by Rabeika Messina

We don’t know much about suspected Ft. Hood killer Nidal Malik Hasan: there are reports he gave away his possessions. There are reports he was terrified of being deployed. And there’s the fact that prior to his killing spree, Hasan worked as a psychiatrist, treating war-affected patients at both Walter Reed and Ft.  Hood. Shouldn’t a psychiatrist have seen his own unraveling coming? Or are psychiatrists more likely to unravel than anyone else? What turns a man professionally endowed to treat the mental ailments of others into one who goes mental himself?  And in his addled state, what did he think he’d achieve by opening fire into a crowd?

We may never fully know what Hasan was thinking the morning before his alleged killing spree, but we do know that some of his professional colleagues frustrated that this attack may be perceived as yet another black mark against their industry. Psychiatrists have long been plagued by jokes about instability, and while most are quite sane, there's some truth to the rumors: studies show that these doctors have the highest suicide rate among physicians. They are most likely to suffer from depression compared to surgeons and GPs, and they’re more likely to be critical of themselves and others. It makes sense: unlike an orthopedic surgeon, treats a broken bone, fixes it, and moves on, a psychiatrist, working to help people make peace with themselves and their troubled psyche, doesn’t get that same closure, the same sense of accomplishment, may feel helpless and frustrated as a result.

Being a psychiatrist doesn’t mean one holds all the keys to mental stability. While the majority of psychiatrists are well-balanced individuals, and according to an article in Psychology Today, an American Psychiatric Association study stated that those with emotional disorders are more drawn to the field than other types of medicine.

“Just because someone is a psychiatrist [does not mean] they’re not prone to the same evolvement of a mental illness,” said Dr. Kathryn Moss, a psychiatrist from the New York Presbyterian Hospital and the Weill Cornell Medical Center. Especially if Hasan was suffering from a something like a Pre-Post-Traumatic Stress Disorder. By routinely treating troops with disturbing experiences, he could have experienced enough strain and trauma to cause PTSD, even without deploying.  “Exposure is not just to visceral traumas, but also to constant, ongoing stress,” explains Dr. Nancy Sherman, a Georgetown University professor with expertise on PTSD and the emotional and mental health of soldiers.  “The mental health workers who are dealing with the current wars are under enormous stress, and it simply isn’t often recognized.  Their needs must be addressed as much as those of the troops up for deployment,” she states.

But while PTSD can lead to violent outbursts in many returning troops, it has yet to result in such a gruesome, public crime. And there are plenty of depressed and dejected docs who don’t go on shooting rampages.

That’s because mass killers aren’t likely to be driven by conditions like anxiety, depression or bipolar disorder, which aren’t normally characterized by violent fits.  Instead, says Moss, someone who inflicts this type of harm on other humans is under a much greater, more troubling psychosis. “They are delusional about what is going on in their environment,” says Moss. “They don’t share a view the reality that other people share, so they act in ways that other people wouldn’t act,” she says.

Nothing made that point more tragically clear than the shooting that occurred almost 24 hours later in Orlando, Florida. There, Jason Rodriguez turned himself in after cops surrounded his home, accusing him of shooting six people, killing one, in a Florida high rise. Rodriguez had no military background. He worked in at an engineering firm, not as a mental health profession. But he, like Hasan, was purportedly compelled to pull the trigger and shoot into a crowd.  The only thing they likely had in common was a deep, troubling mental illness. “Mass shooters are impelled by a mental disorder, revenge, some type of ideological motivation or even perversion,” says Dr. Jeffrey Lieberman, chairman and professor at the Department of Psychiatry at Columbia University.

But to what end? What satisfaction do these killers get from attacking people in a public setting?   “Sometimes, if they have some kind of delusion, these people feel that the group is a person,” explains Dr. Moss.  “They see everyone as part of a conspiracy, out to get them.  In the shooter’s mind, it is specific, because he chose that group.”

If these two men really are guilty of such crimes, could Hasan’s actions have impacted Rodriguez? Perhaps, says Lieberman. For those unstable enough to be considering such a thing, recent attacks can be triggering. “There is a contagion effect; there’s enough people out there who are mentally unstable and emotionally fragile that they can be influenced by the cultural environment,” he says.

A scary thought in a country that's seen more than ten mass killings in the past ten years. Something is triggering these killers, whether it's internal conflict, external stimulus, or a combination of both. Either way, the challenge is to discover what's  motivating the shooters ahead of time, instead of wondering why after tragedy strikes.