Category Archives: US Armed Forces

Military Mental Health

It seems as if daily we are told how shamefully the military handles the problem of psychological distress and emotional pain for our men and women in uniform. In May, the USA Today newspaper empire asserted that the “Pentagon [is] perpetuating stigmas that hang over treatment, study finds.” (Zoroya, USA Today, May 6, 2016). The military is criticized because it takes mental health issues seriously enough to reconsider security clearances…unnecessarily “stigmatizing” those who have sought treatment.

This supposed stigmatization merits careful consideration. These include the depth and breadth of existing mental health services for active duty personnel and veterans; the conflicted American mindset on mental illness and emotional distress; and the logical outcome of this strange ambivalence.

A person not in the military or close to military personnel, may reasonably be under the carefully groomed media misimpression that the emotional well-being of our soldiers, sailors, airmen and marines is some sort of vague afterthought. Perhaps the general public is unaware that military mental health officers (people who are qualified to be licensed solo practitioners in the civilian world) are found in forward operating bases, combat outposts, and other deployment settings, providing critical incident debriefings, assessments, counseling, and referrals for more comprehensive care. When young men in harm’s way are despondent over a wife’s philandering, or are heartbroken over missing their child’s birth, the mental health officer is there. When there are incoming mortars, the mental health officer is there. When someone’s reaction to the weekly required malaria medication is extreme (malaria meds cause short-lived anxiety in about 1 in 10 people, and for some of that 10%, paranoia kicks in briefly, too), the mental health officer is the one who can figure out what’s going on and have the physician provide an alternative medication for the soldier – saving a military career from dissolving due to what looks like psychosis but is a transient medication side effect. In short, when crises occur, the “doc” or “shrink” or “combat stress lady” (quotes from military personnel) is there.

It is understandable that most civilians are unaware of mental health clinics on military bases, where military personnel and their families can receive counseling. Besides basic counseling services, mental health personnel provide services such as outreach before, during and after deployment, support while preparing for new babies, parent training, marriage counseling, couples’ retreat weekends, substance abuse education, and more. All these are part of the routine in military mental health clinics. Mental health officers are also able to veto a transfer if any member of the transferring family’s health or mental health needs cannot be adequately met at the new location. So…if Mom is being transferred to Base “A” and that area doesn’t have the specialized services that one child in the family needs, the transfer is nixed – possibly by a licensed clinical social worker at Lieutenant rank. The 2nd Lt. just overrode the entire command structure, in the military that is decried for not taking mental health needs seriously.

Then there are the VA system and the Vet Centers. Vet Centers are cousins of the VA. Unlike the VA, Vet Centers require only a DD 214 to provide free individual, couple or family therapy. It doesn’t have to be service-related…but if the problem seems to be service-related after all, the Vet Center personnel can help facilitate connection to the VA proper. These, too, are staffed by people licensed in their respective states as solo practitioners. There are no “not good enough to make it in private settings” amateurs serving in mental health positions.

Finally, there is the difference between benefits (think, Tricare, which is insurance for post-military service) versus service-connected health care (think, the VA system). A lot of veterans get that confused, and any of us who have tried to deal with health insurance and making sense of what is/is not covered, copays and coinsurance, and in and out of network…well, it’s understandable that almost anyone would find it confusing. Fortunately, the VA system and Tricare have professionals who do a lot of work (and get yelled at a lot) in trying to help people understand their benefits/insurance/service-connected health care, and connect them to the right services.

There are mental health services for military personnel and veterans. There could certainly be more, and the services available could be better marketed. In addition…there are stigmas.

Those stigmata comprise one more disgraceful example of too many Americans wanting to have their cake and eat it, too.

The regrettable medicalization of mental health has resulted in the mythology – happily embraced by many in the medical, pharmaceutical and professional-helper fields, as well as by many in the general public – that all mental disorder diagnoses are brain diseases. For example, many professionals will assure you that depression is strictly medical in nature; a brain disease, incurable but treatable by manipulating brain chemistry. Likewise, anxiety is (supposedly) purely a physical issue. People collect Social Security Disability, disability from their employers’ insurance, and other benefits, based upon having some sort of lifelong brain disease (according to psychiatry).

There are plenty of people eager to buy into this. We hear depression is epidemic (what else could we call something that apparently affects at least 20% of women and 10% of men each year, based on prescriptions for drugs?). Well, here is a recipe for depression:

  1. Maintain a sedentary lifestyle
  2. Eat a lot of junk food and assiduously avoid adequate portions of healthy foods
  3. Smoke cigarettes and/or abuse illegal or prescription drugs
  4. Drink more than one drink daily (females) or two drinks daily (males), or more than your physician recommends, given your particular health profile.
  5. Cultivate poor sleep habits. Watch television before bed; heck, watch television in bed, or use your smart phone, or tablet, etc. at bedtime. Drink caffeine less than six hours before bed. Wait until night time to argue with your spouse. Have a “nightcap,” which is a short word for “the alcoholic drink that will let you fall asleep more quickly and then wake up at 2 AM and have difficulty going back to sleep.” Eat salty foods before bed to activate your dopamine system and feel a little hyper.
  6. Avoid exposure to natural daylight.
  7. Watch lots and lots of television, or streaming video, or play video games, or surf the internet. The more the better. Strive for the national average of 6 hours or more daily (non-work related).
  8. Spend lots of time on social media. In particular, notice how much your life stinks compared to other people’s (supposed) lives.
  9. Shop for recreation. Spend money you don’t have on things you don’t need and then keep being surprised when, no matter how fancy the clothes or pricy the electronics, you are still, well, you.
  10. Be selfish.
  11. Don’t apologize, and don’t say thank you.
  12. Think a lot about how much other people are unkind, selfish, lazy, and how generally you are not getting your fair share.

Yes, I just described what an awful lot of people do, and yes, if you do enough of these things, you will probably feel depressed. Yet, as can be seen, every single one of these behaviors is optional for most people. Perhaps someone has physical challenges that prevent them from being active, but otherwise, these all represent choices made, choices which could be changed. If you were to do these things, and feel sluggish, unhappy, uninterested in life, helpless to make things better, etc., and reported this to your doctor, you could easily be diagnosed with depression.

The label depression, of course, is itself suspect. Within the mental health field, we are well aware of a dirty little secret. This secret is carefully hidden by pharmaceutical companies from the unsuspecting, suffering, and happiness-seeking public. That is, the criteria for almost every mental disorder diagnosis is a checklist. Committees review the research, argue about what should and should not be on the various checklists, have professional feuds, and publish the criteria. People are then diagnosed based off a checklist of symptoms or complaints. Those categories are fuzzy – a complaint I hear regularly from graduate students who, perhaps naively, expect pure, clear science. As soon as one set of criteria is published, the process starts all over again. This is how it came to be that, in the current diagnostic manual for the American Psychiatric Association, there is no such thing as bereavement. If you are still moping around after two weeks because someone you love has died, the American Psychiatric Association, in its infinite wisdom, has decided you meet criteria for Major Depressive Disorder. That’s the same Major Depressive Disorder diagnosis that many forces are pushing us to believe is simply a brain disease that requires lifelong treatment. I am not being sarcastic or flippant; it’s their decision, not mine. I was Hospice-trained and, even absent that, I am human and understand that bereavement is a long and painful process, even for the resilient among us.

The decision to eliminate the “bereavement exclusion” was supposedly made, in part, to allow people to use health insurance to pay for grief counseling. (At least, that’s the gossip I hear in mental health circles.) In other words, you are despondent. Someone has died. You go to a counselor. They diagnose you with depression, which is supposedly a brain disease, because you meet checklist criteria. You are now labelled with what many people assert is a lifelong condition due to your sick brain. You will now be able to have insurance cover your counseling (after your deductible has been met, of course). The diagnosis of a major mental disorder will last forever – long after you have forgotten whether you paid a copay or full fee for a handful of sessions, or went to a support group in a church conference room that a therapist facilitated as a volunteer.

Depression is worth discussing as one of the most common diagnoses. Psychiatrists and other physicians provide prescriptions for antidepressants, for example, to about 15% of the adult population annually – and many assert that depression is just a disease, like any other disease, and you have to face that you will be sick and need medication for the rest of your life. If that is the case, then why criticize the Pentagon for being concerned about someone whom psychiatrists assert has a lifelong brain disease having their finger on a trigger, or button, or sensitive data? Why should one person with a particular diagnosis be placed on perpetual disability and another maintain top secret clearance? Which do the people complaining about how the military stigmatizes mental health want?

To be clear, this is not unique to the military. People seek counseling, are unwittingly diagnosed, and discover later that they are deemed mentally ill and a high risk for suicide; perhaps their life insurance rates increase, or their health care premiums increase, and when the premium bills come in, they can’t remember having any mental problems except that time they saw a counselor after their grandparent passed away. The labelling can happen without any mental health treatment at all; if your physician lists a mental disorder as a possible diagnosis (fatigue, depressed mood, and poor sleep being symptoms of lots of problems, psychological and physical) while ordering blood tests (for what turns out to be something medical), that possible mental disorder diagnosis is in your health record, now part of your profile, even if you turned out to be anemic, not depressed.

Even if you are diagnosed with depression, the diagnostic categories don’t adequately describe what is happening, and they should. It is reasonable to expect that professionals, viewing the diagnosis on a chart, immediately discern the difference between these types of experiences:

“I’m depressed and exhausted because I’m having hideous nightmares ever since my buddy was blown up and died in my arms” versus,

“I’m depressed and exhausted because the 5 years I spent doing meth have caught up with me and my brain has been damaged,” or,

“I’m depressed and exhausted (and right now no one, including me, realizes it’s because I am among the one in 10 women who suffer depression as a side effect of chemical birth control).”

Right now, the label doesn’t differentiate. As you dig into the chart, yes, it’s there – but the most superficial record just shows the diagnosis code.

So, let us not pretend that the military is some big, horrid bully for treating serious mental disorder diagnoses as a possible risk factor for clearance. As long as those in power – throughout the medical, insurance, pharmaceutical and government arenas – are manipulating the definition of mental illness, one can hardly blame the military for being overly solicitous about the mental health of our men and women in uniform.

The conundrum of diagnoses and the risk of damage to one’s life explain why some military personnel are suspicious about seeking mental health treatment. We ought not to assume ignorance when they instead go to chaplains (who may be precisely who is needed) for wise and useful guidance. Similarly, they may choose to be self-paying for marriage counseling, stress management or other issues…off the record and off the base, their privacy is as sacred as mental health treatment ever was, before psychiatry yielded to intrusive insurance, and, as the big player in the mental health field, dragged most mental health professionals with it.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Lodge Act Soldiers

This piece was originally published in USA Today Magazine, May 2015.

The Lodge Act Soldiers:

The Mural and the Portrait

 

Sometimes, the enemy of my enemy is not my friend. There are many times when, at best, the enemy of my enemy is a useful but dangerous tool: geopolitics on a razor’s edge, perhaps. This often is the case at the macro level. At other times, perhaps more often on a micro level, the enemy of my enemy is indeed a loyal friend.

In 1945, when World War II ended, it was expected that peace would prevail: in the US, the “boys” came home. In Europe, the prison camps were flung open, British children were sent home to London (if homes and parents were still there), and the Marshall Plan was implemented to show mercy and bring the vanquished back from the medieval stage to which they’d been bombed. There was not, however, then as in the oh-so-recent past, to be “peace in our time.” Russia had succeeded in encroaching far into Europe and was in no hurry to surrender those advances. Far from peace, there was instead a very apparent intention to pick up where Hitler had failed, spreading a mantle of totalitarian slavery wherever feasible.

March, 1946: Sir Winston Churchill spoke unapologetically about the dire threat to peace and liberty that was the Soviet Union, unsheathing a previously rarely-used phrase – the Iron Curtain – to summarize its implacable, impenetrable seal against freedom. Nations that ostensibly had freedom were punished for daring to reject communism. A striking example of this, just two years after Churchill’s Iron Curtain speech, was the punishment of West Berlin by the Soviets known as the Berlin Blockade. In this case, the US and Great Britain responded in force, first via small efforts – Operation Plainfare and Operation Little Vittals, and then with a months-long show of force and generosity via an airlift that was, as General Tunner had intended, “…on a beat as constant as a jungle drum.” The relentless rhythm came at a price of military and civilian lives, but ended in a rare and predictably graceless Soviet backtracking…for the time being. Communist states accept rejection with all the irrational fury of a woman scorned, and with a sociopath’s capacity to wait, endlessly, for the opportunity for revenge.

It was clear to anyone paying attention that the worldwide vision of communism held by the Russians was as malignant as the state-based socialism of Nazi Germany, and the urgency to fight the toxic tentacles on one hand drew up in sharp contrast to war-weariness and distrust of anything associated with the enemy on the other. Something needed to be done, despite the desperate drive to maintain a buoyant mood at home and the desire to put war and its ugliness far behind us.

August, 2014: a slim, short obituary appears in the local papers, with a small photo, apparently cut from a larger one, of a soldier’s face: all planes and angles, alert, but with the slightest pull of humor in the mouth. This is MSgt. Jan Janosik of the US Army special forces, and he passed away at home, at age 82, following a long military career (22 years), and a subsequent career with the Hillsborough County (FL) Sheriff’s department and then with the Florida Department of Corrections. He entered the US Army via the Lodge Act. Except for a listing of a few of his medals, and his wife, children and grandchildren, there is nothing else mentioned.

If Janosik had been killed while driving drunk the wrong way on an interstate, we would have known more about him; if he had been notorious for some dastardly deed, or perhaps a gold-hearted local philanthropist, a reporter would have given him a half-page write-up. As it was, and is, someone who merits the big write-up would have been uncomfortable with the spotlight, and an individual deserving of our regard and reflection appears in a tiny notice. Real soldiers are not attention-seekers, and Special Forces members are reserved about their work. They do not do what they do for applause. They seek to serve. In the case of a Lodge Act soldier, the desire to serve is for a love of freedom that surpasses anything else, and transmits itself into sacrifice for a country that is not one’s own.

June 1950: A much-neglected aspect of 20th century American history is the Lodge-Philbin Act, most often referred to simply as the Lodge Act, passed in June 1950. The Lodge Act permitted the recruitment of Eastern European nationals into a specialized fighting force, under the jurisdiction of the US Armed Forces, to fight the spread of communism during the Cold War. Although the Russians had been, ostensibly, an ally during WWII it was only due to a shared animus towards Germany, not actual shared values. Indeed, it did not take long to figure out that Russia was not happy returning to its own borders and to peace; instead, the mission to achieve worldwide socialism, rather than the nationalistic socialism of Hitler’s Germany, went into overdrive. Communism doesn’t tend to work out very well for the little person…and it does not work out well, as it turns out, for great people, either.

In 1951, 19-years-old Slovak Jan Janosik was working as a border guard on the Czechoslovakian/German border. He desperately wished to leave the control of the Communist state, but the price to his family for his defection would be grave. Yet they gave their blessing to his plan, and he and a friend were able to escape. In punishment for Jan’s defection, his family members were dispossessed of their property and sent into prison camps. A death sentence was placed on young Jan. Meanwhile, the two young friends were on the way to West Germany and freedom.

The strangulating grasp of Communism does not release easily, whether on a nation or on the individual. One day, having finally reached Berlin, they stood on a sidewalk, waiting to cross the street. A car pulled up, a window rolled partway down. The muzzle of a gun appeared, bullets flew, and the car sped off. When it was over in mere seconds, Jan was alive; his friend was not. Jan’s determination to achieve freedom, and to fight communism, was even more deeply etched.

The Lodge Act, with its offer of freedom and US citizenship, sounded like a dream: switch teams, spend five years and earn your freedom. It was not as easy as it sounds. The Act allowed only for a relatively small fighting force; Eisenhower was not in favor of “mercenaries,” recalling how poorly the integration of mercenaries had worked for the Roman Empire. The US Army could afford to be, and needed to be, very selective. The young men admitted under the Lodge Act were expected to be able to work within the enemy’s territory, to blend in and help bring down Communism from within its own cage. Someone with Janosik’s abilities (he spoke four languages; English became the fifth) and capacity to work and learn, was highly valued. The next challenge would be to learn English and become an American soldier.

A great many Lodge Act recruits were sent to Fort Devens, MA, for Army basic training as well as training in English and American culture. It was a combination boot camp and rapid acculturation into their newly chosen country. The USO helped out in many ways, including hosting the dances that were part of the introduction to American culture. It was at such a dance that young Janosik met Josie, a petite, bright-eyed Sicilian-American girl who came to the dance with a group of girlfriends. The girls regularly went to dances as a group; there was safety in numbers and it was good, wholesome fun. This dance was different: Jan and Josie each went home convinced they’d met their soulmates (her mother was skeptical). Jan and Josie married a year later.

“We didn’t really speak much of the same language when we met but we managed,” she says now, smiling. “When you want to, you make it work,” and her expressive, Sicilian shrug and graceful hand gestures underscore her words. The dancing that began at that USO event went on for years: jitterbug, waltz, polka – all types of dancing, all types of music. The passionate and playful dancing seems to contradict the no-nonsense, serious soldier and father, but the playful side slipped out again, as so often is the case, with his beloved grandchildren.

The next stage of life took them both away from Massachusetts. Janosik was assigned to Airborne training and volunteered for Special Forces training at Fort Bragg, NC. This fit the circumstances: the point of the Lodge Act was to recruit fit, bright, skilled young men who would be able to function within unconventional warfare. There were to be no routine duties once basic training and basic acculturation were completed.

So, the young newlyweds rented a small trailer off-base at the then-exorbitant price of $35/month and each coped with the culture shock of finding themselves in an environment markedly different from where they’d been. There were not a lot of Catholic girls from Massachusetts; there were not many Slovakian immigrants. Nevertheless, they made friends: the fiercely loyal friendships of military family life. Many significant events soon followed: Jan’s successfully passing the citizenship test, the birth of three children, and ongoing training and assignments to Special Forces teams. Josie Janosik recalls today the closeness of the families and their mutual support, as well as the obligation of the wives to be appropriately vague about their husbands’ work, of which they knew appropriately very little. As it is today, the military spouse who attempted to gain sympathy and attention via borrowing a glint of glamour from the husband’s dangerous work received the disapprobation of her peers. Even so, they were all in it together, and, at least for Josie and their children, Jan always came home. Not everyone was so fortunate, and in those sad cases, the close community gathered to provide care.

Recall that the Lodge Act required five years of service. By 1957, young Janosik had met the requirement. He continued to serve, finally ending his career after 22 years – a full 17 years beyond his required commitment. Almost half of Janosik’s service was performed as overseas assignments. He was not alone: other Lodge Act soldiers, notably Larry Thorne (born Lauri Torni in Finland) also served through the Viet Nam War.

The Lodge Act soldiers have had counterparts throughout history, but in the US wars from the mid-20th century through the current day, what was is sometimes mislabeled (or libeled?) as “irregular” warfare includes the imperative to involve the local population. At risk are not merely small territorial spats but world-changing battles between ideologies. Thus, for example, American soldiers in Laos and in Viet Nam were involved in close collaboration with local personnel, and it was through such a relationship that Janosik earned his treasured “Tiger Tooth” award from his Cambodian troops. Modern efforts during Operation Enduring Freedom and Operation Iraqi Freedom similarly engaged local populations in the effort.

It is undoubtedly a great challenge to sort out who, in the local population, may and may not be trusted and to what degree. On the home front, meanwhile, it has become increasingly difficult to enlist sufficient volunteers who are healthy and fit for service among US citizens. It is also difficult to find families that are encouraging of military service. The general resistance to either a military draft or mandatory national service in some other capacity was underscored by the repetitive proposals by Rep. Charles Rangel (Dem, NY) commencing in 2003 to reinstate such a draft or mandatory service – which he, and almost everyone else in Congress, regularly refused to support with an “aye” vote. It might hardly have mattered: some studies indicate as many as 75% of age-eligible young men in the US are not able to meet the standards. At least 29% are obese; many others have criminal records, psychiatric records (including the ubiquitous medications for that bugaboo of American boyhood, ADHD), large visible tattoos, and drug use histories and/or cannot score adequately on the basic entrance test, the Armed Services Vocational Aptitude Battery (ASVAB). A WWII draft panel would have been stymied by an effort in which 75% of those called up were 4-F. Of course, as the size of the military shrinks, recruiting efforts can become more discriminating. The selectivity of the military in regards to the Lodge Act soldiers has a modern parallel in the MAVNI recruits (Military Accessions Vital to the National Interest), in which highly educated (29% with masters’ degree or higher) and skilled US-resident foreign nationals are recruited into the US military.

The US Army was in a position to be discriminating when recruiting men under the Lodge Act. The efforts made by most applicants simply to present themselves as candidates were a test of intelligence, will, stamina and survival skills. Some journeyed hundreds of miles, on foot, while being pursued, and endured beatings, being jailed, and physical deprivations of various sorts just trying to apply. They were determined, earnest, and deadly serious. Yet any one of them could have been merely an agent for the Soviets, who had, after all, been indoctrinating their children to despise the West and its evil, abusive capitalist system from their earliest years. Perhaps some were, in fact, spies in the making, like sleeper-jihadists working alongside our military in present-day war zones.

Others were entirely sincere in their love of freedom, and these include M.Sgt. Jan Janosik, recipient of the Silver Star, Bronze Star, Air Medal, Purple Heart…and the Cambodian “Tiger Tooth.”