March 11, 2001

By Alen J. Salerian, MD

In the mid-1990s, the FBI sent me to a Southern city to do a psychological evaluation of one of its undercover agents. The reason: The agent was having an affair with a member of the criminal organization he was investigating.

I spent about a week there, talking with the agent in various restaurants and bars, my back always to the entrance so he could keep an eye on who came through the door. During our meetings, the agent seemed quite calm, unfazed by either his dangerous assignment or the firestorm his behavior was causing at headquarters.

He was remarkably candid about what motivated his reckless sexual conduct: anger. Behind his cool exterior he was seething, because he believed the exceptional caliber of his undercover work was not fully appreciated by his superiors. And this unnecessarily risky escapade was his way of punishing the uncaring agency.

Luckily, our work had a successful ending. The agent was gradually extricated from the assignment without arousing suspicion, and he soon retired from the bureau. His final words to me were: “I know I crossed the line and was going to do more. Thank God you came along.”

I have been thinking of that agent and what “more” he might have done since the headlines first appeared about Robert Hanssen, the FBI agent accused of betraying his country beginning in 1985. Were there signals that a professional evaluation would have picked up? Could a psychiatrist have identified Hanssen as a possible threat years before a double agent fingered him as a spy?

Very likely, the signals were there. But very likely they wouldn’t have been picked up — because the FBI doesn’t require regular psychological evaluations of its agents. This is a painfully obvious lack in bureau security. When personnel are hired, they go thorough physical and psychological screenings. After that, however, only the physical exams are routine, even though these employees are subject to stresses and pressures far beyond what most people experience. The FBI keeps regular tabs on its agents’ weight and blood pressure — but not their emotional stability.

It’s not that the bureau doesn’t believe in the usefulness of psychology — consider, for example, its use of extensive profiling to understand and identify serial criminals. And in crises involving its agents, it often relies on the tools of modern psychiatry. From 1992 to 1997, in fact, I worked regularly with the FBI; I helped develop and was medical director of the bureau’s Mobile Psychiatric Emergency Response Team. I trained many counselors and went out on assignments myself, working with agents everywhere from U.S. embassy compounds abroad to Waco, Tex. Not all the agents I have worked with were undercover, but I have evaluated dozens of men and women with secret missions and double lives.

So, while I don’t know Hanssen or pretend to understand his particular case, I understand a great deal about undercover agents. And I believe that regular evaluation of all agents might help expose threats and prevent security disasters.

Let me be clear about something: The overwhelming majority of the bureau personnel I have met are tough, intelligent and stable, with an unswerving dedication to their work. And the bureau itself is, in my view, a singularly well-managed and effective organization. My only concern here is identifying the rare potential problem.

Most secret agents I have met have two signature traits: fearlessness and a high tolerance for anxiety. Whether because of biological factors, such as an elevated level of the mood-enhancing neurochemical serotonin, or because of the influences of their early lives, these people seem to be extreme risk takers who can tolerate and manage worry, tension and stress with natural ease. Not surprisingly, their steely nerves are often perceived by others as aloofness or arrogance.

These characteristics, combined with stamina and the sharp intellect of a skilled chess player, are requirements for a profession distinguished by calculated risk taking in the face of constant danger. “It’s not about money or anything else,” the agent who “crossed the line” in that Southern city said. “It’s about the rush I get when I’m outsmarting them, having a quiet dinner with the enemy in his own home and slowly building the fire to burn him.”

“What about fear?” I asked.

He smiled. “My only fear is not building the perfect fire.”

Though unshakable on assignment, this agent nevertheless displayed a brittle self-esteem easily shattered by his superior’s disapproval or rejection. In this way, too, he was similar to many undercover agents I have known. They have an intense narcissism — the flip side of their confidence. They need constant positive input, and they can only get it from two sources. The first is self-esteem, which is provided by constant mastery of their roles; winning is very important. The second is feedback from their superiors, a need that makes them very vulnerable to real or perceived slights. Not merely criticism but the simple absence of praise can enrage them.

When most of us get angry at the people or system we work for, we vent our frustrations by talking with family or friends. If we get really angry, we might retaliate in straightforward fashion by turning against the boss or organization we perceive as abusive.

Spies, however, can’t vent about their work to their loved ones, because their profession demands absolute secrecy. Their necessarily lonely lives offer none of the safety valves that help the average disgruntled employee cope with stress.

Also, if they decide to take revenge, these people bring extraordinary knowledge, skill, intelligence and — perhaps most important — daring to their plans.

In 1996, the nation’s interest was caught by the case of Eugene Bennett, the former FBI agent who kidnapped his pastor in Northern Virginia. Bennett was angry with his estranged wife, who was intimately involved with crime novelist Patricia Cornwell. But his problems had been building long before he confronted his wife in the church where he had tied the pastor to a chair along with a phony bomb.

I know because, a few years earlier, Bennett had come to me for psychological counseling. It was a rare occurrence for an FBI employee to seek me out on his own, but Bennett clearly knew he was in trouble. Like any good spy, he had done his homework — checked out my background and security clearance, concluded that he could confide in me. Also true to form, he maintained outward control: When he called me, his voice was a monotone, his words cryptic. And during our meetings, his face would remain expressionless.

We met eight or nine times over a period of about six months. One day, something apparently spooked him, and he suddenly vanished into silence and never spoke with me again.

For ethical reasons, I cannot reveal what he told me during those meetings, or how I responded. But because his bizarre case was eventually part of the public record — he spent 12 months in federal prison on a fraud charge even before his conviction on charges including attempted murder and abduction — I can say he was a dangerously volatile character. By the time Bennett called me for help, he was already on administrative leave, in the midst of a publicly messy divorce and fraud investigation. The question is, could some kind of screening have spotted his problems while he was still working undercover in highly sensitive assignments?

It would be wrong to make my argument too simplistic — that certain agents get angry, have no outlet for their rage, and turn to violence and betrayal. These are complex people with paradoxical personalities. An inflated yet fragile ego is a highly combustible thing.

But that is exactly the challenge to the FBI: how to predict who is approaching meltdown and how to prevent that final explosion — or the hidden revenge of secret betrayal. There has been much discussion of lie detector tests, and I believe that regardless of their imperfections, such tests could help identify security risks. But they should be part of a broader, regular psychiatric evaluation.

I have been called to work with the bureau many times after an agent’s mental health was obviously in question. I remember a female agent who was beginning to get reckless and endanger her assignment. She turned out to be the only woman in a highly chauvinistic unit, repressing anger at superiors who merely urged her to “tough out” the harassment. And there was the counterterrorism expert based at a U.S. embassy in the Mediterranean, whose hidden frustrations only came to light when he became publicly abusive toward his wife and child.

Both cases had happy endings: The female agent was removed from the hostile environment and placed successfully in another assignment; the counterterrorism expert received extensive counseling and managed to keep his job. I was pleased and fortunate to be able to help an agency for which I have immense respect.

My disappointment, though, is that too often my fellow counselors and I are called in only after events seem to be getting out of control and there is a possibility of real damage. This reactive response is not enough. As the bureau looks into what might have made Robert Hanssen “turn” in 1985, it should seriously consider a systematic, proactive program to monitor all its agents’ psychological well-being. Both the agents and the country deserve it.

Hoarding as a result of Obsessive-Compulsive Disorder (OCD) is a psychobiological symptom that is treatable.

A few months ago I was talking with a friend who was concerned about her aunt who was about to be evicted from her apartment due to “hazardous conditions” deemed by the Fire Department. Her aunt, Kay, at the time lived amongst mountainous piles (of what most would call trash) as high as the ceilings, with barely passable tunnels to the bathroom, kitchen, and doorway. She described her aunt as a “serious pack rat”. As we continued the discussion, it sounded familiar.

For several years, I have worked with people plagued by hoarding as a result of obsessive compulsive disorder (OCD), a potentially debilitating illness. After explaining the genetic psychobiological nature of OCD to Audra – a deficiency in the system regulating the neurotransmitter serotonin – she decided to intervene with my help. After some family discussion and gentle persuasion, Aunt Kay (who was adamantly opposed to psychiatric medications) agreed to come and see me for cognitive behavioral psychotherapy in order to gain control of her hoarding.

I completed a full assessment which included Kay’s family history which revealed genetic markers for anxiety and OCD in her family. Kay described her mother as a “neurotic” woman who “collected” so many things in the attic that it had started to cave. She also spoke of her paternal grandfather who “washed the dishes three to four times after each meal until his hands peeled and bled.”

After completing the assessment, we developed a treatment plan including weekly cognitive-behavioral therapy to reduce the frequency and intensity of Kay’s fears about throwing things away. After two months of intense work, to my disappointment there was only mild improvement – she had learned to identify main sources of her clutter (junk mail, newspapers, and magazines) and brought them to a halt by canceling subscriptions. However, she was still raptured by intense worry about older more “sentimental” items.

That is when Kay and I stepped up our work and began splitting the sessions – with a portion dedicated to psychoeducation in the hopes that she would understand the biological component of what she was dealing with and agree to meet with a psychiatrist. After a month of psychoeducation Kay agreed to receive a psychiatric evaluation. The doctor diagnosed Kay with Obsessive-Compulsive Disorder and prescribed the medication Paxil.

She reluctantly took the medication and I began visiting her at her home to assist in processing irrational fears and psychological hurdles, as well as aiding in the development of an organized system to reduce feelings of being overwhelmed and assist her in managing her time and items in an emotionally and logistically efficient manner.

During Kay’s third month taking Paxil, I went to her home for a visit after a two week hiatus. I was astonished. Her apartment was relatively clear and organized. As I collected my tongue from the floor we talked at length for an hour about her incredible progress. She told me that all of our talks and the medication had finally “sunk in” and that she was tired of being held captive in her own home.

She went on to describe a feeling of freedom that she hadn’t felt since she was a little girl. Kay is a testament to the remarkable improvement that the partnership between medication and structured psychotherapy can bring to an OCD sufferers life.

Through the use of modern psychopharmacology and individualized targeted psychotherapy it is possible to conquer chaos (mental and physical) and maintain healthy living.

Gregory H. Salerian, MCSW is the coordinator of Conquer Chaos – an individualized program designed to assist people to increase their organizational, emotional and logistical efficiency in day to day life.

February 8, 2007

Alen J. Salerian, MD quoted

By Bruce Leshan

(WUSA) — Local friends of the astronaut accused in that strange love triangle attack are still struggling to understand how she could do it. The coat over her head may be the perfect analogy for mystery of Lisa Nowak. How could a mother of three, a woman smart and driven enough to reach the heavens, do something so strange as attack a woman she saw as her rival for the love of a space shuttle pilot.

Dr. Alen Salerian of the Washington Center for Psychiatry says, “this simply means mental illness doesn’t discriminate, whether your successful, whether you’re young or pretty. Whether you’re smart and have done well. Bad times can hit us with mental illness.

High school friend Dennis Alloy sits in his home in Tysons and remembers watching Nowak blast into space last year. Alloy says, “I saw it take off, and watched it for an hour.”

Alloy cannot reconcile the woman in the coat with the woman he thought he knew. “One of the nicest, sweetest people I grew up with. Straight arrow, not a mean bone in her body. Nice, hardworking, determined, probably the kind of person who would blush if you told her an off color joke.”

Nowak allegedly drove 900 miles from Houston to Orlando to attempt to murder Air Force Captain Colleen Shipman. A judge released her on bail, and she flew back to the Johnson Space Center accompanied by her boss.

Deputy NASA Administrator Shana Dale says “Lisa Nowak, who had been scheduled for duty on the upcoming shuttle mission has been removed from flight status. She also has been placed on 30 day leave.”

She is now undergoing a full medical evaluation at the space center. But what about the future?

The Deputy Director of the Johnson Space Center says mental problems would not necessarily disqualify someone from being an astronaut “I would say no. As long as they get medical help and are given a clean bill of health, I would say there would be no stigma.”

NASA is trying now to figure out if it should be doing more psychological testing of astronauts.

Alen J. Salerian, MD quoted