It is naive to believe that people will respond to stressful events in exactly the same way. Actually, it is stupid. Which is why I am slightly ticked off this morning by an opinion piece written by the Washington Post’s Pulitzer Prize winning columnist Charles Krauthammer.

In it, Krauthammer, a psychiatrist who has not practiced for decades, slams those of us who believe what he skeptically calls “Secondary Post Traumatic Stress Disorder,” “Vicarious Traumatization” or “Compassion Fatigue”. The Army calls it “Provider Fatigue.”

Krauthammer scoffs at recent reports that Dr. Nidal Hasan’s job of listening to the terrible stories of combat-wounded soldiers returning from Iraq and Afghanistan may have contributed to his rampage at Fort Hood: “They suffered. He listened. He snapped.”

“Really? What about the doctors and nurses, the counselors and physical therapists at Walter Reed Army Medical Center who every day hear and live with the pain and the suffering of returning soldiers? How many of them then picked up a gun and shot 51 innocents?”

None, which is my point. We each have our own set of personal circumstances. Dr. Hasan is Muslim. He is against the war. He was afraid of being sent to the battlefields he had heard so much about. He was concerned about going into a combat zone where our soldiers were killing enemies who practiced the same religion – Islam. We do not know if Dr. Hasan is mentally ill. News reports do portray him as a zealot and we know that religiosity is a symptom of some mental illnesses.

To say that Dr. Hasan should have the same emotional strength and fortitude as other doctors, nurses, counselors and therapists at Walter Reed Amy Medical Center is to say that if you swim the same workouts as Michael Phelps you should be as fast as Michael Phelps.

Some of us are physically and mentally stronger than others – ergo – we react differently to the same stressor. I am NOT making excuses for Dr. Hasan. But I will defend Secondary PTSD – which Krauthammer snears at: “After all, secondary PTSD, for those who believe in it (you won’t find it in the DSM-IV-TR, psychiatrity’s Diagnostic and Statistical Manual) is known as “compassion fatigue.” The poor man – pushed over the edge by an excess of sensitivity.”

Krauthammer is entitled to his opinion. However, the Army believes in Secondary PTSD. In fact the Army developed a Compassion Fatigue program in 2005 to deal with issues of Provider Fatigue and Burnout. The program was redeveloped in 2007 into the Provider Resiliency Training Program.

In Army speak: “This comprehensive program currently includes four different modules beginning with Introduction to PRT in the format of a 20 minute video. PRT Level 1 includes two hours didactic training for both military and civilian providers. PRT Level 2 includes four to eight hours didactic training, expanding on PRT 1 and includes practical application of self assessment and self care plans. PRT Level 3 includes 2-3 day training for Clinicians who treat fatigued providers.”

As for Secondary PTSD not being in the DSM-IV-TR, well, PTSD was not included in the DSM until 1980. Does that mean it did not exist before then? Late luteal phase dysphoric disorder (PMS) did not appear in the DSM until the third edition but I am living proof that it existed before then.

Let’s not stir the pot by saying that secondary PTSD is a “handy invention to ignore the obvious” – that Dr. Hasan may have had Islamist motives. Or that those of us who are “downplaying Nidal Hasan’s religious beliefs,” are just a tad too politically correct.

Let’s just slow down. Please. Maybe we are all correct.

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From Psych Central's website:
PsychCentral (November 18, 2009)

LifeWorks NW (November 18, 2009)

Dr. Kathleen Young (November 18, 2009)

    Last reviewed: 18 Nov 2009