Many of the patients who fill the day are bereft, angry, broken. Their experiences are gruesome, their distress lasting and the process of recovery exhausting. The repeated stories of battle and loss can leave the most professional therapist numb or angry.
And hanging over it all, for psychiatrists and psychologists in today's military, is the prospect of their own deployment — of working under fire in Iraq or Afghanistan, where the Pentagon has assigned more therapists to combat units than in previous wars.
That was the world that Maj. Nidal Malik Hasan, an Army psychiatrist, inhabited until Thursday, when he was accused of one of the worst mass shootings ever on a military base in the United States, an attack that killed 13 and left dozens wounded. Five of the dead were fellow therapists, the Army said.
Major Hasan's motives are still being investigated, though his family and acquaintances cited stress from his counseling job, his opposition to the wars, his pending deployment and his feeling that he was being harassed as a Muslim. But those who work day in and day out treating the psychological wounds of the country's warriors say Thursday's rampage has put a spotlight on the strains of their profession and of the patients they treat.
Major Hasan was one of a thin line of military therapists trying to hold off a rising tide of need. So far this year, 117 soldiers on active duty were reported to have committed suicide. The Army has only 408 psychiatrists — military, civilian and contractors — serving about 553,000 active-duty troops around the world. As a result, some soldiers home from war, suffering from nightmares and panic attacks, say they have waited almost a year to see a psychiatrist.
Many military professionals, meanwhile, describe crushing schedules with 10 or more patients a day, most struggling with devastating trauma or mutilated bodies that are the product of war and the highly advanced care that kept them alive.
Some of those hired to heal others end up needing help themselves. Some go home at night too depressed to talk to their children. Others, like Bret A. Moore, a former Army psychologist at Fort Hood, ultimately quit.
"I planned for a career in the military, but I burned out" after about five years, he said.
The biggest problem, Dr. Moore said, was "compassion fatigue."
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