’s History 35
Need to Knows on Subject’s Mental and Physical Condition 36
Interviewing the Subject 37
vii
viii Contents
Summary 38
Situation Analysis: A Tragic Winters Tale 38
3 Assessing Problem Individuals 43

Formalized Threat Assessment Approaches 46
The Stakes 50
Two Approaches for Assessing the Subject’s Stakes 50
JACA 52
Summary 54
Situation Analysis: The Disgruntled Vet 54
4 Managing Problem Individuals 59

Threat Management Rules of Conduct 60
Take No Further Action at This Time 63
Advantages and Disadvantages 63
Watch and Wait 64
Third-Party Control or Monitoring 66
Subject Interviews: Refocus or Assist 68
Subject Interview: Warning or Confront 70
Civil Orders 71
Administrative Actions 73
Mental Health Commitments 74
Criminal Prosecutions 76
Managing the Risk 79
Summary 80
Situation Analysis: A Loser’s Shot at “Redemption” 81
Section II
IDENTIFYING THE HOWLERS AND HUNTERS
5 Introducing Hunters versus Howlers 87

Balancing Physical Security and Threat Management 90
Who Needs Managing? 92
Contents ix
Purpose of Section II: Identifying the Howlers and Hunters 94

Summary 97
Situation Analysis: The Poacher 97
The Facts 97
The Threat Analysis 98
Recommended Protective Response 98
Recommended Threat Management Strategy 98
The Outcome 98
6 Defining Hunters and Howlers 101

Hunters Defined and Exemplified 102
Anatomy of a Hunter 106
Howlers Defined and Exemplified 107
Anatomy of a Howler 109
The Effect of Space and Time on Howling 109
Hunters versus Howlers 114
Summary 116
Situation Analysis: The Payoff 116
The Facts 116
The Threat Assessment 116
Protective Response 117
Threat Management Strategy 117
Outcome 117
7 Understanding Hunters 119

What Hunters Do 119
On Grievances 122
On Ideation of Violence 128
On Research and Planning 131
On Preparation 133
On Breach 136
On Attack 137
The Undetectable 138
Summary 139
Situation Analysis: The Nonaccidental Tourist 139
The Facts 139
The Outcome 140
x Contents
8 Understanding Howlers 143

Howler Categories 143
Personally Sinister Howlers 146
Personally Binding Howlers 150
Impersonally Sinister Howlers 154
Impersonally Binding Howlers 161
What Howlers Want 164
Summary 167
Situation Analysis: The Snitch 168
The Facts 168
The Outcome 168
9 Working with the Intimacy Effect and the Law 171

Working with the Intimacy Effect 172
Violence against Public Figures 172
Violence against Workplace Colleagues 173
Violence against School Officials and Students 173
Violence against Domestic Intimates 173
General Observations 173
Applying Federal Law 177
Working with State and Local Laws on Threats and Domestic Violence 185
State Stalking Laws 188
Summary 190
Situation Analysis: A Mother’s Help 190
The Facts 190
Threat Assessment 191
The Outcome 192
10 Working with the Hunter, Howler, and Other Concepts 195

Working with the Last-Straw Syndrome 196
Other Concepts Influencing the Threat Management Process 202
Managing Hunters and Howlers 203
10 Guidelines for Managing Hunters and Howlers 204
Summary 207
Situation Analysis: The Relentless Pursuer 207
The Facts 207
Threat Assessment 208
Contents xi

The Outcome 208
Appendix: When Should Threats Be Seen as Indicative
of Future Violence? Threats, Intended Violence,
and the Intimacy Effect 211
DEBRA M. JENKINS
Preface to the First Edition
Robert L. Burke settled his disputes with bombs. At work, Burke frequently threatened his
fellow employees in the air traffic control tower at Walker Field Airport in Grand Junction,
Colorado. Several of his colleagues complained that talking with Burke often left them
in fear for their lives. During one conversation with Gary Mueller, his supervisor, Burke
bragged about owning two guns, including a .357 Magnum. When Mueller asked why
Burke needed two pistols, Burke replied that two guns increased his killing power. “Why
a .357?” Mueller asked. “You’ll find out,” Burke told him. During this same conversation,
Burke demanded that Mueller do things Burke’s way because Burke was the only person
who knew how to do things right. If Mueller did not follow Burke’s instructions, “some-
thing big was going to happen” and “Mueller would be sorry” because Burke “had nothing
to lose.” After nearly a year of such conversations, threats, and references to violence, in
March 2004, Serco Management Services terminated Burke’s employment.*
Burke took up a nomadic existence, moving frequently with his belongings packed
into a maroon van. In July 2005, he bought a used ambulance from a couple in Derby,
Kansas, but then failed to take possession of it. When the owners sold it to another buyer,
Burke rejected the check they sent him for reimbursement. He e-mailed them on July 19
saying, “If/when it comes time to get ‘the information’ I will…and then My Farewell Tour
will begin.” The tour began on February 1, 2006.†
Burke left his first bomb on the roof of Serco Management Services headquarters in
Murfreesboro, Tennessee. It exploded around 4 p.m. but did little damage and resulted
in no injuries. Twenty-seven days later, on February 28, Burke arrived in Derby, Kansas,
and left a bomb on the porch of a house belonging to a neighbor of the ambulance sell-
ers. Its explosion also did little damage. A month later, Burke returned to Grand Junction
and, early in the morning of March 25, planted five bombs at the homes of his former
coworkers, all of whom had testified against him during his dismissal proceedings from
Serco Management. Three of the bombs went off; the other two were disarmed by police.
The three that exploded caused minor damage, primarily from the fire resulting from the
incendiary accelerant Burke had added to the explosives. When police searched a storage
shed used by Burke, they found a piece of paper containing the addresses and phone num-
bers of several of his targets.*
On April 3, a man claiming to know Burke called a Grand Junction Daily Sentinel
reporter to arrange a meeting. The man claimed that Burke had stored information on a
computer that “would affect every contract [air traffic control] tower in the country.” The
reporter, however, suspected the caller was actually Burke, so he alerted police. When the
“informant” called back April 5, the reporter agreed to meet him at a motel in Orem, Utah.
* Morris, E., Saccone, M., & Harmon, G. (2006, March 25). Feds take over serial bomber case. Grand
Junction (CO) Daily Sentinel, Morris, E. (2006, March 27). GJ bombs similar to one in Tennessee. The
Daily Sentinel, and Harmon, G., & Morris, E. (2006, March 27). Burke still at large. The Daily Sentinel.
† Harmon, G. (2006, April 6). Burke linked to 7th bomb. The Daily Sentinel.
xiii
xiv Preface to the First Edition
A police surveillance team caught Burke hiding behind the Orem Walmart, his van parked
in such a way as to hide the rear Colorado license plate.* At trial, Burke pled guilty to the
Colorado bombings and received a prison sentence of 10 years. “This was personal,” the
judge noted in handing down the sentence.†
Burke qualifies as what we call a hunter. Simply defined, hunters intentionally use
lethal violence. Their behaviors in carrying out the violent act follow a defined trail which
we call the path to intended violence. Burke developed a grievance against his employer and
coworkers, decided to act violently against them, then researched their locations, built his
bombs, delivered them, and set the timers for detonating them. That the bombs did not do
as much damage as intended does not detract from the hunting process in which Burke
engaged. Like all hunters, Burke intended to act violently, then engaged in all the requisite
behaviors necessary to consummate that lethal violence, including, ultimately, exploding
the bombs.
Around the time Burke planned his hunt, again according to press reports, Suffolk
County, New York policeman Michael Valentine met a woman on Match.com, an Internet
dating service. Beginning in November 2005, they dated about 6 weeks before she broke
up with him. Unwilling to let her go, Valentine hacked into her e-mail account and essen-
tially stole her online identity. He began sending himself and some 70 other men e-mails in
which he pretended to be her. These e-mails expressed romantic interest toward each recip-
ient. On at least two occasions, men showed up at her house believing they had arranged a
date with her. Suffolk County computer-crime detectives believed Valentine used several
computers, one belonging to the police department. In April 2006, the district attorney
obtained a 197-count indictment against Valentine, charging him with stalking, computer
trespassing, official misconduct, and tampering with evidence. Valentine’s lawyer prom-
ised a vigorous defense.‡
On June 30, 2006, Valentine copped a plea. He resigned from the police department
and pled guilty to two counts of Unauthorized Use of a Computer. The district attorney
dropped all of the other charges. The judge sentenced Valentine to 1 year of “conditional
discharge.” The judge also issued a 3-year order of protection for the victim.§
Valentine is what we call a howler. Simply defined, howlers engage in problematic
behavior toward their targets, but that behavior does not result in lethal violence. Valentine
developed a brief relationship with a woman, then targeted her after she rejected him.
However, at no time did he appear to entertain thoughts of committing violence against
her, nor did he take any of the steps along the path to intended violence. Instead, he
embarked on a high-tech harassment campaign to embarrass, inconvenience, and perhaps
even frighten her. By stealing her online identity, Valentine wreaked havoc on her social
life and seriously embarrassed her by attributing messages and emotions to her through
forged e-mails. As despicable as these actions were, at no time did he put her in physical
danger.
Herein lies the distinction between hunters and howlers. Burke wanted to kill his tar-
gets by blowing up their residences or burning down their houses. He measured his success
* Suspected bomber arrested in Utah after tip. (2006, April 7). Salt Lake City Tribune.
† Harmon, G. (2007, February 3). ‘This was personal’ judge blasts GJ bomber with 10 years in prison. The
Daily Sentinel.
‡ L.I. officer charged with cyberstalking. (2006, April 4). Associated Press.
§ Brian Creter, Senior Investigator, Gavin de Becker and Associates, to Frederick S. Calhoun, e-mail dated
October 3, 2014, in author’s personal possession.

Preface to the First Edition xv
in terms of death or destruction. Valentine wanted to harass and embarrass his target. He
sought emotional and mental injuries, not physical. He measured his success in terms of
inconveniencing, embarrassing, or frightening his former dating partner. Hunters deal in
lethal violence; howlers cause stress.
This book explores in detail the differences between those who hunt and those who
howl. Its intended audience goes beyond law enforcement or security specialists. Rather,
anyone involved in managing potentially violent situations or problem individuals, such
as human resource staff, mental health professionals, staff attorneys, employee assistance
professionals, school administrators, teachers, guidance counselors—even potential targets—
might gain from reading it. Our approach avoids theory in favor of practical concepts that
can be readily applied by anyone involved in managing threatening situations or indi-
viduals. We are pragmatists who recognize that at workplaces, schools, homes, courts, and
all the other venues of intended violence, threat management requires a multidisciplined
team approach. We write for every member of that team and use the generic term threat
manager to address them all.
Taken together, hunters and howlers represent problem individuals. More precisely,
they are individuals who purposefully intend to cause problems. At one end of the spec-
trum, the problems involve lethal violence. At the other end, the problems entail estab-
lishing harassing or binding attachments. In between are threats, intimidations, stalking,
vandalism, physical abuse, and other forms of disruption. Threat managers must man-
age both ends of the spectrum and everything in between, although clearly, the killing
end takes precedence. But that precedence in no way means that howlers can be ignored.
By their very nature, problem individuals of every stripe insist on having their problems
addressed. That insistence requires responses from threat managers.
This book, we believe, offers threat managers several benefits. First, it arms them with
ways to identify problem behaviors and associate those behaviors with either hunters or
howlers. Knowing with whom one is dealing is a crucial first step in any threat manage-
ment process. Second, unlike any other study on threat management, we focus as much on
problem individuals who intend to harass or intimidate (the howlers) as we do on individu-
als who intend lethality (the hunters). No other study gives as detailed a definition of howl-
ers, yet howlers comprise the vast majority of problem individuals in any social setting.
Third, through actual case studies and case analyses, we offer the best practices for assess-
ing problem individuals and recommending the best protective response and management
strategy.
Implementing an Effective Threat Management Process
A successful threat management process does not necessarily depend on large staffs or
huge resource commitments, but instead on attention to detail and a thoughtful approach.
It consists of 10 elements, each integral to the others, and they constitute the golden rules
of contemporary threat management. Following them will allow the threat manager to
implement an effective threat management program. We present them in Chapter 1 by way
of introducing the approach to understanding hunters and howlers.
Threat management cases are not about investigating or solving crimes; they are about
managing the behavior of an individual. Threat managers do not have a caseload of crimes
assigned to them. Rather, threat managers manage problem individuals. Consequently, a
xvi Preface to the First Edition
threat manager’s caseload is a hybrid between a criminal caseload and a parole or proba-
tion officer’s caseload.
Hence, we shy away from such traditional terminology as opening or closing a threat
management case. Rather, we find the following designations best suited for managing
threat management cases: active, inactive, chronic or habitual, or long-term.
Contemporary threat management seeks to avert violence altogether. Organizations
must expand their security from simply fortifying physical security countermeasures and
reacting to violent attacks. They need to incorporate an effective threat management pro-
cess for defusing the risks of violence before the violence erupts. We are not talking about
predicting violence. Predictions are the provinces of angels and fools. We advocate estab-
lishing procedures to enable the threat manager to identify potential problem individuals,
assess the seriousness of the risk, investigate the circumstances, and then devise the appro-
priate strategies for managing the subject. Implementing an effective threat management
process requires organizations to follow the 10 golden rules. Doing so will further enhance
their security.
Because hunters and howlers have entirely different purposes, they behave in very dif-
ferent ways. This book explores those behaviors in order to make each more recognizable.
In between those explorations, we offer detailed case analyses to show how being able to
distinguish hunters as hunters and howlers as howlers can offer profound benefits to iden-
tifying, assessing, and managing both situations. Because hunters and howlers behave dif-
ferently, threat managers need to deal with them in different ways. That requires being able
to separate those who hunt from those who howl. This book discusses how to do exactly
that.
Preface to the Second Edition
We take the opportunity of this second edition to expand our scope. The content of the first
edition remains intact, although we updated many of the examples and illustrations. In
this edition, we added a new section. “Section I: Threat Assessment and Management
Strategies” offers our current thinking on how to conduct thorough threat management
processes. We draw on the latest research as well as ideas and concepts from our previous
books. Overall, the second edition allows us to integrate the sum of our careers in threat
management—both our individual experiences managing problem situations and our
research and writing on the topic—into a single volume. Our purpose with this second
edition is to create a stand-alone volume on how to develop a threat management program
and how to run it effectively.
In Chapter 1, we discuss the necessity for establishing threat management processes,
then offer guidance on how to do so. Chapter 2 covers how to identify potential prob-
lems by conducting protective fact finding. As facts are gathered, we then describe the best
methods for assessing those facts to determine the level of risk in Chapter 3. On the basis
of those ongoing assessments, in Chapter 4, we discuss how to select the most appropriate
threat management strategies to defuse the risk. Section I, then, provides the necessary
skeleton for setting up threat management processes.
“Section II: Identifying the Howlers and Hunters” reprises the subjects presented in
the first edition, effectively adding flesh and tissue to the bones of Section I. It defines two
types of problem individuals. Howlers make disturbing and inappropriate communica-
tions but never go beyond those disturbances. Hunters do go beyond to launch attacks and
inflict harm. Both pose problems; both have to be managed; neither can be ignored. Yet,
understanding their differences informs both the threat assessment and the selection of
the most appropriate threat management strategies. Howlers and hunters differ consider-
ably. Threat managers need to understand and exploit those differences. Chapter 5 intro-
duces the twin concepts of hunter and howler. Chapter 6 presents precise definitions for
each concept. Chapter 7 offers insights into understanding hunters, while Chapter 8 does
the same for howlers. Throughout, each concept is illustrated with numerous examples
drawn from real-life events.
Chapter 9, “Working with the Intimacy Effect and the Law,” discusses how the degree
of intimacy between subject and target affects the credibility of threatening communica-
tions and reviews the case law on domestic violence, the most intimate venue for violence.
Chapter 10, “Working with the Hunter, Howler, and Other Concepts,” summarizes the
importance of recognizing hunters and howlers and also reviews a number of important
concepts.
The appendix reprints a summary of research on the intimacy effect written by Debra
M. Jenkins. Nothing has emerged from subsequent research in the field of threat manage-
ment to disabuse her 2009 conclusion that the intimacy effect factors into the credibility
of threatening communications. The more intimate the relationship between subject and
xvii
xviii Preface to the Second Edition
target, the higher the likelihood of carrying out the threatened action. The more distant or
impersonal the relationship, the less likely the threatened action will occur. The intimacy
effect affects both hunters and howlers. Understanding it and applying its principles in
threat assessments give the threat manager better insights into the degree of risk and how
best to manage the situation.
We view working on the second edition of Threat Assessment and Management
Strategies: Identifying the Howlers and Hunters as a great opportunity to consolidate
our thinking on threat management into one volume. For a quarter of a century, we—
individually and as partners—have pondered the perplexities of managing problem indi-
viduals. Over that time, we developed practical ideas and approaches that we applied to
our own work, to our writings, and to our teaching. In this edition, we draw on the latest
research and on our previous works and ideas to present to the reader a comprehensive
approach to setting up a threat management process. Our purpose is to provide guidelines,
not prescriptions. Dealing with hunters and howlers is a volatile, slippery challenge that
belies rules, order, and predictions. It requires approaching the problem intelligently, flex-
ibly, and, with each new problem, with originality. In this edition, we set up the parameters
for implementing a successful threat management process. The threat manager must pro-
vide the intelligence, flexibility, and originality.
About the Authors
Frederick S. Calhoun, PhD, was the lead researcher and principal architect in developing
the threat assessment process used by the U.S. Marshals Service for analyzing risks to fed-
eral judicial officials. He also developed the service’s policies and procedures for conducting
protective investigations. At the request of the National Sheriffs’ Association, Dr. Calhoun
coordinated the curriculum and led a nationwide training program on contemporary
threat management for local law enforcement. He also wrote the curriculum and led the
training of deputy U.S. Marshals Service threat investigators and their supervisors. Dr.
Calhoun earned his PhD from the University of Chicago and is the author of 13 books,
including Hunters and Howlers: Threats and Violence Against Judicial Officials, 1789–1993
and Defusing the Risk to Judicial Officials: The Contemporary Threat Management Process
(with Stephen Weston). In 2013, he and Mr. Weston released their newest book, Concepts
and Case Studies in Threat Management: A Practical Guide for Identifying, Assessing and
Managing Individuals of Violent Intent.
Dr. Calhoun also teaches a periodic 2-day seminar entitled “Managing Threats:
Reducing the Risk of Violence.” This seminar is designed to train law enforcement officers,
mental health professionals, and private security officials to identify, assess, and manage
individuals of violent intent. Instruction includes defining inappropriate communications
and contacts, assessing problem individuals, and employing effective threat management
strategies.
Stephen W. Weston, JD, is a 32-year veteran of the California Highway Patrol. From 1991
to 2006, he managed the unit responsible for the investigation of threats against California
state officials.
Mr. Weston has been on the staff of the Los Rios College District since 1978 as an
instructor in dignitary protection, threat assessment, and major event planning. He was
an instructor in the nationwide contemporary threat management training sponsored by
the National Sheriffs’ Association. Mr. Weston has served on the faculty of California State
University, Sacramento, in the Criminal Justice Division, teaching the course “Violence
and Terrorism.” In 1996, he graduated from Lincoln Law School in Sacramento and was
admitted to the California State Bar.
Stephen Weston is the coauthor, with Frederick S. Calhoun, of Defusing the Risk to Judicial
Officials: The Contemporary Threat Management Process and Concepts and Case Studies in
Threat Management. A Practical Guide for Identifying, Assessing and Managing Individuals
of Violent Intent. Mr. Weston consults with government and private organizations in the
management of threatening situations and lectures throughout the country on public offi-
cial threat management. He has served as president of the Northern California Chapter of
the Association of Threat Assessment Professionals.
xix
Management Strategies I
Establishing Threat
Management Processes
1
We designed the second edition of Threat Assessment and Management Strategies:
Identifying the Howlers and Hunters as a kind of user’s manual describing the threat man-
agement process. The basic process enlivening threat management consists of three basic
steps: identifying, assessing, and managing problem situations or problem individuals.
Establishing an effective threat management process requires mastering those three steps.
As simple as this may sound, in practice, each step presents its own unique challenges, its
own unique obstacles. Overcoming them opens the way for establishing a successful threat
management process.
We intend for these processes to apply to threat management activities in a variety of
venues. We recognize that the threat manager’s role varies depending on the context in
which that role operates. Threat managers, and the teams with whom they partner, dif-
fer depending on the size of the organization or institution, whether it is public or pri-
vate, whether it is law enforcement or not, and who or what is being protected. The threat
manager’s authority and the scope of the threat manager’s functions also vary from venue
to venue. Threat managers specializing in celebrities face different challenges from threat
managers working in schools or universities. Protecting judicial officials raises different
demands from protecting corporate chief executive officers (CEOs). Gathering places such
as sports stadiums and shopping malls also have special issues that threat managers face.
The threat manager’s role likewise depends on whether the threat manager’s functions are
in-house or outsourced and whether the threat management process is an ongoing func-
tion within the organization or institution or a one-time response to a specific event. Yet,
regardless of the venue, the threat management process remains the same.
Therefore, we will walk through each step. In this chapter, we provide a general over-
view of the component parts of the process—the specific steps an organization or indi-
vidual has to take to establish effective threat management processes in any environment.
In the following three chapters, we detail in depth the processes for identifying, assess-
ing, and managing problem individuals. As always, we strive to present practical, opera-
tional tactics that we have found effective in running our own or observing other threat
management programs. This is not an ABC or a by-the-numbers instruction manual.
Situations requiring threat management are far too volatile and much too convoluted
for that. Each situation has to be treated on its own. No two problem situations are alike.
Subjects have different motives, targets have different attractions, and every situation has
its own unique context. Rather, we present in the second edition guidelines for thinking
through the threat management process from taking steps to recognize the initial inap-
propriate approach to applying the most effective strategies for managing the problem
individual. Threat management, culled down to its most elemental facet, is—above all
else—the progression of recognizing and thinking through a problem situation to its suc-
cessful outcome.
3
4 Threat Assessment and Management Strategies
Fortunately for those just entering the profession, the current state of the field presents
an opportune time and climate. A diverse number of different, but complimentary, profes-
sionals now populate the field. These include law enforcement, psychologists, behaviorists,
private security companies, social science researchers, and analysts. Their different perspec-
tives enrich the profession by offering different ways to understand problem situations and
problem individuals. The field, too, has begun producing scholarly studies, dissertations, and
research reports. It boasts of its own quarterly Journal of Threat Assessment and Management.
Threat managers should be encouraged to make good use of these expanding resources.
Recognize the Need for Threat Management Processes
Why do law enforcement, public entities, and private organizations need threat manage-
ment programs? Because the angry and the outraged necessitate it. Problem individuals
may turn to violence or harassment for exoneration, vengeance, even salvation. They direct
their anger, their revenge, and their fears at the individuals or organizations who they per-
ceive wronged them. Without competent threat management processes to identify, assess,
and manage those who intend to cause problems, organizations risk missing any opportu-
nity to intervene and defuse the risk.
Tragically, no one individual, organization, or institution enjoys immunity from vio-
lence. That lack of immunity constitutes the most compelling reason for establishing threat
management processes. In September 2014, the Federal Bureau of Investigation (FBI)
released a study of “active shooter” incidents. The Bureau defined an active shooter using
the agreed-upon definition employed by agencies within the federal government. An active
shooter is “an individual actively engaged in killing or attempting to kill people in a con-
fined and populated area.” In its study, the FBI broadened the definition to include more
than one individual and dropped the word “confined,” thus enabling it to include incidents
that occurred outdoors.*
Using that definition, FBI researchers identified 160 shooting incidents between 2000 and
2013 that matched. The shootings occurred across the entire spectrum of venues for violence,
including private companies; public gathering places, such as movie theaters and political
events; schools and universities; and military installations. Analyzing those incidents pro-
duced a number of disturbing findings that directly support the need for organizations and
individuals to develop threat management processes. FBI researchers found the following:
• An average of 11.4 incidents occurred each year of the study.

• An average of 6.4 incidents occurred in the first 7 years but increased to an average
of 16.4 in the last 7 years of the study.
• 70.0% of the incidents took place in either a commercial or business venue or at an
educational venue.
• Active shooters acted in 40 states and the District of Columbia.
• 60.0% of the incidents ended before law enforcement officers arrived on the scene.†
* A study of active shooter incidents in the United States between 2000 and 2013. (2014). Washington,
DC: Federal Bureau of Investigation.
† A study of active shooter incidents, p. 6.
Establishing Threat Management Processes 5
Not only have these incidents been increasing in recent years, but also the lethality of recent
incidents has increased. The last 6 years of the study, from 2007 to 2013, experienced the
incidents with the highest number of casualties:
• 32 killed, 7 wounded at Virginia Tech on April 16, 2007

• 13 killed, 32 wounded at Fort Hood, Texas, on November 5, 2009
• 12 killed, 58 wounded in Aurora, Colorado, on July 12, 2012
• 27 killed, 2 wounded at Sandy Hook Elementary School in Newtown, Connecticut,
on December 14, 2012.*
Of course, these 160 incidents represent the most horrific and publicity-grabbing events
over the last 14 years. But they had no monopoly on violence. Between the December 2012
massacre of 26 elementary school children and school staff in Newtown, Connecticut, and
October 2014, 87 more shootings occurred at schools across the United States, an average
of one school shooting a week.†
Other venues also suffered terrible tragedies. Domestic violence, workplace violence,
violence against judicial officials, and violence against public figures also occurred, thus
exposing individuals and organizations to the need for threat management processes. Why
the need for threat management processes? Because those processes offer the only way to
prevent a potential shooter from becoming active.
Assign Responsibility to Manage Inappropriate

Situations to Trained Threat Managers
Calling threat management a process rather than a program avoids any implication that
threat management necessitates full-time personnel and the dedication of significant
resources. Establishing threat management processes depends on the size of the organiza-
tion or institution; the nature of its interaction with insiders, clients, and the general pub-
lic; and the projected workload requiring managing. As a result, the staffing of the threat
management processes can range from a fully staffed, full-time group to someone working
part-time as a collateral duty when the need arises. The process can also be outsourced to a
qualified threat management consultant. The Secret Service obviously dedicates significant
full-time resources to carry out its threat management responsibilities. The Transportation
Security Administration’s (TSA’s) national Workplace Violence Prevention Program
employs one full-time national program manager and part-time, as needed, local coordi-
nators at the larger airports. The coordinators all have other responsibilities. In some orga-
nizations, a qualified threat manager is contracted on an as-needed basis. Vulnerability
and workload are the determinants.
We strongly recommend using teams composed of subject matter experts as an integral
part of the threat management processes. The composition of those teams depends on the
resources available to the organization or institution and on the nature of the threat itself.
Not every expert will be needed for every situation, but they should at least be on call. In
* A study of active shooter incidents, p. 7.

† Valinsky, J. (2014, October 24). There have been 87 school shootings since Newtown. So why does no one
seem to care? News.Mic.

6 Threat Assessment and Management Strategies
addition to qualified and trained internal or external threat managers, these experts include
human resource specialists, attorneys, supervisors, security managers, ombudsman staff,
internal affairs, and other specialists appropriate to each organization or institution. For
simplicity, throughout the second edition, we refer to the team as the threat manager.
Whatever the size or composition of the unit, whoever is assigned threat management
responsibilities should be trained and qualified, as well as willing and able to take on the
responsibility.
Provide Training and Liaison with Potential

Targets and Administrative Staff
Regardless of the size of the processes, the threat manager needs to train the workforce or
others associated with the organization to educate them on what behaviors to avoid, what
behaviors to report if witnessed in others, and where and how to report that information.
In setting up new threat management processes within an organization or institution, the
threat manager’s first challenge is to educate everyone within the organization on the spec-
trum of behaviors considered inappropriate. The lesson is that members of the organization
should control their own behaviors and report inappropriate behaviors they may witness
others engaging in. For example, TSA created a 1-hour course every employee is required
to take online. The course explained the threat management processes while emphasizing
the types of behaviors to avoid and to report. Officers in the California Highway Patrol’s
specialized unit responsible for investigating threats to California elected officials spend
considerable time educating those officials and their staffs on what should be reported and
how to report it.
The point is to use people as an early warning radar system. The threat manager can-
not begin to make threat assessments if he, she, or the team does not get reports on inap-
propriate or suspicious behaviors or events. Posting signs listing inappropriate behaviors
that should be reported can be an effective educational tool. The Kaiser Permanente facility
in Reston, Virginia, hanged posters in its restrooms addressing domestic violence, with
information on where victims can get help. The TSA used the following chart to educate
its employees on inappropriate behaviors they should avoid engaging in and—at the same
time—those same inappropriate behaviors they should report if they witness another
employee engaging in them (Figure 1.1).
Training the staff helps the threat manager get the initial facts, one hopes unembel-
lished by exaggeration or worry, as quickly as possible. The key staff members who should
be trained may not correspond to the usual organizational hierarchy. Although CEOs,
principals, victims of domestic violence, and public officials should be well briefed, the
majority of reports the threat manager will receive will come from potential targets, recep-
tionists, mail handlers, website managers, social media coordinators, perimeter security
officers, parking lot attendants, telephone operators, cafeteria staff, gardeners, and other
individuals who are in a position to observe what is going on in or near a particular venue.
These are the people who deal most with the public and the outside world. They are more
likely to see or hear or receive any inappropriate contact, no matter who is targeted.
Once the threat manager trains the staff on what and how to report information, the
threat manager will begin receiving reports of alleged inappropriate situations. We say
“alleged” because not all of the situations reported actually cross the threshold of being
Establishing Threat Management Processes 7
Nonphysical Physical
Inappropriate Inappropriate Physical Physical Assault

statements behavior aggression assaults with a weapon
Verbal or written threats Bullying Intimidating Inappropriate Use of a firearm

behavior physical contact
Verbal abuse Suspicious activity with another Use of an edged weapon
Brandishing a employee
Inappropriate references Stalking weapon, whether Use of bombs or
to weapons it’s real, a toy, or Physical assault incendiary devices
Violent or threatening imaginary
Inappropriate references gestures Damaging Use of weapon of
to death, suicide, Aggressive or destroying opportunity, such as loose
violence, assassinations, Research into the emotions property objects or equipment
or terrorism personal life of
another employee Violence against Acting out anger Throwing things at
Obsessive interest in inanimate objects another person
another employee Frightening other Use of fists, feet,
employees Throwing things or body as a
Claims of mental illness randomly weapon
prompting problematic
behavior
Figure 1.1 Spectrum of inappropriate behaviors. (From Authors’ personal possession.)
inappropriate and thus warranting the implementation of the threat management pro-
cess. The national program manager of TSA received reports with some regularity that an
employee felt “threatened.” When asked for details, the employee would say that his or her
supervisor threatened the employee with some disciplinary action. The program manager
then had to explain that disciplinary actions fell well within the authority of any supervi-
sor. Threats of discipline did not warrant engaging in the threat management processes.
Similarly, the U.S. Marshals Service, the agency responsible for protecting federal judicial
officials, occasionally received reports from a federal judge claiming that a citizen threat-
ened the judge with impeachment. The judge felt threatened by the citizen exerting his or
her constitutional right to seek the judge’s removal, but responding to that stretched far
outside the Marshals Service’s scope of authority.
We recommend that the reporting processes be made simple and user-friendly to those
who report information. The threat manager should foster an atmosphere where all infor-
mation is received with gratitude and in a timely manner to encourage future reports.
None of the threat management processes can work without first setting up viable report-
ing procedures.
Create an Incident Tracking System with Well-Documented Files
Controlling the flow of information requires information management. Depending, again,

on workload, managing the information can be as simple as an index card system or as
sophisticated as a computer database. The system needs to be designed to retrieve infor-
mation quickly and efficiently. It should include not only demographics on the subjects of
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only to point to some of the symptoms which, individually
considered, are found in other disorders, and may therefore be
misinterpreted. The chief of these is vertigo, which, as already
stated, being associated with nausea, and even vomiting, is not
infrequently confounded with stomachic vertigo, while the opposite
error is also, though less frequently, fallen into. The chief differential
points are—that stomachic vertigo is relieved by vomiting, and
anæmic vertigo is not; that the former is rather episodical, the latter
more continuous; that in the free intervals of the former, while there
may be some dulness, there is not the lethargy found with anæmia;
that the headache with the former is either over the eyes or occipital,
and most intense after the passage of a vertiginous seizure, while
anæmic headache is verticalar or general, and not subject to marked
momentary changes. It is unnecessary to indicate here the positive
evidences of gastric disorder which are always discoverable in
persons suffering from stomachic vertigo; but it is also to be borne in
mind that such disorder is frequently associated with the conditions
underlying general and cerebral anæmia, particularly in the
prodromal period of some pulmonary troubles.
There are a number of organic affections of the brain which are in

their early periods associated with symptoms which are in a
superficial way like those of cerebral anæmia. As a rule, focal or
other pathognomonic signs are present which render the exclusion
of a purely nutritive disorder easy; but with some tumors, as is
generally admitted, these signs may be absent. It is not difficult to
understand why a tumor not destructive to important brain-centres,
nor growing sufficiently rapid to produce brain-pressure, yet rapidly
enough to compress the blood-channels, may produce symptoms
like those of simple cerebral anæmia. It is claimed that with such a
tumor the symptoms are aggravated on the patient's lying down,
while in simple anæmia they are ameliorated.34 The latter proposition
holds good as a general rule; as to the former, I have some doubts.
Not even the ophthalmoscope, although of unquestionable value in
ascertaining the nature of so many organic conditions of the brain
and its appendages, can be absolutely relied on in this field. Until
quite recently, optic neuritis, if associated with cerebral symptoms,
was regarded as satisfactory proof that the latter depended on
organic disease; but within the year it has been shown by Juler35 that
it may occur in simple cerebral anæmia, and both the latter and the
associated condition of the optic nerve be recovered from.
34 The increased flow of blood to the brain in anæmia is not always momentarily
remedial: if, for example, the patient stoop down, he flushes more easily than a
normal person, and suffers more than the latter. The same is observed with regard to
stimulants.
35 British Medical Journal, Jan. 30, 1886. In the case reported suppression of the
catamenia is spoken of, as well as the fact that treatment was directed to the
menstrual disturbance. It is not evident from the brief report at my disposal whether
the suspension of the menstrual flow was symptomatic of general anæmia or of a
local disturbance. Optic neuritis has been recorded as having been present in a large
number of cases with no other assignable cause than a uterine disorder. As
previously stated, Hirschberg and Litten found choked disc under like circumstances.
The claim of Hammond and Vance that ordinary anæmia of the brain
may be recognized through the ophthalmoscope is almost
unanimously disputed by experienced ophthalmoscopists, nor is it
unreservedly endorsed by any authority of weight among
neurologists. That there may be color-differences to indicate anæmia
is, however, not impossible; and the fact that a concentric limitation
of the visual field sometimes occurs should not be forgotten. It is
distinguished from that found with organic diseases by its variability
through the day and in different positions of the body.
TREATMENT.—Chronic as well as acute cerebral anæmia, dependent

on general anæmia, usually requires no other medicinal treatment
than that rendered necessary by the general anæmic state of which
it is a part. This has been discussed at length in the third volume of
this work: it remains to speak of certain special precautions and
procedures rendered necessary by the nervous symptoms
predominating in such cases. As the insufficiently nourished brain is
not capable of exertion, mental as well as physical rest is naturally
indicated. And this not only for the reason that it is necessary to
avoid functional exhaustion, but also because the anæmic brain
when overstrained furnishes a favorable soil for the development of
morbid fears, imperative impulses, and imperative conceptions. This
fact does not seem to have been noticed by most writers. The mind
of the anæmic person is as peculiarly sensitive to psychical
influences as the anæmic visual and auditory centres are to light and
sound; and in a considerable proportion of cases of this kind the
origin of the morbid idea has been traced to the period of
convalescence from exhausting diseases. The prominent position
which masturbation occupies among the causes of cerebral anæmia
perhaps explains its frequent etiological relationship to imperative
conceptions and impulsive insanity.
Although the radical and rational treatment of cerebral anæmia is

covered by the treatment of the general anæmia, there are certain
special symptoms which call for palliative measures. Most of these,
such as the vertigo, the optic and aural phenomena, improve, as
stated, on assuming the horizontal position. The headache if very
intense will yield to one of three drugs: nitrite of amyl, cannabis
indica, or morphine. I am not able to furnish other than approximative
indications for the use of remedies differing so widely in their
physiological action. Where the cerebral anæmia and facial pallor
are disproportionately great in relation to the general anæmia, and
we have reason to suppose the existence of irritative spasm of the
cerebral blood-vessels—a condition with which the cephalalgia is
often of great severity—nitrite of amyl acts as wonderfully as it does
in the analogous condition of syncope.36 Where palpitations are
complained of, and exist to such a degree as to produce or
aggravate existing insomnia, small doses of morphine will act very
well, due precautions being taken to reduce the disturbance of the
visceral functions to a minimum, and to prevent the formation of a
drug habit by keeping the patient in ignorance of the nature of the
remedy. When trance-like conditions and melancholic depression are
in the foreground, cannabis indica with or without morphia will have
the best temporary effect: it is often directly remedial to the
cephalalgia. Chloral and the bromides are positively contraindicated,
and untold harm is done by their routine administration in nervous
headache and insomnia, irrespective of their origin. Nor are
hypnotics, aside from those previously mentioned, to be
recommended; the disadvantages of their administration are not
counterbalanced by the advantages.37 Frequently, in constitutional
syphilis, insomnia resembling and probably identical with the
insomnia of cerebral anæmia will call for special treatment. In such
cases the iodides, if then being administered, should be suspended,
and if the luetic manifestations urgently require active measures,
they should be restricted to the use of mercury in small and frequent
dosage, while the vegetable alteratives may be administered if the
state of the stomach permit.
36 There are disturbances in the early phases of cerebral syphilis, whose exact
pathological character is not yet ascertained, which so closely resemble the condition
here described that without a knowledge of the syphilitic history, and misled by the
frequently coexisting general anæmia, it is regarded as simple cerebral anæmia.
Under such circumstances, as also with the cerebral anæmia of old age, amyl nitrite
should not be employed.
37 Urethran and paraldehyde have failed in my hands with anæmic persons.
Among the measures applicable to the treatment of general anæmia

there are three which require special consideration when the
cerebral symptoms are in the foreground: these are alcoholic
stimulants, the cold pack, and massage. It is a remarkable and
characteristic feature of cerebral anæmia that alcoholic stimulants,
although indicated, are not well borne38—at least not in such
quantities as healthy persons can and do take without any
appreciable effect. I therefore order them—usually in the shape of
Hungarian extract wines,39 South Side madeira, or California
angelica—to be given at first in such small quantities as cannot
affect the cerebral circulation unpleasantly, and then gradually have
the quantity increased as tolerated. In fact, both with regard to the
solid nourishment and the stimulating or nourishing fluids and
restorative drugs the division-of-labor principle is well worth
following. The cerebral anæmic is not in a position to take much
exercise, his somatic functions are more or less stagnant, and bulky
meals are therefore not well borne. Small quantities of food,
pleasingly varied in character and frequently administered, will
accomplish the purpose of the physician much better.
38 Hammond, who classes many disorders under the head of cerebral anæmia which
the majority of neurologists regard as of a different character, has offered a very
happy explanation. He says, “Now, it must be recollected that the brains of anæmic
persons are in very much the same condition as the eyes of those who have for a
long time been shut out from their natural stimulus, light. When the full blaze of day is
allowed to fall upon them retinal pain is produced, the pupils are contracted, and the
lids close involuntarily. The light must be admitted in a diffused form, and gradually, till
the eye becomes accustomed to the excitation. So it is with the use of alcohol in
some cases of cerebral anæmia. The quantity must be small at first and administered
in a highly diluted form, though it may be frequently repeated.”
39 Such as Meneszer Aszu; there is no genuine tokay wine imported to this country,
as far as I am able to learn.
The cold pack, strongly recommended by some in general anæmia,

is not, in my opinion, beneficial in cases where the nervous
phenomena are in the foreground, particularly in elderly persons.
Gentle massage, on the other hand, has the happiest effects in this
very class of cases.
Of late years my attention has been repeatedly directed to cerebral

anæmia of peculiar localization due to malarial poisoning. It has
been noted by others that temporary aphasia and other evidences of
spasm of the cortical arteries may occur as equivalents or sequelæ
of a malarial attack. I have seen an analogous case in which
hemianopsia and hemianæsthesia occurred under like
circumstances, and were recovered from. Whether more permanent
lesions, in the way of pigmentary embolism or progressing vascular
disease, causing thrombotic or other forms of softening, may
develop after such focal symptoms is a matter of conjecture, but I
have observed two fatal cases in which the premonitory symptoms
resembled those of one which recovered, and in which these were
preceded by signs of a more general cerebral anæmia, and in one
case had been mistaken for the uncomplicated form of that disorder.
Where a type is observable in the exacerbation of the vertigo,
headache, tinnitus, and lethargy of cerebral anæmia, particularly if
numbness, tingling, or other signs of cortical malnutrition are noted in
focal distribution, a careful search for evidences of malarial
poisoning should be made; and if such be discovered the most
energetic antimalarial treatment instituted. It is in such cases that
arsenic is of special benefit.
The treatment of syncope properly belongs to this article. Where the

signs of returning animation do not immediately follow the
assumption of the recumbent position, the nitrite of amyl, ammonia,
or small quantities of ether should be exhibited for inhalation. The
action of the former is peculiarly rapid and gratifying, though the
patient on recovery may suffer from fulness and pain in the head as
after-effects of its administration. The customary giving of stimulants
by the mouth is to be deprecated. Even when the patient is
sufficiently conscious to be able to swallow, he is usually nauseated,
and, as he is extremely susceptible to strong odors or tastes in his
then condition, this nausea is aggravated by them. By far the greater
number of fainting persons recover spontaneously or have their
recovery accelerated by such simple measures as cold affusion,
which, by causing a reflex inspiration, excites the circulatory forces
to a more normal action. Rarely will the electric brush be necessary,
but in all cases where surgical operations of such a nature as to
render the development of a grave form of cerebral anæmia a
possibility are to be performed, a powerful battery and clysters of hot
vinegar, as well as the apparatus for transfusion, should be provided,
so as to be within reach at a moment's notice.
Inflammation of the Brain.
Before the introduction of accurate methods of examining the

diseased brain the term inflammatory softening was used in a much
wider sense than it is to-day. Most of the disorders ascribed to
inflammatory irritation by writers of the period of Andral and Rush are
to-day recognized as regressive, and in great part passive, results of
necrotic destruction through embolic or thrombic closure of afferent
blood-channels. Two forms of inflammation are universally
recognized. One manifests itself in slow vascular and connective-
tissue changes and in an indurating inflammation. There are two
varieties of it: the first of these, which is associated with furibund
vaso-motor explosions and regressive metamorphosis of the
functional brain-elements, is known from its typical association with
grave motor and mental enfeeblement as paretic dementia or
dementia paralytica. The second, which is focal in the distribution of
the affected brain-areas, is known as sclerosis. The former is treated
of in a separate article; the latter is considered in connection with the
spinal affections which either resemble it in histological character or
complicate its course. The second form of cerebral inflammation is
marked by the formation of the ordinary fluid products of acute
inflammation in other organs of the body; this is the suppurative
form, usually spoken of as abscess of the brain.
In addition to these two generally recognized inflammatory affections

there are a number of rare diseases which are regarded by excellent
authority as also of that character. The vaguely-used term acute
encephalitis has been recently reapplied with distinct limitations to an
acute affection of children by Strümpell. This disease is usually of
acute onset, infants under the sixth year of age being suddenly, and
in the midst of apparently previous good health sometimes, attacked
by fever, vomiting, and convulsions.40 Occasionally coma follows,
which may last for several days, perhaps interrupted from time to
time by recurring convulsions or delirium. The convalescence from
this condition is rapid, and in some cases is complete; in others
paralysis remains behind in the hemiplegic form. The paralysis is
usually greater in the arm than in the leg; in extreme cases it
involves the corresponding side of the face, and, as the paralyzed
parts are arrested or perverted in growth, considerable deformity,
even extending to asymmetry of the skull, may ensue. The deformity
is aggravated by contractures. Usually there is some atrophy of the
muscles, but in one case I found actual hypertrophy41 of some
groups, probably in association with the hemiathetoid movements.
40 As in my case of infantile encephalitis followed by athetoid symptoms (Journal of
Nervous and Mental Diseases).
41 This was followed by atrophy. There are never any qualitative electrical changes.
The sequelæ of acute infantile encephalitis present us with the most

interesting forms of post-paralytic disturbances of muscular
equilibrium. Hemichorea and hemiathetosis, as well as peculiar
associated movements and hemicontracture, are found in their
highest development with this class of cases. Occasionally
epileptiform symptoms are noted,42 and in others true epilepsy is
developed. It is under such circumstances that imbecility is apt to be
a companion symptom or result; and this imbecility is prominently
noted in the moral sphere.
42 Which in one case of my own disappeared spontaneously.
The grave set of symptoms briefly detailed here are attributed by

Strümpell43 to an acute encephalitis, analogous, in his opinion, to the
acute poliomyelitis of children. Its frequent occurrence after measles
and scarlatina, as well as the fact that Ross44 in a carefully-studied
case arrived at the opinion that the disease was an embolo-necrotic
result of endocarditis, would lead to the conclusion that it is a focal
affection, probably due to the transportation of infectious elements to
the brain through the blood-vessels. Its occurrence in children in the
midst of apparent health45 is consistent with the fact that rheumatism
and an attendant slight endocarditis frequently pass unrecognized in
infancy. It is supposed that a diffuse form of inflammatory non-
suppurative softening exists by some of the Germans, but the proof
advanced in favor of this view is not conclusive.
43 As a surmise, for up to his writing no reliable autopsies had been made.
44 Brain, October, 1883.
45 McNutt (American Journal of Medical Sciences, January, 1885) cites Strümpell as

attributing the theory of an inflammatory affection, which is analogous to poliomyelitis
in its suddenness and nature, to Benedict, and refers to p. 349 of Strümpell's textbook
under the erroneous date of 1864. This work was published in 1883-84, and the
theory is advanced by Strümpell as his own. It is only a synonym, hemiplegia spastica
infantile, that is attributed to Benedict.
A number of rare forms of interstitial encephalitis have been

described. In one, elaborately studied by Danillo, an inflammatory
hypertrophy of the cortex, involving the parenchyma as well as the
connective and vascular structures, was found in a limited area of
the motor province of the right hemisphere. There had been crossed
epileptiform convulsions during life.46
46 Bulletin de la Société de Biologie, 1883, p. 238.
There is some question among pathologists as to the recognition of

Virchow's encephalitis of the new-born. Certainly a part of Virchow's
material was derived from the imperfect study of a condition of
infantile brain-development which, as Jastrowitz showed, is
physiological, and on which Flechsig based his important researches
of tract-development. More recent studies, however, demonstrate
that there is a form of miliary encephalitis in new-born children due to
septic causes, such as, for example, suppuration of the umbilical
cord. The demonstration by Zenker of the occurrence of metastatic
parasitic emboli in cases of aphthous stomatitis, and by Letzerich of
a diphtheritic micrococcus invasion in the brain of his own child,
show that the subject of early infantile encephalitis merits renewed
consideration.47
47 The attempt of Jacusiel to revive Virchow's encephalitis of the new-born (Berliner
klinische Wochenschrift, 1883, No. 7) under the title of interstitial encephalitis does
not seem to have met with encouragement, for, besides Jastrowitz, Henoch and
Hirschberg opposed this view in the discussion.
Strictly speaking, the reactive changes which occur in the brain-

substance bordering on tumors, hemorrhagic and softened foci,
belong to the domain of encephalitis; but as they are considered in
conjunction with the graver lesions to which they are secondary both
in occurrence and importance, it is not necessary to more than refer
to them here.
Abscess of the Brain.
As indicated in the last article, there formerly existed much confusion

in the minds of pathologists regarding the terms softening and
abscess of the brain. As long as softening was regarded as an
inflammation, so long was abscess of the brain regarded as a
suppurative form of softening. Aside from the fact that there is some
resemblance in mechanical consistency between a spot of ordinary
softening and one of inflammatory softening, there is no essential
similarity of the two conditions. True softening is to-day regarded as
the result of a death of brain-tissue produced by interference with the
blood-supply; it is therefore a passive process. Inflammatory
softening, of which abscess is a form, is due to an irritant, usually of
an infectious nature. It is to the results of such irritation that the term
suppurative encephalitis should be limited.
MORBID ANATOMY.—In all well-established inflammatory brain troubles

the active part is taken by the blood-vessels and connective tissue;
the ganglionic elements undergo secondary, usually regressive or
necrotic, changes. The brain, considered as a parenchymatous
organ, is not disposed to react readily in the way of suppurative
inflammation unless some septic elements are added to the
inflammatory irritant. Foreign bodies, such as knitting-needles,
bullets, and slate-pencils, have been found encapsulated in this
organ or projecting into it from the surrounding bony shell without
encapsulation and without any evidences of inflammatory change.
As a rule, a foreign body which enters the brain under aseptic
conditions will, if the subject survive sufficiently long, be found to
have made its way to the deepest part of the brain, in obedience to
the law of gravity, and through an area of so-called inflammatory red
softening which appears to precede it and facilitate the movement
downward. This form of softening derives its color from the colored
elements of the blood, which either escape from the vessels in
consequence of the direct action of the traumatic agent; secondly, in
consequence of vascular rupture from the reduced resistance of the
perivascular tissue in consequence of inflammatory œdema and
infiltration; or, thirdly, in obedience to the general laws governing
simple inflammation.
A cerebral abscess may present itself to the pathological anatomist

in one of three phases—the formative, the crude, and the
encapsulated. In the first it is not dissimilar to a focus of yellow
softening, being, like the latter, a diffuse softened area varying from
almost microscopical dimensions to the size of a walnut, and of a
distinctly yellow tinge. Microscopic examination, however, shows a
profound difference. In pure yellow softening there are no pus-cells;
in the suppurative encephalitic foci they are very numerous, and
congregated around the vessels and in the parenchyma in groups.
The crude abscess is the form usually found in cases rapidly running
to a fatal termination. Here there is an irregular cavity in the brain,
usually the white central substance of the cerebrum or cerebellum,
formed by its eroded and pulpy tissue; it is filled with yellow,
greenish, and more rarely brownish pus. In the most furibund cases
broken-down brain-detritus may be found in the shape of whitish or
reddish flocculi, but in slowly-formed abscesses the contents are free
from such admixture, and thus the third phase is produced, known
as the encapsulated abscess. The cavity of the abscess becomes
more regular, usually spheroid or ovoid; the pus is less fluid, more
tenacious, and slightly transparent; and the walls are formed by a
pseudo-membrane48 which is contributed by the sclerosing brain-
substance, which merges gradually into the outlying normal tissue. I
have seen one acute cerebral abscess from ear disease which might
be appropriately designated as hemorrhagic; the contents were
almost chocolate-colored; on closer inspection it was found that they
were true pus, mingled with a large number of red blood-discs and
some small flocculi of softened brain-substance. This hemorrhagic
admixture was not due to the erosion of any large vessel, for the
abscess had ruptured into the lateral ventricle at that part where it
was most purely purulent. In a case of tubercular meningitis,
Mollenhauer in my laboratory found an abscess in the white axis of
the precentral gyrus, with a distinct purulent infiltration following the
line of one of the long cortical vessels. The abscess was not
encapsulated, the surrounding white substance exhibited an injected
halo, and the consistency of the contents was that of mucoid
material.
48 There is considerable dispute as to the real nature of the tissue encapsulating
cerebral abscesses. It is known, through the careful observations of R. Meyer, Goll,
Lebert, Schott, and Huguenin, that the capsule may form in from seven to ten weeks
in the majority of cases, about eight weeks being the presumable time, and that at
first the so-called capsule of Lallemand does not deserve the name, being a mucoid
lining of the wall. At about the fiftieth day, according to Huguenin, this lining becomes
a delicate membrane composed of young cells and a layer of spindle-shaped
connective elements.
In cases where the symptoms accompanying the abscess during life

had been very severe it is not rare to find intense vascular injection
of the parts near the abscess, and it is not unlikely that the reddish or
chocolate color of the contents of some acutely developed
abscesses is due to blood admixture derived from the rupture of
vessels in this congested vicinity. Sometimes the entire segment of
the brain in which the abscess is situated, or the whole brain, is
congested or œdematous. In a few cases meningitis with lymphoid
and purulent exudation has been found to accompany abscesses
that had not ruptured. It is impossible to say whether in this case
there was any relation between the focal and the meningeal
inflammation, as both may have been due to a common primary
cause.49 In such cases, usually secondary to ear disease,
thrombosis of the lateral sinus may be found on the same side.
Where rupture of an abscess occurs, if the patient have survived this
accident long enough—for it is usually fatal in a few minutes or hours
—meningitis will be found in its most malignant form. A rupture into
the lateral and other ventricles has been noted in a few cases.50
49 Otitis media purulenta in the two cases of this kind I examined.
50 In one, observed together with E. G. Messemer, intense injection of the endymal

lining, with capillary extravasations, demonstrated the irritant properties of the
discharged contents.
Some rare forms of abscess have been related in the various
journals and archives which have less interest as objects of clinical
study than as curiosities of medical literature. Thus, Chiari51 found
the cavity of a cerebral abscess filled with air, a communication with
the nose having become established by its rupture and discharge.
51 Zeitschrift für Heilkunde, 1884, v. p. 383. In this remarkable rase the abscess,
situated in the frontal lobe, had perforated in two directions—one outward into the
ethmoidal cells, the other inward into the ventricles, so that the ventricles had also
become filled with air. This event precipitated a fatal apoplectiform seizure.
The contents of a cerebral abscess usually develop a peculiarly fetid

odor. It has been claimed that this odor is particularly marked in
cases where the abscess was due to some necrotic process in the
neighborhood of the brain-cavity. The only special odor developed by
cerebral abscesses, as a rule, is identical with that of putrid brain-
substance, and it must therefore depend upon the presence of brain-
detritus in the contents of the abscess or upon the rapid post-mortem
decomposition of the neighboring brain-substance.
In two cases of miliary abscess which, as far as an imperfect

examination showed, depended on an invasion of micro-organisms,
an odor was noticed by me which was of so specific a character that
on cutting open the second brain it instantly suggested that of the
first case, examined six years previous, although up to that moment I
had not yet determined the nature of the lesion.52
52 Owing to the lack of proper methods of demonstrating micro-organisms, the first
case whose clinical history was known was imperfectly studied; of the second case,
accidentally found in a brain obtained for anatomical purposes, the examination is not
yet completed.
That form of abscess which, from its situation in or immediately

beneath the surface, has latterly aroused so much interest from its
important relations to localizations is usually metastatic, and directly
connected with disease of the overlying structures, notably the
cranial walls. In this case the membranes are nearly always
involved. The dura shows a necrotic perforation resembling that
found with internal perforation of a mastoid or tympanic abscess.
The pia is thickened and covered with a tough fibro-purulent
exudation; occasionally the dura and leptomeninges are fused into a
continuous mass of the consistency of leather through the
agglutinating exudation. The abscess is usually found open, and it is
not yet determined whether it begins as a surface erosion, and,
bursting through the cortex, spreads rapidly on reaching the white
substance, or not. The white substance is much more vulnerable to
the assault of suppurative inflammation than the gray, and not
infrequently the superficial part of the cortex may appear in its
normal contiguity with the pia, but undermined by the cavity of the
abscess, which has destroyed the subcortical tissue. Possibly the
infecting agent, as in some cases of ear disease, makes its way to
the brain-tissue through the vascular connections, which, however
sparse at the convexity of the brain, still exist.
CLINICAL HISTORY.—The symptoms of a cerebral abscess depend on

its location, size, and rapidity of formation. There are certain parts of
the brain, particularly near the apex of the temporal lobe and in the
centre of the cerebellar hemisphere, where a moderately large
abscess may produce no special symptoms leading us to suspect its
presence. There are other localities where the suppurative focus53
indicates its presence, and nearly its precise location and extent, by
the irritative focal symptoms which mark its development and by the
elimination of important functions which follows its maturation. It is
also in accordance with the general law governing the influence of
new formations on the cerebral functions that an acutely produced
abscess will mark its presence by more pronounced symptoms than
one of slow, insidious development. Indeed, there are found
abscesses in the brain, even of fair dimensions, that are called latent
because their existence could not have been suspected from any
indication during life, while many others of equal size are latent at
some time in their history.
53 Practically, our knowledge of localization of functions in the human brain begins
with the observation by Hitzig of a traumatic abscess in a wounded French prisoner at
Nancy named Joseph Masseau. The year of the publication of this interesting case
constitutes an epoch in advancing biological knowledge, which will be remembered
when even the mighty historical events in which Hitzig's patient played the part of an
insignificant unit shall have become obsolete. This, the first case in the human subject
where a reliable observation was made was an unusually pure one; the abscess
involved the facial-hypoglossal cortical field (Archiv für Psychiatrie, iii. p. 231).
An acute cerebral abscess is ushered in by severe, deep, and dull

headache, which is rarely piercing, but often of a pulsating character.
The pain is sometimes localized, but the subjective localization does
not correspond to the actual site of the morbid focus.54 It is often
accompanied by vertigo or by a tendency to dig the head into the
pillow or to grind it against the wall. With this there is more or less
delirium, usually of the same character as that which accompanies
acute simple meningitis. As the delirium increases the slight rise in
temperature which often occurs in the beginning undergoes an
increase; finally coma develops, and the patient dies either in this
state or in violent convulsions. The case may run its course in this
way in a few days, but usually one to three weeks intervene between
the initial symptoms and death.
54 Although Ross seems to be of a contrary opinion, it is the exception for the pain to
correspond in location to the abscess.
Between the rapid and violent course of acute cerebral abscess

detailed, and the insidious course of those which as latent
abscesses may exist for many years without producing any
noticeable symptoms whatever, there is every connecting link as to
suddenness and slowness of onset, severity and mildness of
symptoms, and rapidity and slowness of development and progress.
It is the encapsulated abscesses which are properly spoken of as
chronic, and which may even constitute an exception to the almost
uniform fatality of the suppurative affections of the brain. Thus, the
symptoms marking their development may correspond to those of an
acute abscess, but coma does not supervene, temporary recovery
ensues, and the patient leaves the hospital or returns to his vocation.
But all this time he appears cachectic, and there will be found, on
accurate observation, pathological variations of the temperature and
pulse. The appetite is poor; the bowels are usually constipated; there
are frequent chilly sensations and horripilations, and a general
malaise. This condition slowly passes away in the few cases which
recover; in others relapses occur, usually of progressing severity,
and terminate life. The period during which the symptoms of the
abscess are latent may be regarded as corresponding to the latent
period which sometimes intervenes between an injury and the
development of the symptoms of acute abscess, and which,
according to Lebert, may comprise several weeks or months. In
other words, the morbid process may be regarded all this time as
progressing under the mask of a remission. It is this latent period
which it is of the highest importance for the diagnostician to
recognize. There is usually headache, which is continuous and does
not change in character, though it may be aggravated in paroxysms.
Usually the temperature rises with these paroxysms, and if they
continue increasing in severity they may culminate in epileptic
convulsions.
Many of the symptoms of cerebral abscess—prominently those

attending the rapidly-developed forms and the exacerbations of the
chronic form—are due to cerebral compression. It is the pulse and
pupils, above all, that are influenced by this factor.
In an affection having so many different modes of origin as cerebral

abscess, and occupying such a wide range of possible relations to
the cerebral mechanism, it is natural that there should exist many
different clinical types. So far as the question of the diagnosis of
localized cerebral abscesses is concerned, I would refer to the article
dealing with cerebral localization, in order to avoid repetition. With
regard to the etiological types, they will be discussed with the
respective causal factors.
ETIOLOGY.—Abscess of the brain is so frequently found to be due to

metastatic or other infectious causes that it is to be regarded as
highly improbable that it is ever of idiopathic occurrence. The most
frequent associated conditions are—suppurative inflammation in
neighboring structures, such as the tympanic cavity, the mastoid
cells, the nasal cavity, or inflammation or injury of any part of the
cranium and scalp. The connection of these structures with the brain
through lymphatic and vascular channels is so intimate that the
transmission of a pyogenic inflammatory process from the former to
the latter is not difficult to understand. But disease of far distant
organs, such as gangrene of the lung, and general affections, such
as typhoid fever, occasionally figure among the causes of cerebral
abscess, particularly of the miliary variety.
Among the commonest causes of cerebral abscesses are those

which the surgeon encounters. The injury may be apparently slight
and limited to the soft parts, or the bone may be merely grazed.
Gunshot wounds are particularly apt to be followed by a cerebral
abscess; and it has been noted that those which granulate feebly,
whose base is formed by a grayish, dirty, and fetid material, are most
apt to lead to this ominous complication. The symptoms do not
usually develop immediately, and after the surgeon is led to indulge
in the hope that danger is past, proper reaction sets in, healthy
granulations develop—nay, the wound may close and be undergoing
cicatrization—then the patient complains of feeling faint or drowsy,
and with or without this premonition he has convulsive movements of
one side, sometimes involving both extremities and the
corresponding side of the face. Consciousness is usually preserved,
but the spells recur, and the patient is noted to be absent-minded
during and after the convulsive seizure. On some later day he is
noticed to become pale, as in the initial stage of a true epileptic
seizure; total abolition of consciousness follows, and the clonic
spasms, affecting the same limbs and muscles involved in the first
seizures, now recur with redoubled violence. After such an attack
more or less paresis is observed in the muscles previously
convulsed. A number of such seizures may occur, or a fatal issue
terminate any one of them. Not infrequently the field of the involved
muscles increases with each fit. Thus the thumb or a few fingers
may be the first to show clonic spasm; in the next fits, the entire arm;
in succeeding ones, the leg and face may follow suit. In such a case
the periphery first to be convulsed is the first to become paralyzed,
thus showing that where the disease began as an irritative lesion the
cortex is now destroyed, and that around the destructive focus as a
centre the zone of irritation is spreading excentrically, first to irritate
and then to destroy seriatim the functions of the various cortical
fields in their order. According to the teachings laid down in the
article on Localization, the order of invasion and extension, as well
as the nature, of the focal symptoms will vary. Finally, the attacks
become more severe and of longer duration; the patient does not
recover in the intervals, but complains of nausea, pain, confusion,
and head-pressure. He is noted to be dull, his temperature is slightly
raised (100° F.), and the speech may be affected. Several attacks
may occur in a day, each leaving the patient more and more crippled
as to motility and mind. He is delirious and drowsy at intervals; his
temperature may rise after an attack from one to four degrees,
usually remaining near 103°–104° F. in the evening; and, coma
developing, death occurs, the convulsion or paralytic phenomena
continuing at intervals during the moribund period, and the
temperature and pulse sometimes running up rapidly toward the last.
On examining the parts, it is found that the bone is necrotic at the
point of injury, usually only in its outer table, but sometimes in its
entire thickness. In exceptional cases the normal continuity of the
entire table is not interrupted to all appearances, and a small eroded
spot on the inner table is found bathed in pus, or a detached necrotic
fragment may be found in the latter. Corresponding to the purulent
focus on the inner table the dura mater is detached, discolored, and
perforated in one or more places with irregular rents or holes which
have a greenish or blackish border. An abscess is found in that part
of the brain which corresponds to this opening. There is no question
that it was caused by direct infection from the necrotic spot.
Cases have been noted,55 apparently of idiopathic origin, in which a

sudden paralysis of a few fingers was the first symptom produced by
the development of a cerebral abscess. In a few days such a
paralysis extends to the other fingers and to the forearm.
Occasionally no convulsive phenomena are noted, or choreic
movements indicate, in their place, that the cortical field is irritated.
Such cases usually run a rapidly fatal course.
55 Arthur E. W. Fox, Brain, July, 1885.
The most frequent cause of cerebral abscess in civil practice is

suppurative inflammation of the middle ear. It may be safely asserted
that the person suffering from this affection is at no time free from the
danger of a cerebral abscess, a purulent meningitis, or a phlebitic
thrombosis of the sinuses. Cases are on record where the aural
trouble had become chronic, and even quiescent, for a period of
thirty years, and at that late date led to abscess with a fatal
termination. Of 6 cases of this character in my experience, 4 of
which were verified by anatomical examination, not one but had
occurred at least four years after the commencement of the ear
trouble, and 1 happened in a man aged fifty-four who had contracted
the latter affection in childhood. In 2 there was in addition diffuse
purulent meningitis, limited on the convexity to the side where the
abscess was situated.56 In 4 the abscess was in the temporal lobe, 1
of them having in addition an abscess in the cerebellar hemisphere
of the same side; in a fifth the abscess was in the deep white
substance of the cerebral hemisphere, opening into the lateral
ventricle, and in the sixth it was in one cerebellar hemisphere alone.
56 One of these was seen during life by J. R. Pooley; the other was a paretic dement
at the New York City Pauper Asylum.
The course of this class of abscesses is usually obscure: focal

symptoms are not commonly present, and the constitutional and
local symptoms usually appear as a gradual outgrowth from the
aural troubles. Thus there is at first usually little fever, vertigo, and
chilliness, but considerable tinnitus, and sometimes pain in the ear.
Occasionally local signs of a septic metastasis of the otitis, such as
œdema over the mastoid or painful tumefaction of the cervical
glands, are visible. The pain previously referred to the region of the
ear now becomes general; commonly—even where the abscess is in
the temporal lobe—it becomes progressively aggravated in the
frontal and sometimes in the nuchal region, and under an increase of
the febrile phenomena death may exceptionally occur without further
complication. Even large abscesses in one half of the cerebellum
occur without producing Ménière's symptom—a fact which leads to
the suspicion that the purulent deposit must have been of slow and
gradual development. In one case distinct symptoms indicating an
affection of the subcortical auditory tract were observed. As a rule,
this class of abscesses are accompanied toward the close by active
general symptoms—convulsions, coma, narrowing and impaired
light-reaction of the pupils. Delirium, when a prominent symptom
from the beginning, indicates the probable association of meningitis
with the abscess.57 Occasionally severe pain, rigor, high
temperature, and paralysis may be absent even with rapidly-
developed abscess from otitis.58
57 The same is probably true of oculo-motor paralysis, which Ross (loc. cit., vol. ii. p.
735) refers to uncomplicated abscess.
58 This was the case with an abscess containing five ounces of pus recorded by C. S.
Kilham at the Sheffield Medical Society (British Medical Journal, February 13, 1886).
As illustrating what was stated about the non-correspondence of the pain and the
location of the abscess, it may be stated that notwithstanding this large abscess was
in the temporal lobe, what pain was present was in the forehead.

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Threat assessment and management

strategies identifying the howlers and

Threat assessment and management strategies identifying

The insider threat: assessment and mitigation of risks

Violent and sexual offenders assessment treatment and

Threat assessment and risk analysis : an applied

ADHD in the schools assessment and intervention

Emergency management concepts and strategies

The American Psychiatric Publishing Textbook of Suicide

Fish reproductive biology implications for assessment

Threat Assessment and

Threat Assessment and

Boca Raton London New York

CRC Press is an imprint of the

No claim to original U.S. Government works

International Standard Book Number-13: 978-1-4987-2185-1 (eBook - PDF)

Preface to the First Edition xiii

1 Establishing Threat Management Processes 3

2 Identifying Problem Individuals 25

3 Assessing Problem Individuals 43

4 Managing Problem Individuals 59

5 Introducing Hunters versus Howlers 87

Purpose of Section II: Identifying the Howlers and Hunters 94

6 Defining Hunters and Howlers 101

7 Understanding Hunters 119

8 Understanding Howlers 143

9 Working with the Intimacy Effect and the Law 171

10 Working with the Hunter, Howler, and Other Concepts 195

Recommended Threat Management Strategy 208

October 3, 2014, in author’s personal possession.

Implementing an Effective Threat Management Process

Recognize the Need for Threat Management Processes

• An average of 11.4 incidents occurred each year of the study.

• 32 killed, 7 wounded at Virginia Tech on April 16, 2007

Assign Responsibility to Manage Inappropriate

* A study of active shooter incidents, p. 7.

seem to care? News.Mic.

Provide Training and Liaison with Potential

Inappropriate Inappropriate Physical Physical Assault

Verbal or written threats Bullying Intimidating Inappropriate Use of a firearm

Figure 1.1 Spectrum of inappropriate behaviors. (From Authors’ personal possession.)

Create an Incident Tracking System with Well-Documented Files

Controlling the flow of information requires information management. Depending, again,

There are a number of organic affections of the brain which are in

TREATMENT.—Chronic as well as acute cerebral anæmia, dependent

Although the radical and rational treatment of cerebral anæmia is

37 Urethran and paraldehyde have failed in my hands with anæmic persons.

Among the measures applicable to the treatment of general anæmia

The cold pack, strongly recommended by some in general anæmia,

Of late years my attention has been repeatedly directed to cerebral

The treatment of syncope properly belongs to this article. Where the

Inflammation of the Brain.

Before the introduction of accurate methods of examining the

In addition to these two generally recognized inflammatory affections

The sequelæ of acute infantile encephalitis present us with the most

The grave set of symptoms briefly detailed here are attributed by

44 Brain, October, 1883.

45 McNutt (American Journal of Medical Sciences, January, 1885) cites Strümpell as

A number of rare forms of interstitial encephalitis have been

There is some question among pathologists as to the recognition of

Strictly speaking, the reactive changes which occur in the brain-

As indicated in the last article, there formerly existed much confusion

MORBID ANATOMY.—In all well-established inflammatory brain troubles