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dennis reeves
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Cmdr. Dennis Reeves (U.S. Navy-Ret.), a Navy psychologist for 22 years, spent eight months in Iraq forward deployed as a mental health counselor. He talks in some detail here about the war environment he witnessed or heard about in his talks with the men, and how the troops developed coping mechanisms. He also describes the counseling and crisis intervention that he and colleagues provided the Marines, in particular, debriefing and talking sessions called "Warrior Conservation." And, he discusses some of the common problems troops will face when they return home. This interview was conducted on Nov. 3, 2004.

We're deploying mental health professionals with battalions, part of the fighting unit. ... They're the battalion shrink,  and so the commanding officer learns to trust them...

Tell us about your trip to Iraq.

OK. At the time that the war broke out, I had about 21 years of experience as a naval officer. I knew the war was coming, and I was fairly well prepared for it. And [I was] not looking forward to the war, but looking forward to being there with our troops and providing direct front-line support for them.

One of the first things that comes to mind was the day that we actually went to March Air Reserve Base to board a transport to Kuwait. And I was in a hangar with approximately 1,000 other Marines that ranged anywhere from 18 to 40, but mainly 18-, 19-, 21-year-olds caught my eye. And I remember looking to one of my colleagues, a senior chief, at the time, and I said, "Senior Chief, this is really kind of sad, because we have so much enthusiasm here with all these troops, and not everybody's going to come back." That was my first realization that war was really coming and that it was pretty serious business. ... I'm a father, and I looked around and saw individuals my son's age, and I said, "Well, this could be very sad."

What is it about kids that age?

Somewhere between 18 and 23, you're full of life and enthusiasm, and [you're] idealistic, and you think that if you're a Marine you're invincible; you're bulletproof. And the phrase is a little trite, but [you're] truly gung-ho. And you believe in the Corps and your country, and you're really dedicated to fight and serve your country and give your life if necessary. So that sort of spirit would, I think, impress just about anyone. And the idealism is just very refreshing. When you lose something of that nature, at that age, that's just a travesty, and it's a horrible thing to happen, no matter how just the cause.

I went in in February [2003], just a few weeks before the war started, and then transitioned all the way through, followed the Marines all the way through the very serious battles that they experienced during their 21 days of major fighting. And what I saw was, again, psychologically, this great enthusiasm about finally having a chance to do what they had trained to do. The Marines are trained to fight; they're trained to be, we call it, the point end of the spear -- you know, go in, kick the door down, destroy the enemy. You do it rapidly, efficiently, precisely, and with a great deal of pride in doing what you've been trained to do. ...

Their concept of what they were getting into probably was going to change dramatically and in some cases be shattered. War is not glorious; it is not adventurous. It is a horrible thing. ... During the aftermath of the war, the range of reactions was very varied. What I found mostly was that the younger Marines actually did take a great deal of pride in what they had accomplished, and the majority were still enthusiastic and very -- well, of course they were happy to be alive, but they were so happy to be so victorious. As you get into the older guys, especially if you had been in combat in 1991, in Desert Storm, the more mature senior enlisted and officers, especially the senior leadership among the enlisted, they had a more seasoned, almost fatherlike attitude, at least a big-brother attitude, in terms of what they were getting into. This was not a great adventure; it was serious business to them.

When the Marines finally did get into combat, you don't always end up destroying just the bad guys and just the enemy. We have a certain amount of collateral damage, so when you're shooting things forward and they're blowing things up, those things that blow up don't just house just the enemy. And so the thing that was really sad was when our guys felt or thought that they had maimed or wounded or killed some of the innocent Iraqi civilians. And that was quite devastating to them, because they took a great deal of pride in destroying the enemy, but it was very psychologically traumatic for them to believe that they had killed somebody's father or mother or child.

[What kind of counseling did you offer after the war?]

After the war, my team started conducting a program that we eventually called Warrior Conservation. And it was an opportunity to visit and hold group sessions and allow platoons, which is a group of approximately 40 individuals who have been very close, living together 24/7 [and] know each other well, [to] know exactly what each other had gone through. During those sessions, we [wanted] to kind of normalize the experience and also just allow them to vent and debrief and defuse a bit in terms of their experience during the war, things that concerned what it felt like or what it was like to have been in a firefight, to have killed another individual, to have taken fire, to be shot at, to have seen the destruction and devastation and atrocities of war, and also the collateral damage. We discussed seeing wounded civilians and destroying things that we didn't mean to. Fortunately, this was one of the wars where we had the least amount [of] collateral damage, and that gave them some solace when I was able to report that.

But the perceptions and the perspectives that we obtained during approximately 120 different groups -- and I think by the end total it was about 5,000 troops that we had heard stories from -- the range was highly, highly personal and highly individual. And if you think about that, that does make sense, because every individual comes from a different kind of family. Some of them don't even have a family. They have different cultures, different cultural values, different religions. Some come from the city; some come from the farm. ... So when we would ask, "What was it like to kill the enemy?," one guy would say [anything] from "It felt like making a touchdown for the home team," to "Well, I was just doing my job." ...

[What did you tell them about killing?]

During our Warrior Conservation sessions, we would explore the morality of war, if you will. It wasn't really exploring morality; it was just talking about what had happened to them. And they did frequently have questions about that. And we would have to explain the differences between what it means to be killing in a war as opposed to killing at home.

I actually had one individual say to me, "Hey, hey, doc, what about the Ten Commandments -- you know, the one about 'Thou shalt not kill'?" Well, fortunately every time we did one of these groups we had a chaplain with us, so I turned to the priest that was with me at the time, and said, "So, Father Joe, what about that?" And he was able to explain, well, actually, that was kind of a literal translation. The scripture actually said, "Thou shalt not murder." If you're in a moral, just war, and if you look at the Old Testament, God supported a lot of wars and warriors, and that is not murder. When you go back home, though, if you kill someone, that is murder, and that's a totally different situation [than] when it's justified, and the other is a criminal act.

[How did Warrior Conservation get started?]

The reason we started the Warrior Conservation program after the war [was that] the Marines were held back to provide security operations, and that was quite a paradigm shift, a tremendous change of mentality. One day you're asked to charge in, kick down the door and destroy the enemy, and the next day you change roles, and now you have to be the individual that has to go in and shake hands, rebuild the apartments and win the hearts and minds of the people. For a Marine, that's really tough, because that's not what you're trained to do; that's not what we had the mind-set of doing. We had been given the impression we were going to be that point end of the spear, like the Marines have always been in previous wars. They go in, and they do the initial charge ... and then pack up and go home.

Well, that didn't happen this time, and as a result, we had to stay behind. And the Iraqi climate around May started getting pretty hostile. It was beginning to get very warm. We didn't have air conditioning, we did not have very good shower facilities, and until the latter part of the summer, we didn't have very good food either. They were mostly living in places that were just little camps that were what I would I call dirt farms or sand farms, because there would be sandstorms every day as well. And so you're in a hostile territory; you're being held back to do security patrols as opposed to being the front-end warrior. And that was tremendously stressful.

The war happened so fast that we really had very few combat stress casualties. But after the war, morale was a real challenge. So we started doing this itinerant round, my partners and I, and we would go camp with the battalion for about a week and talk to the Marines and have little group sessions and allow them to vent their frustrations and ask very honest questions about "Why are we still here? We weren't supposed to do this."

Frequently we would use the model of Somalia. We'd been here in 1991 [the Gulf War], and guess what? We had to come back to finish the job. So this time we're really going to finish the job. Same thing in Somalia. Most people have seen the movie Black Hawk Down, [and they] know that we had to go back in because we hadn't really finished the job. Well, this time we're going to stick around until we stabilize the country and we really turn it into a civilized democracy and then go home so that, indeed, we have made a point to the terrorists that America is not going to put up with this. So they would take that pretty much in stride, and at that time it kept them in the theater and kept them motivated. ...

Now, one of the questions I have to ponder and I've discussed with my friends is, was that a really effective approach? Well, there is no such thing as a panacea; there is no such thing as a silver bullet that cures everything. Any intervention you do will have a percentage of effectiveness. So if you take a look at the statistics now that we're seeing in terms of the prevalence of formal, diagnosed PTSD [Post-Traumatic Stress Disorder], we're [seeing] 16 percent to 17 percent, sometimes up to 20 percent. But what? That means 80 percent of the individuals have really readjusted, and they're doing well.

Now, whether or not that had something to do with our Warrior Conservation program and our intervention before they came home and their ability to do a close-to-the-event processing of what had happened to them, I don't really [know]. I can't tell you that we have evidence-based [medical] data to prove that yet. We're working on that. But I do know that about 80 percent of our guys are doing quite well, and then the other 16 to 17 percent do come home, and it depends on what their prior history was and what kind of environment they moved back into. That, too, plays a major role in terms of whether or not they regress and start thinking about what had happened to them. ...

Some events were extremely traumatic to some individuals and no big deal to others. Some had been exposed to things like that before, and others had not. First time around, it makes a major impression on you which is hard to erase. So just a few debriefing sessions and a little bit of talking about it is not going to erase that. So that's why we have some pretty serious follow-up programs now to treat PTSD. ...

[What else did you tell the soldiers in the groups?]

One of the things we would ask them is, "What's the worst thing that happened to you during this war?" And in all fairness, I would frequently start with one of my stories. ... One day a senior officer, a Marine, came into our hospital camp and asked to see a mental health provider. ... He said, "Well, I'm here to prepare the bodies for transport to Delaware." At that point, I didn't realize that our facility had a portable makeshift morgue, which was a very large, refrigerated unit that had been placed pretty much out of sight and toward the back of the camp. And I didn't realize what that refrigeration unit had been [for]. I thought it was for storing food, but what I found out was that it truly was a field morgue, and the individual that had come to visit us was one of the mortuary officers. ...

So I spoke with the individual and kind of got a few details about what he was going to do, and then realized that I was probably going to end up doing what we call critical incident stress debriefing. In this particular case ... it looked like he was going to be operating by himself. I volunteered to go with him. And we did, and we went back, and when we opened the door there were 13 heavy-duty black plastic bags with the zippers on them. And when we opened them they had American troops who had been killed in the war inside.

And when that occurred, I had a kind of flashback memory to March [Air Reserve Base], and it really touched me that this war was not all glorious and victorious. The American troops definitely had been in firefights in which they had been killed as well.

And suddenly the reality of war hit me as well, and it was very emotionally powerful. Americans aren't supposed to die, you know. They never do in the old movies. So that hit hard, and it hit home. And so as a result, when we finished, I sought out one of my other counselors, and instead of me doing the counseling, I became one of the customers, and we both underwent immediate debriefings, and, you know, survived. And here we are.

Sometimes [I was] asked what I saw when we unzipped those very thick black plastic bags. I saw what happens to individuals when they have been in a vehicle that had been attacked with an RPG, the rocket-propelled grenades, and there had been a very severe explosion, or if they had been in a helicopter that had crashed and burned, or if they had been in a vehicle that had been shot and/or driven off of a bridge and had been underwater. Also, what powerful bullets do to the human body. Everything that you see in any of the more graphic Hollywood movies is what I saw that day. Sometimes body parts, sometimes burnt bodies. Sometimes I had a situation [where] we weren't quite sure if it was the same person in the body bag.

And then the thing that made it most traumatic is that during this process, you have to record the range of wounds and any identifying marks, ... and you would have to go through personal effects. And it wasn't really the physical destruction that bothered me so much, but it was when you finally open someone's wallet and you really do see a family there with kids, and you think about this is going home, and somebody is going to get one of those telephone calls or the visit, and the individual that you're dealing with was a real person; it's not just a body. That was one of the American troops and a real person with a real family. And I don't care who, you know -- I mean, if you've got a semblance of humanity in you, that is emotionally distressing and takes a bit out of you.

So that was what I saw. And the worst part was going through personal effects and knowing that there was a family at home that was about to receive some very, very devastating news.

How did you get over that?

Well, first of all, I'm not an 18-to-24-year-old. I have been around for quite a while. I had, as I mentioned, almost 22 years of naval experience, so I've been in the military for a while. I have been through decades where our country's been to war and have seen devastating things in my life. I have had a good support system as well. And at that time, within our company, we had very close relations with each other, and so I did what I always tell my patients to do: You go find somebody that will listen to you, and you talk about it until you don't want to talk about it anymore. You tell your story as many times as you want to, to somebody that will actually listen and not give you advice -- active listening -- and you just wear it out until it finally diffuses and dissipates, and so that's what we did. ...

One of the things that I always tell my patients when we first start working together is that they will never be able to forget what they have gone through, but the emotional impact will be lessened to the point where they will be able to be normal again. ... That's [a] normal reaction and what I experienced as well. ...

[But] when you're very young, you don't have a lot of references, and so [soldiers] could very easily say, "Well, it's like when I was very first heartbroken, and it was like the most traumatic experience that ever occurred in my life." Well, for somebody that's only 18 years old, maybe that is the worst thing that has ever occurred to them in their life. So the way individuals describe their experience of trauma has to do with what their past history is and how they could relate it to what had been previously the worst thing that ever occurred to them in their life.

Heartbreak and being destroyed emotionally by rejection of a significant other -- girlfriends, for instance -- that can be really devastating to a very young person. As you grow older, it's still not very much fun, but it's not devastating. Perhaps something more devastating would be the loss of a friend in a car accident or a parent to cancer or something of that nature, which would be something that other individuals could relate to. But that comes with different experiences, different backgrounds and different ages.

What was the most challenging thing to deal with?

Our experiences in terms of counseling in the field [were] very wide-ranging. First of all, I'd like to mention that when you're in combat, the world at home doesn't just go into suspended animation, and neither do you. So all the reactions and all of the things that are going on before you went to war are still going on. And as a result, individuals would get some devastating news from home, a lot of Dear John letters, like "Don't come home; you don't live here anymore," things of that nature. And when you're really in a very hostile environment and it's dangerous and it's just miserable and then you get a letter like that, that can push individuals over the edge. And so we saw a lot of that, and we did a lot of crisis intervention in terms of just taking care of family situations and personal situations. ...

When it was combat-related, for the most part it had to do with individuals that were afraid, that were concerned that they had killed a civilian, one of the Iraqis that was a mother or a child that was an innocent victim of the war. That was very, very traumatic, and I do recall having to do some very serious interventions and intense sessions with several individuals who had come in, and they were convinced that they had killed a lady in particular.

As it turned out, I ended up hearing that story, [or a] very similar story, quite a few times. I started calling her the bag lady, because the story was that there would be a female in a combat zone that was draped, you know, in the traditional veil and dark black gown, and she would be carrying a bag and holding her hand out and would be approaching a combat group, and if you're in a firefight and somebody is coming at you like that, they're not supposed to be. And so [they] would shoot her.

Now, sometimes they would go over to that lady, and they would open the bag, and it was full of explosives. It was one of those dirty tricks that they were playing on us. And so my intervention with the individuals would be to tell them that story because I knew that that had occurred at least four times. I'd heard that identical story four times. They would also do the same thing in taxicabs, and so our guys would shoot the taxicabs that were charging at us, and the Iraqis would get out and start screaming, "You killed my brother, you killed my brother!" And we'd go over to the taxicabs, look in the back seat, and the brother was loaded with all sorts of explosives and AKs and automatic weapons, and they were masquerading as civilians and playing on the humanity of our troops. ...

What were the most stressful jobs the soldiers had?

Of course, being a front-line warrior, the trigger pullers, you know, and being in firefights and combat was stressful. But I think one of the most dangerous occupations was being a transport driver. ... A lot of transports are actually fuel tanks, right, and tankers. And so if you get an RPG in one of those, you have quite an explosion, a very impressive explosion and quite a bit of destruction. And being in one of those convoys is extremely dangerous and very stressful. And then if you add that 110-degree weather and no air conditioning in the cab, and the shock absorbers are really not very good on those vehicles as well, and then you hit sandstorms and things of that nature, and it is just mile after mile of heat and exhaustion and bumpy rides, and then people, as you go through the towns that don't like Americans, they throw rocks and stones or they shoot at you, and sometimes they hit you, and sometimes they blow vehicles up right in front of you -- very, very dangerous.

And so some of the true heroes from America happen to be in the transport companies, and the individuals that are really risking their lives at least every other day, and that's going on month after month after month. ... I've heard stories where, especially in the armored vehicles, a machine gunner or an operator would fire, and there would be a variety of enemy troops just falling down in front of them, and they'd keep on going, and as a result, their tracks would actually run over the dying or dead bodies. Reactions to that were everything from "That was really, really awful and very stressful" to "It just didn't seem real." Especially if you were looking through the sights, it was like a video game to a lot of them. ...

[There was] graveyard humor, if you will. One body, I remember having seen pictures, and it had been just literally flattened, and they used the phrase "pizza man," so it was a relief-humor kind of thing to just survive and turn something that was so bad into something that was almost cartoonlike. And that's a coping mechanism. An individual that's sitting back home watching it on TV goes, "Gosh, how could they do that?" But what? They had to to be able to survive and just turn it into something that they could deal with. ...

What exactly is PTSD?

During briefings, we had to explain what Post-Traumatic Stress Disorder, or PTSD, is. There are several major symptoms that occur. First of all, you have to have experienced a psychologically traumatic event -- and again, what's traumatic to individuals is highly individual -- but an event so powerful that it actually changes biochemistry in your brain. PTSD is a biological disorder, and it is a trauma that actually changes brain anatomy and causes distortion in parts of the brain. And the effects of those changes happen to be things like recurring nightmares, major nightmares, night terrors every single night, usually a very similar theme. Then, if you are walking around and something kind of catches your eye, or you get a whiff of something that was similar to what you had experienced during the trauma, you will actually lose the sense of reality about time and place and where you are, and you have what we call a flashback, and you believe that you're actually back in the environment.

So you have nightmares; you have flashbacks; you have spontaneous anxiety or panic attacks. Your heart starts racing; your breathing becomes very rapid; you get very sweaty and clammy and lightheaded, and you think that you're going to die. And that's a panic attack. Those are the major things. You have nausea; you have headaches and outbursts of anger.

And as a result, if you don't know what's going on, frequently what happens is individuals start self-medicating, and you get alcohol and substance abuse. Also, with the anger outbursts and substance abuse, you end up with family violence, so it tears apart family units, [child] abuse, spousal abuse. ...

One of the problems with having PTSD, or Post-Traumatic Stress Disorder, is that you can't see the injury, and a lot of people believe that it's a sign of weakness, and it's just something in their head. ... We know that one area that affects memories and things of that nature, the hippocampus, is damaged, and the wiring or connections within the neural networks is distorted, and the biochemical interactions where the nerve cells are communicating are also altered. Now, the good news is that it's treatable. [But] if you don't treat PTSD, it never goes away. It's a lifetime illness. ...

Actually, before the war started coming on, individuals from Vietnam started arriving at the hospital again, ... [because] the occurrences that they were seeing on TV from Iraq brought up everything and exacerbated what they were already experiencing and had experienced for over 30 years. [They] made it to the point where they finally broke down and started asking for help. And we've educated the public, I hope, enough now so that they know that it's truly an illness and it is not a sign of weakness. ...

How can you distinguish between soldiers who have PTSD and who talk about their war experience as if nothing bothered them, and those soldiers who don't have PTSD and talk about their war experience in the same way, because they are stoic about it. And why are they so stoic to begin with?

... A lot of that has to do with training. ... When they finally get to war, mainly the reaction is, "OK, I've been trained to do this; I'm going to do my job." And another common reaction was "Wow, this is cool; we finally get to do what we've been trained to do." So when they did see and experience things that would just horrify somebody that has not been in the military before, for a Marine it's like "Whatever," or "Oh, that was kind of cool." ...

[In support groups,] they are able to in a very matter-of-fact, unemotional fashion talk about some very horrifying things, including thoughts about suicide. This is a very common experience, and that's why you have to have highly trained mental health professionals running the groups that can hopefully determine when an individual that's talking about thoughts of suicide versus thinking about actually acting on those suicidal thoughts. There's a big difference between just thoughts about "I might be better off dead" or "I've been thinking about it" versus "I've got a plan, and I'm getting pretty serious about it."

So that's one of the things that mental health professionals deal with every day, which is not what the general public sees. And so it can be pretty disturbing unless [you can identify] the difference between what's a real threat and what is just passing thoughts, which is not unexpected given the situation.

The other thing that you may see is that individuals may describe a horrible experience or something that they saw and be very frank and almost bland and unfeeling about it. Well, that's one of the symptoms of PTSD -- numbness, emotional numbing. ... The numbness is a survival mechanism. It keeps them alive; it keeps them from being suicidal. And you will witness that in the early phase of counseling. And so guys with PTSD are not crazy, and they're not falling apart, and they're not sitting around crying, and they're not sitting around just mute. They're still real, live, functioning individuals who happen to be experiencing spontaneous panic attacks, which is very disruptive, nightmares and flashbacks and things of that nature. ...

I'll guarantee you, they are hurting on the inside, and that is just their system kicking in and keeping them alive until they really can come to the point where they can emotionally deal with the trauma that they're describing.

[How do you prepare the soldiers for their return home?]

Before guys actually come home, primarily our Chaplain Corps has what they call a Warrior Transition Group, and they talk about "expect the unexpected." ... They've been through some pretty harrowing experiences together. They have been in a small group, for the most part about 40 guys, and that group becomes extremely close. Sometimes, because you're there 24 hours a day, seven days a week with those same people, you create a bond that is as strong as any family tie could ever be, and most of the time stronger. And you become very dependent on each other.

And also because you've gone through similar experiences together, when you talk to somebody, they know what you're talking about, and they can relate to it. Frequently I use [an] example: Before I left, I found a thermometer that read 140.8 degrees Fahrenheit, and when you get home and you try to explain to some[one] what 140 degrees [is], [what] wind with sand coming at you is, they don't understand. There's no way they can relate to it unless they've actually been there. ...

Now, what happens when guys come home is that they sometimes hold that stuff up and keep it in their head, and they don't really talk about it until they get home. And then if they're married, they try to tell their wives about it, and they start dumping all this stuff on the spouse. So the spouse goes, "Well, you know, that was really horrible, but gosh, let me tell you what happened at the office today and what so-and-so said about me; that was really awful, too." And [it's] apples and oranges. ...

Another problem that is commonly experienced when troops return home from an extended deployment in a place like Iraq is that they experience outbursts of anger. It occurs in Iraq, and it's usually settled down. But Marines yell at each other, and they're kind of a violent group, so it's not so abnormal for them, especially in a hostile environment. But when they come home and they're with their families, and they're used to yelling and screaming and hollering and things of that nature, if they start doing it at home, it can make some major ripples in a family unit. ...

But generally speaking, after a couple of weeks you start settling down, and those spontaneous outbursts of anger dissipate, and they go away. If you have Post-Traumatic Stress Disorder, they don't go away. And you are always hyperalert, hypervigilant, and your nervous system is just on pins and needles. You're hypersensitive to everything. And if you think about it, in the environment that you were in, the hypervigilance was survival. If you weren't watching and checking everything all the time, you could end up dead. And so after six months of that, your system has been turned up and turned on to the point where you've always got your antenna out and you're always scanning and monitoring for the enemy, and so little things can really irritate you because you're just at [a] peak emotional state. ...

[How do officers react to the idea of their troops needing psychological help? Is there still a stigma?]

Responses that I've received from commanding officers in terms of my interventions and my offer of support of their troops, both in Iraq as well as at home, have been quite wide-ranging. Some of them are very psychologically minded and do understand the effect of stress on an individual and are quite sympathetic. Those are easy. Other leaders believe that any mental health problem that an individual has is a sign of weakness.

So as a result, we have been able to start a pilot project that has been sanctioned by the highest level of Naval and Marine Corps medicine called OSCAR, which is [the Operational Stress Control and Readiness] project. And we have individuals in theater that are assigned to the battalions, and as a result, they train with them, and they become part of the family. Now, if you're in the family, you're frequently better accepted, and when the battalion surgeon talks to the commanding officer, he listens.

Now, when the battalion shrink talks to the commanding officer, he also knows that he can trust him and that he is not going to just try to let these guys use mental health as a ticket home, which is the major fear. And it's a legitimate fear, because if you allow two or three individuals to cry and convince you that they're not going to be able to cope and deal with the stress of deployment, [and] you let them go home, well, suddenly you're going to have an epidemic, and everybody's going to be lining up in mental health and trying to go home. Commanding officers know that. ...

Some love us, and some really would rather us not exist, especially when you're at war in the field. Commanding officers, their job is to maintain a fighting force. Military medicine's job is to maintain a fighting force. We both have the same job, but sometimes the approaches are different. ...

The commanding officer cannot afford to lose a single individual on his team, and everybody has a critical job in a battalion, in a command, in a platoon. So a loss of an individual -- replacements are very hard to get, so they do not give up easily. The job of the mental health professional is to be able to explain that they don't give up easily either, and they absolutely will treat and keep the warrior active as long as possible. But in certain circumstances, if you keep them, the cost is going to be so much more than the loss will be if you release them. ...

I've never seen them make a wrong decision. Now, [that] doesn't mean that they like you, and it doesn't mean that they want mental health in the field, because if mental health isn't in the field, then they usually aren't confronted with these dilemmas. But for the most part, [with] the education that we're doing now, and because our new program called OSCAR is actually doing a lot of pre-deployment education and preparing them to help themselves, mental health professionals really aren't needed that much. We're using a community mental health model that allows the senior enlisted and the senior leadership officers to learn about identifying mental health problems and stress reactions that may lead to a significant crisis early. ...

We're deploying mental health professionals with battalions, and they are part of the fighting unit, and they're just like the doctor. They're the battalion shrink, and so the commanding officer learns to trust them and know that they know that their job is to help preserve the fighting force as well, and not send people home and not let them get a free pass by feigning a mental illness.

Is that a complicated job to have?

As a mental health professional, you're a doctor in the military. You're both an officer and a doctor. And the patient, of course, is your primary concern. Of course the patient is always your primary concern; that's just the way it is. Now, what you do with the patient, you have a variety of options, and over here, you've got hospitals and a lot of facilities and a lot of resources, luxuries that you don't when you're in the field. When you're in the field, you're in a hard position, because you can't afford to lose anybody in the battalion. You have a responsibility to the unit as well. That's the officer part coming in, the military part of preserving the fighting unit. At the same time, you're bound by ethical code to make sure that the best treatment is provided to the individual. ...

[Can you talk about the extreme case where a soldier commits suicide. What are the circumstances in which that is more likely to happen?]

When an individual commits suicide, it's a very complicated, complex situation that has many factors. And it is not an isolated event that has occurred that is caused by a single factor. And when we do what we call postmortem autopsies, psychological autopsies, you find out an awful lot about the individual's prior history, childhood, childhood trauma, their character and their mechanisms for coping with stress. Unfortunately, a lot of individuals, after they experience psychological stress, they're afraid of the stigma of asking for help and getting mental health counseling because people will think that they're crazy. You go see the psychologist, [people think] you're crazy in a lot of families. That is just really, really awful. People start distrusting you, and they just don't know quite how to react to you. You are treated like an alien and really an abnormal individual. So they're very afraid of that stigma and the reactions of people around them.

And especially even in their unit, if you go see the shrink and people find out that you're seeing the "wizard" -- that's what they call mental health in the Marine Corps -- guys start looking at you like there's something weird about you: "Is he really out there? Is he crazy?" Well, they're not crazy; they're people with problems that just need some help to get over those problems and get back to normal and be fully functional in the unit. And also while they're going through counseling, they're still fully functional, so they're not way out there, and they're not crazy. They're just people with problems that need a little of that extra help. ...

But sometimes that doesn't happen, and as a result the individuals start doing what we call self-medicating, and the most common avenue is alcohol. And they start drinking. A drunken Marine who is depressed and in crisis is extremely dangerous to themselves and others, mainly themselves, because they have ready access to very deadly weapons. They all have a weapon, and they have live ammo frequently that goes with those weapons.

And so if you get drunk and you're out of your mind and you're distressed and you're distraught and you're not thinking straight, and you imbibe and you go over the limit where the blood-brain barrier just crashes, you really are intoxicated to the point where you have alcohol psychosis, then you become deadly, and suicide occurs. It isn't the event, and it isn't the psychological stress that kills them; it's the alcohol-induced psychosis. And they're really crazy at that time as a result of alcohol poisoning, and they commit suicide. ...

In Iraq, alcohol is very hard to get. It's supposed to be zero tolerance, no alcohol whatsoever, so most of these guys are coming back with very low tolerance, and they start drinking, and they can get really crazy. But if they start building their tolerance back up, and they've had stress and are using deployment as an excuse to continue to drink, and they continue to drink to the point where it becomes alcoholism and really alcohol dependence, they will do just about anything that a normal alcoholic, a person who is an alcoholic that wasn't in the military, will do.

You don't have to be a military alcoholic to do these sorts of things. They will start making up just unbelievable stories and provide fabrications and fantastic excuses about why they're drinking to make the individuals that are with them say, "Oh, well, then it's OK," and so that other people will understand why they're drinking. ... Mainly what they're trying to do is get people to leave them alone so that they can drink heavily and they can maintain their alcoholism. And that's what alcoholics do. ...

 

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posted march 1, 2005

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