Dear Mr. Lowry,
I have been following the discussion in various news and opinion sources regarding the psychological state of Major Hasan, the perpetrator of the Fort Hood mass murder. Although PTSD is not my primary area of expertise, I have developed programs for people with trauma disorders and supervised counselors who provide service to people with both PTSD and complex trauma disorders. I am writing to provide you with some information on secondary/vicarious traumitization as well as my interpretation – albeit based only on reported information – of the relevance of trauma to this case.
For the past 10 years or so there has been a growing literature demonstrating that counselors, crisis intervention workers, aid workers and others who provide front-line service to people exposed to significant trauma develop a small but significant chance of experiencing what was formerly called ‘compassionate burn out’ and more lately is referred to as secondary or vicarious traumitization.
Although the book is not closed on this phenomenon, recent reviews suggest that: a) a proportion (undeterred but less than the majority) of people who carry a caseload of traumatized (diagnosis of PTSD or complex trauma disorder) over time will develop some symptoms of PTSD or trauma disorders such as intrusive memories, triggered overly emotional responses etc. And b) a small minority of care givers will develop symptoms that would support a diagnosis of PTSD. My interpretation is that committed, intensive, long-term work with highly traumatized individuals carries a slight to moderate risk of developing symptoms of PTSD or complex trauma disorders.
There have been various attempts to explain why this might happen. Most explanations focus on the dynamics that occur between counselors and clients and use the terms transference (the projection of emotional states etc. onto the therapist by the client) and countertrasferece (the projection of the therapists emotional states etc. upon the client), and empathy (compassion based on a attempt to personally understand the emotional state of the client.) A simplified explanation is that when dedicated, empathic counselors actively engage in highly charged emotional interactions with clients they become over sensitized and begin to experience symptoms themselves. This explains why the terms secondary or vicarious are used to describe this process.
There is no indication in any established literature on this interesting and relatively new phenomenon that secondary or vicarious traumitization leads to psychotic states, murderous rages, etc. Therapists who present with this phenomenon more commonly present as sad, overwhelmed and burned out and this is why is was originally referred to as compassionate burn out.
With reference to the case of Major Hasan two points are of particular interest. First, by all accounts Major Hasan’s observed problems were not overcommitment compassion and over identification with traumatized soldiers. There is no suggestion that he identified with his clients, took his job overly seriously or that he habitually advocated for his clients and went beyond expectations to serve them. (There was, in fact, suggestion that he argued with clients, something rarely seen in cases of compassionate care.) As the previously mentioned characteristics are hallmarks of secondary or vicarious traumatization, it calls this ‘diagnostic’ explanation into question.
Second, there is ample evidence that Major Hasan experienced a long-standing personal religious/moral angst that was fueled by self-defined spiritual dilemmas. The reported chronology pre-dates the clinical work that allegedly produced secondary or vicarious traumatization. Over the course of his training and service with the Armed Forces, there appears to be a clear pattern of thoughts and behaviors that indicate escalating anger and frustration over the self-styled dilemmas created by his choice to be both a committed Muslim and an active member of the US Armed forces.
Given these observations, it is very difficult to characterize Major Hasan’s behavior as being the consequence of his clinical experiences. It is more reasonable to conclude that Major Hasan’s clinical work did not lead to a state of vicarious or secondary traumitization, although it may have served as the final straw or the catalyst which sent his spiraling rage and frustration into a murderous frenzy.
From a psychological perspective, my position is that there is no clear indication, and not even reasonable grounds for speculation, that Major Hasan suffered from vicarious traumitization. There is, however, considerable evidence suggesting the presence of immaturity, narcissism, social disconnection, poor impulse control and poor decision making. None of these are specific symptoms of mental illness and are commonly seen in the criminal population (as well as in the US Congress).
The facile presentation of the tragic events at Fort Hood in poorly conceptualized psychological analyses is brought to the public by the same ‘psychological experts’ who are hyper-vigilant for violent crimes in the veterans population while studiously ignoring the epidemiological data that consistently shows lower rates of violence in veterans than in the general population. I am appalled, but not particularly surprised, when this sort of media behavior occurs.