Perhaps the worst issue in being a military psychiatrist is if your CO tells you to use your psyche exam to boot someone out of the service. It happens.

Positive side which clearly wasn't relevant in this case is, at least if you get educated on Uncle Sam's dime you have few or no debt, and a mostly young healthy population to treat.

Unless of course a war or two are started by some joyous every day tinpot Republican dim wit dictator from Texas.

Its not hard to imagine that the shooter thinks our current wars are wrong and that it bothers him a lot. I think they are wrong and they bother me a lot.

It is not hard for me to imagine that he has empathy and an instinctive inclination to side with and empathize with his own ethnic ancestors. It is the way I am.

It is easy to imagine that in his position he has heard many horrible stories from soldiers about killing rag-heads or from soldiers that hate rag-heads that killed their buddies.

Trying to help these soldiers resolve living with their demons so they can go back and do it some more must have caused him horrible conflicts as to his own duty to his country, to his own sense of morality. to his own sense of humanity, etc.

The very first thing I thought when I heard that he was a Muslim is that he was probably sick and tired of being called a rag-head. I think I heard that he was. I would doubt that he wasn't. I expect that that phrase is very common usage. I know it would piss me off.

It all piled up and made him crazy. I think it would make many people crazy. Some crazy people go nuts and start shooting. If they do it in a foreign country against a declared enemy they often are called heroes. This guy won't get any medals.

Twelve more families are feeling gut wrenching loss. Some members of some of those families will come to hate rag-heads. Some of them might go crazy.

Gee, you'd think that a psychiatrist who was feeling depressed and suicidal would have enough fucking brains to seek help.

Here we have a man who spent his adult life in the military and using the military to advance his education and the moment he is threatened with deployment hires and attorney to agitate for his separation, begins a public rant by blogging with his full name and when those tactics didn't work rages and rampages through his base killing 12 people and injuring 31 more. I doubt that being called a "camel jockey" or a "raghead" had as much to do with this as his utter selfishness and sense of entitlement.

Depression is treatable.

I have compassion for both the dead and wounded and their families (who are suffering), as well as for the gun-man who would have been forced to prescribe anti-depressants to keep soldiers "fighting" when everything inside them was screaming to get out of there.

It is clear this man must be deeply troubled.

It is another sign that our military is unable to help those who need mental health care. Even those who provide it apparently need it!

I know for myself how deeply vicarious suffering can affect a therapist.

I grieve for all.

Peace be with you.

During the latter stages of the Vietnam war, I knew someone in the US Navy who was granted an honorable discharge on the basis of "psychological hardship" after two years of service. The extraordinary thing to me, as well as to some of the other families on base I knew at the time, was that the psychological hardship was not his own; rather, it was that of his wife.
A few years later, when everyone we had known in that time was either dead, or finally out of the military with honorable discharges, we ran into the man in question who, over dinner, revealed that his honorable discharge was the result of a carefully-calculated and patiently implemented strategy.
He had carefully researched the grounds for honorable discharge, identified "psychological hardship" as legitimate grounds for an application, and further discovered that it did not have to be he himself, but rather, could be his spouse who was diagnosed as suffering, or showing the symptoms of suffering, from the precursor of PTS. According to him, the couple decided that though the risk of getting his application turned down was probably higher if the claim was based on the mental health of his spouse, the long-term risk to his future prospects was lower. And so his wife, through the base grapevine, located a politically-sympathetic military psychiatrist who, after several sessions, wrote a supportive letter to the unit captain recommending that the man be discharged, honorably, because his wife was (I paraphrase): "psychologically ill-suited to be married to a military man, particularly in a time of war."
I relate this story because I assumed that PTS tragedies like the one under discussion occur in ever greater numbers because such loopholes had been shut down long since; otherwise, how could servicemen and women with clear symptoms of PTS be ruthlessly sent back to complete multiple tours, or feel obligated to send others to multiple tours? But a quick search on Google this morning revealed this link:
http://www.answers.com/topic/military-discharge
Although the text I read no longer addresses the mental health of spouses, it does clearly say:
"....To receive an honorable discharge, a service member must have received a rating from good to excellent for their service. Service members who meet or exceed the required standards of duty performance and personal conduct, and who complete their tours of duty, normally receive honorable discharges. However, one need not complete a term of service to receive an honorable discharge, provided the reason for involuntary discharge is not due to misconduct. For instance, a person rendered physically or psychologically incapable of performing assigned duties will normally have their service characterized as honorable, regardless of whether the condition or disability was incurred in the line of duty, provided they otherwise exceeded standards.
If these grounds for honorable discharge still exist, surely people are applying for honorable discharge on this basis. And if they are being refused, why is that refusal not a matter for appeal?

This debate about theory of mind aside, this just seems like the VTech shooter, another case of a troubled person who left a trail of breadcrumbs that no one followed.

Can everyone agree that it's a real high risk gamble to sign up for the military in order to get benefits (whether that may be medical training or other type of education or even just three squares a day) hoping that one won't get involved in a war? They give those benefits for a reason, because it's hard to get people to sign up without them. Because people aren't that dumb, they know there's going to be wars (or peacekeeping, or just dangerous rescue activities, or how about just dangerous training and practice activities?)

Some Dude Named Steevo, thanks a whole lot for further enlightening us.

To sum kind of roughly, here the Army was trying to force this guy to adhere to his nine-ish year drudgery contract that he hated. And they're determined to be tough with him, by gum! And all around him, every day, people are muttering about what *scum* are those Muslims! He hears this every day. And he struggles to get out and they won't let him. And he starts wearing Muslim robes around and nobody wonders. Then they are getting ready to order him either to Muslim Afghanistan or Muslim Iraq, which is abhorrent to him for twisted reasons of solidarity and he's also scared out of his mind. And he's coming unhinged, and they're saying, "Listen, Major, a contract is a contract. This is the United States Army!"

And now they all wanna ponder, "Great God in heaven, why didn't he just *REACH OUT* to someone?"

Yuh!