Why do people with mental health issues stay closeted, quiet, and in so many cases untreated? Well, for an answer, all you had to do was watch news coverage of the shooting Wednesday afternoon at Fort Hood, Texas.
As the chaotic not again, not here storyline began to recede into the background, and the could it be terror/second shooter reports (as many who remained cautiously restrained in the early going had predicted) were discounted, a familiar line of questioning and theorizing began to rise almost inevitably, weaving ever-so-quietly-yet-insistently into the on-air chatter:
The shooter, a soldier, was deranged.
When Lt. Gen. Mark Milley appeared before the cameras late Wednesday night, he shared a variety of facts about the suspect in the case: He was a soldier, he'd served four months in Iraq in 2011, and he was married with family in the Killeen, Texas area. Gen. Milley also revealed the shooter had been under evaluation at Fort Hood for possible PTSD, having complained of a traumatic brain injury. He also had received treatment for anxiety and depression -- and was on medication (which has been reported today to be Ambien, a prescription sleeping medication).
Had Gen. Milley added one more fact -- say, that the suspect attended an off-post mosque -- I assure you the conversation would have ramped up to ferocious speed along the lines of nexus to terrorism. That, of course, did not happen.
Here's what did happen, though, resulting in a flurry of anger among advocates for the mentally ill, joined by many working to support veterans of the wars in Iraq and Afghanistan.
Lacking that small fact that could have provided a route into MH370-class conjecture on fundamentalism, terrorism and jihad, journalists jumped on the next most tempting morsel in the highly-limited fact pool: PTSD and mental health.
As early as 8:27 p.m., The New York Daily News was off and running, tweeting, "UPDATE: Mentally ill soldier kills 3, self, wounds 16 at Fort Hood."
Factual? Perhaps. Fair? Not in the least.
Consider what that tweet might have looked like had the suspect been identified, as in the case of the previous Fort Hood shooter, as Muslim. Would the Daily News have tweeted -- merely four hours after the shooting -- "UPDATE: Muslim soldier kills 3?"
Again, factual, but clearly, that headline would have sent a subtle but unmistakeable message: Muslim. Terrorist. Now, as it turned out in the case of Maj. Nidal Malik Hasan, as the Daily News itself noted just this week, "The psychiatrist became a radicalized Muslim while he was serving in the military, unleashing his fury during a 2009 shooting rampage that left 13 dead and 32 injured."
But that's absolutely not what the early coverage of the 2009 Fort Hood shooting went. Reporters and editors, wary of accusations of hostility or insensitivity, included the key fact of the accused's name, but never ran with it toward an explosive suggestion that hey, he's Muslim, right, so could this shooting be terrorism?
NBC News, back in November of 2009, waited until the tenth paragraph of a story on the shooting to note, "The Associated Press, quoting federal law enforcement officials, said Hasan had come to their attention at least six months ago because of Internet postings that discussed suicide bombings and other threats. The officials said they were still trying to confirm that he was the author."
The facts, important as we would later learn, are in the story. But they don't sit in the lede. NBC included other possibly-significant facts, like reports the shooter had been upset over a workplace issue, which could also have proven to be the cause of the shooting spree. Jihad had no business -- then -- in the lede or the headline, which did not read, "Soldier Who Spoke of Suicide Bombings, Threats, Kills 12." It was, "Gunman kills 12, wounds 31 at Fort Hood."
If only the Daily News had been so careful.
The words we choose as journalists matter. So does the emphasis we use, and the significance we assign to facts. Simply knowing that an Army general or any other official shared a "fact" does not make it, in itself, important. If it were, then a headline like, "Chevy driving soldier kills 3" would make sense. Instead, it's ridiculous. Driving a Chevy could be relevant -- even turn out to be the most important fact, explaining what led to a horrific attack. But in the first few hours, when more often than not, most facts turn out to be irrelevant or wrong, it's not worthy of inclusion in a headline or lede. And including the suspect's treatment for depression and anxiety, but not his treatment for, say, digestive upset or his need for corrective lenses, serves only to reinforce the stigma of mental illness.
And by giving high prominence to the soldier's being evaluated (not even diagnosed) for PTSD, it's a huge disservice to the staggering numbers of American men and women returning from Iraq and Afghanistan with PTSD. The link, by the way, between PTSD and violence is at best shaky, and anyone who tells you a person being treated for depression and anxiety is prone to violence or mass shootings is an idiot. Simple as that.
And yet, the potentially stigma-reinforcing and possibly irrelevant correlation between the shooting and the suspect's treatment for mental illness and perhaps PTSD wormed its way into cable news coverage and stories written about the killings at Fort Hood:
- A soldier suffering from mental health issues killed three people and wounded 16 others at the Fort Hood U.S. Army base in central Texas on Wednesday before turning a gun on himself and committing suicide, the base's commander said. (Reuters)
- A soldier being treated for mental health issues opened fire Wednesday at Fort Hood, killing three people and wounding 16 before fatally shooting himself at the same military base where 13 people died in a 2009 attack, authorities said. The gunman was being evaluated for PTSD, but a diagnosis had not been confirmed, said Lt. Gen. Mark A. Milley, the senior officer on the base. (Dallas Morning News)
- A soldier being treated for mental health issues opened fire Wednesday with a semiautomatic weapon at Fort Hood, killing three people and wounding several others before taking his own life as a military policewoman confronted him, officials said. (CBS News)
- While the gunman's motive is still unclear in Wednesday's deadly incident at the Texas Army base, military officials say he had "mental-health issues."(Daily Beast)
- A soldier who was being evaluated for post-traumatic stress disorder opened fire at Fort Hood on Wednesday, killing three people and wounding 16 before killing himself, the authorities said. The shooting set off a huge police response and shut down the sprawling Army base, the same facility where a deadly rampage by an officer resulted in 13 deaths in 2009. (The New York Times)
Yes, the last link is to the venerable New York Times, prompting Paul Rieckhoff, founder and executive director of Iraq and Afghanistan Veterans of America, to tweet: "Correlation does not imply causation. The @NYTimes should know that. And everyone else should take note."
These kinds of subtle connections, floated out in headlines, ledes and in repeated questions to experts in endless cable news coverage, result in reinforcement of stigma, and a lost opportunity to educate viewers and readers on what mental illness and PTSD really are.
At a recent forum at a forum on mental illness and violence held in Washington last month by the Institute of Medicine, doctors and researchers warned about the ways incidents of mass shooting magnify misunderstanding about mental illness.
"The recent wave of mass shootings, often attributed to individuals with mental illness, should be placed in perspective, said Thomas Insel, M.D., director of the National Institute of Mental Health. "Most people with mental illness are not violent, and most acts of violence are not committed by people with mental illness," said Insel in his keynote address.
"People with untreated psychotic illness are at increased risk of irrational behavior, including violence, especially directed at family and friends. This usually happens at the onset of illness and before diagnosis or treatment. However, once treatment starts, these people have no higher risk of violence than the general population and are more often victims of crime."
So yes, perhaps the shooter at Fort Hood did have PTSD. He may also have had any number of issues in his life that may or may not have led him to buy a gun, bring it to base, and kill. And yet news organizations including the Times thought there was enough reason to put a potential diagnosis of PTSD ahead of the facts of the shooting itself. What does that convey to readers?
Again, consider the alternate lede: "A soldier who attended a local mosque opened fire at Fort Hood on Wednesday." That would never make the cut at the Times. But like the Daily News, mental illness does slip right into the first words of the first sentence, and it implies cause and effect.
That's just plain sloppy journalism, and with millions of Americans facing mental health issues through the course of their lifetimes, and a generation of American men and women returning from wars suffering from these treatable illnesses and yet often resisting reaching out for help and ending their lives in suicide, we have a responsibility as journalists to be much more careful.