WASHINGTON – The case of a military psychiatrist accused of 13 deaths at Fort Hood has prompted mental health professionals to examine whether those who treat patients with post traumatic stress disorder occasionally experience “secondary” symptoms of the affliction.
Maj. Nidal M. Hasan, an Army psychiatrist, was trained to treat soldiers with trauma as an intern, resident and fellow at Walter Reed Army Medical Center in Washington, D.C. There he described the moral dilemma of being Muslim in an army at war with Muslim countries and even had contact with a radical imam in the months prior to the shootings, according to the FBI.
Hasan had about one year of clinical experience before he was arrested on Nov. 5, for the shooting spree that left 13 dead and more than 30 wounded at the Fort Hood military base in Texas.
He is in an intensive care unit at a military hospital near San Antonio recovering from injuries suffered in the shooting, according to retired Col. John Galligan, Hasan’s lawyer. Hasan may use the insanity defense in pleading not guilty, Galligan said on Sunday.
Secondary PTSD, or secondary traumatic stress, is how some psychoanalysts describe the emotional, cognitive, and behavioral changes that occur after learning about a traumatic event experienced by someone close, like a patient.
Other professionals, however, say the symptoms can be diagnosed as other afflictions, such as depression.
“PTSD is the official disorder, when you read about secondary it is referring to, essentially, anyone working with someone with PTSD,” said Dr. Aaron Jacoby, coordinator for trauma recovery programs at the Veterans Affairs Maryland Health Care System.
PTSD affects the thinking, feeling and behavior of patients according to Walter Reed documents. In response to traumatic experiences, patients may grow numb with symptoms that appear much like depression. There is no specific category for secondary PTSD listed in the Diagnostic and Statistical Manual of Mental Disorders, which prompts some psychiatrists to claim it is a misdiagnosis.
“Technically in the manual it implies that a person can get PTSD by hearing about something horrible happening to a loved one,” said Dr. George Harris, a psychologist in Kansas City, Mo. “It just doesn’t strike me as reasonable to view someone as having PTSD simply because they have heard this horrible thing happening to another person.”
But others believe certain groups of mental health professionals are susceptible to the disorder.
“It is certainly more common in individuals who are new to psychotherapy and less common among veterans (psychotherapists),” Jacoby said. “People who treat combat veterans are more likely to be affected than other populations because of the frequency of traumas they confront. Often they see multiple patients with traumas every day. The closer they are, the realer the trauma is.”
Harris agrees the question is valid but wonders why the countless other mental health practitioners who treat first responders, including firefighters and police, don’t experience PTSD.
“My view is it dilutes the diagnosis and I think there are lots of other things that describe a person’s reaction to hearing about a horrible event,” Harris said. “In soldiers’ minds it is demeaning to lay this diagnosis on someone who has simply heard of these horrific things.”
Brian Bride, a professor at the University of Georgia, has studied the disorder in social workers and said he believes it could be even more prevalent in military mental health professionals.
“What is really at issue is not the quantity of patients but the level of exposure to the patient’s trauma,” Bride said. “That is, someone who has a lot of PTSD patients, but does not delve into the traumas in some form has less risk than someone with half the number of PTSD patients, but hears much more about the traumas.”
Bride said more work has to be done to increase awareness of the secondary disorder. In a study published by “Social Work” journal in January 2007, Bride found 15 percent of social workers met the diagnostic criteria for PTSD. A 2008 study by Geisinger Health System found instances of secondary trauma in professionals who treated Sept. 11, 2001, victims.
“I do not think it is being diagnosed nor treated adequately,” Bride said. “There is a great need to increase awareness of STS among health care professionals and support the adoption of self-care and organizational prevention strategies.”
There is a support system to prevent this disorder from affecting health care professionals at the VA Maryland Health Care System, according to Jacoby. Organized retreats, consultation and critical stress debriefings are offered to caregivers who regularly see patients with PTSD.
“We as clinicians realize that when we are working with people with trauma, at end of the day, we need to be as mentally healthy as can be,” Jacoby said. “If it were to occur, I would refer staff memberd to receive their own therapy, same as any disorder. I’ve never had to do that.”