PTSD may not answer Fort Hood’s painful questions

In the coming days, law enforcement and military personnel will try to piece together the reasons a 34-year-old soldier with a clean service record and no history of violent behavior shot three of his colleagues dead at Fort Hood military post in Killeen, Texas, injured 16 more and then turned the gun on himself.

That the suspected gunman may have had a combination of depression and anxiety, as Fort Hood senior officer Lt. Gen. Mark Miley told reporters, and was undergoing an assessment for post-traumatic stress disorder (PTSD), is unlikely to be among those reasons, psychiatry and military experts say.

“Most mental illness is not associated with violence,” Dr. Elspeth Cameron Ritchie, a longtime Army psychiatrist who is now chief clinical officer for the District of Columbia’s Department of Mental Health, told Al Jazeera.

Rather, it’s much more likely that the suspect, identified as Army Spc. Ivan Lopez — a man who was deployed to Iraq for four months in 2011 and reportedly had a self-diagnosed traumatic brain injury — suffered from some other, concurrent problem. Experts warn that blaming PTSD or depression for the shooting could further stigmatize mental illness and prevent more people from seeking treatment.

That’s because long-standing anger issues, substance abuse, serious mental illnesses like schizophrenia and even just the presence of a gun in the home are far better predictors of mass shootings than depression or PTSD, Ritchie told Al Jazeera.

“What we do see with mass shootings, when associated with mental illness,” she said, is that “it is associated with more severe forms like delusions or paranoia. There’s also anger going on,” from something like a strained romantic relationship or a perceived humiliation from a co-worker. “What you often see is a combination of anger, irritability, paranoia and easy access to weapons.” She added that she cannot comment specifically on what may have happened to Lopez.

PTSD, which can set in after a shocking or very difficult experience, involves symptoms such as nightmares, difficulty sleeping, increased jumpiness, upsetting memories and flashbacks about the disturbing event. Conversely, someone suffering from PTSD may shut down or feel emotionally numb, explained Paula Schnurr, acting executive director of the National Center for PTSD at the U.S. Department of Veterans Affairs.

 “PTSD is a normal reaction to a terrible event,” Schnurr told Al Jazeera, cautioning that she could not comment specifically on Lopez’ situation. “This is very common, and in most people, in most cases, these symptoms tend to go away in the days and the weeks” after a traumatic incident.

Regarding Lopez’ possible traumatic brain injury, Ritchie said that even a mild one can cause symptoms like anger and irritability — which are also symptoms of PTSD.

But she and Schnurr were emphatic that violence is not an inevitable result of the condition. 

“Irritability and anger are actually symptoms of PTSD, but it’s really important to communicate that most people with PTSD never engage in acts of violence or criminal behavior,” Schnurr said.

Ritchie said, “There’s got to be more of a discussion about access to weapons, especially by people who are seriously mentally ill or have a criminal history.”

Focus will likely turn to whether the Army provides sufficient treatment and care to those retuning from war zones with mental health problems.

The Department of Defense has been heavily criticized for the growing problem of military suicides and for the Department of Veterans Affairs’ backlog of untreated disability cases, often involving depression or other mental health problems.

Along with this heightened scrutiny of mental health treatment for veterans and active-duty soldiers, an increase in gruesome mass shootings in recent years — like those in Newtown, Conn.; Virginia Tech; and an earlier shooting at Fort Hood — have drawn attention to the relationship between guns and mental health and how to better secure army bases and schools.

“When we have these kinds of tragedies on our bases, something’s not working,” Department of Defense Chuck Hagel told reporters at a briefing in Honolulu on Wednesday. “We’ll identify it, we’ll get the facts, and we’ll fix it.”

But a crucial difference between Lopez and other gunmen — and the shooters are almost always male, experts say — is that Lopez looked beyond the pervasive stigma surrounding mental illness and appears to have sought help for his alleged problems.

“This is the perfect example of what I’ve been saying all along,” retired Gen. Peter Chiarelli, a former vice chief of staff of the Army, told Al Jazeera. “An individual went in to get help, and lo and behold, even when he goes and gets help, we don’t know exactly what he had, and we fail in our ability to make him well.”

Chiarelli, who has been a vocal advocate for treatment to prevent military suicides and who emphatically drops the word “disorder” from PTSD in order to eliminate stigma, says more research should be done about the brain in order to locate possible blood biomarkers for PTSD, much as researchers have for other physical illnesses.

“I think the military, much more than society as a whole, has made huge advances in destigmatizing traumatic brain injury,” he said. “The issue is, we just don’t know enough.”

While research has shown that cognitive behavioral therapy and aversion therapy are helpful in treating people with PTSD, Chiarelli said there’s a shortage of practitioners trained in these methods — in both the military and civilian society — which has lead to an overreliance on medication.

“When people feel pressured and they have people backed up outside the door and don’t have time to execute protocol correctly, I think it’s the tendency of some doctors to turn to [prescription] drugs,” he said.

However, other public health experts caution that, based on the few facts immediately at hand, Army psychiatrists may not have been able to predict the gunman’s violent tendencies from a diagnosis of PTSD or depression. It may be found that he did not slip through the cracks in the same way Virginia Tech shooter Seung-Hui Cho did. Cho was able to purchase a firearm and killed 32 people even though a judge ordered him to seek outpatient treatment.

Terry Schell, a senior behavioral scientist with the Rand Corp. whose research has focused on PTSD in both civilians and war veterans, said, “The job of a psychiatrist is not to assess for violence” but to diagnose mental health problems; if his colleagues or superiors had seen delusional or angry behavior, that would have been a better indicator.

With many of the questions in the latest Fort Hood shooting left unanswered, many experts hope that the media don’t attempt to fill the gaps by focusing on the role mental health conditions may have played. Experts fear that doing so would help undo the work done to encourage those with problems to seek help.

Schnurr points to the National Center for PTSD’s outreach campaign, in which veterans with the condition tell their stories in order to destigmatize it.

“PTSD can happen to anyone, and there shouldn’t be this feeling of shame or avoidance of treatment,” she said. “People don’t have to live with PTSD. People can get help, and they can get better.”