Psychiatrist Reports Inside View of Fort Hood Killer’s Evaluation

It took a year of investigation, but members of a military sanity board ultimately found that the U.S. Army psychiatrist who shot and killed 13 people at Fort Hood, Texas, on November 5, 2009, was not mentally ill and was able to stand trial, said Kaustubh Joshi, M.D., who chaired the board, at APA’s 2016 Annual Meeting in Atlanta.

Maj. Nidal Hasan, M.D., also wounded 32 other people on that November day before he was shot by two police officers and paralyzed. Most of the dead and injured were fellow members of the U.S. Army, preparing to deploy overseas. Hasan was tried and convicted in 2013 for the crimes, and his case is undergoing a mandatory appeals process.

Joshi said he could finally discuss the case publicly now that the trial was over and a verdict rendered.

Sanity boards are appointed by the military convening authority or the judge in charge of a court martial, not by the prosecutor or defense, said Joshi, then an Air Force psychiatrist and now an associate professor of clinical psychiatry at the University of South Carolina School of Medicine. Failure to cooperate with the sanity boards bars the defendant from introducing psychiatric witnesses later in the legal process.

An Army psychiatrist and a Navy neuropsychologist joined Joshi on the board. Together, they had to decide whether Hasan understood the nature of his actions and was competent to stand trial.

Joshi and his colleagues reviewed 10,000 documents, interviewed witnesses, and evaluated Hasan directly for about 13 hours over a three-day period in December 2010.

“This was the only time in my professional life I got everything I wanted,” said Joshi about what became his primary job for an entire year.

The investigation revealed a quiet man whose life spiraled downward inexorably after a series of personal and national tragedies: the deaths of his father in 1998 and of his mother in 2001, followed by the September 11 terrorist attacks. By then he was a student at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Md. Hasan had struggled in medical school but was granted a leave of absence to take care of family affairs, he told Joshi.

Collectively, those events led Hasan, the American-born child of Palestinian immigrants, to a deeper involvement with religion. “Islam became more of the focus, not simply a focus, of his life,” said Joshi, who speculated that religion came to fill the void created by his parents’ death.

Then, after the United States invaded Afghanistan and Iraq, Hasan concluded that the country was fighting an unjust war against Islam and trying to force democracy on Muslims. He said that he had been on the wrong side as a U.S. soldier and that he had switched sides.

“He could not balance being a Muslim with his obligations as an American military officer,” Joshi said. “But that never translated into overt behaviors regarding that conflict up until November 5. Although he may have made verbalizations about his beliefs on Islam, he never verbalized a threat to harm others.”

Nevertheless, no matter how extreme his views of his religion may have been, then or later, they could not be considered delusional, said Joshi.

Hasan graduated from USUHS in 2003 and entered residency at Walter Reed Army Medical Center. He was counseled about preaching to his patients and was cited for a “lack of professionalism and work ethic,” but responded to counseling by correcting his behavior.

He was allowed to graduate from residency in 2007, despite continuing questions about his professionalism and work ethic. He spent the next two years in a disaster and preventive psychiatry training fellowship at USUHS before being assigned to Fort Hood as a staff psychiatrist.

There, an evaluation completed just two days before the killings declared Hasan to be “an outstanding physician who has the potential to excel. ... He should be selected for positions of increasing responsibility. Promote now.”

Hasan told the board that he had begun contemplating doing something violent but had informed no one. In fact, said Joshi, Hasan had no unusual risk factors or history of violence before the attack at Fort Hood. There was no evidence of abuse, bad behavior, or special education during his childhood. An indifferent high school student, he served as an enlisted man in the Army in 1988-90 before going to college.

Hasan for a time corresponded with Anwar Al-Awlaki, an imam and an American citizen who became a leader of Al Qaeda in Yemen. Awlaki was killed in a U.S. drone strike in 2011. Their communication was noted by the FBI, but its inquiry ended when it was learned that Awlaki had earlier presided at Hasan’s mother’s funeral outside Washington, D.C.

In the end, the sanity board concluded that, at the time of the crime, Hasan was not suffering from a mental illness and he was not “unable to appreciate the nature and quality and wrongfulness of his conduct.” Nor did he have any clinical diagnosis when evaluated. Finally, he understood the charges against him and was competent to stand trial, said the board.

Hasan told the board that he wanted to become a martyr, either by being killed at Fort Hood at the time of the shootings or by the death penalty, said Joshi. “He denied having remorse for his actions.” ■