Friday, November 6, 2009

An Educated Guess: Hasan Knew Difference Between Right and Wrong (He just didn't care)

The details of Maj. Nidal Malik Hasan's life, accused shooter at yesterday's Fort Hood horror, are few and far between. There is, what I feel, an explanatory tone to what details have been given and some of the commentary offered on network and cable TV. Some of this tone concerns me.

The New York Times is reporting from multiple sources Hasan is an American born of immigrant parents from Palestine, a Muslim, army-educated psychiatrist, and, in the latter capacity, second-hand witness to the horrors of war. It was reported he was to be deployed to a combat zone later this month, and that he told a cousin he did not want to go. He was also reported in the NYT as being a vocal critic of the Iraq and Afghanistan wars and was acutely aware of the brutality some soldiers experienced in these wars through his work treating Post Traumatic Stress Disorder, PTSD, a severe and persistent anxiety disorder, in returning soldiers.

The entire episode is a horror beyond my abilities to describe and the surviving victims will be the appropriate tellers of the story. I simply want to point out the emphasis given by some commentators of Hasan's exposure to second-hand trauma through his treatment of soldiers, and the implication this could have been partly to blame for his outrageous behavior, may be misleading.

I would be surprised if hearing the horrors of war from fellow soldiers didn't negatively impact Hasan. But it is the way in which it effected him that singles Hasan out from other mental health professionals, soldiers, and people in general.

In my work, I have had opportunity to do forensic interviewing with mental health professionals and am trained in the field myself. I have seen a therapist so effected by years spent listening to children recount their stories of abuse and neglect that this woman literally cried the entire time I spoke with her. A coworker happened across this therapist's garage sale around the same time and mentioned how the poor woman began crying in a casual conversation. This is an understandable secondary PTSD reaction in a therapist.

I worked on a case through the juvenile court system as a child advocate that became so upsetting to me I literally had an anxiety reaction to the sight of the social worker on the case. She had the same reaction to the sight of me, and we snickered sadly at how upset we must be to have such a reaction.

Some people in the helping profession who are experiencing what is called Compassion Fatigue, or "burnout," may have difficulty with personal relationships, develop compulsions and even commit suicide at least partly as a result of bearing too much witness to the agony of others. The line that connects these varied negative responses is one that did not intersect with Hasan's deeds yesterday. Burned out helpers generally cause harm to themselves. Of course, people closest to them may suffer, as is typical when a loved one is having a difficult time. But for Hasan to take aggressive action against the very people he was trusted to heal is completely out of bounds and has a different rationale entirely, I suspect.

Hasan's behavior points much more toward anti-social personality disorder or perhaps narcissistic personality disorder than it does a severe anxiety disorder. It certainly sounds in the reports that he was scared as hell of being deployed into a combat zone where he could not control the violence. So why would he walk in and do so much violence, likely aware he would be hurt or killed in the process? My guess is that it wasn't violence this man feared, but not being able to decide who does what violence to whom.

In short, he may have simply wanted control. Where this level of need for control exists, I believe, there cannot be empathy, as well. And empathy for the lives of more than forty people should be an easy thing for a psychiatrist to feel no matter how many horror stories he heard or negative comments he may have gotten from ignorant people about his heritage as a Muslim or Arab.

If I am correct, a desire to control so powerful that it entirely supersedes a person's natural ability to empathize with other people may have a lot to do with serious mental health problems and emotional limitations Hasan developed over a lifetime. These mental health problems, notably, a personality disorder, are distinct from other mental health problems in several ways and very importantly here, because someone with anti-social or narcissistic tendencies knows the difference between right and wrong (unlike people suffering from something like a psychotic stress response). They just don't care what they are doing is considered wrong, because they believe they are unique, separate from others, and not rightly subject to the rules the rest of us live by.

The distinction between knowing the difference between right and wrong and not for this surviving gunmen will become very important when he stands trial. It could become that of life from death. I doubt anyone will afford him any more control when it comes to those matters.


Anonymous said...

If Hasan had a personality disorder, this would never be a mitigating factor in a civil trial. A personality disorder is not considered as "insane". The law is all about "intent" and Hasan certainly demonstrated plenty of intent to commit this crime. People with personality disorders usually can function outside an institutional setting. There are almost NO medications for personality disorders. My guess would be under the DSM-IV the European definition of Paranoid Personality Disorder.

P. S. Moore said...

Precisely. If personality disorders were considered a mitigating factor in criminal or civil trials, there probably would rarely be convictions for violent crimes. I'm looking up the definition for Paranoid Personality Disorder. I hadn't thought of that. Thanks for bringing that to my attention.

There is more info coming out through the press that Hasan had been flagged as a problematic practitioner and saw only a fraction of the number of patients the average military psychiatrist sees.

There is a real and urgent need nationally and in the military for psychiatrists. Few med students go into that specialty and often general practitioners who have excellent training, but not enough training specific to mental health, fill in the gaps.

There is some talk emerging in the media that the extremely short-handed military mental health services are one reason Hasan was allowed to work in the field after being recognized as a problem.