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Combat Stress Control: Prevention Downrange, as Preparation for Garrison

The “prevention” part was very different from other aspects of psychiatry, such as treatment. It was classes, debriefings, and the so-called “walk abouts” during which mental health providers checked in with various groups. These experiences in non- pathologizing work, rather than in the traditional model of seeing an individual and diagnosing an “illness,” helped greatly in my future work in Garrison when I was Chief of Behavioral Health and Installation Director of Psychological Health at Ft Campbell, in working with preclinical programs such as resiliency and suicide prevention.

I got to know the function and limits of such health promoting, rather than disease treating, interventions. But I never seemed to be able to reconcile how effective such things are, or whether it was a good use of my time. (For monitoring by headquarters, the reporting was done in encounters or contacts with individuals. So there was no transparency between running a psychoeducation “prevention” class versus seeing individual patients in treatment.)

The debriefing experience remains probably one of the most controversial. Specifically, there is controversy about types of psychological debriefing intended to prevent PTSD. I remember one such incident during which I taught a series of classes to members of an allied military. Their senior enlisted person—a Sergeant Major equivalent—showed up at the clinic. He explained their annual training mandates were for something akin to psychological first aid and debriefing.

Not having been trained in either of these modalities, specifically, I did some research and I put together several hours of training for them, including didactic instruction, discussion, and role-play. In retrospect, I am impressed by creatively doing my part to advance our relationships with key allies.

Having had some training in organizational consultation and executive coaching at this point, I approached all of these requests with that in mind. Specifically, I ensured I met with the leadership of the requesting organization to help formulate exactly what they wanted and why, rather than somewhat impulsively and thoughtlessly jumping into the reaction of putting a class together. One such request from a Reserve unit activated for the deployment and ended up providing a snapshot of the COB security, in which the consultation evolved into a venue for the leadership to discuss their feelings of inadequacy, as Reservists, rather than to teach stress management class, as had been originally requested.

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