Psychiatrists can get compassion fatigue
12:00 AM CST on Sunday, November 8, 2009
Maj. Nidal Malik Hasan had never set foot in Afghanistan or Iraq when he allegedly pulled out a semiautomatic pistol and began shooting his comrades at Fort Hood.But as an Army psychiatrist, caring for soldiers scarred by both wars, Hasan had experienced the conflict almost as if he had been in the combat zone for the past six years, psychiatrists and traumatic stress experts said.
"Many of the soldiers you evaluate and treat talk to you about horrific events," said Dr. Daniel Amen, a former Army psychiatrist who, like Hasan, once worked at Walter Reed Army Medical Center. "Psychiatrists can develop something called compassion fatigue. You just get worn out by the trauma."
At its worst, compassion fatigue becomes secondary trauma – a condition similar to post-traumatic stress, mental health experts said.
"They may not see combat themselves ... but they see the outcome of it and they hear the stories of it day in and day out," said Rep. Tim Murphy, R-Pa., a psychologist in the Navy Reserves. "It can be very real when you are dealing with people's difficulties every day."
An uncle of the 39-year-old shooter said Saturday that the work clearly weighed on Hasan.
'Tears in his eyes'
"I
think I saw him with tears in his eyes when he was talking about some
of [the] patients, when they came overseas from the battlefield," Rafik
Hamad told The Associated Press from his home near the West Bank town of Ramallah.Hasan also was torn between his religion and his military service, officials and acquaintances have said, and stressed about his imminent deployment to Afghanistan – a place "where all these terrible things he had heard about had taken place," Amen said.
While it's not yet clear what might have factored into Hasan's alleged attack on fellow soldiers Thursday, secondary trauma has been sparingly addressed in the military and civilian worlds, experts said.
"There have been a lot of cases and stories of those who just couldn't take it any longer and were transferred," said Charles Figley, a traumatic stress expert and former Marine who consults on the subject for the Pentagon. "And for those who are active duty, your career is over in that area if you transfer."
Emotionally drained
An
acute shortage of trained mental health workers in the military has
left these therapists emotionally drained and overworked, with limited
time to prepare for their own war deployments.A military mental health task force in 2007 expressed concern about the stress on nondeployed mental health personnel because of the shortage, which it said was leading to high attrition rates. "A vicious cycle has formed that will probably continue to worsen before it improves," the report said.
Dr. Layton McCurdy, a psychiatrist and dean emeritus at the Medical University of South Carolina who served on the task force, said the shortage is compounded by the thousands of troops suffering combat-related stress. "The psychiatrists are working with more people than they have time to work with," McCurdy said.
Post-traumatic stress is in essence a memory-management problem – an "inability to effectively manage the frightening experiences they've had," said Figley, who has conducted pioneering research on secondary traumatic stress at Tulane University. "It comes out in flashbacks, sleeping problems, being on edge."
Secondary trauma causes similar symptoms: sleep disruptions, nightmares, depression and jumpiness. Sufferers may avoid situations that remind them of past stresses. A mental health practitioner also may feel guilty about not having done more to help a patient or may obsess about individual patients – particularly those with whom they identify.
One noted study found that social workers who treated survivors, victims' families and first responders at the World Trade Center after 9/11 were most susceptible to secondary trauma if they lacked social support.
Suicide risk
Doctors generally have relatively high suicide rates, with psychiatrists having the highest rates. Both male and female physicians are significantly more likely to commit suicide than the rest of the population, according to a 2004 article in the American Journal of Psychiatry. Among all physicians. Psychiatrists are considered to be at greatest risk for suicide, according to the 2007 version of Kaplan and Sadock's Synopsis of Psychiatry.
Secondary stress poses more potential risks for military personnel – especially psychiatrists, said the study's principal investigator, public health researcher Joseph Boscarino of the Geisinger Health System in Danville, Pa.
"They are at high risk," said Boscarino, a Vietnam veteran and defense consultant.
No pleas for help
In
2008, the trend of military suicide rates being historically lower than
the civilian population reversed, according to the National Institutes
of Mental Health. In the first nine months of 2009, the Army reported
117 confirmed or suspected cases of suicide among active-duty
personnel, compared with 103 over the same period in 2008.If Hasan was suffering from the stress of secondary trauma, he told no one, military officials said. That would not be unusual for the medical profession, according to the experts.
"Doctors are the No. 1 profession for suicide," Amen said, but "doctors don't ask for help."
The Associated Press contributed to this report.
gjones@dallasnews.com;
lhancock@dallasnews.com
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