The story that Nidal Hasan had proposed prosecuting his own patients for war crimes had a strong effect on me. While one might read that as his having his loyalty in the enemy’s camp. I heard it as a sign that he was over the edge – whatever the reason – unfit for the job. In any rational system, he would have been removed on the spot. I wrote:
The day Hasan proposed prosecuting his own patients for war crimes was the day he should have been relieved of duty – irrespective of his obligation, his cost to the Army, or any other mitigating circumstances. All the other things that were overlooked are understandable, but not that. Whoever made the decision to not grant his request, and then didn’t follow through to make sure he saw no other soldiers from that day forward was not thinking clearly – and needs to be removed from duty as well. That was not just a red flag. That was a desperate cry for immediate action…
Carl, who comments here, has been a friend since the early 1970’s when we were stationed together in the Air Force. After we left the service, I went into Psychiatry and Carl became a Doctor of Psychology. His thoughts on the subject in a comment say what I was feeling more clearly than I could say myself:
The Army has had a fretful and complex relationship with psychiatry for as long as there has been psychiatry as a professional discipline. The Army just doesn’t know what to do about psychiatry, partly, I think because the outputs don’t fit neatly into boxes, data flows, decision trees, quick solutions, ready answers and the quick fix. The idea that a uniformed corps of volunteer psychiatrists is a good one is, I think, arguable on many levels. As disruptive as it was, the Berry plan, (the draft for that matter), ensured a level of quality in the system. The idea that the uniformed services are competent to grow their own psychiatrists is laughable on the face of it…at the very least it is a very bad idea. I don’t know what the chain of command particulars were in this story but I won’t be surprised to learn that ditzy protocol or the artificialities of military social organization will underlie the “reasons” that this case was so tragically botched.
We were stationed on an overseas base where there was a large mental health unit. At the time, I was an Internist. We had some Psychiatrists who were, like us, just doing our time, and several career Psychiatrists – military trained. The difference was striking. The drafted Psychiatrists were the ones we sent people to for help [if they would go]. The career doctors seemed to be there in a more administrative capacity – evaluating behavioral problems, discharging people who they thought might be too disabled to serve in the military. We used to joke that Military Psychiatry was conflict in terms. But it was a serious point. The career psychiatrists had an obvious conflict. Their primary task was to keep mentally ill people out of the military. There’s nothing wrong with that, except where it conflicted with the usual role as helping professional. Unfortunately, that conflict came up all the time. And to further complicate matters, the active duty soldiers were phobic about having a psychiatric visit in their record. Their family members had the same fears. And, those fears were not irrational.
My own earliest experiences with psychotherapy were in trying to help my own patients with their psychological problems, because they were unwilling to seek mental health care. There was one psychiatrist who was one "of us," [a draftee] who understood the conflict and would come over and see my patients in my office with me so we didn’t have to record a mental health visit [working with him was actually part of the reason I changed specialties and became a Psychiatrist myself]. I was impressed with how helpful he was.
I don’t mean to disparage Military Psychiatrists or even the place where their loyalties lay – with the military. It just seems that the Administrative needs to be separated from the Clinical. There is no civilian mental health facility in America that would have kept someone like Major Hasan seeing patients after he had given some of the presentations described in the articles about him, or after he suggested that he use what he had been told in sessions against his own patients. I hope that this horrid event will focus the Army’s attention of its whole approach to mental health problems. War causes epidemics of psychological disorder. It always has. It’s time for a long hard look at the system available to treat our soldiers. Perhaps all actual treatment should be "farmed out." And it’s obvious that the oversight of the mental stability of the people evaluating our soldiers is severely dysfunctional – literally fatally flawed….
Sorry, the comment form is closed at this time.