An important issue that has not yet been addressed in reports of the Fort Hood shootings is an apparent but serious failure to ensure that the perpetrator of the attacks, Major Nidal Malik Hasan, was himself engaged in self-care activities to manage the high probability of job burnout and becoming overwhelmed by the stress inherent in his position as a military psychiatrist.
In fact, since Fort Hood was developed by the Army to provide the medical and mental health evaluations necessary to certify soldiers as fit to be deployed for service overseas, Hasan, as one of the few psychiatrists there, was required to talk to an endless number of soldiers, day after day, who expressed their deepest fears, anxieties and concerns about being sent to Iraq or Afghanistan. At the same time, he was experiencing his own fears and distress over his anticipated deployment, which were understandably exacerbated and heightened by the conversations he had with the soldiers. Moreover, he was also a Muslim who actively and devoutly practiced his religion and was conflicted over reconciling his service to the Army with his religious beliefs.
I am in no way condoning what Hasan did. It was a horrific and tragic act, and my heart goes out to all the victims and their families.
But even under the best of circumstances, mental health professionals are at risk for experiencing a significant level of job-related stress than can impact their own physical and psychological health. Over time, working with clients with their own serious life problems, such as helping clients manage and change their potentially self-destructive behavior, can take a cumulative toll on the helping professional.
It is unfortunate, however, that most education and training programs for mental health professionals focus almost exclusively on giving them the skills to help others, and pay little or no attention to providing the tools and strategies they will need to help them to maintain their own psychological health while doing their jobs.
In fact, perhaps there are lessons to be learned from the Fort Hood tragedy. First, it should be incumbent upon institutions and organizations that educate and employ mental health professionals to guarantee that opportunities to learn and engage in self-care are provided on a regular basis. A formal monitoring must also be established to ensure the professional's compliance with these activities. Specific examples of self-care strategies include regular participation in a support group with other mental health professionals; participating in one's own on-going psychotherapy; practicing activities that promote physical well-being, including healthy eating, regular exercise, adequate sleep, relaxation procedures; and taking sufficient time for oneself to do the things that bring enjoyment and satisfaction to one's life other than one's job. This includes the periodic scheduling of vacations and other time away from work to allow the person to recharge his or her batteries.
I know the importance of such engagement first hand. In my position as a child and adolescent psychologist, I volunteered for several months to work with families who were affected in the immediate aftermath of the September 11, 2001 tragedy. For some two months, I saw families with children where a parent or other adult relative was missing or unaccounted for several weeks after the destruction. My three decades as a mental health professional did not fully prepare me for this task. In fact, it was the most challenging and emotionally demanding activity of my entire career. At the end of each day, I was physically exhausted, emotionally drained and very sad, having cried along with the families that I talked with that day.
Yet, during this difficult and professionally stressful period, I made sure that I implemented as many self-care strategies as I was able to successfully cope with this difficult experience. First, I agreed to work a schedule where I worked for two consecutive days followed by two days off in between. This allowed me the necessary down-time so I did not feel overwhelmed by my job responsibilities.
Second, I engaged in some physical activity at least five days each week -- jogging, going to the gym, riding a bicycle -- to help me to minimize and manage my stress level. I also made every effort to participate in pleasurable activities as often as possible such as going out to dinner, the movies, or the theater with friends.
Most important, at the end of each day, all mental health professionals who offered volunteer counseling participated in a support and discussion group that lasted for several hours. This group provided the opportunity for emotional support, sharing and normalization of feelings, sharing of strategies to address a person's specific issues and concerns, and a forum for honest and corrective feedback.
In the end, it is highly unlikely that Hasan was given the support, encouragement, or the opportunity to practice such appropriate self-care activities that might have helped him cope more effectively with his stressful job at Fort Hood. At the very least, it is unfortunate that he did not have access to an on-going support group of his peers with whom he could share his fears and concerns and ask for help without any concerns about being negatively judged or evaluated by his superiors on the army base. Again, I am by no means am I offering excuses for his horrendous act. But had these procedures been available to this psychiatrist on a continuous basis, this terrible tragedy might have been prevented.
Dr. Lawrence Siegel is Dean and Professor of the Ferkauf Graduate School of Psychology at Yeshiva University. A Fellow of the American Psychological Association and Board certified in clinical psychology, he has devoted his 35-year career to the education and training of doctoral-level professional psychologists.
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