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Lesson 4: We Must Be Held to a Higher Standard

I always took my role as a military officer very seriously. Those in the Air Force who I trained with frequently wrote in my quarterly counseling statements that I was “too Army.” I always took this as a compliment and sought to maintain my foundation in the Army values. Throughout my Army upbringing we frequently heard of the importance of choosing the harder right over the easier wrong, but it was not until I deployed that I realized how important that was and how much of an easier wrong would be present.

We did receive training during our military psychiatry residency to prepare for combat operational stress control, but the majority of that training focused on the battle fatigue that would result from continued offensive operations. Nothing prepared me for how to manage the morale questions that I did not consider I would encounter, such as infidelity.

Within the first few weeks I found myself discussing with my colleagues that it felt like at times that I was running an adultery support group and that a number of individuals were seeking some form of justification or affirmation that their behavior was acceptable. On several occasions I saw infidelity rip apart units, teams, and soldiers, but never considered that it might occur within our own team. However, it did and had lasting ramifications. Within a few weeks of taking over my team I received numerous complaints about one of my providers for poor boundaries including complaints of counseling in inappropriate locations (talking to patients in shower areas, inviting soldiers into her living area, etc.).

My psychologist and I would counsel this provider and discuss the risks of these actions. Each time we were baffled by the rationalization we would receive justifying the actions taken and lack of insight into making the corrections. But none of that prepared us for the day we learned of her pregnancy.

Prior to the deployment the provider was undergoing fertility treatment and even initially requested to not deploy due to the desire for fertility treatment. She was one of the first in the unit to take the two week rest and recuperation visit and she was meeting up with her husband and going to Europe. There was significant discussion throughout the unit that she would seek some fertility treatment in Europe and would become pregnant after return. To our shock, she did return from the break and shortly thereafter made us aware that she was pregnant; however, we rapidly learned that the father of the child was not her husband but one of the brigade chaplains.

This event was devastating to our credibility and effectiveness. Over the coming week’s our team had to go before the Commanding General for disciplinary action for this lack of judgment. The action became a rumor, joke, and/or story throughout the base undermining the credibility of the service. Over the coming weeks to months numerous inappropriate comments were made, including soldiers coming to behavioral health bordering on propositioning and harassing our female staff.

It took months of work to repair the damage that this event caused and to repair the team’s credibility. The worst part is that who was injured were the soldiers we were not able to help because of the lost trust in the services provided because of an event. The bottom line, deployments are a very lonely place for mental health providers, yet finding sanctuary can be difficult. But I cannot stress enough the importance of maintaining professionalism at all times.

Conclusion

In the end, my first deployment went faster than I ever could have imagined and was a rich and rewarding experience. I would have never expected that I would jump straight from residency to a war zone, but thanks to mentors who reached out on a frequent basis and provided guidance, the close friends I developed during the deployment, and my family’s support as well as the brave men and women who I had the privilege to serve with, I returned home safely. I learned key lessons of both what to and what not to do and remain in awe of the honorable men and women we serve with every day and their willingness to put themselves in harm’s way.

References

  • 1. Rock NL, Stokes JW, Koshes RJ, Fagan J, Cline WR, Jones FD. U.S. Army combat psychiatry in war psychiatry. Washington, DC: Office of the Surgeon General - Borden Institute; 1995. p. 149-75.
  • 2. Jones E, Wessely E. “Forward psychiatry” in the military: its origin and effectiveness. J Traum Stress. 2003;16:411-19.
  • 3. US Department of the Army. US Department of the Army field manual (FM) 8-51, change 1 combat stress control in a theater of operations: tactics, techniques, and procedures. Washington, DC: Headquarters Department of the Army; 1998.
  • 4. Ritchie EC, White R. Becoming a successful division psychiatrist: guidelines for preparation and duties of the assignment. Mil Med. 1993;158:644-48.

Christopher H. Warner In 2005, Christopher Warner graduated from Psychiatry/Family Practice residency program and shortly thereafter found himself on a plane headed to a combat zone in Iraq. This account highlights key lessons learned during those first crucial months in the war zone.

 
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