WASHINGTON -- The deadly shooting at Fort Hood, Texas, on Wednesday comes amid widening awareness of the deep and enduring war trauma that exists within the military after 12 years of war. Army Spc. Ivan Lopez, 34, who was struggling with depression, anxiety and insomnia, killed three people and injured 16 others before taking his own life.
There is no scientific evidence proving that such mental health issues increase likeliness to commit mass homicide, and military officials said Thursday the investigation is continuing as they struggle to understand what ignited Wednesday's violence.
Certainly today's 1.4 million active-duty military members, including the 152,986 active-duty personnel diagnosed with post-traumatic stress disorder since 2001, have weapons training and access to firearms, and yet homicide inside the military community is so rare that there is no detailed research on the link between war trauma and murder.
William P. Nash, a retired Navy psychiatrist and national expert on PTSD, acknowledged that not enough is known about the ultimate effects of post-traumatic stress and other forms of trauma and the potential link to murderous aggression.
"With homicide, there is so little data," Nash said. "I'm not aware of anyone looking at those things. I wish people did more -- these are important questions."
Lopez, from Guayanilla, Puerto Rico, served with the Puerto Rico National Guard from 1999 to March 2010 before going on active duty as an infantryman with the 1st Armored Division at Fort Bliss, Texas. In February of this year, he transferred to Fort Hood as a truck driver with the 13th Sustainment Command. According to records released by the Army, Lopez deployed to Egypt in January 2007 for a year with the Sinai peacekeeping task force, and spent four months in Iraq, from August to December, 2011, according to an Army statement. During his career he was awarded two Army Commendation Medals, four Army Achievement Medals and three Army Good Conduct Medals -- all typical awards for a junior enlisted soldier -- as well as other service medals.
Although Lopez claimed to have suffered traumatic brain injury, essentially a concussion of the type that has often gone undiagnosed or mis-diagnosed among deployed troops, Army Sec. John McHugh said Thursday there was no record of Lopez being injured. He also said there was no record of any misconduct on Lopez's part.
Lt. Gen. Mark Milley, commander of the III Corps and Fort Hood, said at a press conference later Thursday that Lopez's medical history showed an "unstable psychiatric condition" that may have been the "fundamental underlying cause" of the shooting. Milley also noted reports that Lopez had been involved in a verbal confrontation with other soldiers shortly before the shootings.
From initial reports, at least, the Army has acknowledged Lopez' psychological problems and was providing appropriate care. Military officials said Lopez was being assessed for the possible TBI and PTSD. He also had been seen by a Fort Hood psychiatrist and was under treatment for insomnia with Ambien and other drugs for anxiety. McHugh said Thursday there was no record of Lopez ever mentioning or threatening suicide, and that he hadn't shown any sign indicating a likelihood to commit violence against himself or others.
Researchers and therapists have found that the hyper-vigilance common to PTSD -- the "can't calm down," sleepless, on-edge state that many experience -- can lead to anger and aggression. Research has also indicated that lack of sleep can blunt a person's ability to make responsible decisions and foresee consequences of their actions.
"Very poor sleep means a person may not be able to maintain and restore their normal level of neural transmitters in the part of the brain they need not to do stupid stuff," said Nash, the retired Navy psychiatrist.
As late as two years ago, Defense Department officials acknowledged to The Huffington Post that they had no precise definition of mild TBI, did not understand the mechanisms that cause the brain injury and could not precisely diagnose what had become the most common cause of combat casualties in Iraq and Afghanistan. Nevertheless, the Defense Department has recorded 294,172 cases of TBI between 2000 and 2013 worldwide, highlighting the extent of brain injury.
But researchers and therapists now are looking beyond the specific, narrowly defined understanding of PTSD and concussion to describe the more common and often deeper psychological effects of war. Some are grouping the symptoms of depression, anxiety, sleeplessness, shame, guilt, grief and remorse under the term moral injury. It is a description of trauma more broad than that of PTSD, which requires a person to have suffered at least one terrifying, life-threatening experience.
Moral injury, the subject of a recent series by The Huffington Post, is described as a wound to a person's moral foundation, a violation of what a person believes as right and wrong. It might be experienced by a combat soldier whose closest buddy is killed in combat, or by a wounded Marine who feels guilty at being medevaced and having to leave his unit behind. Medics have described their guilt and shame at being unable to save a mortally wounded soldier.
What caused researchers to focus on moral injury was the dramatic surge in cases of mental health issues during the Iraq and Afghanistan wars. A detailed study last year by the Armed Forces Health Surveillance Center examined medical evacuations of U.S. military personnel from Iraq and Afghanistan between 2001 and the end of 2012. It found that the most common reason for airlifting troops away from the battlefield was not physical wounds, but disabling psychological issues.
A second study by the center, published in November 2012, looked at the burden of the war years on military hospitals by comparing wartime rates of hospitalization for mental health issues to peacetime rates. It found that mental disorders were the "largest single contributor" to the sharp increase in hospital use: Six million additional ambulatory visits, 42,000 additional hospitalizations and 300,000 additional bed-days were attributed to mental disorders.
At the San Diego Naval Medical Center, staff psychologist Amy Amidon sees a steady stream of Marines and others struggling to absorb their war experiences. "They have seen the darkness within them and within the world," she said, "and it weighs heavily upon them."