Hasan’s Therapy: Could "Secondary Trauma" Have Driven Him to Shooting?

Hasans Therapy: Could Secondary Trauma Have Driven Him to Shooting?

As an army psychiatrist treating soldiers returning from Iraq and Afghanistan, Major Nidal Malik Hasan had a front row seat on the brutal toll of war. It is too early to know exactly what may have triggered his murderous shooting rampage Thursday at Fort Hood — Hasan is accused of killing 12 people and wounding 32 others before he was wounded by a police officer — but it is not uncommon for therapists treating soldiers with Post Trumatic Stress Disorder to be swept up in a patient’s displays of war-related paranoia, helplessness and fury.

In medical parlance it is known as “secondary trauma”, and it can afflict the families of soldiers suffering from P.T.S.D. along with the health workers who are trying to cure them. Dr. Antonette Zeiss, Deputy Chief of Mental Health Services for Veteran Affairs, while not wishing to talk about the specific case of the Fort Hood slayings, explained to TIME that: “Anyone who works with P.T.S.D. clients and hears their stories will be profoundly affected.”

It’s entirely possible that other factors may have acted as a trigger for Hasan’s alleged killing spree. The army major was a devout Muslim who reportedly had been harassed because of his religion and had developed strong objections to the wars in Iraq and Afghanistan. But he was also due to be shipped out to Afghanistan, drawing him closer to the terrible scenes described in detail by his patients. At army hospitals dealing with P.T.S.D. patients, the staff is required to periodically fill out a ‘resiliency’ questionnaire that is supposed to gauge how well they are coping with the burden of their patients’ emotional and psychological demands. “It takes its toll on people,” says one officer at a Colorado military hospital. “You cannot be un-affected by the terrible things these soldiers have undergone.”

Most army psychiatrists now have a full caseload of men and women returning from combat zones with P.T.S.D.. A survey by the Rand Corp. last April revealed that one in five service men and women are coming back with post-traumatic stress and mental depression. Previously known as “combat fatigue” or being “shell-shocked”, P.T.S.D was only diagnosed as an illness in the 1980s, but it has been around for as long as men have been killing one another and undergoing fearful experiences. It can lead to outbursts of rage, emotional numbness, severe depression, nightmares, and the abuse of alcohol and pain-killers. In extreme cases, P.T.S.D. sufferers have committed suicide and murder. Since the late 1980s, doctors have also learned that over time, along with drugs and therapy, P.T.S.D. is curable.

As part of their therapy, PTSD sufferers are typically asked to dredge up their worst wartime memories. Hearing these nightmarish experiences can stir up powerful reactions in even the most seasoned therapists. One Colorado sergeant, diagnosed with P.T.S.D., who had served as a dog-handler in Iraq, told me how his psychiatric counselor had broke down sobbing after the soldier described how he had been sent out to find the remains of his close friend, a helicopter pilot, shot down in southern Iraq. “I looked up, and there she was crying,” the sergeant says. “I didn’t want that from a shrink.”

But there is a major difference, says Veteran Affairs’ Zeiss, between a therapist being moved by combat horror stories and being traumatized by them — though it can happen. “Psychiatrists are trained to notice their own reactions and emotions, and if there’s something hard to deal with, they should turn to their peers,” she says. But according to some news reports, Hasan’s unprofessional conduct was red-flagged early on; at Walter Reed he was given a poor performance report, but that did not hinder his transfer to Fort Hood.

And for even the most hardened army psychiatrist, that would be a grueling assignment. Fort Hood has the highest suicide rate of any army base in the country, largely because so many service men and women stationed there have undergone severe trauma while deployed in Iraq and Afghanistan. At Fort Hood, in other words, there was no shortage of horrific tales that could have set loose the demons in Hasan’s mind.

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