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As a U.S. Army psychiatrist treating soldiers who had returned from Iraq and Afghanistan, Major Nidal Malik Hasan had a front-row seat for the brutal toll of war. It is too early to know what may have triggered his murderous shooting rampage on Nov. 5 at Fort Hood in Texas — Hasan is accused of killing 12 people and wounding 32 others before he was wounded by a police officer — but it is not uncommon for therapists treating soldiers with posttraumatic stress disorder (PTSD) to be swept up in patients' displays of war-related paranoia, helplessness and fury.

In medical parlance it is known as "secondary trauma," and it can afflict the families of soldiers who suffer from PTSD along with the health workers who are trying to help those soldiers. Dr. Antoinette Zeiss, deputy chief of Mental Health Services for Veterans Affairs, while not wishing to talk about the specific case of the Fort Hood slayings, told TIME that "anyone who works with PTSD clients and hears their stories will be profoundly affected."

It's entirely possible that other factors may have acted as a trigger for Hasan's alleged killing spree. The Army major was a devout Muslim who reportedly had been harassed because of his religion and had developed strong objections to the wars in Iraq and Afghanistan. But he was also due to be shipped out to Afghanistan, drawing him closer to the terrible scenes described in detail by his patients. At Army hospitals dealing with PTSD patients, staff members are required to periodically fill out a "resiliency" questionnaire that is supposed to gauge how well they are coping with the burden of their patients' emotional and psychological demands. "It takes its toll on people," says an officer at a Colorado military hospital. "You cannot be unaffected by the terrible things these soldiers have undergone."

Most Army psychiatrists now have a full caseload of men and women returning from combat zones with PTSD. A survey by the Rand Corp. in April revealed that 1 in 5 service men and women are coming back with posttraumatic stress and mental depression. Previously known as "combat fatigue" or being "shell-shocked," PTSD was only diagnosed as an illness in the 1980s, but it has been around for as long as men have been killing one another and undergoing fearful experiences. It can lead to outbursts of rage, emotional numbness, severe depression, nightmares and the abuse of alcohol and painkillers. In extreme cases, PTSD sufferers have committed suicide and murder. Since the late 1980s, doctors have learned that, over time, along with drugs and therapy, PTSD is curable.

As part of their therapy, PTSD sufferers are typically asked to dredge up their worst wartime memories. Hearing these nightmarish experiences can stir up powerful reactions in even the most seasoned therapists. A Colorado sergeant who served as a dog handler in Iraq and was diagnosed with PTSD says his psychiatric counselor broke down sobbing after the sergeant described how he had been sent out to find the remains of his close friend, a helicopter pilot, who was shot down in southern Iraq. "I looked up, and there she was crying," the sergeant says. "I didn't want that from a shrink."

But there is a major difference, says Zeiss, between a therapist being moved by combat horror stories and being traumatized by them — though it can happen. "Psychiatrists are trained to notice their own reactions and emotions, and if there's something hard to deal with, they should turn to their peers," she says. According to some news reports, Hasan's unprofessional conduct was flagged early on; at Walter Reed he was given a poor performance report, but that did not hinder his transfer to Fort Hood.

Even for the most hardened Army psychiatrist, counseling PTSD sufferers with terrible wartime stories can be a grueling assignment. Fort Hood has the highest suicide rate of any Army base in the country, largely because so many service men and women stationed there have undergone severe trauma while being deployed in Iraq and Afghanistan. At Fort Hood, in other words, there was no shortage of horrific tales that could have set loose the demons in Hasan's mind.

• Tim McGirk
• As an Army psychiatrist treating soldiers returning from Iraq and Afghanistan, Major Nidal Malik Hasan had a front-row seat on the brutal toll of war