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17 May 2009

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Don Bacon

The Army, in conjunction with the University of Pennsylvania’s Positive Psychology Center, is initiating "resilience training" that will take place before, during and after deployments and at every school that soldiers go to. The premise is that just as soldiers exercise their muscles, they also must exercise their minds.

The goal is to reduce post-traumatic syndrome by building resilience in soldiers exposed to combat.

arbogast

I believe that it is possible that there is a yawning gulf between how soldiers and officers regard their mission in Iraq and Afghanistan. The men in the middle, the men who stand between the officers and soldiers must experience an almost impossible strain trying to merge these two views.

There is an article in Le Monde that captures this divide. Here is a poorly translated excerpt.

American soldiers frustrated by the tactics of the insurgency
LE MONDE | 15.05.09 | 15h53

They came to "revenge-September 11", "fight the Taliban" and add their officers, "to help Afghanistan." At the same time "exterminate these fucking terrorists", as the sergeant Boutot says and "bring peace to the Afghans," as Lieutenant Speaks hopes.

Soldiers of the 501st Airborne battalion are deployed in the Paktika province in south-eastern Afghanistan. The battalion participated in the "surge" (escalation) in Iraq.

In Paktika, the Taliban are everywhere, hidden in the mountains or submerged in the population. The men of the 501st, immersed in hostile terrain and faced with logistical nightmares, do not know very well where the conflict will lead.

The majority of soldiers are on the Right politically and support an America celebrated for its militarism. "Do not mention the name of Obama in front of me or I get my gun," said a soldier. A sergeant shows a canteen "Obama 08" on which the President is drawn as a monkey.

So when in operation, these men are united, united in their fight to "protect America," convinced that we must "win the war", said a soldier, "to return as soon as possible at home." Because if there is concern that Barack Obama will put an end to the war too soon, all only dream of the signal of departure, the plane home.

Charles I

"Then there's the issue of what the army would do. . ."

Having suffered from acute non-combat related mental illness, I would say that treated is always better than untreated and still know not whereof I speak in this context. And the meds suck - I wouldn't want to be in combat, on them.

I can say unreservedly that mental illness and treatment made me a much more tolerant, grateful and empathetic human being. And on several occasions, I refused prophylactic treatment until prophylaxis was moot. Maybe not the best qualities to be drawing on in combat.

The stigma is still real - which an individual can tilt against, but which is another thing entirely in a specialized group/unit/mission context, as Pat's questions demonstrate. Could be that stigma in this context is a positive value tending toward unit efficacy. That I don't know.


So please, if there are posters here who have served, and suffered, can you share your perceptions about treatment and return to combat, or return to combat without treatment? Can you function as required, both as an individual and group member? Would you want to? Would your unit want you?

I salute you soldiers, sufferers and sharers alike.

In the alternative, perhaps your voters could reduce the number of cognitive dissonance producing missions to those actually addressing an existential threat to the U.S. You know, one world war every other generation rather than constant intervention and carnage all around.

Jon T.

Col Lang, Thank you for writing this. A couple things: (1) please write more from your own experience on your own
"experience of the social sciences and mental health communities that set the agenda with regard to military mental health issues" - all families of veterans and veterans themselves that I know, save the most emotionally hardened, want and need information about combat soldiers' re-integrating into society and living with their experiences (2) let us consider the effects of Donald Rumsfeld's, ( et. al.), privatization of combat operations - how that influences relations between people who do the fighting in numbers and attitudes both, and (3) let us consider the possible resolution of the strain on our culture an all volunteer army is placing. If the USA is going to be in the business of multiple front major campaigns, then the difficult confrontations inherent in considering re-instituting the draft may need to be faced sooner than later. Please: Talk about this more, tell Cheney he needed to have listened to Shinseki, and reinsitute the draft. Thanks.

Cold War Zoomie

Would you put a leader emerged from therapy back in command of a unit in which your brother, sister, son or daughter served? Would you want that? Really?

For me...and I want to emphasize that fact right up front...if the therapy has been successful, yes. SWMBO works in the "mental health industry." I've learned a lot over the last 10 years about how we Americans view mental health illness. The brain in many ways is like every other organ in our body - it can be healed when it becomes ill. And sometimes, it cannot be healed just as any other illness.

For whatever reasons, we haven't accepted that fact here in the USA in a broad way. Many times mental health illnesses are viewed as a character flaw. It's no more a character flaw for someone to become depressed than for someone to catch pneumonia. And just like pneumonia, there are treatments that work most of the time, but not always. This social stigma and the military culture make the matter even more difficult.

What if a soldier decided to speak to his pastor rather than a mental health professional? That is therapy, as well, without the social stigma.

A *healthy* mind should be affected by prolonged stress much in the same way a healthy body would be, and someone who is affected by those stresses shows they are normal! Does that mean I think every combat vet needs therapy? No! Healthy people have coping mechanisms just like they have immune systems. The differences between people are by degree. Some people may need therapy while others do not based on their circumstances. And we must not forget that soldiers have already been "screened" for mental health illnesses when they joined - we're not talking about extreme psychosis here.

But...and this is the kicker...we must consider those who do not view mental illness as I do. Not everyone lives with a mental health professional! The social stigma is real. We *must* consider the stigma in the military as a whole. Under that light, I'm not so sure it's a good idea since now we must consider the viewpoint of those under his or her command. That's the big difference between civilian work and the military. The individual's *right to work* after therapy in the civilian world would trump the team. It's the team that matters most in the military.

So, after a long drawn out comment, I wouldn't mind but we must consider the social stigma of others. And I'm not so sure they would be too happy with the idea.

Maybe we should let the soldiers in his unit decide. I don't know how combat units operate. Is that feasible?

Cliffman

Interesting piece. I would suggest a different view.

Put all the NCO's through a little stress-relief/coping therapy. Make it a routine part of post-deployment. Think of this as a part of training.

Good therapy will never hurt a healthy mind. Heck, you could call it 'extended lessons-learned debriefing' if you wanted to.

Good therapy can give you tools to help deal with a stressful situation before that situation occurs. It's good preventative medicine.

If everyone goes, you help the problem of stress build-up from multiple tours, you catch the people who have minor issues before they become major. Every doctor knows, it's best to catch problems when they are small. Mandatory attendance means you will catch the problem before the soldier fails.

If it's required of everyone, the stigma and accusation goes away.

This won't cure all ills, life still happens. But I'd bet it would reduce the problems. We give our soldiers armor for their bodies, because we know they go in harms way. A little armor for the mind wouldn't hurt.

Old Bogus

Sen. Webb's nihilistic novel, "Fields of Fire", addresses this issue but offers no conclusion except combat death.

Patrick Lang

Jon T

1- I am on the board (and program committee)of a foundation that funds academic research on these subjects and I have to read and listen to a lot of this. There is a very strong tension between the needs of individuals (they can be returned to civilian life)and the force which must maintain a high level of experience and maturity in its leaders.

2- I don't know that Rumsfeld privatised combat operations. Blackwater? Guards, only that. I don't see the connection.

3- A lot of drafted soldiers served very well. A lot of others did not. The draft produces private soldiers. How is that a help? pl

srv

A Warrior Caste is the inevitable conclusion of an all-volunteer force, where the human and mental toll of empire are not the burden of the public. Such a caste is not in the best interests of this republic.

If the NCO's have their hands full with draftees, one would hope there would be a lot less superfluous war.

On another note, I hope you've seen this:
http://men.style.com/gq/features/topsecret

Patrick Lang

srv

Mindless sophomoric bullshit. How do you suppose we managed in WW2, Korea and Vietnam.

I will clue you in to the fact that the best WW2 units had a higher proportion of pre-war NCOs in them. In Korea and VN us "lifers" as the conscripts called us were always there. pl

Tyler

Interestingly enough, I was with the 501st in the above quoted article the first time we went to Paktia province, outside of Khost.

A good hard fight out there, to say the least. Unfortunately, the dumbest, loudest elements seem to get the most attention.

Cold War Zoomie

To follow up on Don Bacon's and Cliffman's comments. God knows the one thing every person serving in the military understands is mandatory training! We all went to all sorts of crap whether we liked it or not. At those sessions, leaders can explain how this training can make everyone a better soldier. To me, that would be the winning argument.

One factor I didn't think of in the beginning is age. Going to therapy as a 20yo one-striper would have never entered my mind - the world is out there for my taking! I was bulletproof and invisible, after all.

As we all get older, our fragile existence on this planet becomes more and more obvious.

So, mandatory "training" of some sort would help at least plant the seed, and slowly remove the stigma over time. Sure, many of the younger guys will blow it off and just do it because they were told to go. But it will provide cover for those who need it but don't want to admit it to anyone else.

William R. Cumming

Thanks for this sensitive post and questions as to the facts! Clearly the Army is doing its best to fashion various solutions to perceived problems. The incident in WWII where Patton slapped with his glove a soldier outwardsly OK but hosptialized with combat stress is one bookend of this issue. Determined to be unacceptable behavior (Patton) by IKE is set a new tone for recognition of "combat fatigue." The British armed forces as early as WWI worked hard on this issue and recognized its importance. The other end of the bookend now is our civilian society. With by some counts up to 40% of adults on prescribed pyschotropic medication, and with events such as the death of Presidential Counselor by his own hand possibly over the fact that he did not know whether he would be granted a clearance after disclosure or non-disclosure of his treatment by a mental health professional, it is still clear that part of our culture fears and therefore stigmatizes something they cannot see or understand--specifically mental illness. As modern psychiatry has gone much more pharmacheutical (sic) these days, and with even GP's prescribing drugs for depression and other things, it is clear that at this time and place this issue could well be at crisis stage. We have chosen as a society to have an all-volunteer professional military but until recently I am not sure that beyond intelligence recruits are screened for personality or mental health disorders. I hope so but doubt it. Perhaps on the go-in some might need screening out. It is also clear as you say that the NCO's will make or break our boots on the ground effort. In a way like middle managment everywhere in our society the get pressure from below and above that is enormous. It is unclear to me whether the repeated cases of abuse of these ranks by the "system" is intentional or not. I do know that once the first basic tour is completed these men and women should have a guarantee of completing 20 with appropriate benefits. I do keep hearing of discharges to prevent retirement elgibility and given the stresses of modern society hope this is not true but uncertain. Provision of professional mental health care to the active service members needs to be the best. It is now part of the costs of war. Hope this sparks Inspector General and Congressional oversight of this specific case and issue. Thanks again for bringing it up.

Charles I

I forgot to commend a 2007 film "Operation Homecoming Writing The Wartime Experience" aired as part of PBS' America at a Crossroads series, which touches on this topic.

From the film website:

"OPERATION HOMECOMING is a unique documentary that explores the firsthand accounts of American servicemen and women through their own words. The film is built upon a project created by the National Endowment for the ArtsOff-site link to gather the writing of servicemen and women and their families who have participated in the wars in Iraq and Afghanistan.

Through interviews and dramatic readings, the film transforms selections from this collection of writing into a deep examination of the experiences of the men and women who are serving in America’s armed forces. At the same time it provides depth and context to these experiences through a broader look at the universal themes of war literature.

The writing in OPERATION HOMECOMING covers the full spectrum — poetry, fiction, memoir, letters, journals and essays. The stories recounted here are sad, funny, violent and uplifting. Yet each one displays an honesty and intensity that is rarely seen in explorations of the war. Through an extraordinary group of men and women it presents a profound window into the human side of America’s current conflicts.

At the core of the writing in OPERATION HOMECOMING is a deep desire by all those who have served in war to come to terms with their experiences. Throughout the film the servicemen and women, young and old, express a profound hope that people will listen to their stories and try to understand what they have seen."

http://www.pbs.org/weta/crossroads/about/show_operation_homecoming.html

I can't imagine a more effective tactic than specifically addressing this subject in NCO training. All kinds of frontline helping professionals receive receive training specifically tailored to assist them in "buffering" themselves from their stressful, often existential work. Negotiating the psychological terrain between battlespace and home can be effectively facilitated. But it requires that a certain amount of non-theatre human squishyness be acknowledged and addressed. Pat's comments about agendas are part of that, so lucking out with the right trainers is part of the current state of the art, odds of the latter as in any field, somewhat discouraging.

alnval

Col. Lang:

You asked:

“I would like to know why he was ordered into therapy.”

So would I. Some thoughts:

I remember reading that SSgt Russell’s weapon had been taken from him and that he had overpowered the driver who had been transporting him to the Clinic in order to go back to the Clinic with a sidearm.

In order for this to happen, someone, rightly or wrongly, and we don’t know who (was it a medical officer, or SSgt Russell’s commander?) judged that he was a danger to himself or other people and believed that taking his weapon away would reduce that threat. The problem lies in whoever made that judgment not recognizing the consequences that might flow from the decision to deprive SSgt Russell of his weapon.

(I have to believe that the army has a behaviorally based protocol of some kind which, when followed, results in this type of judgment. I’m not sure, however, whether that’s what happened. Only, it’s what should have happened.)

Moreover, after the sergeant was stripped of his weapon, I’m not sure how the army addresses the implications of taking someone’s weapon away, particularly a long serving noncom. The current circumstances demand that we believe that no one was willing to consider the worst case scenario even though that would have been in everybody’s best interest to do so. I’m afraid that folks were trying to “not rub it in” and didn’t really understand the potential implications of the decision. The rule is, if you’re going to err you err on the side of safety.

Furthermore, if someone judged that the sergeant was sufficiently unstable as to require the removal of his weapon, I would also wonder why they would implicitly expect that his interactions with others would no longer be compromised. It should be patently obvious that just because his weapon had been taken from him that it would not cause him to interact with others in a safe and stable way.

Lots of painful, obvious questions here related mostly to the level of experience and training of the medical officers involved, and flowing from that, whether they are allowed to make decisions in the best interests of their patients.

Maybe the answers will result in better treatment.

Highlander

I spent 10 years in the Corps. Some of my NCO's had done multiple combat tours in 3 wars. Starting with Tawara, and Iwo Jima in WWII, Korea, and at least two tours in Vietnam.

Some were a little strange around the edges from time to time(but then so was I, still am). But they could all do their jobs superbly, and at the same time do my job to if needed. They saved my college boy butt many times. None ever went any crazier than the rest of the general population.

These elitist twits at the Post don't really give a damn about SSGT Russell,his victims, or the military NCO's in general. I agree with the Colonel on this. It is "sophomoric bullshit". But it isn't "mindless",it is a veiled antiwar rant from somebody who probably never served, and would in all probability fight like hell to avoid serving if called upon.

It's not a trite phrase. "America's NCOs are the backbone of all the military." In doing their job they knowingly take some hits, some physical, some emotional. They are REAL MEN. they accept this as part of the job.God bless them all!

Fred

Perhaps off topic, but apparently we no longer have soldiers, only ‘warriors’. Why the rebranding?
"We show …-- all the sensory inputs . . . so they are not taken by surprise," Keller said. The program sounds like it has the emotional compassion of a bureaucrat. I can’t read more than FAQ page (perhaps my own firewall?) Wouldn’t the ‘battle mind’ program be an outgrowth of work begun with SLA Marshal? Certainly the army has been looking at this issue at least since the 1940s? Psychiatry has made immense progress since then, too.

Training is good, but seasoned NCOs are vital in understanding what may happen during combat and what happens after you survive it. Perhaps more billets for combat veterans in these training commands (after you give the training on how to teach)?
CWZ has a more elegant post than I could produce, I agree with many of his points. From my experience the unit commander also has great local influence upon the tone of acceptance or stigma for treatment.

I would take the Le Monde article arbogast quotes with a grain of salt. Reporters can always find the evidence to support a pre-conceived idea (Iraqi WMD comes to mind). The anecdotal evidence I’ve seen of returning vets is they are very pro-Obama, that hardly makes them liberal.

WRC “I do keep hearing of discharges to prevent retirement eligibility.” From personal experience I would say this is nothing new.

alnval

Col. Lang:

The SSgt Russell matter continues to percolate.

You wrote:

“One must consider the effect on the force of telling soldiers that what they do as their primary role in life and service inherently cripples them emotionally, damages their sanity severely and that the virtually inevitable end for them will be therapy for their service connected illness.”

This is a key problem that DOD and the respective Surgeons General are trying to deal with. They are universally concerned with understanding and mitigating the variables that contribute to the incidence of combat stress requiring treatment. They appeared before a house subcommittee on Friday May 15 and discussed this issue extensively. (It is in C-Span’s archives for that date under Defense Health Programs.)

For example, they all indicated (and it was emphasized by LTG Schoomaker the army surgeon general) that dwell time is a significant variable that mitigates stress related disorders in personnel rotating out of combat.

Given that these health and personnel issues that impact stress are still being sorted out, it may be too early to assume that for enlisted personnel an army career will only result in “therapy for their service related illness.”

You also wrote:

“It is now often said in those communities that the "stigma" that attaches in the military to mental health treatment must be eliminated so that soldiers like Russell will voluntarily seek treatment.”

Frankly, I am concerned about this emphasis that the military is placing on personnel “voluntarily” seeking mental health treatment. This strikes me as an ultimate oxy-moron because it reflects the view current in mental health that treatment works best in those patients who put up their hands and ask for it. This has led the mental health profession to believe that you can get people who need mental health treatment to ask for it if they get the right training and education.

By the time that exercise is over, of course, it’s too late. As a result, the mental health professional is often forced by circumstance to impose treatment on the patient “involuntarily” rather than wait for the patient to seek it out. This struggle between doing what is right for the patient even if it means imposing it, as opposed to waiting for the patient to recognize their needs and seek appropriate help, is a long standing one within the mental health community that has its roots in our concerns about preserving civil liberties and individual rights.

Thus, although we may get a cultural paradigm shift that will reduce the “stigma” IMO that’s still a long time coming. Much better the military worry as it is now about maximizing prevention so as to reduce to a minimum those service members for whom imperfect psychiatric treatment is genuinely required. This is one of those cases where an ounce of prevention is really worth a pound of cure.

marcus

I have no military experience but I can imagine that the type of combat experienced in Iraq can be VERY stressful. The primary danger is get blown up with no warning beforehand? Nearly every encounter is a surprise attack with catastrophic probabilities? Couple that with the repeated deployments and the results are psychologically disastrous.

Maybe we should revisit the idea of "citizen soldiers" rather than "career warriors"? We may see less entanglements like Iraq.

R Whitman

This is not a new problem

1. I am currently reading the Frank Delany novel "Shannon" whose main character is a US military chaplin Catholic priest after WW I who suffers from "Shell Shock".

2. In the mid 50's I served as a draftee in an US Army unit that had a high proportion of WW II and Korean War veterans. About 30% of them had mental problems usually manifested by severe alcoholism, both field grade officers and NCO's. Most of this behavior was tolerated until the guy had his 20 in. Then mandatory retirement.

Patrick Lang

Whitman

They don't drink much anymore. It is a career ending habit. Do you think that makes it better?

You really enjoyed your experience in the army. I can tell. pl

anna missed

I don't think there is any real solution to this problem. A persons (intrinsic personal) identity is formed by how they quantify experience into who they think of themselves as being. Repeat deployments into a combat zone increases the odds that a solders experience will be pushed into actions that do not reconcile with the limits or boundries he or she uses to identify themselves. Once a person witnesses, is a part of, or actively participates in actions that exceed ones (former) boundries, then that person's identity has been transformed - into a person who has, "seen that", or has "done that", and away from a person who ordinarily would never be allow for such a personal transgression to occur. The big problem in such a scenario is that once the transgression has occured, there is no going back to the former sense of identity - you either accept the new identity, or you deny it, or you rebel against the circumstances that are responsible for it. A significant enough number of people will choose the latter two choices to make it a problem for both the military and society, that simply will not go away, or be "fixed". It's simply the new "what is", get used to it.

mikeyes

A similar incident happened at Ft. Lewis (I think) a number of years ago in which a soldier shot several people including a psychiatrist. (My job incidentally and the most dangerous in medicine as they are killed more often than any other physician, usually by their patients.)

It is hard to say why this latest incident happened. SSGT Russell's parents blame the Army and the newspapers point out his underlying legal and social problems but none of that is enough to say why he killed five people. A lot of soldiers have similar problems and don't go on a killing spree.

I think that before anyone jumps to broad conclusions in this case more has to be learned.

BTW, is he a SSGT or a SGT? The official picture used in all the articles shows three stripes only. He joined the NG in 1988 according to one article.

Jim Price

Col, Policy and perceptions change slowly. When I graduated from Marine Corps OCS in 1965, a trip to the Psychiatrist was a career ending move, particualarly for aviators like myself. Now the services are beginning to come to grips with the psychological effects of warfare and the realization the need for couseling isn't necessarily a character defect. Interesingly it is the more elite of the military, who you would assume to be the most hidebound are the most modern thinking. For example the 160th SOAR, a relativley small but elite combat unit has on board a full time psychologist and psychiatrist who contiunally monitor and cousel all of it's soldiers. A trip to the shrink in the 160th isn't a black mark it's a requirement. Perhaps the services will follow their lead.

Hypatia

A recently repeated 2005 Frontline called "The Soldier's Heart" discusses what happened to several individuals as well as the attitude toward the fellows who asked for help.

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