A Psychiatrist’s Perspective about Hasan the Psychiatrist Healer Turned Killer: What Made the Good Doctor Snap?
Posted Nov 20 2009 10:04pm
Fort Hood Nidal Mali Hasan, a 39 year old American psychiatrist of Palestinian descent, opened fire on fellow American soldiers, killing 13 and wounding 31 at his Texas army base. Major Hasan who was thought to take excellent care of his patients turned from a healer to a killer. We are all left wondering how could this happen? Here is the data that has emerged:
He had trouble during his psychiatry training at Walter Reed Army Medical Center where he had received a poor performance evaluation and required extra supervision and counseling.
He did not want to deploy to Iraq. He was scheduled to leave November 28th. (His cousin told the New York Times that he was mortified by the idea of having to deploy and that people were telling him on a daily basis the horrors they saw over there).
He did not agree with the war on terror. Col. Lee said, “He [Hasan] said Muslims should stand up and fight the aggressor and that we should not be in the war in the first place.”
He had a possible history of alcohol abuse according to 20/20 which aired on November 6th, 2009. ( If you think you or someone you care about are drinking too much, click here to readmy free guideabout the symptoms of alcoholism toassess if you or a loved may have an alcohol problem. )
He had been harassed on several occasions for his Muslim faith by fellow soldiers.
He was under stress from treating PTSD.
He had gotten the attention of law enforcement officials for postings on the internet regarding suicide bombings. (He compared Muslim suicide bombers to soldiers who leap on a live grenade to save comrades’ lives, “Their intention is not to die because of some despair…You can call them crazy if you want but their act was not one of suicide that is despised by Islam”).
Here is my perspective as a psychiatrist: What caused Hasan to snap?:
First, he went against his own nature by killing, not healing. This is a completely irrational act which defies rational explanation. Anyone who is a doctor is a healer, not a killer. Doctors respect life. For example, if a “shooter” is brought into an emergency room, doctors will make huge efforts to save that life, regardless of that person’s actions. Therefore, Hasan went against his own nature under stress. Was he psychotic? Did he have a history of excessive drinking that impaired his judgment? Did he have a mental illness like bipolar disorder that wasn’t diagnosed?
Second, I think he was completely overwhelmed by treating post traumatic stress disorder. He couldn’t handle his role as the “secret keeper” anymore. Over the course of my career as a psychiatrist, people share their deepest feelings and memories with me that they have not shared with a friend or even a family member.
Intense, frightening memories are often more than many people can handle whether the memory is of a natural disaster, rape, or war. Our brains can be overwhelmed by the intensity of the feelings that emerge from nightmarish memories. Post traumatic stress disorder may develop.
In post traumatic stress disorder, people experience flashbacks, an exaggerated startle response, and emotional numbing. Hasan heard the most horrific stories from his patients. Furthermore, Hasan was being sent overseas where he might personally experience the very horrors his patients described and it was more than he could bear. He felt trapped.
Third, I do not have the impression he had a strong support system or a balanced life. Most psychiatrists handle their work stress by keeping a balance in his/her life which often involves a good support system of family and friends, exercise, and pursuit of other interests (reading, music, cultural events). Although Hasan had a foundation in his faith, he was described as quiet without many friends. If indeed he turned to alcohol to anesthetize himself, he was not coping with his stress in a healthy way.
Fourth, stress leads to aggression. Look at the last military killing spree in May 2009 when a soldier in Bagdad who was getting treatment at Camp Liberty Stress Clinic opened fire on his fellow soldiers killing five and wounding three. Sound familiar? Under stress we release more cortisol which leads to more aggression in humans and animals. In a study in 2004 in the Netherlands and Hungary, rats put under stress released more cortisol and attacked other rats almost killing them. This suggests a biochemical link between stress and aggression. Look at the incidences of road rage, the incidences of murder when someone is a victim of domestic violence or feels trapped, the increased incidences of domestic abuse with stress, the post office killings, mothers killing their own children. The list goes on and on.
The bottom line of this tragic incident is that the military must address the significant impact of PTSD on the soldiers and those treating them. This shocking trauma where the “healer turns killer” is a wake up call for the military to address the mental health issues related to war. It should be treated as a top priority before another innocent victim dies.
The irony is that the doctor who treated PTSD seems to have developed a form of it himself. In his act of terrible violence, he may have even given PTSD to the victims of the families whose loved ones he murdered.