THE BLOG
04/15/2014 03:34 pm ET Updated Jun 15, 2014

The Right Question to Ask

Here is what we know so far about the recent tragedy at Ft. Hood. We know that 34-year-old U.S. Army Specialist Ivan Lopez was born in Puerto Rico. He began his military service with the National Guard and then joined the Army in 2008. We know that he served for four months as a truck driver in Iraq. Records indicate that he did not see combat, and there is no indication that he suffered any physical injuries while deployed, though it has been reported that he claimed to have sustained a traumatic brain injury while in Iraq. We know that Specialist Lopez moved into an apartment with his wife and young daughter a little more than a week before he opened fire on base with a .45-caliber handgun, killing three and wounding 16 before killing himself (http://www.cnn.com/2014/04/02/us/fort-hood-shooter-profile/).

We are also learning that Specialist Lopez had a history of mental health concerns -- including anxiety and depression -- though it is not yet clear what this means in terms of the history of his struggle or the course of treatment he received. It appears that he was on sleep medication and that he was being assessed for post-traumatic stress disorder. (http://www.cnn.com/2014/04/02/us/fort-hood-shooter-profile/)

And finally, it seems that Specialist Lopez had no prior history of violent behavior. One soldier who served with Lopez for 17 months was quoted as saying that he was "one of the best soldiers that we had in our infantry." (http://www.cnn.com/2014/04/02/us/fort-hood-shooter-profile/)

As is often the case when tragedies occur involving service members, their families, or veterans, I am asked by the media to speak about the issue as a mental health professional who after nine years of working with this community has become a subject matter expert. Sadly, it seems that many of those who interview me want to know the answer to the same question: "Is DoD (or the VA) doing enough?" This is the wrong question to ask.

Based on the information currently available, I suspect we will find that Specialist Lopez's violent behavior resulted from a deterioration in functioning that followed from severe -- and probably prolonged -- emotional distress. It is likely that he suffered a complete collapse in his ability to cope effectively. This level of distress would have likely clouded his judgment and interfered with his ability to control his impulses. He may have been acutely depressed, agitated, and possibly exhausted from an inability to sleep. We may find that there were acute triggers that contributed to his psychological disintegration. Or it may be that the cumulative effect of a variety of stressors and internal states created the circumstances that led this young man to first strike out against his community and then to turn the aggression on himself. We may come to find out that the issues that affected Specialist Lopez began long before his military service -- or perhaps some of his experiences since joining the military contributed to the tragedy that unfolded on April 2.

Specialist Lopez wore the uniform and served our nation. And because of that, we want to know if the Department of Defense is doing all that it can to ensure that those who serve, and their families, are receiving the mental health care they need and deserve. Most who serve -- whether they are exposed to combat or not -- will come home to lead productive and meaningful lives. Some will struggle for a time as they reintegrate back into civilian society. Sadly, others will endure an extended period of struggle and suffering; and even fewer may hurt themselves or others.

Over the past nine years of building Give an Hour, the organization I founded to help meet the mental health needs of the military community, I have been impressed with the interest and efforts of the Department of Defense regarding the mental health care of our nation's military. I have many colleagues within DoD -- high-ranking officials and on the ground mental health providers -- who care deeply about these issues. There is a tremendous amount of time and significant resources being devoted to screening, research, intervention, and awareness. Is DoD doing "enough" in the area of mental health? No, it is not. But neither is our nation as a whole. And we have a much bigger problem to overcome if we want to prevent future tragedies like the ones that occurred at Virginia Tech, or in Aurora, or at Sandy Hook.

It is time to change the conversation in America about mental health, mental illness, and wellness. One in four American adults has a diagnosable mental health condition, and yet we continue to struggle with how and when to talk about and address these universal experiences that are part of the human condition (http://www.cdc.gov/features/mentalhealthsurveillance/index.html). We don't talk about our mental health challenges publicly or openly, the way we talk about our physical health and well-being. We don't reach out to others for care, assistance, and support -- no doubt because most of us feel ashamed of our mental health challenges and struggles. The cost to employers of unmet mental health needs in our nation is staggering, and the cost in human suffering is shocking.

Specialist Lopez sought help. We don't know the severity of his condition, we don't know how much care or assistance he received. Nor do we know how those around him responded to his pain, or if he even shared it with them. We do know that early intervention is key and that one size doesn't fit all when it comes to helping us heal from or cope with mental health challenges and mental illness. Was Specialist Lopez identified as being in distress early in his military care? Was he receiving the level of care that he needed? And should the level of care that he received have been based on whether or not he reported suicidal or homicidal ideation? If our goal was to optimize his mental health and not just manage his symptoms, probably not.

Although those who serve face stressors and challenges that place them at risk for developing psychological injuries and conditions, mental health is not a military issue. And while the military culture -- with its promotion of self-reliance and toughness -- unintentionally contributes to the shame and guilt of those who fail to "man up" emotionally, we all struggle with acknowledging our psychological vulnerabilities, and we are all reluctant to admit we need help. The question we should be asking ourselves and each other is how do we move from being afraid of our mental health to being open to all aspects of our humanity.

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