Some patients at St. Elizabeths Hospital in Washington, D.C., are
designated “White House cases.” To gain that distinction,
they first display some type of bizarre behavior at the White House or
other prominent public building. They are then referred to the federal
mental hospitaly by a Secret Service agent who considers them to be
mentally disordered and potentially dangerous to a public official.
How dangerous, in fact, are these individuals? David Shore and
colleagues at St. Elizabeths reviewed Secret Service records of 328
White House cases treated between 1971 and mid-1974. Although 22
percent of this group threatened a prominent politician before or after
hospitalization, none of them had made an assassination attempt as of
August 1984. One of the patients, however, shot and killed a Secret
Service agent in 1980, and two others assaulted nonpoliticians. The
typical White House case was an unmarried, white male with a diagnosis
of paranoid schizophrenia, report the investigators in the March
AMERICAN JOURNAL OF PSYCHIATRY. Many patients sought to advise or gain
help from the President, who had been incorporated into their delusions
as a benevolent authority.
Shore and co-workers are now examining whether White House cases
were more likely than the general population to be arrested for violent
crimes during the follow-up period.