What happened at Fort Hood? Why would a psychiatrist, a physician trained in the treatment of “mental and nervous” disorders, go on a rampage against his own comrades? I suspect we will be reading about the following in the days ahead:
1. Did Major Nidal Malik Hasan, the accused murderer, have proper supervision of his work and his own fitness for duty? Did he suffer from a psychiatric disorder of his own and was he being treated? News accounts suggest that he was terrified in anticipation of an expected deployment to Iraq or Afghanistan.
2. To what extent did he feel marginalized within the Armed Services? He is said to be a man born in the USA, the son of immigrant parents. It is also reported that he had become increasingly devoted to his Muslim faith and might have experienced some harassment from other soldiers because of his religion.
3. Was the Major marginalized in other ways? He is described as a 39-year-old bachelor who had been looking unsuccessfully for a mate.
4. Major Hasan is believed to have treated numerous veterans suffering from PTSD (Post Traumatic Stress Disorder) returning from the Middle East. Is it possible that he suffered a form of vicarious trauma from hearing the disturbing, if not tragic stories of these young people?
5. To what degree have the Armed Services been able to reform an organizational culture that discourages soldiers from showing emotional vulnerability and seeking treatment before they become dysfunctional? It is one thing for the returning wounded veterans to get psychiatric services; it is another for them to believe, early on, that their anxiety, worry, and depression will not be seen as a weakness by their comrades, make it harder to perform their duties in war-time, and cause them to be ridiculed? Did Major Hasan, who apparently had not experienced combat himself, believe that his own inner-turmoil was acceptable and would have received support from his superiors?
6. Did Dr. Hasan have a history of having received treatment prior to his entrance into the military? If Dr. Hasan did seek treatment at any time, what was the result? Is their any routine assessment of the psychological status of both the soldiers and those who are given the task of treating them? Does the military realize that the nature of their work puts virtually all personnel at psychological risk?
7. What security procedures exist in military installations such as Fort Hood?
8. Is the military sensitive to cultural conflicts that are experienced by its uniformed personnel?
Most of us assume that mental health professionals have their own personal lives well under control. Unfortunately, such is not always the case. For more on this subject, please read my recent blog: “When Helping Hurts: Therapists Who Need Therapy.”
Dr. Gerald Stein 
Good points raised
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I cannot tell you the countless stories I hear from African American and Hispanic/Latino veterans who have experienced racial microaggression and discrimination in the military. I have not read into this tragedy, but those who identify as Muslims are treated more harshly than other minorities in the military. Military personnel should be on the same side, but it does not often feel that way when you are a minority. You have excellent questions! I am sure that the training involved coupled with the culture of the military influences hate speech. If the enemy is largely seen as Muslim, the rifle range, the PT, and the discussions during wartime will include verbal attacks against Muslims during their preparation exercises for Defense. In the Marines, we were trained to say “Kill, kill, kill” before entering the chow (mess) hall. After basic, your training with your company/platoon is more casual, so you add words after those kill words. It conditions you to fight the enemy without emotion. To exterminate your target. To hate the enemy so much that you are prepared to die in defense of your country. You identify as a representative of your country and learn to see the other country as the enemy. You are conditioned. My father was conditioned to hate Japanese people, since he fought in WW2. You can only imagine what my Japanese mom and us half-Japanese kids went through during his flashbacks or otherwise. But my experience is vastly different from the experiences that the Muslim person must have faced with his clients. Psychologists in the military have more flexible boundaries than those in the civilian sector. Conflict of interest in military settings is almost non-existant because everyone’s therapist is the same. It is similar at the VA, too. My vet friends and I have the same therapist. The therapist joins us on outings funded by the VA, such as weekend equine therapy and sky diving (recreationally). When the therapist is under verbal attack by a bunch of their military clients, it will feel like psychological warfare. Talk about the worst nightmare you can experience as a therapist, and the fears about not only the reaction of one client, but that of a whole gang of clients who are trained to kill. I can sympayhize without condoning hostile and lethal behavior on both sides. I can somewhat imagine what everyone went through without knowing what it is like to be in that particular situation. I suspect that you can too, based on your questions.
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Thank you, Multinomial. Very informative. Creating people willing to kill, no matter what the rationale and necessity, can only have unintended and tragic consequences. Treatment by military personnel, I imagine, must attempt to achieve wholeness without robbing them of this capacity. I wonder how much the conflicting agendas (as, compared to civilian counselors) are frankly discussed within the body of military psychologists.
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Hi Dr. S. You’re totally right. Admittedly, I felt sickened by the fact that it would be my job to kill someone one day, and to be very honest, I’m so glad that I never had to do that as part of my job. I don’t know how I’d live with myself, even if it were the enemy, though I’ve been trained to think of it as a positive. Even the drill instructors yelled at me for being “too nice,” and then they made me “lay reader,” which requires me to pray with the recruits before lights out, which I absolutely loved, actually. I think the poor military psychologists need psychologists of their own; it is stressful enough, I imagine, to be a therapist in civilian life, but in military life, I cannot fathom that. The psychologists and/or psychiatrists sometimes deploy with the company, and so they might actually witness warzone stuff, in addition to hearing it. When psychologists see their clients in training, they must wonder how they can keep them “thinking positively” in a very hostile environment. “PMI” or “positive mental attitude” is mentioned during basic and thereafter, but the “positive” is more in line with the mission, not so much about preserving your life or detecting when PTSD is about to hit you head on. A lot of people in the military are afraid of getting slapped with a PTSD diagnosis (or worse, a personality disorder or adjustment disorder diagnosis) because it could mean a less than honorable discharge, a career killer, a “weakness,” a lack of effort on their part, and the horrid words “unfit for duty.” Many would rather get a medical discharged, but many are also afraid of getting med-boarded out. Instead of treating military personnel with the best care they deserve to get back out in the fighting ring, so to speak, they are more afraid of their reputation when it comes to any of their diagnoses – mental or physical. I’m wondering how that affects the way the soldiers interact with therapists, and how therapists in the military struggle to interact with soldiers and keep their own mental health practices in line with what the military would deem “mission critical.” Would there be an ethical dilemma involved when the therapist would like to treat the clients with the proper care but can’t because of what their own mission calls for? Do therapists in the military have their own agendas and missions? I’ve always wondered that, and more. I could never be a therapist, and I don’t know what in the world compelled me to think that I could. I see how hard you’ve worked, my own therapists have worked, and the grad students work. That’s just not something I’d be good at or comfortable with; I do have too many hangups that I’ve not resolved, but I can still apply psychology to research without the clinical. It is amazing, however, to learn about all that the therapists struggle with. In my mind, you guys are like heroes because you help save lives and keep the peace. You do more than what society gives you credit for! And us “clients” sometimes give therapists hell.
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Thank you again for this, Multinomial. Among the many things I couldn’t do, serving in combat surely would be one. I doubt that heroism is a requirement for being a good therapist, but we try to make the world better. Even as civilians, we still have our ethical dilemmas and conflicts of interest. No human being can escape them and they are so easily rationalized.
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Thank you, too, Dr. S. 🙂 Indeed, you do make the world better. And a hero is more than war fighting and nation defending; to me, a hero is the kind of person who cares enough to change lives, prevent a person from committing suicide, help others change the way they think so that they can live a life in peace, etc. To be honest, as much as I love the hero archetype, the reality of it isn’t something that I would be good at. The Marines would hate me for admitting that, but I would rather see world peace than victory by the number of death counts on the enemy’s side. Life is so important.
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