The Virginia Tech massacre has, I'm sure, prompted scores of instructors to soul search and review past and present classes for troubled, disturbed students who might and who could harm themselves or others.

The question is how far should an instructor go to ensure the student receives the appropriate counseling (psychiatric care, long-term, etc.)? Seung-Hui Cho, the student responsible for the Virginia Tech massacre, had an English professor who went to exceptional lengths to direct him to counseling and to alert others. But somewhere between juggling campus counseling and off-campus/outpatient care, the necessary psychiatric treatment appeared to stop.

In my ongoing classes on ethics I now intend asking all participants to brainstorm the "ethics of responsibility" toward students or colleagues. How far do you go before becoming entangled or thwarted by laws regarding a patient's right to privacy?

Those of us who teach any form of bodywork involving a lot of movement, stretching, qi exercises, and a range of practical techniques, well know the speed with which we can spot a student who is emotionally troubled, depressive, has sensitive issues around touch, or may have experienced violence or past abuse. Such problems may not always be verbalized by the student, but subtle clues will filter through body language, as well as interaction with other students during group exercises and treatment exchanges.

A compassionate and mindful instructor can note these clues to see if there is a repetitive pattern or a subtle transformation during the semester. Watchful instructors always reassure students that they have the right to discuss (in private, if necessary) any issue. Whether it is an issue of discomfort, or having to do with a technique or range-of-motion procedure performed too quickly or mechanically, or an application of pressure performed too deep, too quick or too reminiscent of some clumsy past medical procedure - the instructor should be available for discussion. However, even the most observant and interactive instructor can miss nuances in a large class unless students voice them. We all know it's vital to deal with these problems immediately and decently, especially if there is any misunderstanding between students on a physical or emotional level. Cultural or language differences can often prompt miscommunication.

I have helped train scores of shiatsu therapists and future instructors during nearly 25 years in schools across the U.S., Canada, Germany, Switzerland, and recently in Ireland, Holland and Austria. Most students work consciously to evolve through the program, especially when they experience the transforming multi-layered effects of in-depth qi training. We have all encountered the occasional Mr. or Ms. Perfect Arrogance who knows everything. There's also, of course, the qi prince or princess who doesn't want to work with this or that student, or those mercifully-few disruptive students who act out any patterns of behavior carried over from home, high school or college.

In all my years of teaching, only one student lingers in my consciousness as being seriously and deeply troubled. To protect his identity, I'll call him "Bobby" and won't mention the name or location of the school. He was new to the city where I taught, and several hours by air from his home town, family and friends. Bobby was in his early 20s, and eager to start a career in some form of alternative healing. But after a few classes, I began to notice signs of extreme distress and agitation. Bobby would break out in a sweat, found it hard to focus, especially when performing practical techniques. He began to arrive late for each class and would ask to leave early.

These red flags prompted a talk with him alone. First, I asked about his time management. He explained that he had been receiving herbal advice from such-and-such naturopath in town, chiropractic adjustments from a local DC, and acupuncture from different practitioners in town. Their schedules sometimes conflicted with class, he told me. I voiced my concerns and observations. It really wasn't wise for him to leapfrog from practitioner to practitioner like a "clinic junkie." He said that as he was starting a career in the health profession, people told him he should sample everything that was out there. "Sample?" I asked. "And for what reason?" After a pause, he told me he had decided to take himself off anti-depression medication as he thought "Western medication" was taboo in the "alternative healing" community.

I hit the roof. I asked if he had consulted his primary physician. No, he had not. I told him about the dangers of suddenly coming off prescription meds without close supervision. I asked if he had shared this piece of information with the variety of practitioners he was currently consulting. No, he had not. Again, I expressed deep concern. I began to wonder if Bobby was shedding his meds and advice from his hometown physician as part of what he considered to be his own personal growth. He then told me he had been on anti-depression meds since his teens and a "suicide attempt," but was trying hard to put all that behind him. Yes, he admitted he was also suffering from acute insomnia.

At that point, I knew I had to do more than merely talk to Bobby. At my insistence, he agreed to call his family physician. But a complication arose as the physician could not, as I understood it, prescribe new meds on the basis of a phone consult. Because he had no health insurance coverage out of his home state, he had problems connecting with a local mental health outpatient clinic. So I asked close colleagues of mine who were counselors and psychiatric RNs to talk to Bobby. All agreed it was imperative for him to seek more in-depth psychiatric help and resume his meds under supervision. At that stage, I felt family involvement was paramount, and established that his family situation was sound and supportive which was vital under the circumstances. My main concern was his personal safety. I sensed he was hallucinating and had suicidal thoughts, but never felt he was a danger to others. As he seemed in no shape to continue his training, my close colleagues and I agreed we should encourage him to return home. Other colleagues rolled their eyes and accused me of behaving like a "mother hen."

Finally, he drove home in a frenzy, reaching his home in just a couple of days. His mother called me late the night he returned to say, "Bobby just walked in the back door. Thank you for all you did." I felt relief knowing he was home, but wondered if I had done enough.

According to state laws, instructors or counselors may not call the parents of any student over the age of 18, without the student's permission. I am sure many of us would defy that law if faced with a drastic or life-threatening situation. Tight laws regarding patient privacy have also prevented names of those who have received treatment for mental illness from appearing on FBI lists, which would bar them from purchasing firearms.

What is an instructor's responsibility? Those of us who teach both practical and didactic classes within the health profession probably observe more patterns of physical and emotional behavior in the classroom than teachers of purely didactic classes. As teachers, we all enjoy a dash of eccentricity in our students, but that behavior, of course, is not cause for concern. How well I remember the student in Berlin who used to come to class with lumps of mud hanging in her hair. "Mud is healthy," she would say. And how well I remember those (mercifully-few) students who felt that personal hygiene was "bourgeois." But they usually got the message well before student clinic.

Regarding seriously disturbed students, we have a double responsibility, not only to them, but to their future patients. So my advice to any new instructor is this. If a student's behavior seems emotionally erratic, violent or if the student consistently shows signs of distress, then act. Do something. If in doubt, consult your peers or the school's directors. Make sure the student is counseled and make sure that someone, if not you, tracks the student's progress. Yes, this can take time, but it could save a life, if not many lives.