Diagnosis by journalism

FT. Hood Suspect may be paralyzed

The Washington Post has a story alleging that Major Nidal Hasan had stepped up his communications with a radical, American-born Muslim cleric in Yemen in the months before he killed 13 people at Ft. Hood. An FBI-led task force had obtained the emails between late 2008 and June 2009 but they were not forwarded to the military, for some reason. Some were sent to the FBI's headquarters but they apparently weren't considered terribly worrisome:

Hasan's contacts with extremist imam Anwar al-Aulaqi began as religious queries but took on a more specific and concrete tone before he moved to Texas, where he allegedly unleashed the Nov. 5 attack that killed 13 people and wounded nearly three dozen, said the sources who were briefed on the e-mails, speaking on the condition of anonymity because the case is sensitive and unfolding. One of those sources said the two discussed in "cryptic and coded exchanges" the transfer of money overseas in ways that would not attract law enforcement attention.

"He [Hasan] clearly became more radicalized toward the end, and was having discussions related to the transfer of money and finances . . .," said the source, who spoke at length in part because he was concerned the public accounting of the events has been incomplete. "It became very clear toward the end of those e-mails he was interested in taking action."

Senate Armed Services Committee Chairman Carl M. Levin (D-Mich.) said Friday that he would investigate the handling of the e-mails -- 18 or 19 in all -- and why military officials were not aware of them before the deadly attack. Levin told reporters after a briefing from Pentagon staff members that "there are some who are reluctant to call it terrorism, but there is significant evidence that it is."

Bits and pieces of Hasan's communications with Aulaqi have become public since the Fort Hood massacre, but the sources provided the most detailed description yet of the messages. The e-mails will help investigators determine whether Hasan's alleged actions were motivated by psychological deterioration or inspired by radical religious views he found online and through e-mail exchanges with Aulaqi.

Aulaqi is considered by the U.S. to be an al-Qaeda supporter and someone who has inspired terrorists throughout the world, so this is not insignificant news. It was previously reported that Aulaqi had formerly served as the leader of a mosque Hasan attended and had praised Hasan after the attack, calling him a "hero." The story discusses Hasan's paralysis -- and the apparent paralysis plaguing various federal agencies that are responsible for protecting America from terrorist attacks.

I think Levin's quote is interesting -- that there is significant evidence that this is "terrorism" but that some are reluctant to call it such. People might debate the meaning of the word terrorism -- I myself thought it required intentionally targeting civilians or non-combatants with violence for political purposes. But I think most public discussion of this violence speaks of it in terms of either Hasan's alleged psychological deterioration or Hasan's terrorism. This news that it may have been conspiratorial terrorism makes things more interesting.

It's important -- whether we're talking about violence against Dr. Tiller or federal employees in Oklahoma City or soldiers at Fort Hood -- that the media not jump to any conclusions, as President Obama said. Now, a few weeks out, we're seeing many reports of Hasan's involvement with terrorists but I have yet to see much evidence of mental illness. Now, don't get me wrong -- I think you have to be suffering mentally in at least some sense to go on a killing spree -- but I haven't seen much evidence of an actual diagnosable illness.

This Newsweek article penned by religion editor Lisa Miller has a thesis I actually agree with -- why must we choose between whether he's a mental-health victim or a terrorist? Why can't he be both?

But I didn't feel she made the argument terribly well:

Major Hasan may suffer from loneliness, isolation, PTSD, and a terror of being deployed overseas. He may, indeed, be mentally ill. But he was also allegedly exchanging e-mail with Anwar al Awlaki, a Yemeni-American cleric whose rhetoric urges Muslims to see terrorism as a selfless and righteous act for the greater good of the global Muslim community.

Notice how the evidence for the latter claim is just so much more specific than the evidence for the former. And on that front, let's just look at the discussion of whether Hasan has PTSD. Here's what the National Institute of Mental Health says about Post-Traumatic Stress Disorder:

Few Clues To Motive Remain In Apartment Of Alleged Ft. Hood Gunman

Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

As far as has been reported, Hasan was not a victim of a violent assault, natural disasters or an accident. And while people talk of his lack of desire to be deployed, he had never seen any combat. And, further, he claimed his negative views about deployment were because of his religious views.

Now, therapists who treat victims of actual PTSD or other trauma can experience what is called vicarious traumatization. I don't think it's terribly common but some of these folks could have some symptoms of PTSD and some could experience full blown PTSD. Basically, some therapists overidentify with their patients and become so sensitized to what their patients experienced that they begin to experience some of their symptoms themselves.

None of us are privy to Hasan's mental state, of course, but I think it's safe to say that there is precisely zero evidence to support a diagnosis of vicarious traumatization. Instead of identifying with his clients, or habitually advocating for them or going beyond expectations to serve them -- which is what you see in cases of compassion burnout -- there is evidence that he argued with his patients, failed to show up to work and abandoned the few patients he had.

Again, I have no problem agreeing with Miller's thesis that we must not choose between "mentally ill" and "terrorist" when characterizing Hasan. But we seem willing to just throw around diagnoses such as PTSD without any evidence to support it. If we should not jump to conclusions about religious motivation, neither should we jump to conclusions about his mental state.

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