When Soldiers’ Minds Snap

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“Every man has his breaking point,” said military doctors in World War II, believing that more than 90 days of continuous combat could turn any soldier into a psychiatric casualty.

For Maj. Nidal Malik Hasan, the Army psychiatrist who military officials said gunned down dozens of soldiers at Ft. Hood, Tex. on Thursday, that point may have come even before he experienced the reality of war; he was bound for a combat zone but had not yet embarked.

Much is unknown about Major Hasan’s motives. He is said to have dreaded deployment, but what he feared is unclear. And officials have not ruled out the possibility that his actions were premeditated or political. One report had him shouting something like “Allahu Akhbar” — Arabic for “God is Great” — before the shooting.

Over the centuries, soldiers have often broken under such stress, and in modern times each generation of psychiatrists has felt it was closer to understanding what makes soldiers break. But each generation has also been confounded by the unpredictability with which aggressions sometimes explode, in a fury no one sees coming.

In World War I, the disorder was known as shell shock, and the soldiers who fell victim were at first believed to have concussions from exploding munitions. Their symptoms appeared neurological: They included trembling, paralysis, a loss of sight or hearing.

Yet it turned out that some affected soldiers had been nowhere near an exploding shell, suggesting “that the syndrome could arise in anticipation of going into a stressful situation,” said Dr. Richard McNally, a professor of psychology at Harvard and an expert on traumatic stress.

Some doctors devised methods to treat shell shock victims — one German doctor tried electroshock to the limbs. But there was also widespread suspicions that the soldiers were malingering. Some soldiers were shot for cowardice.

Yet shell shock was simply the Great War’s version of a reaction to combat that has been detected even in the writings of antiquity. Achilles, Jonathan Shay maintains in “Achilles in Vietnam,” (Scribner, 1994) displayed a form of traumatic stress when in the Iliad he grieves over the death of his friend Patroclus.

Soldiers in the Civil War suffered from irritability, disturbed sleep, shortness of breath and depression, a syndrome Jacob Mendes Da Costa, an Army surgeon, described in 1871 as “irritable heart.”

In World War II, the paralysis and trembling of the early 1900s did not recur. But nightmares, startled reactions, anxiety and other symptoms persisted as “battle fatigue” or “war neurosis,” a condition whose treatment was heavily influenced by the rise of Freudian psychoanalysis.

Out of that war emerged a theory of battlefield treatment known as PIE, or proximity, immediacy and expectancy. The doctrine held that if a soldier broke down during combat, he should be treated close to the front, because if he was sent home, he would do poorly and seldom return to battle. Major Hasan, had he reached Iraq, would have practiced a similar approach: Soldiers are treated close to the forward lines and only removed to hospitals farther from the front in the most severe cases.

Today, the flashbacks, nightmares and other symptoms of soldiers are diagnosed as post-traumatic stress disorder or P.T.S.D., a term that replaced “post-Vietnam syndrome” and entered the official nomenclature in 1980, appearing in the American Psychiatric Association’s diagnostic manual. Like its predecessors, the disorder has been easier to diagnose than it has been to understand or to treat.

Yet no theory seems able to capture the unpredictable effects of sustained violence on human beings, the subtle pressures that years of killing and more killing exert on a soldier, a doctor or a society — or the reality that every war travels home with the soldiers who fight it.

“All these people have been under a tremendous amount of stress,” said Dr. Stephen Sonnenberg, a psychiatrist and adjunct professor at the Uniformed Services University of the Health Sciences, speaking of soldiers and those who treat them. “They are holding the stress for everybody.”

Whole article and analysis can be read from here: http://www.nytimes.com/2009/11/08/weekinreview/08goode.html?hp

 

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FORT HOOD, Texas (CNN) -- The bumper sticker reading "Allah is Love" was torn off and the car was keyed.

A police report was filed in the August 16 incident involving Maj. Nidal Malik Hasan's Honda, and a neighbor was charged with criminal mischief. But what kind of impact that incident, and possibly others, had on Hasan remains a mystery.

While few official details have been released about Hasan, his family and others have given some insight into the man accused of killing 13 people and wounded 38 others in Thursday's massacre at Fort Hood Army Post in Texas.

Relatives say Hasan, a U.S.-born citizen of Palestinian descent, was a "calm" individual who had been taunted after the terrorist attacks of September 11, 2001. Others describe him as a vocal opponent to the war on terror whose rhetoric concerned colleagues.

The bumper sticker incident at Hasan's apartment complex in Killeen, Texas, is the first known example of harassment that has surfaced since the shooting. Apartment manager John Thompson said Friday that he reported the situation to police after the girlfriend of then-resident John van de Walker told him that he did it. Thompson said he saw van de Walker apologize to Hasan and that a police report was filed.

He added that the bumper sticker said "Allah is Love" in Arabic, but that van de Walker knew that Hasan was Muslim before seeing it. Thompson said the last time he asked Hasan about the incident, Hasan said he was still waiting for reparations for damage to his 2006 Honda Civic.

Hasan's cousin, Mohammad Munif Abdallah Hasan, said the Army major had wanted to leave the military because he felt disrespected over his religion.

"There was racism towards him because he's a Muslim, because he's an Arab, because he prays," the cousin said in a CNN interview in the Palestinian city of Ramallah. "They used to see him dress in traditional Muslim clothing, so he was a bit irritated because of this. Also, the fact that they wanted to send him to Iraq. He decided to leave the Army for good and hire a lawyer because of this matter."

"They wouldn't treat him as if he is one of them. He was a major in the Army and other majors wouldn't treat him equally as a major should be treated," the cousin said. " 'Yes, you are a major in the U.S. Army, but you are still an Arab, a Muslim, you have your own traditions and values and we have ours.' He was bothered by that a lot. He wasn't respected as he should have been."

The cousin added that he wanted to leave the Army, especially after getting deployment orders.

Army officials have indicated that Hasan was to deploy to Afghanistan to work with a unit already there as part of behavioral health support. It wasn't clear when Hasan was scheduled to go overseas for what would have been his first deployment.

Dr. Val Finnell, a former medical school classmate of Hasan's, described him as "a very outspoken opponent of the war" in the classroom and in public settings.

"He equated the war against terror with a war against Islam," Finnell said.

More can be read from: Fort Hood suspect's religion was an issue, family says - CNN.com