Friday, April 4, 2014

The Ft. Hood Shooter and the Military

One of the US military's top psychiatrists indicated that over the past year military personnel counseling/treatment appointments in the various mental health facilities run by the armed services account for over 10 million hours.  To me, that sounds like an extraordinary number of hours and while I don't want to question it, if it is accurate, then the military may have a really big problem on its hands.  In fact, the military probably has several problems on its hands and I will briefly outline them here as I discuss some of the facts currently available regarding the recent shootings at Fort Hood in Texas.

As you probably already know, the shooter, Specialist Ivan Antonio Lopez, a former member of the Puerto Rican National Guard, had been in the Army for about 11 years and had been reassigned from the infantry to the motor pool.  His most recent job was that of a truck driver.  Specialist Lopez had also spent time in Iraq in 2011, recently experienced the death of both his mother and grandfather and had been reassigned from another Army post.

The information that is being provided to the public also indicated that Specialist Lopez was receiving at least three psychotropic medications for depression, anxiety and sleep.  He had complained to the medical staff that he had experienced head trauma and PTSD.  A recent evaluation by a military psychiatrist found no indication of PTSD and there, apparently, was no current diagnosis for him. A senior officer, who I assume is not a psychiatrist or mental health specialist, indicated Lopez had something like an Adjustment Disorder. I find this curious.

Granted, the facts here are quite sketchy and there is a great deal of information which is necessary before we can come to any conclusions regarding what may have precipitated the violent attack on military personnel.  What we do know is that the gun which was used in the assault had been purchased in the past week and was not government issue.  Media military consultants have indicated that it is not permissible for military personnel to carry personal weapons on base.

Looking at what we have at the present time, several factors must be considered.  The first factor, of course, is the fact that this is an Hispanic man who was grieving the loss of two beloved relatives, his mother and his grandfather.  The second fact is that he had been reassigned to the position of truck driver which may have, in his estimation, been an affront to his self-esteem.

I do not know who the psychiatrists were who evaluated him, but I can wonder about their cultural competence regarding this man and his particular cultural perspective on life in the military.  One retired military consultants on TV suggested that the fact that Specialist Lopez had not advanced in rank would have raised some red flags in terms of his ability.  We do not know what the reason was for his lack of advancement and speculating is always a slippery slope.

One fact that also came out was that, although he was not given a diagnosis of PTSD, he was being "evaluated" for it and that was ongoing.  Another retired military person suggested that PTSD is not one of the overriding diagnoses in military personnel returning from active combat zones.  She stated that it was only about 30 percent of the cases being treated for mental health disorders.  In my experience, as a medical consultant for disability determinations, I have seen that there appears to be a reluctance to provide the diagnosis of PTSD even to military personnel with symptoms which would seem to indicate its presence.  I might suggest that there may be an effort ongoing to limit the number of personnel with such a diagnosis.  I will not offer an opinion regarding why this might be done.

After the shooting at Fort Hood, Specialist Lopez, when approached by a female military police officer, pulled out his gun and killed himself.  This may offer something in the way of some insight or it may have no meaning at all.  Remember that question of cultural competence?  It may have been involved here.

Neighbors on base when questioned about specialist Lopez's actions while in their presence, indicated that he was pleasant, exhibited nothing in the way that would make one expect he would turn to violence for any reason.  There are a number of questions, again, here and I suspect that a thorough investigation may uncover some details which could point to potential reasons for his actions.

At this point, however, we can come to no conclusion regarding whether or not this man had PTSD, if he had a simmering grudge regarding superiors refusing him adequate leave to grieve the loss of his relatives, if in fact he had experienced some type of traumatic brain injury while in Iraq and how, if it did, his culture may have played a role here. 

Please understand that when I say culture, I am not casting aspersions but suggesting that a sensitivity to his culture and how it might have an impact on his thinking and his actions is vital.  Dismissing it and also dismissing, if this has been done, the lack of consideration regarding his culture in the PTSD evaluation are important factors.

I have seen a psychiatrist who was foreign born, non-Hispanic and who failed to understand what a patient with a heavy Spanish accent was saying and who missed the importance of what she was being told. The man was complaining that another patient called him using a common slur which she misinterpreted as “speak” instead of the denigrating term the other patient had used toward the Spanish patient. “Well,” she said, “why didn’t you just speak to him?” He stared at her blankly and tried repeatedly to help her to understand, but she didn’t hear him.

Now, I believe, it is time to turn the rhetoric down on this shooting and to begin to use a much calmer, methodical approach to this entire matter.  As we've heard in the past, this can be a teaching moment rather than another tragedy.  Finding something positive now is one way to begin the healing and the hope that everyone in the military and the nation needs.