Stress can be contagious, which is why psychotherapists need to take extra care regarding their own mental health. Had Dr. Hasan himself been emotionally traumatized and ethically conflicted by hearing the grotesque horror stories of war from his fellow soldiers? By constantly being told about his fellow Muslims and Army brethren slaughtering and maiming each other for their countries?
This could result in a form of what we call countertransference: the psychotherapist's personal reactions to his or her patients and their particular presenting problems. Countertransference is a common phenomenon in mental health professionals, an occupational hazard, and must be carefully monitored. When it begins to become disturbing for the psychotherapist, impairing his or her objectivity and interfering with the treatment process, it becomes crucial to address it in supervision, consultation and/or one's own personal therapy. If the countertransference cannot be resolved in relatively short order, or at least kept in check, psychotherapists must ethically recuse themselves from such cases and refer the patient elsewhere. This begs the question: Should Dr. Hasan, given his apparently passionate religious and political beliefs, have been working with such patients in the first place?
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From a forensic perspective, there is certainly far
too little information available at this time to come to any meaningful conclusions regarding such a defendant's mental status. And it is improper to do so without having conducted a formal forensic evaluation. But determining his state of mind at the time of this crime and prior to it will prove crucial to his legal case. As a forensic criminal psychologist, here are some of the questions I would be asking myself if appointed by the court to evaluate such a defendant:
Was the defendant clinically depressed, possibly to the point of paranoid psychosis? Could there have been any kind of substance abuse or intoxication involved? Was he in treatment and taking any psychiatric medications? Is there an underlying personality disorder? Were these shootings a tragic, impulsive manifestation of a manic or hypomanic episode, indicating the possible presence of bipolar disorder? Or, was this the hateful, calculating, vengeful act of a profoundly angry, frustrated, resentful and embittered--but not psychotic--person? (See my previous posts on post-traumatic embitterment disorder.)
Was Dr. Hasan a suicidal individual, who, like so many mass murderers, chose to die--very much like a suicide-bomber--taking as many victims with him as possible? Psychiatrists as a group have a notoriously high rate of suicides, though suicide rates in Muslim populations are exceedingly low. The notion that Hasan had become actively suicidal is supported by unconfirmed reports today that he allegedly advised his landlord two weeks ago that he would be leaving his apartment on the day of the shooting--despite the fact that he was not likely to actually be physically deployed for another few months. Hasan also is said to have given away his belongings, furniture, food, cleaned out his apartment, and said goodbye to friends just prior to the massacre, handing some of them copies of the Koran. Unless he was convinced he was leaving the country in the immediate future, such preparatory behavior could be interpreted as a prelude to suicide. Or, in this case, premeditated homicide-suicide. Hasan may have hoped to have time to take his own life after his murder spree, or be taken out by police. So-called suicide by cop.
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