For Robert Champ, idiot
Matthew Kruk
Painful Stories Take a Toll on Military Therapists
By BENEDICT CAREY, DAMIEN CAVE and LIZETTE ALVAREZ
This article is by Benedict Carey, Damien Cave and Lizette Alvarez.
Many of the patients who fill the day are bereft, angry, broken. Their
experiences are gruesome, their distress lasting and the process of
recovery exhausting. The repeated stories of battle and loss can leave
the most professional therapist numb or angry.
And hanging over it all, for psychiatrists and psychologists in today's
military, is the prospect of their own deployment - of working under
fire in Iraq or Afghanistan, where the Pentagon has assigned more
therapists to combat units than in previous wars.
That was the world that Maj. Nidal Malik Hasan, an Army psychiatrist,
inhabited until Thursday, when he was accused of one of the worst mass
shootings ever on a military base in the United States, an attack that
killed 13 and left dozens wounded. Five of the dead were fellow
therapists, the Army said.
Major Hasan's motives are still being investigated. But those who work
day in and day out treating the psychological wounds of the country's
warriors say Thursday's rampage has put a spotlight on the strains of
their profession and of the patients they treat.
Major Hasan was one of a thin line of military therapists trying to hold
off a rising tide of need. So far this year, 117 soldiers on active duty
were reported to have committed suicide. The Army has only 408
psychiatrists - military, civilian and contractors - serving about
553,000 active-duty troops around the world. As a result, some soldiers
home from war, suffering from nightmares and panic attacks, say they
have waited almost a year to see a psychiatrist.
Many military professionals, meanwhile, describe crushing schedules with
10 or more patients a day, most struggling with devastating trauma or
mutilated bodies that are the product of war and the highly advanced
care that kept them alive.
Some of those hired to heal others end up needing help themselves. Some
go home at night too depressed to talk to their children. Others, like
Bret A. Moore, a former Army psychologist at Fort Hood, ultimately quit.
"I planned for a career in the military, but I burned out" after about
five years, he said.
The biggest problem, Dr. Moore said, was "compassion fatigue."
"I thought that was a bogus phenomenon, but it's true," he said. "You
become detached, you start to feel like you can't connect with your
patients, you run out of empathy. And the last thing you want to do is
talk about it with someone else. It really puts a wedge between you and
loved ones."
Whatever the facts in Major Hasan's case, some therapists who work with
the military agree that the tragedy is likely to have a "lasting impact
on how we look at mental health providers," said Dr. Martin Paulus, a
psychiatrist at the University of California, San Diego, and the
Veterans Affairs San Diego Healthcare System.
The Army has added to their ranks in recent years, as the number of
soldiers with the diagnosis of post-traumatic stress disorder has
climbed to 34,000. But the shooting has raised a pressing question: Who
counsels the counselors? Dr. Moore and other therapists who have worked
in the military or for Veterans Affairs said that mental health
evaluations of therapists themselves were virtually nonexistent.
"I have worked with the Army, the Navy, the V.A., and I'm not aware of
any formal, systematic process to evaluate professionals," said Dr. Andy
Morgan, a psychiatrist at the National Center for P.T.S.D.
At Walter Reed, where Major Hasan was in training until recently, Lt.
Col. Brett Schneider, a psychiatrist, described a complicated system of
checks and balances, including a training committee with superiors and
civilians who evaluate residents and mental health staff members.
"There is a lot more built into the processes to keep tabs on each
other," said Colonel Schneider, who spoke on the condition that he not
be asked any questions about Major Hasan. "If somebody is starting to
get to the point where these things are a problem, there are a number of
ways we can intervene."
Generally, though, the military, like many large civilian employers,
relies on self-evaluation and voluntary employee-assistance programs.
"Once training is over, you're basically on your own," Dr. Paulus said.
At Fort Hood, the nation's largest military base, Major Hasan, like
other therapists, would have had to manage many patients with severe
combat stress. At his relatively high rank, he would have been expected
to seek help on his own if he thought he needed it, experts said.
The base sees continual traffic in and out of war zones, and the work
conditions are especially stressful, according to at least one report
provided to the Army.
Dr. Stephen M. Stahl, a psychiatrist at the University of California,
San Diego, who worked on the report, said the base's program for
soldiers returning from war simply lacked the staff it needed. He said
there were about 15 psychiatrists on staff, treating hundreds of
inpatients and outpatients. Generally, the psychiatrists did not do
therapy but prescribed medication.
"They're so under-resourced that people just don't end up getting enough
care," Dr. Stahl said.
He added: "It's a pretty damn stressful place to be. I think it's a
horrible place to practice psychiatry."
Soldiers described similar situations at many other installations. Jason
Yorty, 34, an Arabic linguist with the Army who deployed to Iraq four
times and Afghanistan once, said that when he returned to Fort Gordon in
Georgia two years ago, the system appeared to be overwhelmed and
resistant to diagnosing problems that would require multiple visits.
First, he said, he saw a physician's assistant at the base, then a
clinical social worker, neither of whom agreed that his nightmares and
panic attacks amounted to post-traumatic stress disorder. "It took me
eight months just to get an appointment to see a psychiatrist," he said.
"When I got there, he blew me off."
A few weeks later, after he refused the Army psychiatrist's prescription
for a sleep aid, a nonmilitary mental health provider gave him a
diagnosis of P.T.S.D.
Experts say that the military has made big strides in taking mental
health issues seriously, but that military therapists are sometimes
pressured to place the needs of the force above the needs of the
patient. Indeed, they can be overruled by commanders who need soldiers
in the field.
Since 2001, the military has deployed many soldiers with post-traumatic
stress disorder or other ailments. "The focus in the military is
readiness," said Charles Figley, a psychologist at Tulane University.
"There is an inherent conflict."
And in war zones, the relationships between soldiers and mental health
providers can be especially fraught. Therapists in Iraq said that they
could often do little more than provide a few coping tips to soldiers,
just enough to keep them functioning. There were simply too many people
and not enough time, as Army officials have acknowledged.
Providing care has its own risks. In studies of therapists working to
soothe mental distress in victims of violence, whether criminal, sexual
or combat-related, researchers have documented what is called secondary
trauma: contact distress, of a kind. In one 2004 study of social workers
on cases stemming from the Sept. 11 attacks, researchers found that the
more deeply therapists were involved with victims, the more likely they
were to experience such trauma. The same associations have been found in
doctors working with survivors in war zones.
Dr. Hasan was reportedly facing his first deployment - a prospect that
scares even trained fighters, many of whom become increasingly frantic
before going to war, according to surveys.
The workload itself is enough to give psychiatrists and psychologists
pause. In Iraq, with sectarian violence at its peak in 2007, officials
say there were 200 such specialists serving more than 130,000 troops,
driving between bases on bomb-rigged roads.
The experience of Lt. Col. Reagon P. Carr was common. In six months with
the Second Brigade of the 10th Mountain Division in 2007, he said he saw
more than 700 soldiers. In one typical week, he visited three locations,
meeting with 36 soldiers who came in for immediate help: 3 were
contemplating suicide, a dozen were unable to sleep, 5 said they were
apprehensive about returning to a dysfunctional marriage and 16 said
they were disgruntled with their leadership.
Few who are deployed feel prepared for this punishing task.
Dr. Peter Linnerooth, a former Army psychologist who treated soldiers in
Germany and Iraq and at Fort Hood, said that in Schweinfurt, Germany, he
was the sole psychologist for a community of 10,000 people in 2005.
At Fort Hood, he treated a burly man whose job in Iraq was to recover
the bodies of soldiers. His patient was devastated by one particular
loss, Dr. Linnerooth said.
"He had picked up this corpse that was so badly burned, it weighed about
20 pounds," he said. "He was this big, tough, awesome guy. For him, it
was like picking up his daughter. That was an extreme case. But you get
those at least once or twice a week."
If it turns out that Major Hasan did in fact break partly under the
stress of the job and impending deployment, many veterans would not be
surprised.
"If this guy can go over the edge, imagine what it is like for the
actual combat troops who have been through four or five deployments,"
said Bryan Hannah, 22, a disabled Iraq war veteran from San Marcos,
Tex., who was stationed at Fort Hood until he was discharged a year ago
because of post-traumatic stress disorder and other injuries.
He added, "There are a lot of others who are worse off than him."
Erica Goode and Gretel C. Kovach contributed reporting.
Copyright 2009 The New York Times Company
Magnus
> November 8, 2009
> Painful Stories Take a Toll on Military Therapists
> By BENEDICT CAREY, DAMIEN CAVE and LIZETTE ALVAREZ
>
> This article is by Benedict Carey, Damien Cave and Lizette Alvarez.
>
> Many of the patients who fill the day are bereft, angry, broken. Their
> experiences are gruesome, their distress lasting and the process of
> recovery exhausting. The repeated stories of battle and loss can leave
> the most professional therapist numb or angry.
>
Painful stories. Then get out of the business. A psychiatrist gets
paid to hear painful stories.
Idiot? I'm twice as smart as you are, Matt--as evidenced by your
frequent dollops of nonsense.
Your attacks are almost as dumb as Fuego's.
Magnus
islanders
>
> Idiot? I'm twice as smart as you are, Matt--as evidenced by your
> frequent dollops of nonsense.
Only twice? Don't underestimate. roy is twice as smart as krucky.