Fort Hood: Psychiatrists & Stress...

No one will ever know exactly what snapped in the psyche of U.S. Army Major Nidal Malik Hasan, but something surely did. 

How else can you begin to fathom why this highly-trained medical doctor and psychiatrist started blindly shooting innocent young soldiers at close range on yesterday afternoon at Fort Hood, Texas – the largest military base on U.S. soil.

I'm not making excuses for his unspeakable behaviour. But what happened? Was he sleep-deprived? Why? This is bewildering so many of us.

Stress has been uppermost in my mind this week and if anything illustrates the staggering power of stress on the human mind, body, spirit and soul, surely this horrifying catastrophe does. Thirteen people died. Twenty-eight others are seriously wounded. Hundreds of families and friends are in shock and grieving, desperately in need of counsel and support. A whole country is mourning.

Perhaps Major Nidal Hasan desperately needed but didn't have any support because of the nature of the harrowing emotional demands of his profession. 

Surely, what happened to him to cause him to act out as he did had to be related, in part, to the mounting stress, anxiety and fear he must have been feeling at the prospect of his imminent deployment to Afghanistan on November 28.

But I have another thought.

Remember, he's a psychiatrist specializing in "disaster and preventive psychiatry." Post Traumatic Stress in a specific demographic – veterans of war.

He has been treating soldiers returning from intense, active combat in Iraq and Afghanistan – shattered emotionally, spiritually, mentally and physically – after fighting in these two endlessly gruesome, fruitless wars. When his patients unburdened themselves on him, confided in him, vented on him, where did this single, 39-year-old man go to get help for himself. How did he manage to shoulder all that pain?

How do psychiatrists deal with stress?

"Doctors, who ought to be in the best position to help the public, are not distinguished by their own ability to help one another or themselves," psychologist and prolific writer Kay Redfield Jamison wrote in her groundbreaking book Night Falls Fast – Understanding Suicide, published in 2000.

"They are, to start with, twice as likely to kill themselves as other people are," writes Jamison, who has lived with bipolar disorder since her teens and has seriously attempt suicide. "Doctors, more often than not are left alone to struggle with their suffering. Many find it hard to ask for help, or, indeed, to acknowledge needing it: they are trained to be independent, to be accountable for decisions that cost or save lives, and to assume an undue portion of the miseries of others. They function within a closed system that too often discourages seeking treatment ..."

I'm sure the military would be especially tough here.

This morning, I sent an urgent request for help with this question to my muse, friend, mentor and polymath, Tufts University clinical psychiatrist and professor of psychiatry Dr. Ron Pies. He answered quickly, admitting candidly that he didn't have "any profound or learned comments, except to recognize that mental health professionals and physicians of all stripes are under extraordinary levels of stress, a great deal of the time."

He wrote to me, understandably briefly, because he was "on the road," as he often is, adding that "without prejudging anybody, I think it is fair to say that the horrific shootings at Ft. Hood represent a terrifying illustration of how one's emotional turmoil can be fuelled by a specific set of environmental factors. If not detected early, and followed by timely clinical intervention, the results can often be tragic."

Then Dr. Pies added a more personal perspective.

"I have always found it important to have many interests, supports, and creative outlets, beyond my profession as a psychiatrist. I always worry about colleagues who say, "Psychiatry is my life!" and who spend every waking hour thinking about nothing else. 

"Balance and perspective are great stress-busters, and I have always found these in areas such as literature, philosophy, and creative writing. Others will find relief and solace in sports, music, or spending time with family. 

"The important point is that all of us need to find ways of monitoring our levels of stress, and to provide ourselves with fulfilling activities that help us achieve emotional balance."

So, I leave you with these wise words on stress from my dear friend, Dr. Pies. 

Think balance. Perhaps that's what was lacking in the tragic, tormented life of U.S. Army Major and psychiatrist Nidal Malik Hasan. Who will ever know for sure?

This, however, I do know. 

From now on, every weekend, my husband and I plan to take a few hours to do something for ourselves. Nothing major. A movie. A walk in the park with the dogs. Just a little something to divert ourselves from the ongoing pressures of our work – we both teach at community colleges.

Because nothing. No job. No deadline. No pressure. No virus. Nothing is worth sacrificing one's emotional, spiritual, physical and mental health and well-being. One's psyche. One's hope.

Take care and enjoy this brisk, November weather!

Speak soon!

Comments

[Robin Harvey]

So well said, Sandy, again.
But I think there is a third ground - he was being recruited into what the world has reported he felt was a horrible war.
Now - if I (assuming I were he) were not insane and we were to assume he was not - and if I wanted to help people who had returned from such an insane experience - I think this may have been a very good place to inject myself - and I would have tirelessly worked for resolution, calm and peace.
But did he?
He broke down and became all he hated or considered - what - we do not know - psychosis is fearful -
He joined the military - as its worst elements - I do not know that he hated violence as an out for things - but his actions set him on these violent end goals.
But his carnage would not withstand the tenants of normal psychiatry - which I assume - require some level of detachment and objectivity.
So maybe he broke - or maybe he was pre-programmed.
I prefer to think the former.
War is hell. That is so easy to say.
Helping people with their own personal wars must bear an incredible cost - whether the war is sanctioned - or not.
That is not new and has been said so many times before.
And perhaps anyone touched by it - falls into an inescapable hellmouth.
RH

[Sandy Naiman]

Hi Robin,

Thanks for sharing your perspective on this truly tragic man. I don't yet know enough about him or his situation to really go into the detail you have done in your thoughtful "third ground" interpretation.

I hesitate. I'm not good at making assumptions, either.

But consider another case. Lisa Nowack, remember her?

http://www.mooddisorders.on.ca/pdf/GlobeComment.pdf

What happened at Fort Hood is one of the supremely stunning commentaries on the spoils of war. The human spoils and what the stresses of war can do to a single human being. I cannot imagine it. And that's the point, I guess. I don't know anyone, personally, who has been to Iraq or Afghanistan to fight. I've read about this war and what it does, but I'm not close enough, not inside the heads of those who face going overseas, let alone, try to help the soldiers who are suffering spiritually, physically, emotionally and mentally, and putting on a "brave face"!

That, alone, is deadly stressful.

You know me, Robin. I let it all hang out. I'm always "Coming Out Crazy" and that's how I've recovered. This military mode runs against my grain. You have to hold it in and, like physicians, absorb the pain. That emotional turmoil does it's damage. Big time. It's an emotional cancer. It eats away at your psyche and your health and well-being.

That's why so many people are depressed in this country. That's why the statistics about "mental illnesses" are going through the roof.

People keep it inside.

I know from my research into the work of Meg Olmert who works with the U.S. Department of Veterans Affairs setting up sophisticated dog-therapy programs in Vet Hospitals with soldiers returning from Iraq and Afghanistan and suffering with Post Traumatic Stress Disorder, how utterly devastated they are fighting these wars.

http://thestar.blogs.com/mentalhealth/2009/05/megs-book.html

Can you imagine how it feels to have to shoulder their pain and then fight a war you detest?

The military paid this Nidal Malik Hasan's tuition for his medical training. Why did he choose to be in the military? Why did he choose to specialize in "disaster and preventive psychiatry?" All that will unfold as this story unfolds. Especially if he survives.

Now he had to pay back. And there is only one psychiatrist for every 700 soldiers in the military. What psychiatrist in the private sector has that kind of case load?

I don't think Nidal broke down. He snapped. He didn't have a psychiatric illness. His mind snapped under the pressures and stresses of his life, his work and his own personal demons.

Whatever they are? I don't know. I wouldn't even want to try to make a guess.

It's very difficult to reason it out. It defies reason. Isn't that the definition of insanity.

A lightning rod of madness seemed to strike him fast and furiously.

Your interpretation is intriguing and it helps us to try to explain what might not have a rational explanation. We'll have to wait and see.

My heart breaks for the brave young and not-so-young men and women who died.

You'll cry as I did, when you see their faces and read about their dedication and commitment to peace.

http://www.nytimes.com/interactive/2009/11/05/us/20091105-fort-hood.html?hp

Thank you, dear Robin. This helps. It really helps.
Hugs,
xox
s

[Crazy Mermaid]

I have taken note lately of the military's current challenge. There are so many people committing suicide while in Iraq and Afganistan that they've had to implement new programs. There are so many troops returning from war with mental illness that they're having to start new programs to handle them. http://www.military.com/news/article/organizations-join-to-help-veterans-families.html. Very sad.

My own encounter with extreme stress forced me into a psychotic break with reality, resulting in my hospitalization at a mental hospital for 3 weeks. I can relate.

[Sandy Naiman]

Hi Crazy Mermaid,

Thank you for sending along this article. Beyond suicide, Post Traumatic Stress in the military, Shell Shock, whatever it's called depending on the war, is deadly and devastating for the fighters.

I've had many psychotic episodes in my life. They're sudden and often related to lack of sleep. They, too, have necessitated lengthy hospital stays.

But, as this story from today's New York Times suggests, what happens in the military to soldiers in combat when their minds snap is entirely different. It's a mystery. It's probably still stress related, but a profoundly different, more acute, more intense stress than what we civilians ever experience or can even imagine.

Have a look and let me know what you think...

http://www.nytimes.com/2009/11/08/weekinreview/08goode.html?_r=1

Take good care and thank you for sending the above article. I think there will be a great deal written on this subject, now. Good thing. Lots for all of us to think about and perhaps some serious consideration as to how to make things better for soldiers at war. More study. Change, maybe.

Like peace. Who am I kidding? I can dream. Here, preparations for withdrawal from Afghanistan are beginning.

I am so grateful to have you contributing so thoughtfully to the dialogue in our "Coming Out Crazy" community!

Cheers and speak soon!
sln

[Josh]

This was great to read. I had heard of that incident and was shocked to hear about it. That man must have had a lot of weight on his shoulders. Especially dealing with soldiers who have witness some traumatizing things on the battlefield and just in that situation. I respect the men and women who have to go over there a deal with such issues and fruitless wars.

I enjoy your posts there always informative and help me gain another step up on dealing with my stress. Just yesterday a friend of mine finally come to accept that he may have an anxiety and stress issue himself. I commended him on coming out about the issue, and he is seeking council today. I look forward to your next intriguing post. Take care.

[Sandy Naiman]

Hey, Josh!

What a lovely comment. I just got home from school – I teach, too! – and your thoughtfulness and support buoys me on and helps me to know that here, at "Coming Out Crazy," we may be making a difference.

Huge thanks and good on you for helping your friend to come to terms with his anxiety and stress issues. Your support will undoubtedly mean the world to him. It will help him to feel less isolated. You've helped to set him on a recovery journey that will have long term and extraordinarily positive results, although it's not always a cake walk! It's hard work. I'm sure you'll be there to encourage him.

I am enormously grateful, Josh, for your kindness.

I'm sending you lovely, safe e-hugs and hopes that you have a great day, week, future. I can tell you have an empathic soul and I'm thrilled that you're contributing to the dialogue in our community and in your personal circle.

Great work. Bravo! Keep it up and keep talking! It's so healthy. So liberating!

Fondly,
sln