Fort Hood had suffered even before this shooting, with suicides on the rise
While it is still unclear what led a US army major to shoot dead 13 people on a Texas army base, the killings come at a time when US forces are under increased strain from repeated combat tours and suffering from a marked rise in suicides and depression.
Dr Joseph Mancusi once directed the largest programme of psychology in the world for the US Veterans Administration. He says current US military leaders may need to do more to protect their soldiers from the impact of modern warfare.
No war is like any other war. Only one thing remains constant: Old men send young men into battle. Wives and girlfriends cry and wait for the final homecoming.
With victory, bands play, medals are given and the warrior goes home to heal and forget.
But what if there are battles won and no victory? What if there is no time to go home, heal and make the horrors part of the past?
What if you are sent to war again and again before your mind and relationships heal? What if there is no final homecoming?
That is where we find ourselves today.
There are additional dilemmas facing the American warrior today. Fathers and mothers leave sons, daughters and partners behind. Men return to families that have adjusted to new roles without them.
After returning from the Iraq and Afghanistan theatres, the sounds of war are barely out of their heads when it is time to return to the battle.
The past tells us that old military men were more interested in new hardware than new treatment approaches for the wounded warrior
The stress associated with this type of warfare, the open-ended nature of the conflicts and the repeated re-entries into civil society have resulted in severe stresses not previously seen.
When I treated Vietnam veterans in the US Veterans Administration medical system, post traumatic stress disorder (PTSD) was not an accepted diagnosis.
It was not (and still is largely not) possible to be a warrior and admit to damage that could not be measured by shrapnel removed, eyes lost or legs shortened.
The military in the USA has started to change its approach.
The focus is now on both the warrior and the mission. The military realises that warriors cannot be sorted into just two piles: whole and broken.
Because of the nature of the volunteer military, the National Guard and Reserves, the stresses endured by the warrior must be faced, identified and eased so he or she can return to battle. The stresses on the family are equally grave.
Unlike the past, problems cannot simply be shifted to the Veterans Administration after discharge and a new group of warriors trained.
Now, the warrior cannot be allowed to simply deny the negative psychological impacts of his or her service and be allowed to return to duty.
The denial of psychological pain by the "macho man" is now seen as a weakness, not strength.
Hardware v treatment
The military seems to understand that the institutional denial of PTSD that I saw 30 years ago results in a defective fighting force not capable of carrying out its mission.
It leads to broken families, lost jobs, psychological distress and suicides.
These are essentially new responses to new problems that stem from the way these wars are fought. Medical and service records are searched for clues of impending problems.
The military is now more open to the necessity of coping with the overly stressed warrior.
Chaplains, psychiatrists, psychologists and officers are trained to identify and assist the re-entry into civilian life. Family and marital counselling is encouraged and supported.
The Department of Veterans Affairs has set up a suicide prevention programme with a 24-hour anonymous hotline coupled with professional follow-up.
Are these responses enough? Will they be effective?
The past tells us that old military men were more interested in new hardware than new treatment approaches for the wounded warrior.
Perhaps this has changed. We will see.
Dr Joseph L. Mancusi is the former Director of USA Veterans Administration Psychology Programmes. He has experience treating veterans and their families and has developed programmes to help families integrate the new warrior into family and community.