The Fort Hood Shooter: A Psychiatrist?

As details begin to emerge from the Fort Hood shootings (you can read the CNN article here), it appears that the shooter, Dr. Hasan, was in fact, a Psychiatrist. Not only that, but he was considered an excellent clinician who had been treating military trauma victims. More information about this should come out over the next few days (some are calling this an act of terrorism, in part due to the fact that his name appears to be Muslim), but I wanted to share some initial thoughts.

I’ve made no secret of the fact that I view mental health professionals as just as quirky, neurotic and idiosyncratic as the general population. Perhaps even more so. I’ve discussed Dr. Gail’s OCD, Dr. Pete’s Social Phobia, and Dr. Steve’s raging narcissism. And if you’re fairly new here, do note that I’ve never spared myself while doing so (feel free to comb through the Archives to read about my own…problems). But I’ve usually painted these people in at least a somewhat humorous and light-hearted manner, with the goal of showing that all of us are flawed and fragile in our own way. It’s part of the human condition. I’ve never discussed more serious mental illness as it relates to my peers, so I’d like to touch on that subject now.

I agree with the professional in the CNN article who points out that most people who work with trauma can experience a vicarious, depressive and anxious state, but that such extreme action like Dr. Hasan’s is not part of the process. This doctor must have had much, much more going on with him. Perhaps he suffered from a psychotic disorder, although that in and of itself doesn’t greatly increase the risk of violence in people. Psychotic conditions such as Schizophrenia and Delusional Disorder paired with substance abuse do, however, greatly increase the risk of harm to others, so these are factors worth considering. If this man perhaps suffered from PTSD, along with a possible psychosis and/or a substance abuse issue, why was he not getting treatment himself? In fact, why not treatment if he experienced just one of these issues? The reality is that we don’t always know who, if anyone, has a mental illness, and we rarely look at the healers as those with the disease.

I’ve met a few mental health clinicians with severe mental illness. One suffered from extreme paranoia, believing the government was plotting to arrest him for no viable reason. He took strong anti-psychotic medications to remain functional and stable at work. Another had suffered an assault and was so traumatized by it that she would often approach and scream at strangers who reminded her of the perpetrator, truly believing she needed to protect herself from them. And yet another had a history of violence and substance abuse, to the point that he needed to be supervised nearly every minute of the work day just to keep his license.

Cardiologists get heart problems, vascular surgeons experience strokes and shrinks suffer from mental illness. If you don’t view what Major Hasan did as a symptom of a psychiatric disorder and just an act of terrorism or hate, then this post will fall flat for you. But for the rest of us we have to realize that no one is immune from mental illness. You can believe as much as you’d like that your brain is strong, but that doesn’t mean it can’t possibly crash and burn on you.

Did Dr. Hasan have a greater responsibility to seek help, given his job description and training? Yes. But sometimes the illness itself prevents people from getting treatment. If he suffered from a psychotic disorder, perhaps he believed that he would be persecuted if he disclosed any violent thoughts. This would be an even greater possibility if he considered how people might respond to his last name. And, sadly, there are still plenty in my field who still see help-seeking as only for the “weak and crazy,” even as they tell their patients to believe the opposite. Dr. Steve holds that view and he’d need to be standing on the edge of a building before even considering an admission of mental distress.

This post was written early on in the investigation of what went on at Fort Hood so many elements may change over the next few days. But the fact that severe psychiatric illness is present in the mental health community does not. These providers need to dig deep, acknowledge the reality of sickness and get the help they need. Until then, we’re not really putting the dent in the world of mental disorders that we claim we are.

18 Responses to “The Fort Hood Shooter: A Psychiatrist?”

  1. Lindsey says:

    I saw this earlier today in the New York Times… It made me sad. Years ago, when I was interested in going into Psychology, I was concerned that having depression would be a problem, a “conflict of interest” if you will. However, as you mentioned, there are certainly many people in the field who suffer from mental illness, because we’re all human, and some of us are bound to have a few flaws in that department.

    I do find it really sad that he, for whatever reason, didn’t get help. One of the best parts of being in the field of Psychology is learning that there are some pretty good treatments for things, and I’m surprised he let it get so bad… I’ve always thought you have to be pretty far gone to do something that violent.

    Like you said, I’m sure we’ll hear more, but it’s tragic.

  2. Most people forget that in addition to our professional lives….we are people too. I was saddened to hear about this incident, but moreso to read that there were warning signs, which may or may not have been discounted because of his position.

    I think it is important to acknowledge the idea of vicarious traumatization, which is the secondary traumatization of the caregiver and/or professional who deals with other people’s trauma on a regular basis. Pearlman (and others) have written on this topic, and I think clinicians often over-estimate our abilities to leave our work at work, and under-estimate how constant exposure to traumatic material can negatively impact how we experience the world. I don’t do much trauma work any more, but I can very much see how someone who does can be effected by hearing horrible things day after day.

    Friedman has written some good stuff on self-care that I think all clinicians should read. (Dr. Rob, I have some good references if you are curious.

  3. Keith M says:

    As a master’s student in mental health counseling with bipolar disorder and ADHD, I find this article hitting close to home. I’ve sometimes worried about whether or not I was fit to work in this field when I myself have had problems. The conclusion I have come to, after much thinking (and even an email to you, Dr. Rob) is that in fact I am able to work in this capacity, and my experience may even make me a better clinician. At any rate, my therapist has expressed amusement at the possible challenge of treating a student of therapy, so that’ll be fun, anyhow.

    Thanks for writing this article.

  4. Rob Dobrenski says:

    Yes, definitely send me those references if it’s not too much trouble.

  5. Toni says:

    Fort Hood has had the most soldiers killed in Iraq and Afghanistan. There have been 75 suicides there since 2003, and ten this year. The base has been forced to build spiritual and mental fitness centres; but knowing the military, it’s probably career suicide to utilise those places in any meaningful way. Over here in the UK the media is basically playing it as an “evil Muslim sleeper cell” story, but it seems far more likely that this man was mentally ill and simply couldn’t deal with a situation that many people have obviously found difficult at the base.

  6. Anthony says:

    Hi Dr Rob, a couple of things: first up I wouldn’t worry about the tucker/rudius hate – it’s coming to your site because you were the only one that really explained anything and you’re on the wikipedia link – its happening now i guess due to the failure of the film – the imdb hate group really hit its strides for a couple of weeks there. Don’t worry about it, it’ll go away.

    Secondly, thanks for blogging, please keep it up – I’m not sure how to express things, but I think it’s helping me (even though I should probably go to a psych in person) – you seem different to all the psychs i know (just personally, not session wise) although i’m sure they’re all good people, you just seem a lot more open. Thanks, and please keep it up – i find it easier to read general thoughts on psychology (i’ve pretty clearly got depression – not self diagnosed, it’s just really obvious to those around me) than to be asked questions – that makes me uncomfortable.

    On the topic of the shooter – I’m sure there was interplay between his own psychological illnesses as well as his faith, the wars in iraq and afghanistan and the pyschological trauma he was exposed to through his work on base. He was wrong – but he didn’t really seem evil, just like he’d had enough I guess.

    Anyways, this is becoming a really long creepy rant now (didn’t mean for it to be), but I just wanted you to know that your stuff is helping people out. Wishing you the best and I’ll be sure to buy your book when it comes out (if it’s half as good as this site, it’ll have no problems getting published).

    Thanks again, and your passion for psychology really comes across. Good luck.

  7. Rob Dobrenski says:

    This was sent in from a friend in via email due to length, but permission was granted to post it as a comment:

    I’ve read tons about troops mental health during and after war and it continues to boggle my mind as to how we disregard the importance of their mental health. At times I find myself so infuriated that I am driven beyond all sense of reason to do something about it- read:quit my job, sell my earthly possessions and catch the next flight to Afghanistan, if only to give out hugs. I have a few ideas about how my little self could make a difference, but I have to get them a bit more together before I venture out to change the world. Will keep you posted as you may be able to contribute in some way….

    This response is way too long…I apologize in advance. Clearly I have an opinion on this subject. Having lived within a military community for 3+ years and experiencing my ex-husbands and my brother’s return from war, I can tell you that there is a lot more going on with this situation that any CNN article will ever come close to revealing. That being said, in the interviews conducted the night of the shootings I nearly fell off the couch when a senior military official remarked, “there is such a shortage of mental health professionals in the US Army it is quite possible that the red flags were there and were just disregarded because someone, somewhere along the line said ‘he’ll have to suck it up”". I doubt this was aired again after I saw it. Why this shocked me if only momentarily, I don’t know. This attitude is common place in today’s military and its deplorable. We do not have enough people for key positions, this is true. However, red flags like the ones showing on this particular individual, are just too many to be missed. Someone needs to be held accountable. Not that holding someone accountable brings back these lives, but its a start to stopping it from happening again. I have been to Fort Hood at least a half a dozen times. My brother lost friends to suicides in those barracks and others to gun violence and DWI’s, days after returning safely from 15 + months in a war zone. I’ve seen the gyms and the mental health “areas”. Want to guess which ones are packed and which ones are empty? I’m sure there are great people on the ground there, working tirelessly to make a difference in the lives of soldiers. I am positive of this actually, I’ve met them. My rantings are certainly not to eclipse their efforts. Dr. Rob is 100% correct, no one is immune to mental illness, even those in professional mental health positions, we’re all human. But when it comes to our military, a highly stressed group of young, under paid individuals, we need to do a better job of supporting them. This is an area that deserves much more attention from the American population as a whole, let alone our senior military officials. Veterans day is November 11th, as a country we should vow to make changes to how we support our troops by this time next year. Our economy will bounce back, but how about our troops? Can we expect them to bounce back? The are human beings and they need our help. God Bless them and their families.

  8. Dr. Rob, I’ll drop you an e-mail when I’m back in the office.

  9. Rebecca says:

    I’m so glad you posted this entry. As soon as I heard that the shooter was a psychiatrist, I was both stunned and saddened. Stunned because, well, it just seems like the exact opposite of what a psychiatrist would do; and saddened, both because this is going to really screw over the reputations of mental health professionals and Muslims, and because it appears he was afraid of getting help himself (if he even realized he needed it).

    Like some of the other commenters, especially Keith, I worry a lot about being a mentally ill person studying to go into the field of clinical psych: “What if a potential employer finds out and doesn’t hire me?” But I think it’s because of my current struggles with PTSD/depression and past struggle with anorexia that pushes me toward the profession. I believe that some of the best clinicians in the field struggled with and successfully overcame psychological disorders. And, as a bonus, my therapist says it helps that he doesn’t have to explain a lot of his techniques and stuff, because I’m already studying them.

    This past summer, I spent time on a mental health unit at Landstuhl Regional Medical Center (my dad’s retired Navy, so I have some military health benefits), and I saw just how sick some of these poor soldiers were. Every day we had new patients Medevac’d in from the battlefield, and it was heartbreaking. Some were traumatized into catatonia, others were triggered into violence by loud noises they thought were gunshots. However, they were some of the kindest people I’ve ever met, and a couple of them even told me that they thought that my inpatient experience would make me a better therapist in the future because I’d have a broader understanding of “what it’s like”.

    Keep up the good work, Dr. Rob!
    PS: Those posts about Dr. Steve make me LMAO.

  10. Pippi says:

    I live close to fort hood and have several friends there on the base and even one who was shot by this man and will most likely die. Luckily my best friend was deployed to Iraq during this shooting.

    But I can see how it got to this point. This man was about to get deployed which is hard enough for many soldiers to deal with. I used to talk to soldiers on a daily basis for four years due to my job and many of them hated the idea of being deployed and had some even want to kill themselves to keep it from happening.
    Not only did this man know that he was being deployed to attack other muslims but he also had to listen to the stories every single day of those soldiers who returned with PTSD or other problems. He had to sit there and listen to them talk about the horror stories that happened to them. Who wouldnt try to find a way out of that?

    I am not saying what he did is right! I do not agree with his actions at any level! I have a good friend fighting for his life in the hospital because of this. There are better ways to deal with what was going on, but obviosly he felt like those werent options. He was a known muslim who was already getting harassed by fellow soldiers, he was a psychiatrist and held to a different level than others, he was scared to death of being deployed and if you tell your supervisor you are scared of being deployed you dont get help. you get told that so is every other soldier. And he was also being sent somewhere to kill others that were in his religious family.

  11. Lindsey says:

    Rebecca, I can relate to your concerns about being worried about going into mental health care when you have to manage your own mental health. However, I think that in many ways, it makes us much more compassionate and better able to understand some of what others go through. If you’ve never experienced depression, it’s hard to really understand how it feels for someone (i.e that it’s not just “sad”). I know that there are some amazing therapists out there who don’t have depression, but I find it interesting to be able to relate to people on that level. A few years ago, I asked my doctor if it was a conflict of interest for me to be in Psychology, and she told me that if everyone who had a mental illness wasn’t allowed to go into this field, there would be very few Psychologists left…

    That being said, I do think that we have a special responsibility to manage our own depression etc. Something that this Psychiatrist clearly wasn’t doing. I think we are in a great position to have a unique understanding of the ways that these things CAN be managed, and also a responsibility to the people we treat. That might involve taking some days off, or shuffling appointments if need be, but I would think that’s all part of managing this and it’s never going to be easy.

    Sorry, bit of a long response!

  12. Soldier says:

    He was actually not considered an excellent clinican and had received a poor performance evaluation. Being an officer in the military myself, let me tell you that if you’re not good, you will get a standard Officer Evaluation Report (performance review) To get an actively bad OER, you have to be pretty awful at your job.

    Dr. Rob: I was not aware of this. The CNN article painted him in a much more positive light. And, as discussed, new details continue to come out.

  13. Bob Roberts says:

    “I’ve made no secret of the fact that I view mental health professionals as just as quirky, neurotic and idiosyncratic as the general population. Perhaps even more so. I’ve discussed Dr. Gail’s OCD, Dr. Pete’s Social Phobia, and Dr. Steve’s raging narcissism. ”

    Perhaps? The whole science of mental health is extremely young and based upon very subjective and conflicting data. You still have one group of therapists praising Freud as the great grandfather of all things; and the other group trying to distance themselves from his theories entirely. Aside from organic brain disease, talk based mental health folks are still largely in the world of trial and error in terms of what actually works. There are some cognitive based therapists doing some good work, but I’m not convinced that there is any real treatment for what therapists call PTSD as it relates to war trauma.

  14. Bob Roberts says:

    http://www.nimh.nih.gov/science-news/2009/ptsd-treatment-efforts-for-returning-war-veterans-to-be-evaluated.shtml

    Here is an interesting link concerning my post above. As you can see, mental experts are really struggling with the best way to treat post war PTSD in vets; and it is really still in the trial and error stage. I am skeptical that current treatment approaches are effective.

    Not hating. It’s just reality.

  15. Bob Roberts…PE and CPT have shown some promising preliminary results, so that is a place to start. One of the issues with PTSD is the sensory impression that happen during the traumatic event(s). It is one thing to tell yourself that you are safe and that it’ll be be okay, but it is an entirely different thing to get your body to not respond to every single fiber wanting to react to what feels very real.

  16. GettheShrinkaShrinkAlready says:

    The media keep working the possible terrorism angle without admitting that perhaps, just perhaps, the man was truly ill and just had a psychotic break with reality.

    That might just explain the general lack of ties (if these reports, so far, are absolutely substantiated) to a true terrorist plot.

    Some people are hyper-religious kooks, possibly even schizophrenic kooks (not a shrink, nor am I posing as one, just speculating as a layperson, here).

    That may very well be all there is, a sudden break with reality…possibly due to the stress of a deployment he didn’t really want.

    Plus, what does one expect from people who work with troubled populations all day long? Stable and even-keeled people? I cannot imagine keeping that kind of company all day long (I work in sales, and the general public behave in an absolutely bizarre manner half the time, let alone clinically significant populations!).

    My two cents: Guy’s a schizo. No more, no less.

    We shall see what the military investigation uncovers, however. This should be very interesting, to say the least, especially since they have the guy in a now conscious state (that’s amazing that he survived to be interrogated).

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