04/03/2014 06:05 pm ET Updated Apr 07, 2014

Fort Hood Shooting Highlights How Little Is Known About Military Trauma And Homicide

WASHINGTON -- The deadly shooting at Fort Hood, Texas, on Wednesday comes amid widening awareness of the deep and enduring war trauma that exists within the military after 12 years of war. Army Spc. Ivan Lopez, 34, who was struggling with depression, anxiety and insomnia, killed three people and injured 16 others before taking his own life.

There is no scientific evidence proving that such mental health issues increase likeliness to commit mass homicide, and military officials said Thursday the investigation is continuing as they struggle to understand what ignited Wednesday's violence.

Certainly today's 1.4 million active-duty military members, including the 152,986 active-duty personnel diagnosed with post-traumatic stress disorder since 2001, have weapons training and access to firearms, and yet homicide inside the military community is so rare that there is no detailed research on the link between war trauma and murder.

William P. Nash, a retired Navy psychiatrist and national expert on PTSD, acknowledged that not enough is known about the ultimate effects of post-traumatic stress and other forms of trauma and the potential link to murderous aggression.

"With homicide, there is so little data," Nash said. "I'm not aware of anyone looking at those things. I wish people did more -- these are important questions."

Lopez, from Guayanilla, Puerto Rico, served with the Puerto Rico National Guard from 1999 to March 2010 before going on active duty as an infantryman with the 1st Armored Division at Fort Bliss, Texas. In February of this year, he transferred to Fort Hood as a truck driver with the 13th Sustainment Command. According to records released by the Army, Lopez deployed to Egypt in January 2007 for a year with the Sinai peacekeeping task force, and spent four months in Iraq, from August to December, 2011, according to an Army statement. During his career he was awarded two Army Commendation Medals, four Army Achievement Medals and three Army Good Conduct Medals -- all typical awards for a junior enlisted soldier -- as well as other service medals.

Although Lopez claimed to have suffered traumatic brain injury, essentially a concussion of the type that has often gone undiagnosed or mis-diagnosed among deployed troops, Army Sec. John McHugh said Thursday there was no record of Lopez being injured. He also said there was no record of any misconduct on Lopez's part.

Lt. Gen. Mark Milley, commander of the III Corps and Fort Hood, said at a press conference later Thursday that Lopez's medical history showed an "unstable psychiatric condition" that may have been the "fundamental underlying cause" of the shooting. Milley also noted reports that Lopez had been involved in a verbal confrontation with other soldiers shortly before the shootings.

From initial reports, at least, the Army has acknowledged Lopez' psychological problems and was providing appropriate care. Military officials said Lopez was being assessed for the possible TBI and PTSD. He also had been seen by a Fort Hood psychiatrist and was under treatment for insomnia with Ambien and other drugs for anxiety. McHugh said Thursday there was no record of Lopez ever mentioning or threatening suicide, and that he hadn't shown any sign indicating a likelihood to commit violence against himself or others.

Researchers and therapists have found that the hyper-vigilance common to PTSD -- the "can't calm down," sleepless, on-edge state that many experience -- can lead to anger and aggression. Research has also indicated that lack of sleep can blunt a person's ability to make responsible decisions and foresee consequences of their actions.

"Very poor sleep means a person may not be able to maintain and restore their normal level of neural transmitters in the part of the brain they need not to do stupid stuff," said Nash, the retired Navy psychiatrist.

As late as two years ago, Defense Department officials acknowledged to The Huffington Post that they had no precise definition of mild TBI, did not understand the mechanisms that cause the brain injury and could not precisely diagnose what had become the most common cause of combat casualties in Iraq and Afghanistan. Nevertheless, the Defense Department has recorded 294,172 cases of TBI between 2000 and 2013 worldwide, highlighting the extent of brain injury.

But researchers and therapists now are looking beyond the specific, narrowly defined understanding of PTSD and concussion to describe the more common and often deeper psychological effects of war. Some are grouping the symptoms of depression, anxiety, sleeplessness, shame, guilt, grief and remorse under the term moral injury. It is a description of trauma more broad than that of PTSD, which requires a person to have suffered at least one terrifying, life-threatening experience.

Moral injury, the subject of a recent series by The Huffington Post, is described as a wound to a person's moral foundation, a violation of what a person believes as right and wrong. It might be experienced by a combat soldier whose closest buddy is killed in combat, or by a wounded Marine who feels guilty at being medevaced and having to leave his unit behind. Medics have described their guilt and shame at being unable to save a mortally wounded soldier.

What caused researchers to focus on moral injury was the dramatic surge in cases of mental health issues during the Iraq and Afghanistan wars. A detailed study last year by the Armed Forces Health Surveillance Center examined medical evacuations of U.S. military personnel from Iraq and Afghanistan between 2001 and the end of 2012. It found that the most common reason for airlifting troops away from the battlefield was not physical wounds, but disabling psychological issues.

A second study by the center, published in November 2012, looked at the burden of the war years on military hospitals by comparing wartime rates of hospitalization for mental health issues to peacetime rates. It found that mental disorders were the "largest single contributor" to the sharp increase in hospital use: Six million additional ambulatory visits, 42,000 additional hospitalizations and 300,000 additional bed-days were attributed to mental disorders.

At the San Diego Naval Medical Center, staff psychologist Amy Amidon sees a steady stream of Marines and others struggling to absorb their war experiences. "They have seen the darkness within them and within the world," she said, "and it weighs heavily upon them."

04/04/2014 4:57 PM EDT

U.S. Military Official: Mental Health Of Shooter Not Direct Factor In Shooting

The Associated Press reports:

FORT HOOD, Texas (AP) — The senior officer at Fort Hood says the mental condition of the soldier who fatally shot three soldiers and wounded 16 others earlier this week was not the "direct precipitating factor" in the shooting.

The comments Friday by Lt. Gen. Mark Milley came a day after he said Spc. Ivan (ee-VAHN') Lopez's mental condition appeared to be an underlying factor.

Milley said Friday that an "escalating argument" precipitated the attack.

Authorities say their investigation has found Lopez had an altercation Wednesday with soldiers in his unit that prompted the shooting.

04/04/2014 4:36 PM EDT

U.S. Military Officials Update On Fort Hood Shooting Investigation

Lt. Gen. Mark Milley and other U.S. Military officials provided additional details on the investigation of the Fort Hood shooting, saying that while the process was ongoing, the rampage was believed to have been preceded by a "escalating argument" involving the alleged shooter, Spc. Ivan Lopez. Officials said that the alleged shooter's mental condition was not the "direct precipitating factor" to the shooting. He said that the alleged shooter's mental health would be fully investigated.

An official said that at the time it is believed that there was "No premeditated targeting of any specific individuals" in the shooting. The weapon used in the shooting had been recovered, and the official said the weapon was purchased on March 1 outside of the base.

The Fort Hood officials said that 10 of the 16 wounded who were admitted to hospital facilities following the shooting had been released and returned to duty.

04/04/2014 4:25 PM EDT

U.S. Military Officials Identify Shooting Victims

In a press briefing, Lt. Gen. Mark Milley identified the three soldiers killed in the Fort Hood shooting: Sgt. First Class Daniel M. Ferguson, age 39; Staff Sgt. Carlos A. Lazaney Rodriguez, age 38; Sgt. Timothy W. Owens, age 37.

Read HuffPost's report here.

04/04/2014 2:03 PM EDT

Official: Alleged Fort Hood Shooter Was In Dispute Over Leave Before Rampage

The New York Times reports:

The soldier at Fort Hood who killed or wounded 19 of his fellow Army members on Wednesday had a dispute with his superiors over their denial of a leave request shortly before the shooting rampage, a law enforcement official said Friday.

The report goes on:

Investigators were also looking into Specialist Lopez’s dispute with Army superiors who had denied his request for leave. He met with Fort Hood officials about the denial on Wednesday shortly before the shooting started and had been clearly agitated and disrespectful after the meeting, the law enforcement official said. It was unclear why he wanted to take time off, but it appeared to involve his family.

Read the report from The New York Times here.

04/04/2014 1:58 PM EDT

Father Of Fort Hood Gunman: He 'Must Not Have Been in His Right Mind'

NBC has released a statement from the family of the alleged Fort Hood shooter, Spc. Ivan Lopez.

Facing the tragedy that occurred on April 2 in Fort Hood, TX, the family of the Puerto Rican soldier Iván López is concerned and asks for prayers for those affected and deceased by the unfortunate incidents. Iván López, father of the soldier, is still in shock and described his son as a calm family man, a young worker who always looked out for the well being of his home and a good son.

"This situation has caused great pain. I ask for prayers for the affected families, even more so when there is still an ongoing investigation. My son must not have been in his right mind, he wasn't like that," said Iván López, Sr.

As an active soldier he defended the nation and received medals. He also worked honorably as a policeman on the island. According to his father, the soldier was under medical treatment and the passing of his mother, his grandfather and the recent changes when transferring to the base surely affected his existing condition because of his experiences as a soldier. No more comments shall be made during the investigation conducted by authorities.

Read the NBC report here.

04/03/2014 8:33 PM EDT

Defense Secretary: Too Soon To Draw Safety Conclusions

AP reports:

Defense Secretary Chuck Hagel says it's too soon to draw any broad conclusions about safety at U.S. military bases after the deadly shootings at Fort Hood, Texas.

He said Thursday that as the investigation unfolds, the Pentagon will continue to take a close look at any new lessons that can be learned from Wednesday's tragedy and implement any needed changes to base security.

Read the full story here.

04/03/2014 7:08 PM EDT

6 Shooting Victims Discharged From Hospital

04/03/2014 5:54 PM EDT

AP Identifies Victim Of Fort Hood Shooting

One of the victims of Wednesday's shooting has been identified as U.S. Army Sgt. Timothy Owens. His family told the AP that he was a native of Effingham, Ill.

04/03/2014 5:38 PM EDT

Fort Hood Does Little To Keep Out Firearms

According to the NYT, Fort Hood does very little to keep guns off the military base.

"Fort Hood’s weapons rules for soldiers who are not police officers rely in large part on the honor system," the Times reports.

The base does not require entrants to go through a metal detector or any similar screening, a source told the Times.

For more, click here.

04/03/2014 4:52 PM EDT

Family Of Fort Hood Gunman Reportedly Didn't Know He Was Being Treated For Mental Problems

He [Lopez] sought help for depression and anxiety and was being evaluated for post-traumatic stress disorder, military officials said. But Army Secretary John McHugh said Thursday that a psychiatrist last month found no violent or suicidal tendencies. The soldier was prescribed Ambien for a sleeping problem.

He had no apparent links to extremists, McHugh said.

Glidden Lopez Torres, who is not related to the gunman but identified himself as a family friend speaking on behalf of the soldier's family in Puerto Rico, said Lopez's mother died of a heart attack in November.

Lopez was close to her and was apparently upset that he was granted only a short leave — 24 hours, later extended to two days — to go to her funeral, which was delayed for nearly a week so he could make it, the family spokesman said.

The family was not aware that Lopez was receiving any treatment for mental problems, the spokesman said.

Read more here from The Associated Press.