WASHINGTON - Amputations. Combat stress. Divorce. Suicide. For troubled service members, military therapists are at their sides.
But with the United States fighting two wars, an acute shortage of trained personnel has left these therapists emotionally drained and overworked, with limited time to prepare for their own war deployments.
An Army psychiatrist is suspected in the shootings at Fort Hood, Texas, and the rampage is raising questions about whether there's enough help for the helpers, even though it's unclear whether that stress or fear of his pending service in Afghanistan might be to blame.
An uncle of Army Maj. Nidal Malik Hasan said yesterday that Hasan was deeply affected by his work treating soldiers returning from war zones. "I think I saw him with tears in his eyes when he was talking about some of the patients, when they came overseas from the battlefield," Rafik Hamad said from his home near the West Bank town of Ramallah.
Rep. Tim Murphy (R., Pa.), a psychologist in the Naval Reserve, said the toll was sometimes described as "compassion fatigue" or "vicarious trauma."
"They may not see combat themselves . . . but they see the outcome of it, and they hear the stories of it day in and day out," Murphy said. "It can be very real when you are dealing with people's difficulties every day."
A military mental-health task force in 2007 expressed concern about the stress on nondeployed mental-health personnel because of the shortage, which it said was leading to high attrition rates. "A vicious cycle has formed," the report said, "that will probably continue to worsen before it improves."
Layton McCurdy, a psychiatrist and dean emeritus at the Medical University of South Carolina who served on the task force, said the shortage continued with the thousands of troops needing help because of combat-related stress.
"The psychiatrists are working with more people than they have time to work with," McCurdy said. "They are pressured in terms of the numbers."
Doctors seeing a constant stream of troops with symptoms of post-traumatic stress disorder can start to have problems of their own - an issue that has not gotten enough attention, said Allen Taylor, a cardiologist at Walter Reed Army Medical Center for 20 years before recently moving to Washington Hospital Center.
"It's time for some introspection: Who cares for the caregivers?" he said.
The military has used bonuses and scholarships and has allowed the hiring of legal nonresidents as part of its effort to bolster the number of therapists. It's even trying a pilot program that allows older health-care providers to enter the Army for two years.
While it may be difficult, those providing support to troops must be willing to seek it themselves, said Capt. James Joppy Jr., a social worker in the Pennsylvania Army National Guard, who is preparing to deploy to Iraq.