Dr. Amen's Blog

I was sickened by the news yesterday that a fellow military trained psychiatrist decided to unleash his own private hell, killing and maiming his brothers and sisters at Fort Hood.

Ironically, today (11/6/09) at Fort Lewis, Washington one of my colleagues, Dr. Vern Cherewatenko, from the Amen Clinics Northwest in Tacoma is presenting a program he created for the military called “Brain Strong” on how biology drives behavior and the need to take care of soldiers from a brain science perspective.

Also, ironically, Major Nidal Malik Hasan and I have traveled long several similar roads.  I am a military trained psychiatrist.  I did my internship and residency at the Walter Reed Army Medical Center in Washington, DC, same as Dr. Hasan.  I am also an Arab American.  My grandparents on both sides immigrated from Palestine and Lebanon.  I too felt harassment after September 11, 2001 because of my looks and last name.  But I never thought of killing anyone, at least not for more than 5 minutes.

How and why do these terrible things keep happening in our society?  Can the brain imaging work we do at the Amen Clinics add any insights?

Over the past 18 years we have been using a sophisticated brain imaging study called SPECT to help us understand and treat our patients and we have performed now over 53,000 scans, including looking at the brains of 75 murders, including a number of mass murders, such as Kip Kinkel, who shot 25 people in Springfield, Oregon in 1998, and Louis Peoples, who killed 4 people in 11 days on a methamphetamine run in 1997.  To truly understand any patient, even mass murderers, I always look at four circles of behavior: biological, psychological, social and spiritual.  Let me explain how these four circles can help us in this case?

Biological Factors (Brain)

The physical underpinnings of behavior come from the brain.  When the brain works right people tend to be thoughtful, happy and effective.  When they brain has trouble, people generally tend to have more trouble in their lives.  In 2007 we published a study on our work with murderers in the Journal of Neuropsychiatry and Clinical Neurosciences, demonstrating that many had severely damaged brains and as a group they had significantly low activity in the prefrontal cortex, the most human, thoughtful part of the brain that is involved with forethought, judgment, and empathy.  Brain abnormalities are often involved in these cases.  They may come from a brain injury at some point in the past, some form of brain toxin, prior substance abuse, or a mental illness such as depression, which has definable brain effects. 

But clearly brain issues alone are not usually sufficient to explain troubled behavior. Many people with troubled brains never act badly.

Psychological Factors (Thinking Patterns)

This circle includes how we think and how we talk to ourselves, the running dialogue that goes on in our minds, plus our self-concept, overall upbringing and significant developmental events.  In the case of Dr. Hasan the early evidence points to a number of psychological problems.  He demonstrated evidence of anxiety to his family.  He was deeply emotionally conflicted about going to war, where he might be called upon to hurt other Muslims, which he likely thought of as part of his family.  

In addition, Dr. Hasan likely felt trapped, with no options.  He had tried to get out of the military and now he was faced with going overseas.  People who feel as though they do not have options may turn to suicide as a way out.  Many mass murderers know they are going to die and decide to take others with them in their suicidal behavior.  To unload an automatic weapon in a crowd of soldiers in the middle of a military base is clearly acting in a way consistent with suicide. Not an easy way to escape.

There is evidence of this form of thinking when he posted a piece of the internet 6 months ago comparing suicide bombers to soldiers who would throw their bodies on a grenade to save fellow soldiers.  

Social Factors (Stress)

The social circle emphasizes the current events in our lives.  When we are in good relationships, experience good health, have a job we love and enough money, our brain tends to do much better than when any of these areas are stressed.  Stress negatively impacts brain function.  By all accounts Dr. Hasan was feeling significant stress. He did not want to be in the Army, but had no choice, because they had paid for his schooling and advanced training.  He did not want to be deployed and did not want to have to shoot fellow Muslims.  He was also unattached, at least not married, which makes it easier to commit these crimes or commit suicide.

Another potential stress for Dr. Hasan is something called “compassion fatigue.”  As a military psychiatrist during war time, Dr. Hasan likely listened to many soldiers about the horrors of war.  New research demonstrates that the brain has a “mirror neuron” system that allows us to understand and really feel another person’s pain.  Listening to soldier after soldier about the horrors of war can cause caregivers to feel stressed, depressed, and anxious.

Another critical social piece is his military environment.  I was both and enlisted soldier and officer.  There is a mentality of toughness, “Army Strong,” that does not encourage or tolerate weakness. It is often hard to ask for help.  Plus if you are an Army Major, Psychiatrist, you may not feel comfortable asking for help from someone who is also your boss, with whom there may be conflict.

Spiritual Factors (Meaning)

This circle involves the part of our lives that is involved with the deepest levels of meaning and purpose.  Why am I here? What does my life mean?  Many people go through spiritual crises, not knowing why their life has meaning, which sets them up for depression or substance abuse.  Morality, connection, values and a spiritual connection to others and the universe is critical for many people to feel a sense of wholeness and connection.  But often spiritual connections can go dangerously awry.  Many terrorists have a distorted  sense of spiritual meaning and are willing to kill innocent bystanders as a way to fulfill their belief system that is based on fear or hatred.

Over the coming days more and more information will be uncovered about Dr. Hasan, and hopefully we may learn something that will help other soldiers who are desperately in need of help.

I feel very sad for the families of the dead, and for the wounded and their families.  The emotional trauma, as we have seen with our brain imaging work, will likely leave a lasting negative change in their brains without significant help.  Many traumatized people may be hesitant to get the help they need from a mental health corps that spawned Dr. Hasan.  

Daniel G. Amen, MD is a former military psychiatrist, medical director of Amen Clinics, and the bestselling author of Change Your Brain, Change Your Life.