Mental-health professionals speculate on what went wrong

By JAN JARVIS

jjarvis@star-telegram.com

As an Army psychiatrist, Maj. Nidal Malik Hasan treated soldiers with post-traumatic stress and mental disorders.

But did being bombarded with horrific tales of combat and loss — especially when he was preparing for his own deployment — push Hasan over the edge?

Mental-health professionals say probably not.

Hasan was certainly exposed to a lot of trauma, but becoming a mass killer is not a typical reaction to high levels of stress, said Dr. Alan Podawiltz, chairman of psychiatry at the University of North Texas Health Science Center in Fort Worth.

"We hear a lot about individuals who have gone berserk and killed someone," he said. "But PTSD doesn’t typically manifest itself that way."

If Hasan, who is suspected of killing 13 people Thursday at Fort Hood, was suffering from trauma brought on by years of working with soldiers, then a more common reaction would have been to turn his anger inward.

Hypervigilance, drug or alcohol use and depression are among the more common symptoms, Podawiltz said.

Mental-health professionals can experience vicarious trauma through working with individuals who have endured horrible experiences, said Dr. Alina Suris, clinical director of mental-health trauma services at Dallas VA Medical Center. It is not a mental illness but a process that occurs among professionals helping people who have been traumatized.

"When dealing with trauma at that level of severity every day, it can be overwhelming," she said. "You can become traumatized because you care about people."

These providers need debriefing and intensive counseling as much as the individuals who experienced the trauma, Podawiltz said.

Mental-health professionals are trained to deal with vicarious trauma by talking with colleagues or seeking their own therapy, said Suris, who is also associate professor of psychiatry at UT Southwestern Medical Center. The VA has professional peer review to help with vicarious stress, and no one professional is assigned all the most severe cases.

Hasan graduated from Virginia Tech in 1997 and received his medical degree from the Uniformed Services University of the Health Sciences in 2001. He worked as an intern, resident, and fellow in disaster and preventive psychiatry at Walter Reed Army Medical Center.

At Walter Reed, he was probably exposed to many young soldiers suffering from acute trauma, Podawiltz said.

Fifteen to 17 percent of returning service members have significant mental-health and substance-use problems, according to the Walter Reed Army Institute.

The heavy demand for services and a shortage of mental-health professionals may have added to Hasan’s psychological burden. Being Muslim may have been another stress factor, given that he likely counseled some soldiers who were angry at terrorists after fighting in Iraq and Afghanistan.

Even if he recognized his symptoms, he likely did not seek care because of the stigma surrounding mental illness, Podawiltz said.

"If you are seen as having a mental problem, then you may not get promoted," he said.

The military is working to change that, but the stigma still prevents people from getting help, Podawiltz said.

In Hasan’s case, there are too many unanswered questions to understand why someone who is trained to help others might go on a rampage, Podawiltz said.

"Does he have some other mental illness that was not treated? We don’t know," he said. "Were there other conflicts? Did he have a substance-abuse problem? Was he a victim of prejudice?

"What pushed this doctor, as far as committing this act, needs a lot more investigation into his history."

JAN JARVIS, 817-390-7664

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