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Nov. 5 2009 - 10:03 pm | 267 views | 4 recommendations | 19 comments

Vicarious traumatization: PTSD is contagious and deadly

All the facts about the Fort Hood massacre are not in yet, and may not be for some time. The early facts left me horrified, and a little scared: Terrorism? Warriors run amuck? But when I learned that the likely shooter was an Army psychiatrist who treats PTSD, himself on the cusp of deployment, I thought, “I’m not surprised.”

One fact we do know is that treating PTSD is itself traumatic. Before you judge or maybe make a joke about some shrink wigging out–or indulge ugly racist fantasies–I want you to imagine a work day spent bearing witness to traumas so horrific media outlets won’t even show the videos. Imagine every day trying to help young men and women somehow put their lives back together despite their night terrors, flashbacks, and chronic sleeplessness. While you reach out to help,  they mistrust your every move and respond with hair-trigger tempers, not to mention all the physical symptoms, alienation, and hopelessness. Surrounded by thoughts of suicide–and homicide–you try and keep faith with the honor and challenge of providing care.

But soon the line between their experience and yours starts to blur until, well, something like what happened at Fort Hood today becomes an all too real possibility.

The fact is treating soldiers traumatized by war experience is not just an honor and a challenge; it is itself a risky behavior.  McCann and Pearlman, in a 1990 article in the Journal of Traumatic Stress were the first to identify

the problem of vicarious traumatization (VT), which they defined as the cumulative transformative effects upon therapists resulting from empathic engagement with traumatized clients. As part of their work, these clinicians must listen to graphically detailed descriptions of horrific events and bear witness to the psychological (and sometimes physical) aftermath of acts of intense cruelty and/or violence. The cumulative experience of this kind of empathic engagement can have deleterious effects upon clinicians, who may experience physical, emotional, and cognitive symptoms similar to those of their traumatized clients (Harrison, Richard L.; Westwood, Marvin J. “Preventing vicarious traumatization of mental health therapists: Identifying protective practices.”Psychotherapy: Theory, Research, Practice, Training. Vol 46(2), Jun 2009, 203-219.)

Early reports seem to suggest VT–also called compassion fatigue and secondary traumatization–as the most likely explanation for what happened.

Having counseled scores of returning soldiers with post-traumatic stress disorder, first at Walter Reed Army Medical Center in Washington and more recently at Fort Hood, he knew all too well the terrifying realities of war, said a cousin, Nader Hasan.

“He was mortified by the idea of having to deploy,” Mr. Hasan said. “He had people telling him on a daily basis the horrors they saw over there.”

via Gunman ‘Mortified’ About Deployment to War – NYTimes.com.

New facts may change the contours of the story, but if events continue on anything like their current course then vicarious traumatization will end up part of the final version.

The shooter was himself wounded by war, perhaps fatally so, well before he first pulled a trigger (and at 9:15 PM we learn, correcting earlier reports, that the gunman-doctor was NOT killed). Those killed and wounded by his actions at Fort Hood are as much casualties of war as are all our other neighbors, friends, and family so far killed and wounded in Iraq and Afghanistan. Understanding what happened is not to excuse anything that was done, far from it, but understanding may help prevent subsequent and possibly preventable tragedies.


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  1. collapse expand

    And if PTSD is contagious to trained professionals, we can only imagine what happens on the ground (here and “there”) for the families of those who have not just witnessed, but often committed atrocities. But none of these victims will be considered when deciding to continue these wars.

    • collapse expand

      Many also come back victims of atrocity, and you are tragically right that there is tremendous family suffering. That’s why when we designed our post 9/11 first responder mental health project we provided care to first responders and families, however conceived.

      And I think they’ll be considered, they just won’t get much help …

      In response to another comment. See in context »
  2. collapse expand

    Interesting.
    I’m reminded of this story (below) that ran last year in the New Yorker about a soldier who suffered from PTSD, and where it tragically took him. It’s pretty sobering on its own, but certainly if you are correct about this incident.
    It’s here: http://www.newyorker.com/reporting/2008/09/29/080929fa_fact_finnegan

  3. collapse expand

    Todd, you seem to have missed or ignored reports in the media that Maj. Hasan said Muslims should stand up and fight the aggressor in Iraq and Afghanistan on more than one occasion. (This was on Fox news yesterday.) He also posted approval of suicide bombings to the Internet.

    I’m not sure if this is what you mean by “ugly racist fantasies,” but it seems to me that none of us are served by not mentioning all the facts, however unpleasant. Certainly to say the shootings were the results of Maj. Hasan suffering from PTSD is premature.

    • collapse expand

      The reports on Fox were presented in an incendiary, incomplete manner that can light the match for ugly racist fantasies. Of course, I’ve read all the reports you mention. But we need balance and all the information, including for example, his cousin reporting ““His parents didn’t want him to go into the military, ….. He said, ‘No, I was born and raised here, I’m going to do my duty to the country.” So if those postings on the Internet comparing suicide bombers to soldiers throwing themselves on a grenade were indeed from him, which has not yet been either proved or disproved, it *may* have been the first signs of the problems he was having, And again, this is not to excuse but to understand so we can prevent future similar events.

      With that said, the very first line of my piece says all the facts are not yet in so we are in agreement that conclusions are, at this point, premature. Might he be a terrorist? Perhaps. But he also might be a damaged patriot. A too willing readiness to believe the former because he is a Muslim is exactly what I mean by an ugly racist fantasy. Until the facts are in we need to keep possibilities in balance. So, don’t beleive Fox, or any ONE source, keep an open mind.

      In response to another comment. See in context »
      • collapse expand

        Todd, I agree with you that we need to keep open minds, but it is hard to do that if not all the facts are presented. I’m not sure what you mean by Fox presenting the information in an “incendiary, incomplete manner that can light the match for ugly, racist fantasies.” I didn’t get that impression from what I watched and referenced in my previous comment: Fox interviewed a retired colonel who had worked with Maj. Hasan—he spoke on the air about comments he’d heard the major make. I’m not sure why his remarks should be discounted and those of Maj. Hasan’s cousin, which I also listened to, should be taken as gospel. Neither individual is inherently more trustworthy than another. In fact, it’s possible that a family member has more of an interest—totally understandable—to in making a case for his cousin. It’s natural to support one’s family.

        I don’t know that I can imagine what it’s like to hear horrific memories while treating soldiers with PTSD, but soldiers have been counseled for this since Vietnam, and I’ve yet to hear of a psychiatrist mowing down folks because of it. A theory should have at least some facts or science to back it up, and this one has none. Unfortunately, there are facts to support the conclusion that some—not all—Muslim soldiers feel a greater loyalty to their fellow Muslims in Afghanistan and Iraq than to their fellow soldiers and Americans. The Muslim who shot people in an Arkansas recruiting center comes to mind, as does the Muslim who threw grenades into the tents of his fellow soldiers. Facts coming to light since you posted your piece seem to support this, unfortunately.

        The truth is important. If we don’t know the cause of a problem, we cannot effectively resolve it.

        In response to another comment. See in context »
        • collapse expand

          Not quite sure how to respond to you layla. You seem to believe you are speaking the truth, But I think you are just calling bigorty and racism, or at best religious intolerance, truth. Picking out isolated facts that confirm your prejudice is not truth, nor is it a way to find truth … because if it were we should fear all Christians because of Timothy McVeigh.

          But this is all tired, familiar territory in American political discussions these days, so I think our dialogue is probably at a dead end. But I do want to say the science behind VT is pretty strong, so too is the experience. After 9/11 I helped run an organization that provided free mental and behavioral health care to first responders and their families. Helping protect our network of volunteer clinicians from compassion fatigue was the highest priority.

          In response to another comment. See in context »
  4. collapse expand

    And if he were a fundamentalist Christian? Or Jewish…?

  5. collapse expand

    Thank you, Todd, for responding, and for allowing me the chance to comment.

    I don’t think I am cherry-picking facts to support my perceptions; rather facts I have read or observed over the years have contributed to my perceptions. I also disagree with the analogy of fearing all Christians because of the Oklahoma City bombing. Timothy McVeigh, Terry Nichols, and Michael Fortier were not practicing Christians (McVeigh even said his religion was science), nor did they cite Christian scripture as justification or basis for what they did. Unfortunately, one of the reasons we are in Afghanistan now is that some—not all—Muslims thought 9/11 was justified based on Muslim scriptures—parts perhaps that they cherry-picked—and it seems that Maj. Hasan and others in our armed forces may have done so as well.

    Caitlin raised the question what if he were fundamentalist Jew or Christian. If we had been attacked by fundamentalist Jews or Christians citing Torah or Bible as justification, and if soldiers of these faiths murdered their fellow soldiers while crying out Adonai hu ha elohim or What would Jesus do—if there were a pattern of incidents like this, I would want that raised as well. When I read in the paper that a doctor who performs abortions has been gunned down in cold blood, I don’t want the media to start looking at every possible reason the killer might have acted but leave out any facts that might imply he did it because he believed his Christian faith demanded it, because that might be “bigoted.” And that is what I was objecting to in my original comment.

    I looked up Vicarious Trauma (VT) on the Internet as I’d never heard of it, and what I read described symptoms such as burnout, depression, and blaming the victim/patient. I did not see anything that indicated a psychologist might engage in mass murder. If there are such cases, I’d be interested in learning about them.

  6. collapse expand

    Todd, thanks so much for this. You and I are on the same page, as I wrote a very similar piece about PTSD’s communicable aspects in my blog last week. And I heard from many in the business who reported little/no resources from military mental health workers. The military has to face the fact that this is the 21st century and we know mental illness is equal to physical illness, but harder to cure.

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