As the world pored over the ashes of the massacre at Fort Hood this week, a number of disturbing new questions emerged about the character of Major Nidal Hasan, the U.S. army psychiatrist accused of perpetrating one of the worst cases of military fratricide in American history.
For days on end, the Internet was buzzing with theories on how Hasan's religious faith may have motivated his alleged crime. How much time, bloggers asked, did he spend e-mailing with his radical imam? Was he acting alone or under the influence of international extremists? Why did he put on traditional religious garb to pick up his morning coffee and hash browns?
We don't know, of course, whether Hasan is or ever was a fanatic, but there is another possible contributing factor to this terrible story that should not be ignored - and that is his job as a shrink.
American mental-health practitioners need psychological help, a new report says, and they are not getting nearly enough of it. An amazingly prescient article published a few years ago in the U.S. journal Psychology Today and recently reprinted on the Huffington Post lends clinical credence to the commonly held assumption that mental-health workers (and by that the essay's author, Robert Epstein, means psychotherapists, psychologists and psychiatrists like Hasan) have historically suffered from relatively high rates of mental illness. As Epstein, a high-profile clinical psychologist himself, put it, "mental-health professionals are, in general, a fairly crazy lot - at least as troubled as the general population … The problem is that mental-health professionals do a poor job of monitoring their own mental-health problems and those of their colleagues. In fact, the main responsibility for spotting an impaired therapist seems to fall on the patient, who presumably has his or her own problems to deal with."
Which sounds a bit nuts, doesn't it?
The possible reasons for high rates of mental illness among mental-health professionals are thought to be twofold.
Firstly, people with a history of psychological problems seem more attracted to the profession. There is ample published research back this up. According to Epstein, an American Psychiatric Association study reported that "physicians with affective disorders tend to select psychiatry as a specialty." And a 1993 study found therapists reported higher rates of family dysfunction, parental alcoholism, sexual and physical abuse and parental death or psychiatric hospitalization than their peers in other professions. Even Anna Freud, the daughter of Sigmund and a respected shrink in her own right, once admitted that her "most sophisticated defence mechanism in life was becoming a psychotherapist."
The second reason is the nature of the job itself. Most therapists are continually exposed to disturbed, depressed and often violent and/or suicidal individuals. Indeed, it is their duty to interact with them. As Epstein put it, "virtually all mental health-professionals agree that the profession is inherently hazardous. It takes superhuman strength for most people just to listen to a neighbour moan about his lousy marriage for 15 minutes."
In this area too, the numbers are distressing: Three out of four therapists report experiencing "major distress" within the past three years and more than 60 per cent may have suffered significant clinical depression at some point in their lives. Of those who suffer from depression, more than half said that in the period after a personal crisis they find it difficult to provide quality care.
According to Jon Bisson, a former military psychiatrist who works for the British Veterans Mental Health Service, counselling during wartime poses even greater risks. "Therapists can be vicariously traumatized by hearing these terrible stories and develop some of the symptoms of post-traumatic stress disorder," he recently told the Guardian, adding that, within the profession, vicarious trauma among army shrinks is "a well-recognized phenomenon."
Realistically, what psychotherapy patient hasn't wondered, at some point, if their shrink is actually the troubled one? I know I certainly have - at the time it almost seemed part of what therapists are always referring to as "the process."
Pop cultural stereotypes reinforcing the demented/hysterical/homicidal therapist (see Hannibal Lecter, Lorraine Bracco's character on The Sopranos or, most recently, the creepy shrink on CBC's Being Erica ) certainly didn't help dispel those nagging suspicions.
In the end, therapy was a beneficial experience for me, as it is for so many. But in the wake of Fort Hood, some mental-health professionals are worried the entire profession will be stigmatized.
In a recent blog post, U.S. author and psychologist Judith Sills worries that the tragic events in Texas "will be used to stir the pot of fear and rage and contempt that pushes so many people away from the tools and techniques of psychotherapy - tools that might well bring them relief."
It may never become entirely clear what terrible cocktail of emotions may have motivated Nidal Hasan in his alleged actions, but one thing is certain: Therapists are as vulnerable to mental illness as the rest of us. As practitioners of an emotionally hazardous profession, shrinks should monitor themselves carefully and seek help where needed. Even Freud himself - who suffered from neurosis, agoraphobia and occasional paranoid delusions - believed that it should be mandatory for every psychoanalyst to "submit himself" regularly to psychological analysis by a professional.
If Major Hasan had taken that advice, perhaps tragedy would have been averted.