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Locked and Loaded: Safety Issues for a Deployed Psychiatrist

How can a psychiatrist practice safely, when there are loaded weapons? Practically speaking, the threat of an unsafe patient is partly dealt with by having the patients put their weapon in a rack prior to being seen, though combat weapons, including large knifes, are ubiquitous.

Firearms, aside, there was another time when a disgruntled Sergeant took to cleaning his knife in a session. I took it as a desperate veiled threat, and not surprisingly he was hospitalized shortly thereafter. Somehow on this one, despite, the 5 years of intervening time, I am still not in touch with my emotions regarding this episode—another example of an intense situation calling for strong defenses.

What I have not heard discussed is the meaning of the armed psychiatrist. I look back with a certain phallic narcissism, as I see pictures of my 9 mm holstered while I am wearing a T-shirt.

One afternoon I was in my CHU (container housing unit—a small living quarter made from a metal shipping container). There was a loud boom, an explosion, it was a mortar or rocket, and it hit just on the other side of the “T-wall” barrier near where I was living. I was fine, and it did not sink in immediately, but a few hours later, the reality of just a few meters hit me—had the mortar been aimed just slightly differently and landed on my side of the barrier, then I would have been seriously injured or even killed.

The next day two patients presented as walk-ins to our small clinic building, with acute stress symptoms from the same mortar/rocket attack. There were feeling acutely anxious, could not sleep, and were ruminating about their own potential death had they been closer. I saw these two patients, and provided several sessions of supportive psychotherapy.

What they never knew was that I had experienced the same explosion and existential anxiety. It is a rare thing for a psychiatrist to experience the same trauma, as a PTSD patient, but that happens on deployment.

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