On Major Nidal Malik Hasan
by Siegfried Othmer | November 23rd, 2009
Up to this point, commentary on Major Hasan has had as much to do with us, the observers, as with Hasan himself, given how little we actually know about him. One wants to be careful not to jump to conclusions prematurely. That may also have been at work early on while Major Hasan was working at the Walter Reed Army Medical Center. The question has been raised as to why his colleagues at Walter Reed did not pick up on the various signs of instability and of mental disturbance in Major Hasan during his years there.
The professional reluctance to identify Hasan as a problem may very well have been due to the “protective garb” provided him by his status as a psychiatrist. He was one of them. Beyond the simple reluctance to indict a professional colleague, there is also the assumption that such an individual has more resources to “pull himself together” and to conduct his life within acceptable bounds even if he has “issues.” The mental health disciplines have developed from a very rational framework that unsurprisingly places the rational order at the top of our regulatory hierarchy. In the disciplined mind, rationality rules the emotions. The will is unquestionably in charge of our actions.
Hasan’s appointed lawyer continued in the attempt to reassert the primacy of rationality by promising a fair trial. What does a fair trial mean here but the ability to set aside one’s emotions, emotions that would rather see this man’s entrails spread over the Texas outback for the vultures to pick over than to see him sitting in court smartly dressed in our nation’s uniform. He will also be wearing the “virtual” armor of his status as Army psychiatrist once again.
Hasan illustrates a more general problem in our society that professional status is inherently protective against charges of criminality, of mental failings, or of moral turpitude. Consider the case of Roman Polanski, where “Hollywood” recently rose up in his defense, arguing that the criminal process against him should not finally be consummated after all. He was one of them. He was a unique creative mind who could not be defined by that single act so many years ago. And one should not neglect the fact that he himself had suffered tragedies in his personal life.
Of course there hadn’t been just a single act. There was a progression of actions indicating a carefully laid out plan to impose himself on this 13-year-old girl while she was under the influence of alcohol at his instigation. There is clearly a bias here in the protective reaction of his peers, because these same people are all in favor of dragging white-haired old men before German courts if they had anything at all to do with the Holocaust more than sixty years ago. No statute of limitations there. Justice must be served….unless it involves one of “us.”
The ‘protective coloration’ of professional identification may also have been at work in repeated failures of the SEC to investigate Bernie Madoff’s operation. He was capable of saying all of the right things and of mounting all the usual verbal defenses during their various perfunctory investigations. SEC officials could at least tell themselves that a “shot across the bow” had been delivered, and if his act needed cleaning up, then he had best be about it.
The very best example of ‘protective coloration’ remains that of the Church scandal of sexual abuse by priests. It was so easy for culpable priests to present themselves as pious workers in the vineyard of the Lord, and thus to retain immunity from investigation of their hideous behavior. Similarly, we now have CIA agents sporting effective immunity from prosecution for their involvement in torture.
It seems almost impossible to prosecute white collar crime in this country, and our corporate CEOs appear to be yet another protected class. In a society now organized around the economy rather than the other way around, we have ostensibly become dependent on CEOs to take the society forward. So they are the good guys, by definition, and they surely mean well, don’t they? Helmut Schmidt, former German chancellor, once mused that there are three kinds of people: There are those who may have swiped some apples from an orchard when they were young, but they go on to live decent lives and pay their taxes. Secondly, there are those who end up leading lives outside of the law, and finally there is a third category, investment bankers!
In a study of ethical norms around the country a few years ago, it was found that New York stood apart. When the researchers delved into the data more deeply, they found that the divergence in the New York data was entirely attributable to the participation of members of the investment community in the survey. Their ethical norms were different from everyone else’s.
On every occasion, from Enron to the financial scandals in Wall Street to the misdeeds at the Office of Legal Counsel in the Justice Department, the lawyers nearly always escape sanction. They would have to be tried by other lawyers. In California, cases brought against nurses for malpractice take on average three and one half years to resolve. They would have to be judged by other nurses. Matters are even worse when it comes to MDs, where hands are merely slapped for gross infractions. Police departments are almost impossible to clean up, and rogue officers are rarely subject to sanction. One might as well forget about cleaning up among prison wardens. The collective record of criminality among members of Congress vastly exceeds that of any random set of 453 American citizens. They constitute a protected class.
Within the scientific research community, fraud is the equivalent of pre-meditated, first-degree murder in society at large. The disgraced Korean stem cell scientist Wong Suk Hwang had two of his key papers found to be fraudulent, and was recently found guilty of violations of bioethics laws (and for good measure, embezzlement) in a forty-month trial. Nevertheless, while the trial was ongoing and before the verdict was rendered, Wong was given an award for scientific excellence by a Korean foundation.
One problem is that the sanctioning of professionals typically amounts to a “professional death sentence.” When it comes to professional malfeasance, there are no misdemeanors. A judgment of such finality is often seen as too harsh, so the whole matter is simply avoided from the outset. The other major problem, however, is the deference we yield to skilled verbal discourse. We honor rationality beyond the bounds of reason, and if a case can somehow be made to “explain” the deviant behavior or to circumscribe and contextualize the criminal act, then that goes a long way, particularly with fellow professionals, and even more so in the legal process.
What is missing is an understanding of the centrality of our emotions in so much of life. This is not surprising because we lack both the formal scaffolding for such a discussion and we even lack a shared terminology. Major Hasan appeared to be a cauldron of restive emotions, caught between fundamentally discordant world views, and yet he was able to contain himself enough to do his work. A hint to his internal turmoil lay in his praise of the suicide bomber, in whom both rationality and the emotions have been recruited into self-destructive behavior. Hasan’s views here are not intrinsically suspect, however. Did we not all honor the integrity and respect the message of the Buddhist priests who immolated themselves on the streets of Saigon?
Well before we even have a chance to scope out the full dimensions of our emotional universe “scientifically,” we now also have to come to terms with our unruly physiology. This is essentially the story of PTSD. The veteran tells us that he has to live “day to day.” He has no idea when some event might trigger his physiology into dysfunction. He hurts his loved ones against his will just by being near them continuously. Many find this a simply intolerable state to be in. It is such a contradiction of their entire training, which is to have every moment of their lives be subject to their will and direction. They are supposed to be in charge, and now they find out that they cannot be. Their condition is an affront to everything they wanted to be and were told to be.
The conundrum of PTSD confronts us with the inadequacy of present understandings. Our models of top-down control of our behavior, with deliberate conscious agency sitting on top, cannot cope with this. Nor would it be enough to allow, at long last, a central role for our emotional universe in guiding our behavior. We have to look at the interface of physiology and behavior. We are finally encroaching upon the domain that is much talked about in principle but much ignored in practice—the mind-body connection. This is the domain of our cerebral networks that encode our thoughts and feelings and both govern—and are in turn governed by—our physiology. Once the scope of our vision is enlarged in this fashion, it becomes possible to intervene directly with our physiology, resolving problems of control in a bottom-up fashion.
This is the path that mental health has already taken in a number of specific instances. The profanities of Tourette Syndrome were originally thought to be a moral issue. Then they became a mental health concern, and finally a matter of managing our cerebral circuitry. The symptoms of PMS were long blamed on women as a lack of self-control before the role of physiology was recognized. Homosexuality was first seen as a moral issue (and hence a criminal one), then as a mental health problem, and only lately as a physiologically-mediated condition. Addiction was seen first as a moral failure, then as a failure of the will. The obvious physiological dependencies have yet to inform treatment programs. It is time to acknowledge that physiology plays a role in all mental health issues. The more intractable and irrational the behavior, the more likely that it involves a physiologically-mediated dysfunction.
This is not, however, just a matter of logistical support of our brain architecture through psychopharmacology. It is a matter of the regulation of our cerebral conversation in all its aspects. This is the domain of neurofeedback and the related neuromodulation technologies. The effectiveness of neurofeedback, in turn, proves the hypothesis that gave rise to it: physiology plays a central role in all mental disorders; it cannot be ignored. In the empirically refined technique of neurofeedback, we finally have the means for the liberation of our veterans from victimization by their own physiology. We can unburden them from the notion that their lives confront them with their own moral failings.
After the world of mental health “discovers” the neurofeedback remedy for PTSD, its application to emotional disregulation in general will become apparent. That has relevance to so many in the professions who are running under the protective cover of a skilled left hemisphere, but whose emotional makeup—or physiological stability—is questionable. At the moment, the need for this is not even being recognized, but that will change with time. There is, after all, no alternative. Just as pharmacology does not hold the answer here, neither does talk therapy. It is simply not adequate to these tasks for a number of reasons.
Nearly all of us live our lives with certain “healthy illusions.” Among them is the belief that we are ok, that we are in charge of our lives, and that our moral compass is at minimum defensible even if it might be a bit wobbly. These positive illusions do help to keep us alive and healthy. They also armor us against the insinuation that there may be something deeply amiss, and that we need help. So, with our veterans we cannot start in this endeavor from the medical/psychological paradigm of dysfunction and of disability. They would just stay away in droves. The work must simply be seen as a matter of enhanced self-regulatory control and of augmented skill sets. Our emotional repertoire is part of our skill set, and it can be enhanced just as readily as our cognitive skills. The experience will be one of liberation.
First of all there will be the realization that we need not be the victims of our own squirrely physiology. Secondly, there will be the discovery that our mental well-being is largely under our own control. And finally, the training may open the door to new competencies that one may not have recognized. Individually, this will allow people to live a more wholesome existence. Collectively, this may allow our society to escape from its present tyranny at the hands of those who may indeed be highly skilled by current standards but may be either woefully disregulated, stealthily predatory, or shockingly devious—the Hasans, the Polanskis, and the Madoffs of this world.
Just as with the veterans, we have to approach these particular societal deviants, the protected classes in general, and the society at large out of a wellness and enhancement model rather than a deficit model. We have to build upon the wholesomeness that is in accord with their self-image. And in fact this is also in accord with nature as we observe it. It is just amazing to see just how ‘intact’ and resourceful people are who are struggling with the most challenging of conditions. And when we observe how trivially some severe mental conditions can be made to disappear with neurofeedback, we realize that we are working with nervous systems that are in fact largely intact already. The dysfunction that appears profound at the behavioral level may in fact be a triviality at the neurophysiological level. The healthy illusion of wellness gets a lot of support from life experience.
The concept of healthy illusions also applies at the level of the professions, through a shared belief within the profession that it is the custodian of a certain core truth. Here we come up against the other major way in which the professional categories protect themselves. Professional disciplines develop a finely honed immune system that recognizes foreign ideas and mounts an assault upon them. The burden is similar to that of our own immune system: It is to distinguish self from non-self, and to obliterate the latter. There is great subtlety in discrimination of self versus non-self, but not much subtlety in the discernment of merit. So it is that the neuromodulation technologies have had to develop largely independently, without much official sponsorship, over the last forty years.
We do now have a lot of interest developing in the “Brain-Computer Interface” technologies, but most of these are concerned with specific functions such as motor control. The same principles are at work in neurofeedback, but here the target is the more diffuse issue of the regulation of our states—the states of emotion in particular. This is the oceanic domain where neither psychology nor psychopharmacology has distinguished itself to date. Within the mainstream we don’t yet have a cartography of the space of the emotions and of the related regulatory functions.
So it is almost impossible for the professions to recognize—and to acknowledge—that their standard remedies have now been eclipsed by something new. In addition to the usual institutional barriers to acceptance, this is because in our ordered rational universe we must have a model in our heads in terms of which the results make sense, or else the results are simply ignored. Such a model is only now coming together in the neurosciences. Once again, the truths of nature are found to be simple in conception even if they are complex in implementation. Once the real source of the difficulties lies revealed, the remedy is straight-forward. If it was psychological trauma that deranged the networks in first instance, then it is the re-ordering of network function that can effect the resolution:
Train your physiology to behave, we tell our veterans, and your moral compass will again be there for you.
Train your physiology, and you will no longer need the substances you now rely on to get you through.
Train your physiology, and your heart will again open up to your loved ones.
Train your physiology, and your nagging memories of the past will subside and torment you no more.
Train your physiology, and you’ll again be able to get some sleep.
Train your physiology, and thoughts of suicide will vanish.
Train your physiology, and you can manage your pain.
Just as you trained your physiology for war, now train it for peace, your own and that of your family.
And what is good for our veterans is also good for the rest of us.
Hi,
I have emailed a few times because I am so convinced that neuro feedback works. I have been in a doctorate program for over 2 years then had to switch to a masters which I have just finished my last papers and will be graduating next month.
As a young girl I was trying to climb up a steep hill and fell many feet backwards as I was trying to catch my stepbrother from falling who was up a head of me. This fall resulted in a crack in my skull and I did not report that I was hurt because I was afraid of getting into trouble. My step mother rushed my step brother to the hospital where he had a head injury and I was sent home to my mothers where not until many years later I was once again knocked out by a gang and went to the hospital where they saw the previous head injury on the x-ray.
As an adult I worked for a psychologist who had me do neuro feedback a few times. He said he could not stand that I vibrated even while I was sitting still.
My life has not been easy and I have really tried to pull myself out of poverty. I did not even start college until I was in my late thirties. I almost could not graduate because I could not pass math. In fact I still cannot remember my 8 children’s birth dates.
I will be continuing in the doctorate program in March and at some point I have set my goal to become a provider of neuro feedback when I can save enough money for the instruction or sell a few paintings. I know nuero feeback helped me just from the few times I was able to have it. And believe that so many people would benefit from it.
I just really enjoy all the articles and thought I would write and says thanks!
Anne
Thanks for your inspiring post. You might want to arrange for some additional neurofeedback sessions to ease your path through the doctoral program. Memory function is obviously crucial to your success, and that is typically the last to respond to neurofeedback. This is because memory is distributed in the brain, and utterly depends upon the coordination of many different brain areas. Memory function is the final criterion of whether we’ve accomplished our objectives with neurofeedback in traumatic brain injury.
And when the time comes, we would welcome you into our professional training course.
Recalling Bruce Ivins:
We have in Bruce Ivins, the presumptive source of the anthrax letters in 2001, yet another obvious case of a professional being given the benefit of the doubt at every turn. On the one hand, we have the credible report of Jean Duley, his therapist, that Ivins threatened his coworkers with annihilation. “He was going to go out in a blaze of glory…he was going to take everybody out with him.”
There is further evidence that Ivins’ psychological derangement has a long-term history. Another psychiatrist called Ivins “homicidal, sociopathic, with clear intentions.” Another counselor, who had seen Ivins back in 2000, also identified psychiatric problems and reported homicidal threats to the police.
Meanwhile, Ivins continues to be held in high regard by the very coworkers whose existence he threatened. According to Anne Hull of the Washington Post, “(t)he backlash of grief and anger over Ivins’s death was swift among co-workers and former colleagues at the high-security biodefense lab where he worked at Fort Detrick, the Army base in Frederick. In interviews, they said the 62-year-old scientist had been persecuted to the point of disintegration by an overzealous FBI that still had no solid evidence linking him to the anthrax mailings, which killed five people. They described a much-loved, bright, playfully mischievous man who devoted his life to science.”
When Ivins’ home was searched, the haul included hundreds of rounds of ammunition, homemade body armor and a bulletproof vest, quite beyond what is needed to go hunting.
A lot of argument has gone back and forth on whether the evidence brought forward would have been sufficient to convict Ivins if he had not precluded his day in court by committing suicide. At a minimum, the time line of the anthrax mailings appears inconsistent with a single-perpetrator theory, so even if the FBI ‘has its man,’ its job is not done. Yet others have asked the more crucial question of whether Ivins’ mental health status shouldn’t have prevented him from having access to such sensitive and toxic materials as anthrax in the first place.
These are two very different questions. In the basic issue of legal jeopardy of Ivins, our system of justice accords Ivins the presumption of innocence until proven otherwise. In the matter of a security clearance, however, the presumption goes broadly in favor of public safety.
The Ivins case illustrates how successfully an intelligent person can hide his or her pathologies from the public at large. The superficial encounters between colleagues in professional settings are not likely to expose them. But colleagues are also more likely to overlook ‘signs and symptoms’ that in retrospect could be seen as significant.
There is another disagreeable side to the Ivins story, which concerns the venom with which the therapist’s report was greeted. “They made me out to sound like a white-trash biker druggie,” said the therapist. Now it’s true that the therapist was still struggling with her own addiction issues. But is it not commonplace in this country to use ex-addicts as addiction counselors? And if this counselor was still struggling with addiction, is she expected to fire herself as an addiction counselor, or is this just another instance of a lapse in standard of care? After all, she didn’t hire herself either.
Addiction rarely stands alone. It is usually marbled through with other mental health issues, including in particular personality disorders. Normally in medical care the most difficult issues are handled by the most competent and the most highly credentialed. As long as our mental health community leaves the most intractable issues to the least credentialed, we should not be surprised by cases such as this.
This disagreeable history reveals a disregard for public safety and an insensitivity to standards of care. The blame should not fall on the whistleblower at the bottom of the heap of failure, the one person who acted correctly through it all, despite any personal shortcomings she may have.
So we have in this one case three professional categories gracelessly defending themselves: Ivins’ scientific colleagues; the FBI for its sloppy investigation of Ivins over a period of years; and the mental health community in its retroactive disparagement of Jean Duley’s credentials, even though it is in accord with common practice even to this day.
Hasan Karim Akbar
The case of Major Hasan calls to mind an earlier incident in which Hasan Karim Akbar killed two superior officers with grenades and wounded many soldiers with rifle fire in a premeditated attack. This occurred while his unit was awaiting entry into combat in Iraq in 2003. There were signs of mental instability here as well, and both had been loners. The military obviously has very little tolerance for bizarre behavior, which is only too likely to lead to hazing on the part of fellow soldiers. There were also performance lapses that did not fit with Akbar’s prior history of academic success. Performance lapses were an issue with Major Hasan as well.
The uncharacteristic loss in function suggest that Akbar may have suffered a minor traumatic brain injury during his initial military training, which could account for both his chronic sleepiness and the bizarre behavior. With a lack of understanding of such phenomena all around, Akbar interpreted the hostility now directed toward him as anti-Muslim. He was the only African-American Muslim in his unit, and there was of course a lot of anti-Muslim chatter on base at the time.