Army Psychiatrist's Possible Insanity Defense May be Undermined by Evidence of Premassacre Preparations

November 5 Marks First Anniversary of Fort Hood Shootings

Ron Zimmerman

November 05, 2010

November 5, 2010 — Friday, November 5, marks a full year since the deadly shootings of soldiers at Fort Hood, Texas.

Major Nidal Hasan, a military psychiatrist, is charged with opening fire at a crowded soldier readiness center at Fort Hood, killing 13 soldiers and wounding 32 others. A hearing to determine whether he should face trial and a possible death sentence is set to continue November 15th.

After 8 days of chilling testimony from 56 witnesses, the prosecution rested its case last week.

Nidal Hasan

At the start of the hearings in October, the prosecution set the scene that deadly day a year ago by playing back two 911 emergency calls. Screams and rapid gunshots could be heard in the background of both calls.

"The shooter just came in and shot soldiers and started shooting!" nurse Shemaka Hairston screamed at the 911 operator.

The facility's chief nurse, Kimberly Regina Huseman, also reached 911 while the gunfire echoed around her. "He's coming back in! He's got all of us! He's still walking around....I don't know where he is," the clearly terrified Huseman said. "Where is he? Where's the guy? The shooter?" Huseman shrieked. "He's a soldier!...Oh, my God!"

Michelle Harper, a civilian medical technician on the base, told how she also dialed 911 and left her telephone on as she hid. In this third 911 call, sounds of shouting, groans from the dying and wounded, and more popping noises were heard. The 911 dispatcher asked for details of what was happening and tried to reassure Harper that help was imminent.

"They are on the way, sweetheart. Michelle, they are on the way," the operator said.

Harper said that as she hid underneath a desk she saw a soldier next to her shot 3 times and heard footsteps walk past her hiding place.

The accounts of these 2 witnesses were followed by similar chilling testimony from more than 3 dozen young soldiers, most of them wounded in Hasan's alleged shooting rampage.

They described a gunman who shot and killed bleeding soldiers — including a pregnant private, Francheska Velez — as they were gathered in a post medical facility's waiting room.

Several soldiers, some of them glaring at Hasan from the witness stand, identified him in the courtroom as the uniformed major who cried out "Allahu Akbar" — Arabic for "God is great" — before opening fire.

Target Practice

First responders use a table as a stretcher to transport a wounded soldier to an awaiting ambulance at Fort Hood, Texas. DOD, via AP

In the courtroom, Hasan at times looked down, closing his eyes and stroking his chin. Other times he looked straight ahead.

While a resident at Walter Reed Medical Center, Hasan, a Muslim born in the United States to Palestinian parents, reportedly told colleagues he believed the United States was waging war on Muslims. He said Muslim soldiers shouldn't be asked to kill fellow Muslims.

Hasan attended each day of the hearing in a wheelchair, wearing his military uniform. He was paralyzed from his chest down when he was shot by a civilian policeman who rushed to the scene of the shooting.

His defense attorney said that because of his injuries, Hasan cannot regulate his body temperature and had to wear a watch cap and long underwear in the air-conditioned courtroom.

Evidence of prior planning may undercut a possible insanity defense and could be significant if the US Army decides to seek the death penalty.

The final day of the prosecution's presentation focused on evidence showing that Hasan began preparing and practicing months before the November 5 massacre. Such evidence of prior planning may undercut a possible insanity defense and could be significant if the US Army decides to seek the death penalty.

In fact, Hasan bought the weapon he used in the shootings just 2 weeks after being newly transferred to Fort Hood.

ABC News earlier reported that investigators at one time suspected that the shooting might have been triggered by the refusal by Hasan's superiors to act on his request to prosecute his patients for "war crimes" based on statements made to him during their psychiatric counseling sessions. But those requests were apparently made after Hasan began serious advance planning for his assault.

Investigators at one time suspected that the shooting might have been triggered by the refusal by Hasan's superiors to act on his request to prosecute his patients for "war crimes" based on statements made to him during their psychiatric counseling sessions. But those requests were apparently made after Hasan began serious advance planning for his assault.

During testimony, a firearms instructor recounted how Hasan practiced regularly at Stan's Shooting Range east of Fort Hood throughout the months leading up to the rampage. The instructor, John Choats, also testified that Hasan once asked for help in improving his aim on human silhouette targets at the 100-yard range.

After a day of coaching, Choats recalled, Hasan's shooting improved from erratic to tight patterns routinely hitting each target's chest and head.

Handgun Purchase

Fifteen days after Hasan reported to Fort Hood, former gun salesman Fredrick Brannon testified, the US Army psychiatrist walked into Killeen's largest gun store, Guns Galore. He drew attention in the store by appearing to be ignorant about guns, yet he asked which handgun in the store was "the most high-tech."

"The manager, after a little head scratching, came up with the FN 5.7 pistol," Brannon said.

Army Specialist William Gilbert was browsing at the store, and he testified that he was asked by store employees to tell Hasan about the weapon because he personally owned a Herstal FN 5.7. He then spent an hour discussing with Hasan the choice of weapons.

Gilbert said he "tried to kind of feel him out" about what he would do with such a handgun. Hasan was vague, Gilbert recalled, saying that he wanted something high-tech with the biggest magazine possible. "He did not know what he was looking for," Gilbert said. "He did not know about handguns."

After a day of coaching, Choats recalled, Hasan's shooting improved from erratic to tight patterns routinely hitting each target's chest and head.

Gilbert explained that the Herstal FN came standard with a 20-round magazine but was capable of being fitted with extenders to hold 30 bullets. The gun was lightweight and "very easy to fire with one hand," he recalled. He told the major it was “just like shooting a .22."

Gilbert also explained to Hasan that one of the weapon's 3 types of ammunition, the 55192 blue-tip round, had such penetrating power that federal authorities ordered it taken off the market once existing stocks were exhausted. Gilbert said he told Hasan that the round could penetrate Kevlar armor and that it expanded on hitting flesh, "basically liquefying anything in that area."

Brannon testified that Hasan left that day, saying that he had to look up the weapon. The next day, he bought the gun, an expensive laser sight, several magazine extenders, and boxes of the blue-tip armor-piercing ammo.

The entire sale was odd, the gun salesman recalled, because Hasan took out his cell phone and videotaped the manager's demonstration of how to load the new pistol, remove its magazine and break down the weapon. Brannon told the court he'd never seen anyone make such a videotape. Hasan said that "he wanted to review it later."

Hasan's grainy cell phone video was played in court. According to court observers, the gun, a set of hands, and a fluorescent-lit gun display case were all that were visible. Hasan voice could be heard asking the manager about the gun.

According to Brannon, Hasan came by the store every week to buy more magazines, magazine extenders, and 4 or 5 boxes of ammo, 50 rounds to the box.

Not a Sudden Mental Breakdown

In court, US Army investigator Kelly Jameson testified that at the shooting scene Hasan carried 10 magazines for the Herstal 5.7 and also a spare revolver; 214 spent cartridges were recovered inside and outside the processing center, and when Hasan went down, shot 4 times by civilian police officer Mark Todd, he still had 177 unfired rounds on him.

Hasan's Article 32 hearing will determine whether he faces trial at a court martial, where he could face the death penalty. After the prosecution's case was concluded, the defense may present witnesses, but it is not required to put on a case.

Hasan's elaborate preparations in the months before his assault on the medical center argues against a conclusion of a sudden mental breakdown.

Anthony Ng, MD, the immediate past president of the American Association of Emergency Psychiatry, told Medscape Medical News that Hasan's elaborate preparations in the months before his assault on the medical center argues against a conclusion of a sudden mental breakdown.

Dr. Tony Ng

"Someone who goes through that much planning implies he had a clear understanding of his actions and he understood the consequences — that he would possibly be shot or go to jail, and that he was aware of all the possible outcomes. If you act in the heat of the moment, you don't think of the aftermath. It's not like someone said something to him and he ran and got his gun. His actions built up over a period of time."

Dr. Ng said the numerous steps in Hasan's planning allows one to infer about his thought process. “If he planned it that long, it means he thought doing about it at length and the ramifications of his actions...It's possible to be mentally ill, but you can still be held liable for your actions if you're aware of the consequences.”

"Screams Premeditation"

Extending Dr. Ng's assessment is another psychiatrist, former US Army infantryman and US Navy flight surgeon Eric Anderson, MD, who said he watched the court testimony closely.

"It screams premeditation," said Dr. Anderson. "Was he suicidal or trying to die in the event? I don't think so. It may be possible to be suicidal and work on that progressively, but the time he took to plan argues against it being caused by depression or anxiety.

"It's more like Columbine. He took time to practice, find the right weapon, find the right ammo, and the results speak for themselves. He was effective. He was successful in carrying out his mission, which was to murder as many people as he could."

Al Qaeda and other Islamist terrorist groups are hailing Hasan, an American-born Muslim of Palestinian descent, as a hero. Although the November 5 shooting spree was not on the scale of the 9/11 attack, it served the same purpose: to terrify America, according to an Al Qaeda spokesman.

"The Mujahid brother Nidal Hasan has shown us what one righteous Muslim with an assault rifle can do for his religion and brothers in faith and has reminded us of how much pride and joy a single act of resistance and courage can instill in the hearts of Muslims everywhere," American-born Al Qaeda spokesman Adam Gadahn said in a video released March 7.

"The Mujahid brother Nidal Hasan, by the grace of Allah and with a single 30-minute battle, singlehandedly brought the morale of the American military and public to its lowest point in years."

An expert on Al Qeada, Jarret Brachman, said "Hasan has become almost everything they've been hoping...he's legendary now within their movement." Brachman, author of Global Jihadism: Theory and Practice, told a reporter from the Christian Science Monitor that "Hasan proves that you can be Al Qaeda by not even being Al Qaeda — that's the model they're now promoting. He has populist appeal within the jihadi movement. The fact that he's not exceptional...is what makes him so compelling."

In a Congressional committee hearing last month, Federal Bureau of Investigation (FBI) Director Robert Mueller said that "since 2006 al-Qaida has looked to recruit Americans or Westerners who are able to remain undetected by heightened security measures."

Despite Mueller's congressional testimony, the FBI was previously aware that Hasan had posted comments on the Internet in which he equated a suicide bomber who kills himself to protect other Muslims as the same as a soldier who throws himself on a grenade to protect his comrades.

PTSD a Possible Explanation?

Whatever Hasan's motives, Al Qaeda's spokesman said Hasan pulled off a near-perfect operation by keeping his plans secret, carefully picking a target for optimal effect, and carrying out the attack without regard for his own life.

The Fort Hood attack showed that "there are countless...strategic places, institutions, and installations which, by striking, the Muslim can do major damage to the Crusader West and further our global agenda and long-range strategic objectives," said Adam Gadahn, the American-born Al Qaeda spokesman.

It's interesting that he didn't attack a church or a chapel or a cafeteria. There were plenty of targets on base. He went to where people are hurting and further victimized them. He violated every oath and tenet of the medical profession and certainly that of psychiatry.

Dr. Anderson finds Hasan's target, the processing center, a puzzling one. "I think the fact that he went after a medical center is absolutely sick. Was it because it had the most number of people or because it held clinicians that he had a beef with? It's interesting that he didn't attack a church or a chapel or a cafeteria. There were plenty of targets on base. He went to where people are hurting and further victimized them. He violated every oath and tenet of the medical profession and certainly that of psychiatry."

Is posttraumatic stress disorder (PTSD) or even secondary PTSD a possible explanation? Dr. Ng discounts it. "Secondary PTSD is not a diagnosis. The term might be secondary traumatization, as in, ‘I heard it from you, and therefore I feel bad,' but for it to be PTSD, I have to go through the primary event myself."

Dr. Ng pointed out that the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) requires 6 criteria for a PTSD diagnosis, and Hasan thus far lacks the very first, criteria A, which is firsthand experience with a life-threatening event. "It could be depression or an anxiety disorder," said Dr. Ng, "but don't extrapolate from that to secondary PTSD. It doesn't meet the clinical criteria."

After the prosecution rested its case, defense lawyers asked to recess the Article 32 hearing until November 15. They said the delay was needed to give their forensic psychologist time to evaluate Hasan. Such an evaluation might give important clues to Hasan's motivation.

But just last month, Hasan refused to be interviewed by a military psychological board. Hasan's lead defense lawyer, John Galligan, said the prosecution's request for a psychological interview then was inappropriate because authorities overseeing the case had already agreed to delay the army's mental review until the Article 32 hearing ended.

Dr. Anderson sees the delay in Hasan's evaluation as a calculated defense move. "My hypothesis is that they wanted the stress of the trial, of all the evidence being brought forth, to put him under duress," he said.

"He's been present every day, he's heard all the testimony from the eyewitnesses, it possibly makes him look more mentally unstable now, because he's been reexposed to the trauma, over and over again in the courtroom, even if it was trauma of his making."

Dr. Anderson continued, "So did he get PTSD from his own experiences? His defense undoubtedly hopes he'll be unsettled by the graphic testimony. And they're looking to evaluate his mental condition now so it can bear weight on his sentencing. It's definitely a ploy by the defense."

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