Major Nidal Hasan, the army psychiatrist who allegedly murdered 13 people and wounded 29 more at Fort Hood, apparently had been trying to contact al Qaeda and had attended the same mosque as the radical imam Anwar al Aulaqi. He reportedly was torn between being a Muslim and serving his country in a war against Muslims. He seems to have written on the Internet that he felt suicide bombers could be heroes, sacrificing their lives for the greater good.
All of this may mean Dr. Hasan was a terrorist, but it also might mean he was insane. I have never met Hasan, but I know as a forensic psychiatrist that a surprisingly large number of delusions-fixed and false, sometimes very bizarre beliefs-that psychiatric patients sometimes exhibit are religious in nature. Hyperreligiousity can be one of the symptoms of bipolar disorder or schizophrenia or schizoaffective disorder (among other conditions). This is why the cliche of a delusional person, as depicted by Hollywood, is frequently someone who believes he or she is God or the devil or a prophet.
Mental illness can hijack our core and strongly held beliefs and behaviors and turn them into grotesque symptoms. This isn't just the case for our spiritual beliefs, but also for our sexual behaviors, which can also be sent into hyperspace by conditions like those I have named. People vulnerable to mental illness can end up selling sex, buying sex, gambling away their homes and, yes, committing horrible acts of violence in a pathological perversion of the religious belief system that had previously sustained their humanity and sense of connectedness to their fellow man.
Again, I don't know whether Major Nidal Hasan was simply a terrorist or a mentally ill person, but my point is that much more needs to be uncovered before anyone knows.
After all, it doesn't make much sense that a terrorist would give as many hints as Hasan to fellow soldiers about his seeming antipathy for America. He may have been "disinhibited," one of the signs of a mood disorder.
Some radical Islamic terrorists frequent strip clubs, I suppose, but the fact that Hasan reportedly did-staying for several hours at a time- may be further evidence of that sort of disinhibition.
Ultimately, the question of when extreme religious beliefs (especially those connected with murderous intent) constitute mental illness may be one that needs to be answered in this case.
What we need are facts. Did Major Hasan show signs of a mental disorder before the Fort Hood massacre? Does his family have a history of mental illness that would suggest he is more vulnerable to it? When he needed additional supervision while training as a psychiatrist, was that because he was asserting his political/ religious views to patients or because he was unable to refrain from doing so, because he was sick then, too? Was he on psychiatric medicines then or at Fort Hood? Did he prescribe them to himself? If he did take medicines, were they the right ones or the wrong ones? Some can cause severe behavioral abnormalities.
Clearly, it seems to be the case that more should have been done to look seriously at Dr. Hasan's behavior and his thoughts before he picked up a gun and started shooting. But whether the lens should have been one focused on him as a terrorist-in-army-clothing or one focused on him as a man slipping out of rational thought, into psychosis, remains to be seen.
Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His book, "Living the Truth: Transform Your Life through the Power of Insight and Honesty" has launched a new self-help movement including www.livingthetruth.com. Dr. Ablow can be emailed at firstname.lastname@example.org.