Tampa psychologist Michael Sunich knows that as he counsels patients suffering from post-traumatic stress and other mental trauma that it takes a toll on his own mind.
His answer: Sunich sees his own therapist regularly.
Mental health professionals say it may be too soon to draw conclusions about Fort Hood psychiatrist Nidal Malik Hasan, an Army major who authorities say killed 13 people and wounded 30 others on Thursday, shortly before he was scheduled to be deployed overseas.
While an intern at Walter Reed Army Medical Hospital, Hasan had some "difficulties" that required counseling and extra supervision, said Dr. Thomas Grieger, who was the training director at the time. But one of his supervisors at the Fort Hood hospital, where he counseled distressed soldiers, said he provided excellent care for his patients.
The reasons for Hasan's rampage aren't yet known. But the shooting may put a spotlight on how the military monitors mental health professionals.
Who counsels the counselors?
"I deal with a lot of tragedy," said Sunich on Friday. "I don't want to bring that home. So I see a therapist. Listening to this stuff over and over again, the world becomes dark. You start to forget what normal is."
Sunich, a psychologist in private practice, has worked with veterans suffering from post-traumatic stress disorder. Dealing with such soldiers, spouses and psychiatrists can be traumatized too, he said.
"Many times mental health professionals will have their own issues that they carry into the ring," Sunich said.
An Army spokesman did not return calls. A spokesman at U.S. Central Command, spearheading the wars in Iraq and Afghanistan from MacDill Air Force Base, declined to comment.
But some critics say the military doesn't do enough to ensure the mental well-being of their own medical professionals, especially when psychiatrists and psychologists are in short supply.
"There is no care for the caregivers," said Tom Berger, a senior analyst for veterans benefits and mental health issues for the Vietnam Vets of America. "It's just overlooked."
Professionals, however, say they are trained to be alert for "burnout" and to engage in self-examination.
"If you have a case that bothers you, you should meet with your supervisor or mentor, tell them what's bothering you, get help for that patient and for yourself," said Dr. Patrick Marsh, assistant professor in the Psychiatry and Behavioral Medicine Department at the University of South Florida. "Unfortunately," he said, "many doctors may not recognize the symptoms in themselves that they do in their patients."
Bryan Ballot, a psychiatrist who is a regional manager of mental health services for the Department of Veterans Affairs in Florida, said the agency has no specific program to identify stress among counselors.
But he said if a counselor is exhibiting signs of trouble, it will probably be quickly identified by supervisors. "If there are changes in the quality of work," he said, "we'll look into that."
Lt. Col. Ron Tittle, a spokesman for the Florida National Guard, said that in the military a basic rule applies to psychiatrists and privates alike.
"You look after your buddy," Tittle said. "If something's wrong, you let someone know."
Times staff writer Lane DeGregory contributed to this report, which used information from the Associated Press. William R. Levesque can be reached at firstname.lastname@example.org or (813) 226-3432.