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When are mental health professionals at risk?

November 9, 2009
by Dennis Grantham, Senior Editor
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Psychiatrist-turned-shooter at Fort Hood was well trained.  What went wrong?

On paper, Major Nidal Malik Hasan would have appeared well suited for US Army service and deployment and into the troubled Middle East: He was an Arab American, a practicing Muslim trained in medicine and skilled in psychiatry, an increasingly important wartime specialty. But beneath this façade, he was also a man in crisis. He was disillusioned about his career. He faced deployment to Afghanistan and a war that made him an enemy of those who shared his faith. His anguish over this prospect —or perhaps, the influences of another yet-unseen factor—so compromised him that he ultimately carried out a shooting spree among unarmed and innocent fellow soldiers.

The continued deluge of news reports indicates that, while many got a glimpse of Hasan’s struggles, no one could put all of the pieces together in time to prevent tragedy at Fort Hood. Would it have been possible for anyone to do so?
Case loads are heavy for a military psychiatrist treating patients with horrifying and gruesome memories. Today, just over 400 Army psychiatrists serve more than 550,000 active duty troops. A 2007 Veterans Administration study found that among 205,097 seeking VA care after deployment in Iraq or Afghanistan, over 73,000 (36 percent) received a diagnostic code for a mental disorder and, of these, over 33,000 were diagnosed with post-traumatic stress disorder (PTSD). Certainly, Army psychiatrists like Hasan would have to deal with a remarkable amount of pain and suffering.
Hasan joined the Army against the advice of his parents and appeared to struggle for years to reconcile his obligations as an Army psychiatrist with the strictures of his Muslim faith, a faith to which he turned for consolation following the death of his mother in 2001. Stationed at Fort Hood, the primary deployment gateway for Army personnel heading to Iraq and Afghanistan, Major Hasan was “mortified” at the prospect of his likely deployment to Afghanistan since, according to some practitioners of his faith, a Muslim who fights and kills other Muslims is condemned.
He was also the target of some racial and religious harassment which, although not physically threatening, could have caused unknown anger, resentment, and isolation.
As we all know, it ended badly. Investigators assigned to the Fort Hood shootings in Killeen, Texas, where 13 were killed and 29 wounded, are seeking evidence that links Major Hasan to a terrorist plot. In the absence of such an obvious explanation, investigators must sort through an awful series of questions as to why an Army-trained psychiatrist, a fellow in disaster psychiatry, and a former psychiatric resident at Walter Reed Hospital in Washington, D.C., would unleash a disaster among his fellow soldiers. Hasan enlisted in the Army following college in 1997, completed a medical degree in 2003 and began serving a seven-year Army obligation with a two-year fellowship in psychiatry at Walter Reed Army Medical Center. During that time, reports say that Hasan became disillusioned with Army service and angered by anti-Muslim harassment. In early 2004, he sought advice from an attorney about obtaining an early discharge from the Army. However, the New York Times reported, his status as a much-needed mental health professional and an Arab American made such a discharge unlikely.