Fort Hood Exit Strategy

03/18/2010 05:12 am ET | Updated Nov 17, 2011

With the recent tragedy at Fort Hood, the time has come to face up to two facts: War is Hell -- this we know. War is not conducive to mental health -- this we don't want to realize.

And it may be that if a little war is bad for one's mental state, a whole lot of war is a whole lot worse.

Leaving aside the merits of this particular war, and more detailed information about Major Nidal Malik Hasan, the 39-year-old man accused of Thursday's mass shooting at Fort Hood, Texas, if we look at the inherent contradictions of his situation, it's easy to imagine how any one of any background would feel terrified and entrapped under the following conditions:
• Possessing first hand knowledge of the combat experience and the severe mental damage it inflicts upon deployed military
• Knowing how successfully (or not) the military is able to address post-traumatic stress disorder (PTSD)
• Facing deployment, (and unlike other military heading into deployment), having prior knowledge of the hazard to one's mental health and psychological status

It's safe to say that the majority of those facing deployment, have no real clue what they are in for. But Major Hasan undoubtedly did. How did that affect him? Further he,

• Received his medical and psychiatric training as a military officer
• Was therefore beholden to the military for the cost of that training
• Had no way to leave the military

As heinous and reprehensible as were his actions, correctly or mistakenly, Hasan saw no way out of the military, no way out of his deployment. Sadly for all concerned, firing a gun was his exit strategy.

I am sure that soon all the "bad apple" stories will briskly circulate. But before they do, let's ask: Isn't it possible that being a military psychiatrist could readily induce outsized cognitive dissonance in susceptible individuals? Is there a point when it could just become too much?

Cold, calculating, numb, sedated, and murderous. Bonded first and foremost to comrades in arms. Is this a prescription for mental health, a solid marriage, successful parenting, or even a good night's sleep? Of course not. But these are the traits cultivated and inculcated in servicemen heading to battle.

Upon returning they can change into civilian clothes, but they can't so easily shed their traumatized neurology. For many, the military becomes a form of life long entrapment, a club that once joined, can't so easily be left behind, for economic, social, and psychological reasons.

By definition, a military psychiatrist is acting under military authority-- is that a conducive environment for building therapeutic trust or helping your clients?

A couple of months back, I attended a program lead by a military specialist in treating returning military suffering from psychological distress. First of all, this specialist, himself a combat veteran, appeared to be traumatized. Empathy was for sissies. Maintaining the military code trumped facing up to the pain. PTSD, he claimed, could be dealt with by snapping out of it.

"Just change your attitude," he reported telling his clients.

This "expert" didn't want to call a spade a spade. He didn't want to call it post-traumatic stress. He wanted to call it "combat stress." That was more manly. In fact, the entire thrust of his therapeutic approach could be captured in a single sentence: "Figure out how to conform to military codes, and appease higher ups, but don't admit to psychological damage."

His demeanor said: "Men, emulate me." But I've never see that anywhere in the psychological literature is "stuffing it" the recommended approach.

I can't say for sure whether this attitude is endemic to military psychiatry. I hope not, and would welcome hearing about the numerous mental health professionals in the military who do a lot of good. I know that guided imagery has been proven successful with CDs available for addressing PTSD at

But the basic problem is that when you train people to be eternally hypervigilant, bond them as one in a killing group, put them through traumatizing experiences, and then upon their return signal that retaining the military code is more important than their personal mental health, then I can guarantee you several things:
• They won't feel safe in receiving mental health treatments in a military context
• They won't easily find their way to helpful treatments for fear they violate their military code and bonds with their fellow officers
• It will be harder for them to down-regulate their automated stress reactions and heal
• They won't be safe for their families and loved ones people to be around
• Ours will not be a safe world

In going to war to create safety, we have to take a hard look at what came back.

Until we can admit all of this, how can we help troubled people in the military? Or for that matter, find safety as civilians?

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