Nidal Malik Hasan, a United States Army psychiatrist, is alleged to have killed 13 persons at the Fort Hood Army Base. It has led many people to question his motive and others have asked how could a psychiatrist, a doctor who specialises in treating conditions of the mind, carry out such an act?

The incident has certainly left many in pain. Some people have been left with a sense of betrayal and others a sense of helplessness and hopelessness. After all, our doctors should be people to help, not hurt us.

I do not know this man and I, therefore, am not qualified to discuss his situation, and even if I did know him, it would have been unethical to discuss his specific situation. This article is merely intended to focus generally on the situation, and to explain what could have prompted any individual in a similar situation to act in the manner that this psychiatrist did.

What motivates people to engage in violence?

Perpetrators of violence fall into several categories. The ideologically motivated perpetrator is influenced by religion, politics and personal beliefs. There are people with psychiatric or psychological problems which may lead them to carry out acts of violence. These individuals may have a psychotic condition or a severely flawed personality, such as antisocial personality disorder. The third group of perpetrators of violence includes individuals who act out of revenge or personal benefits, as is the case in reprisal killings or violence to gain status in gangs or for financial reward.

Compassion fatigue

Compassion fatigue is now used to described what was previously referred to as burnout. Mental health professionals, social workers, church workers and other people who are involved in the caring professions are at great risk for personal and professional burnout. Such individuals are constantly bombarded by bad news and have to listen to people's pain and suffering on a daily basis.

Often, many of these problems are not easily resolved. In many situations, mental-health personnel have limited opportunities for expression of their sense of frustration, pain, hurt and sometimes anger. In addition, many people working in the caring professions sometimes take on too much and neglect their own self-care. Compassion fatigue may lead to physical problems, and one's emotional and spiritual energies may be stretched. It is, therefore, important for all of us working in the caring professions to not only balance our lives, but to know when and how to seek help.

Secondary traumatisation

There are many people who are exposed to trauma every day or have to work with others who are exposed to high levels of trauma. These workers include mental-health workers, firefighters, persons working with women and children who are abused, workers in residential facilities for children and criminal defence lawyers. I would imagine that in Jamaica, we would include in this group the police and some community workers. The end result is that they themselves become traumatised and may develop the symptoms of post-traumatic stress disorder. This is also referred to as secondary exposure or vicarious traumatisation.

Ideological conflicts

The psychiatrist implicated in the Fort Hood killing is a Muslim and he was about to be sent to a Muslim country to fight a war in which he would see people with whom he identifies religiously killed and maimed. Questions are asked as to the extent to which this psychiatrist is conflicted. Only he can answer that question. The reality, however, is that many times, people find themselves in situations that generate conflict or which could be compromising. This is true for all professions. We need to be able to identify these situations and seek help.

Dr Wendel Abel is a consultant psychiatrist and head, Section of Psychiatry, Dept of Community Health and Psychiatry, University of the West Indies, 977-1108; email: yourhealth@gleanerjm.com.