Fort Hood tragedy rocks military as it grapples with mental-health issues

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The U.S. military’s culture of silence about troops’ mental health had finally begun to change.

In the early years of the wars in Iraq and Afghanistan, the various branches had been roundly criticized for failing to adequately address post-traumatic stress disorder and other psychiatric problems. Responding to that criticism, leaders made progress in diagnosing and treating such illnesses among service members.

But Thursday’s attack at Ft. Hood -- as well as two other recent incidents in which military personnel turned guns on their own -- indicates an intractable problem not easily overcome.

In the Thursday incident, Army psychiatrist Maj. Malik Nadal Hasan reportedly fired repeatedly at colleagues on the Texas base, killing 13 and wounding 30, before being felled by civilian base police officers. Hasan, who was about to be deployed to Afghanistan, is now hospitalized.

The fact that the shooter was a psychiatrist ‘is a one-in-a-billion case,’ said Floyd Meshad, who served as a psychiatric social worker in the Vietnam War and is president of the National Veterans Foundation in Los Angeles. ‘But it does red-flag a lot of questions.’

Those questions include whether, even today, military personnel can easily obtain mental-health services.

The factors that led to Hasan’s alleged actions are not yet clear. What is clear is that no one is immune to mental-health problems; doctors even have slightly higher suicide rates than the general population.

‘Psychiatrists can have emotional difficulties too. We are humans like everyone else,’ said Dr. William Callahan, a psychiatrist in Aliso Viejo who served as a flight surgeon in the first Gulf War. ‘It’s a shocking reminder of how much we need to do to get people access and better treatment.’

Military leaders acknowledge rampant psychiatric problems in their midst. According to the Army, the suicide rate among soldiers in Iraq is five times the rate seen in the Gulf War and 11% higher than that seen in Vietnam. The Army reported 133 suicides in 2008, the most ever. In January, the 24 suicides reported by the Army outnumbered U.S. combat-related deaths in Iraq and Afghanistan. The Marine Corps also reported an increase of suicides in 2008 -- 41 deaths. The Army and Marine Corps have provided most of the troops in the two wars.

In April 2008, researchers at the Rand Corp. published a study showing that almost 20% of personnel returning from Iraq or Afghanistan reported PTSD or depression. Just over half of those had sought treatment.

‘I think the military fully understands the magnitude of this problem,’ said Dahr Jamail, a journalist and author of a new book titled ‘The Will to Resist: Soldiers Who Refuse to Fight in Iraq and Afghanistan.’

‘This issue of redeploying people repeatedly is a massive crisis,’ Jamail said. ‘It’s creating a point of collapse in the military.’ Jamail said he’s ‘actually surprised’ that incidents of violence are not more frequent.

The wars in Iraq and Afghanistan have generated an array of mental and behavioral problems, experts say. Besides PTSD, a high rate of traumatic brain injuries has contributed to cognitive and psychiatric symptoms. The wars have been long and, without a draft in place, many troops have been subject to repeated deployments. The nature of the conflicts -- fighting insurgents who mingle among civilians -- is considered an additional, constant source of stress.

Military violence has occurred on a regular basis in recent years. An Army sergeant has been accused of killing two superiors at a Baghdad base last year. And in May, an Army sergeant allegedly opened fire in a stress clinic on a base in Baghdad, killing five fellow soldiers.

Mental-health problems can develop at any time but especially during a tour of duty, after returning home or among people with secondary exposure to the war -- such as those who treat, or live with, people who have completed such duty. The symptoms include anxiety, depression, hyper-vigilance, insomnia, nightmares, emotional numbness, cognitive difficulties and intrusive thoughts. Some troops report feelings of guilt or sorrow that they cannot overcome. Others begin to abuse alcohol or drugs. Loneliness, divorce and domestic violence are common.

Service men and women have traditionally been reluctant to seek counseling because it may go on their records, said Meshad, who trains mental-health workers on compassion fatigue -- a gradual erosion of compassion for one’s patients and apathy about their plight.

‘We have a system that has a Catch-22, and it’s time the military faced it,’ he said. ‘These soldiers would like to see a therapist. But there must be a way where it can be confidential.’

Recently, military leaders have made strides in addressing the mental-health crisis. In 2007, the Department of Defense established the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury to support better prevention and treatment.

The department also recently launched a program called Real Warriors meant to fight the stigma surrounding mental-health issues and promote treatment. In July, the Army provided $500 million for the largest study ever on suicide and mental-health issues among military personnel and last month announced it would begin emotional-resilience training to prepare troops for the psychological duress of service.

‘The military is doing more and more to address emotions,’ Callahan said. ‘They are becoming more focused and precise in realizing they have got to prepare people emotionally for war.’

Some say military mental-health providers, possibly including Hassan, carry heavy workloads as a result.

‘They are horribly burned out,’ said Aaron Glantz, an editor at New American Media and author of the 2009 book ‘The War Comes Home: Washington’s Battle Against America’s Veterans.’

Military psychiatrists may face especially frustrating circumstances because they may recommend releasing a soldier from active duty or redeployment due to mental-health problems only to be overridden by a commanding officer, Glantz said.

In 2007 , a soldier at Fort Hood reported to mental-health services that he was suicidal but was ordered to redeploy anyway.

‘His commanding officer said, ‘I don’t care, I want you redeployed anyway,’ ‘ Glantz said. ‘He walked into a field and killed himself. Imagine if you’re the psychiatrist in that situation. All of these psychiatrists are experiencing this.’

-- Shari Roan