Monday, November 16, 2009

Preventing the Murders at Fort Hood

Nidal Malik Hasan entered a processing center at Fort Hood and in a tragic act used a 5.7 millimeter pistol to kill fourteen people, 13 of whom were soldiers. These horrific murders of innocent people were committed by a medical doctor, a major, and a psychiatrist. In our opinion these murders were predictable and consequently preventable. Understanding the psychology of this event and overcoming the reasons people failed to act could save lives and insure that tragedies like this never happen again.

According to an Associated Press report "Doctors and staff overseeing Hasan's training viewed him at times as belligerent, defensive and argumentative in his frequent discussions of his Muslim faith". He was sent to Fort Hood because "this was the best assignment for Hasan  because doctors could handle the workload if he continued to perform poorly." At times, Hasan complained about harassment, once describing how someone had put a diaper in his car, saying, "That's your headdress." In another case reported in the New York Times, someone had drawn a camel on his car and written under it, "Camel jockey, get out!".

While neighbors described Major Hasan as gentle and kind, they reported that he virulently complained about the oppression of Muslims in the Army. His behavior was described as intense and combative. "Around 2004, Major Hasan started feeling disgruntled about the Army, relatives said. He sought legal advice, possibly from an Army lawyer, about getting a discharge...He wanted to leave the Army...But because the Army had paid for his education, and probably because the Army was in great need of mental health professionals and was in need of Arab-Americans he was advised that his chances of getting out were minuscule..." Not only would Hasan be unable to leave the military, his transfer to Fort Hood extended his military service by a year. He had few friends, was never fully accepted by the men at his Mosque, and lived frugally in a run-down apartment despite making a good salary. Immediately prior to his violent rampage, Major Hasan said goodbye to his friends and asked forgiveness from one man for any past offenses.  "I'm going traveling," he told a fellow worshiper, giving him a hug. "I won't be here tomorrow."

As clinical psychologists we believe that Hasan's delusional perceptions and aggressive actions sent clear warning signals that he was capable of violence. His voicing "I won't be here tomorrow" is a statement that would have alerted mental health professionals that Major Hasan was a potential danger to himself or others. (However, in the context of a military staging area it is possible that those around Hasan may have took this statement to mean he was about to be deployed.)

Many traumatized soldiers internalize their aggressive feelings and self-inflict wounds, sometimes resulting in their death. This usually occurs after the experience of being in a war. In this case, Major Hasan's trauma was second-hand, something internal, and not the result of being in a combat zone himself. His psychology is not the post traumatic stress of the soldier, but the narcissistic self-righteous delusion of the school shooter. Like a school shooter it was Hasan's feelings of isolation, hopelessness, despair, and delusional feelings of moral injustice that precipitated his aggression. Army health professionals at Ft. Hood, overworked, understaffed, and with their focus of post traumatic stress should be forgiven for not seeing the warning signs. After all, on the surface, who would expect a psychiatrist to follow in the footsteps of Klybold, Harris, or Cho?

In general, humans in groups tend to minimize the warning signs of violence. We recently have seen examples of this in the Jaycee Lee Dugan kidnapping, where parole officers failed to see the signs of her rape and imprisonment.  Likewise in the case of the Cleveland rapist-serial killer Anthony Sowell, police did not pick up the warning signs of his crimes despite being alerted to his violent behavior numerous times by people in the area. In a classic study Darley and Latane (1969) found that subjects remained in a dangerous situation when others in the room seemed unconcerned. Likewise subjects failed to come to the aid of a hurt "victim" when others failed to act. These results show the tendency of people to ignore an impending crisis because; there is no reward, they are unprepared, they don't know how to respond, and they are inhibited in highly stressful situation. In a stressful environment  it is all too easy for us to see the inaction of others and do nothing ourselves.

It is also known that people under pressure in organizations will 'normalize deviance'. In his book The Knowing Organization: How Organizations Use Information to Construct Meaning, Create Knowledge, and Make Decisions, Chun Wei Choo (1998) discusses what he calls the "production of culture". This is where a group repeatedly uses a decision-making sequence to develop norms, values and procedures that support their central beliefs even in the face of deviant information. This involves five steps: 1. Perceiving a potential danger; 2. acknowledging escalated risk; 3. reviewing evidence; 4. normalization of deviance and accepting the risk; and finally 5. a decision to act or not act that reinforces the core beliefs of the group. While there is no way to know for sure whether the production of culture allowed military and medical professional to overlook Hasan's aggressive, deviant, and delusional behavior over the years, we think this is likely given the relatively closed nature of both medical and military organizations. The production of culture is less likely to occur when there is regular unconstrained input from others outside the group.

Military health professionals are educated to identify the behaviors that represent psychological conflicts that would promote violent acts to self and others. In Hasan's case investigators are asking how did this man get through medical school and the military without any intervention by medical or mental health professionals. Another recent article stated that Hasan was offered psychotherapy as part of his psychiatric training but he turned it down. We have to ask why this was allowed when personal psychotherapy is a strict requirement in most mental health professions? Given his argumentativeness, stressful work with soldiers returning from battle, and his inability to connect with others, it is not surprising that he could become "self-radicalized' under the influence of an Islamic extremist. What is surprising is that Hasan could be allowed to train and work as a psychiatrist for a number of years without anyone realizing his serious emotional serious issues put him at risk for becoming unhinged. A professional evaluation of the well understood and identifiable precursors to violent behavior would have likely prevented Major Hasan from murdering thirteen sodiers at the Fort Hood processing center.

References:

Blackledge, B.J., & Lardner, R. (2009). Fort Hood suspect's superiors questioned behavior. Associated Press. November, 12th.

Choo, CW. (1998). The Knowing Organization: How Organizations Use Information to Construct Meaning, Create Knowledge, and Make Decisions. New York: Oxford University Press.

Latane, B., & Darley, J. Bystander "Apathy", American Scientist, 1969, 57, 244-268.




Shane, S. & Dao, J. (2009). Investigators Study Tangle of Clues on Fort Hood Suspect. New York Times, November 14th.

Shane, S. & Johnston, D. (2009). Questions, Not Alarms, Met Exchanges With Cleric. New York Times, November 11th.


--------------------------------------


 






No comments:

Post a Comment