Sunday, May 14, 2006

And now the shrinks are starting in... 
That's right - the mental health industry - the same industry that had the wool pulled over its eyes by a few losers who claimed to be combat vets allowed thousands of attention-seeking REMFs to clog the VA system with unwarranted PTSD claims, is now criticizing commanders in the field for sending troops into battle when they're feeling blue.

U.S. military troops with severe psychological problems have been sent to Iraq or kept in combat, even when superiors have been aware of signs of mental illness, a newspaper reported for Sunday editions.

The Hartford Courant, citing records obtained under the federal Freedom of Information Act and more than 100 interviews of families and military personnel, reported numerous cases in which the military failed to follow its own regulations in screening, treating and evacuating mentally unfit troops from Iraq.

The article specifically refers to major depression, and makes mention of suicide rates, making much of the fact that 22 soldiers committed suicide in Iraq last year. And yes, that's the fault of commanders who don't send our complainers back to the rear when they get a case of the snivels.

The article fails to mention, though, that the average national suicide rate back home for males age 20 to 34 is 22.3 per 100,000. There are currently about 120,000 personnel in Iraq at any one time. Which means the expected number of suicides for that demographic would be 26 per year. Which means that despite the heat, the hardships, the separation from family and friends, the lack of creature comforts, and despite the fact that everyone has a weapon and ammunition 24 hours a day, seven days a week, and can blow their own brains out any time, day or night on a whim, the suicide rate for soldiers in Iraq is 15.3 percent lower than the national average!

Why does it fall on me to do a reporters' job for them?

And where on earth is THAT story, Associated Press?

“I’m concerned that people who are symptomatic are being sent back. That has not happened before in our country,” said Dr. Arthur S. Blank, Jr., the most gullible psychiatrist in the history of the profession a Yale-trained psychiatrist who helped to get post-traumatic stress disorder recognized as a booming industry diagnosis after the Vietnam War.

For much more on the PTSD racket, check out Bud Burkett's excellent book Stolen Valor. Or read this.

Know what would happen if anyone who was symptomatic could get to stay home? Dr. Blank? All of a sudden, half the Army would become symptomatic! Everyone else would have to experience more stress, to give the goldbrickers a free ride. Basic game theory. Basic economics. Meanwhile, we'd be paying the goldbrickers to sit in medical holding units popping prozac and yapping their traps in (ahem) "group", and making the moves on the wives of real soldiers.

This guy Blank must be some kind of naive.

Commanders, not medical professionals, have final say over whether a troubled soldier is retained in the war zone.

Damn right. As it should be. Albert Camus wrote that military officers "know men as if they had made them." Well, I wouldn't go that far. But between us and our First Sergeants, we know them a hell of a lot better than any shrink they're likely to see.

And look who qualifies as a source:

“Your average commander doesn’t want to deal with a whacked-out soldier. But on the other hand, he doesn’t want to send a message to his troops that if you act up, he’s willing to send you home,” said Maj. Andrew Efaw, a judge advocate general officer in the Army Reserves who handled trial defense for soldiers in northern Iraq last year.

Clearly, this guy understands. But a JAG lawyer? Not a commander or First Sergeant? No trigger pullers interviewed at all? Is the AP's rolodex really that thin?

Splash, out


When you're counting apples, Jason, you can't include the oranges. That's particularly true in setting equivalencies for risk factors.

And the larger pool of US males, ages 20-34, have a more risk factors for suicides, based on CDC standards, than do the military.

Such as:
Previous suicide attempts, history of chronic illness, mental disorders, particularly depression, history of alcohol and drug abuse, barriers to accessing mental health treatment, loss of job, economic insecurity.

Are don't you agree that those factors are largely factored out of the military group?

So it's understandable that suicide rates in the overall pool of folks in the age group would be higher.

A portion of the AP story you failed to note, however, is that the increased suicide rate among soldiers serving in Iraq is:

Some service members who committed suicide in 2004 and 2005 were kept on duty despite clear signs of mental distress, sometimes after being prescribed antidepressants with little or no mental health counseling or monitoring. Those findings conflict with regulations adopted last year by the Army that caution against the use of antidepressants for “extended deployments.”

You may think PTSD is a sham, but I assure you the military docs do not. They began recently sending medical teams out closer to the troops in combat to begin dealing with the effects of battle stress early. It's shown signs of success and has made believers of some commanders to remove the stigma of seeking psych counseling.
Oh, I don't think PTSD as a battlefield stressor is a sham at all. I think PTSD to admin clerks who claim to have been Navy SEALs on classified super secret missions in Laos in order to collect 100% disability checks after the fact is a sham, though.

The military is right to intervene forward - and I worked with Army mental health officials to make that happen in my neck of the woods - and transported a lot of soldiers back to Al Asad for a two or three day "mental health break" from infantry operations in Ramadi that they sorely needed and richly deserved.

I also advocated strongly for increased mental health care for soldiers' families - especially for reserve component soldiers, who generally had no access to on base hospitals and on post support services that many active duty families take for granted (i.e., day care assistance, etc.).

Each battalion has a battalion surgeon, though - who while generally not a mental health care professional (though our battalion surgeon for a while was a psychiatrist!) is available to monitor medications and assist and advise commanders.

I also know that the prescription of prozac and other antianxiety medications for premission jitters is far from unheard of. I don't have the background to determine whether that's a good idea or not - I have to trust the judgement and knowledge of the surgeons who were doing it. I don't think it was widespread, but I think that would be an interesting story.

I'd love to see a major paper do a story on mental health care access for reserve component soldiers' families back home - because that was as big a mission detractor as anything out there. Lots of wives had nervous breakdowns while the soldier was doing fine ...and then the soldier wasn't doing fine anymore - and in some cases had to be sent home as the sole person capable of taking care of their children.

Your comments about apples and oranges are entirely appropriate - and well taken. I should also point out that it is true that the suicide rate in Iraq is substantially higher than the suicide rate within the Army overall - though I don't know how one could reasonably expect anything else.

But my chief objection is the absence of any sort of benchmarking at all. Suicide rates are just that - a rate - a statistic - and every good statistic deserves another. I thought it was a hole in the story you could drive a truck through, and I wish I could have been coaching this reporter, who actually isn't bad. The story just needed another look and a little more research before it hit the streets.
How about comparing the suicide rate of Coalition Troops to the Suicide rate of the insurgents? I would think that the insurgency is not getting it's suicide bomber the mental health treatment required.

Pyschology right now is where surgery was in the dark ages: If you weren't dead before going into surgery, you would by the time you came out. They would bleed people as a treatment for bullet wounds to get the "bad Blood" out (Up to the Civil War may I say.) If you're not crazy by the time you go see a shrink, you'll be crazy by the time you're done seeing them. Look at their cure rates. They are deplorable.
"I would think that the insurgency is not getting it's suicide bomber the mental health treatment required."

Hmmm, this would be the basis for a funny movie ala Team America. Medecins San Frontieres Paris office would do some statistics and find that the insurgents seem to have a high suicide rate and on that basis dispatch a team of psychologists to Iraq to offer mental first aid.

The hijinks begin when they find out that the high suicide rate is because...
I saw this story on MSNBC while working out in the gym. They had the obligatory angry mother (moral authority) who's son died of what the Army called an accidental overdose (not even a suicide) to berate the heartlessness of the Army.

My reaction was the same as yours - I wanted to throw a weight through the TV at the stupidity of the "drive-by media." Presumably the cliche now goes that 'war is hell,' but those that fight it must be happy.
I absolutely agree that this is not a sham, and those who truly need help should be given it. That said, former Marine Jeff Cooper has this take:

"We're told from all sides that if one wins a lethal encounter he will feel dreadful. It's odd that no one seems to have felt dreadful about this until very recently. Throughout recorded history the winning of a fight has generally been considered a subject for congratulation. It's only just now that it is tainted.

"From the Pharoahs to the Falklands, the principle feeling of the survivor of mortal combat was satisfaction; i.e., it was necessary and I'm glad I did it.

" When David slew Goliath no one records that he went into shock. Nor did Andy Jackson when he killed Dr. Dickinson in a duel, nor did Teddy Roosevelt when he was set upon in a frontier bar, nor did Grijalvo when he shot down two assassins in San Salvador...

"Police are now instructed by their supervisors that, should they get involved in a fight, their attitude afterward should be one of shock, horror, dismay and hysteria. In actuality, what they usually (and should) feel after such an experience, is pleased and proud."

Throughout history, says Cooper, surviving a terrible conflict has been deemed admirable and something to be proud of. Now, winning a mortal conflict is somehow disreputable, casting an evil cloud over the entire enterprise, whose immorality even infects it's young soldiers. It's an historically aberrant notion.

His final counsel: If it is advisable for the soldier to display distress for various ulterior reasons, that is entirely an administrative matter.
Yahoo News today is running the headline "Iraq troops free of Gulf War Syndrome" or something like that.
No one, and I mean NO ONE, should be given Zoloft or one of its cousins without proper psychiactric supervision. Civilian or Military, at home or on the road. And you do not want to be in a foxhole with someone taking these meds. Side effects include sleepiness, short attention span, and halucinations, especially when ramping up to, and down from theraputic dosage.
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