John Liebert, MD

In studying the case of MAJ Nidal Hasan, the Army psychiatrist convicted of 13 counts of premeditated murder and 32 counts of attempted murder at the Fort Hood mass murder, I was reminded of a patient named “KJ,” a successful CFO for a large corporation.


Despite growing up in an impoverished area of Oklahoma with a minimally employed alcoholic father, KJ became a star football player and received a full scholarship from a major university. There, he completed his accounting education. It was clear in therapy that KJ reenacted much of his life through his own son, whom he trained to box at an early age, as his father had trained him. This training seemed almost an obsession for a man who successfully managed the books of a large corporation with billions in revenue. Much of our therapy revolved around his ambivalent emotions toward his father, whom he portrayed as the town bum, but still, he was a present figure in his life. They played pool together and his father loved the regular “smokers” where he could watch his son box.

KJ cancelled an appointment because his father had died. Upon his return, he entered my office literally dressed in his father’s disheveled clothing with a cigar in his mouth and sloppy hat tipped over his forehead. I tried not to show emotional shock, and we spent an hour talking about his father. KJ obviously had not only dressed like his father. He 

 his father; this was not an act. This was a dissociated identity state that was at the core of pathological grief. His wife told me KJ now looked, talked, and behaved like his father. KJ had not been a drinker, partly because he trained his own son to box. Now he would become extremely intoxicated, spent time in sleazy pool halls, and was mean-just like his father.

Dr Nidal Hasan was Palestinian-American; his parents had emigrated from a town outside of Jerusalem and relocated to Roanoke, Virginia. An honors student at the nearby Virginia Tech University, Hasan entered Army officer training school, graduated, received his commission and decided, against his parents’ wishes, to make the Army his career. He was accepted to the military School of Medicine where he received his MD and completed his residency in psychiatry. All of this occurred in the pre-9/11 world when our military was not perceived to be at war with Islam. MAJ Hasan moved through the ranks relatively quickly, furthering his training with an MPH and Disaster Psychiatry training. This military psychiatrist was especially well prepared for his role as a psychiatrist dealing with the emotional and neuropsychiatric problems of troops returning from combat or in screening them for combat.

Between 1998 and 2001, both of Hasan’s parents died. We can only speculate on the psychosocial interior of Hasan’s family of origin, but most likely he heard of suicide bombings-whether merely in the fact of their occurrence or with political overtones of support as the only effective means of regaining occupied territories from Israel. Regardless of the politics in his home, MAJ Hasan in his grief isolated himself from any social life, turned to religion, and became an increasingly devout Muslim, seeking counseling from his mosque in Virginia. His imam was Anwar Al-Awlaki, a fiery speaker who incited his followers to oppose American operations in the Middle East. Later he was designated a terrorist and killed in a CIA drone strike in Yemen in September 2011.

Hassan increasingly perceived that this was an American war against Islam prosecuted by “crusaders and Zionists”-a war, his imam said, all righteous Muslims must oppose by any means necessary.

Hasan sought to get out of the Army, but the Army, which had poured hundreds of thousands of dollars into his military and medical training, offered him no legal exit. Hasan, believing it impossible legally to break his contract, openly jeopardized his security clearance with obviously radicalized emails to his imam al-Awlaki in Yemen. Still, the Office of the Secretary of the Army did not take action against Hasan and transferred him to Fort Hood.

 that he was a risk emerged. MAJ Hasan’s unit was scheduled for deployment processing on November 9, 2009 at Fort Hood, the very place he attacked with a vengeance. He all but said repeatedly a massacre would occur. In a 2007 

, he warned of Muslim soldiers committing Jihad from the inside!

 That is precisely what he did. Weeks before the planned attack, he informed another medical officer that he was not happy with what he was learning about the war; he told her that if the Army was going to deploy him, “they will pay.”

A Fitness for Duty Profile is maintained for all Army personnel on the Army Electronic Health Record (AHLTA); this includes the demand for regularly updating and grading a soldier’s psychiatric and physical capacity, for the purposes of deployment to a combat zone. In Hasan’s case, a Fitness of Duty exam should have been ordered because of his pattern of misconduct as an officer. But there seemed to have been an enforced denial of Hasan’s escalating dangerousness from far up the chain of command.

Then he struck. “It was on a fateful November 5, 2009, that Dr Hasan mercilessly mowed down almost a hundred soldiers, killing 13 and wounding 86. Repeating ‘God is great’ in Arabic as if he were a martyr in the act of self-sacrifice.”

 Acting as his own lawyer, Hasan, claiming to be on the wrong side of this war, said, “We in the mujahedeen are imperfect beings trying to establish a perfect religion. If I died by lethal injection, I would still be a martyr.”

Like KJ, in the despair of his pathological grief, Hasan seemed to have identified with an aggressor from somewhere-perhaps someone within his family’s psychosocial interior. Ironically, as in the case of James Holmes’ descent into psychosis amidst the experts in schizophrenia at University of Colorado, Hasan’s superiors are being held accountable for what very likely should have been investigated for gross personality change with not-so-veiled threats of violence.

It is not clear, however, that the psychiatrists now being held accountable in the Fort Hood case are the ones responsible for allowing a progressive and ominous personality change to explode into mass murder. The contradictory information MAJ Hasan’s Fitness for Duty report raises the question whether those higher up the chain of command pulled strings and allowed several lower-level medical officers to be held accountable to face punishment.

The public will never be privy to what really happens inside the closed system that is military medicine, controlled by the Office of the Secretary of Health, Department of Defense (DOD). But civil suits will be hammering the DOD for answers for a long time. Hasan, like many other suicidal and violent soldiers, was in no way fit for duty.

Dr Liebert is a psychiatrist in Phoenix, Arizona. He specializes in diagnostics, psychopharmacology and supportive psychodynamic therapy of complex neuropsychiatric clinical presentations. He is the author of several books, including 

Wounded Minds: Understanding and Solving the Growing Menace of Post-Traumatic Stress Disorder (

1. Browne P, Herridge C. Exclusive: Video shows Fort Hood shooter’s controversial lecture on Islam [Video]. Fox News. August 30, 2013. 

http://www.foxnews.com/us/2013/08/30/fort-hood-killer-warned-before-shooting-possible-adverse-events/

. Accessed October 8, 2013.
2. Liebert J. 

Wounded Minds: Understanding and Solving the Growing Menace of Post-Traumatic Stress Disorder;

Articles

Army psychiatrist MAJ Nidal Hasan sought to get out of the service, but the Army, which had poured hundreds of thousands of dollars into his military and medical training, offered him no legal exit.

Author | John Liebert, MD

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