At one or another time during the past thirty-five years, I directed human service systems in Massachusetts, Illinois, Pennsylvania, and the District of Columbia. Occasionally, I managed some reform. Too often, things went miserably.[i] No doubt, I came with an attitude.
Having obtained my graduate degree in psychiatric social work during the heyday of psychoanalytic influence on social work, with a bit of therapy, a fledgling grasp of the nomenclature, a proper professional attitude, and a modicum of technique under my belt, I enlisted in the Medical Service Corps of the United States Air Force. The Air Force was good to me.
Over the next decade, I was assigned to various Air Force psychiatric units in this country and overseas – taking a three-year hiatus to obtain a doctorate under the Air Force Institute of Technology’s sponsorship.
General George Patton embodied the dilemma that would hound psychiatry in the military from its introduction during World War II. His full slap in the face of a clueless enlisted man gave clear salience to a common attitude his peers shared but usually kept sub Rosa.
Psychiatric personnel were an embarrassment to the military – the crazy cousins who came to visit during World War II and once inside, couldn’t be allowed to leave. They knew too much about the family.
While psychiatric clinics are now a fixture in the military, they remain a contradiction to it. Any serviceman or woman – officer or enlisted – who walked through a military psychiatric clinic door puts his or her career in jeopardy.[ii]
There were only the chanciest guarantees of confidentiality. All psychiatric records were open to commanders and military investigators – if they chose to look. Most didn’t. Some did.
I wasn’t surprised to hear that my cynical assessment from 40 years ago is still largely valid. While discussing his book, Odysseus in America, Dr. Johnathan Shay, staff psychiatrist in a Boston veteran’s outpatient clinic put it bluntly. “In the armed forces today, no career NCO or officer can go to mental health without ending his career.” [The Diane Rehm Show, WAMU Washington, D.C. 12 Dec 02].
My response to this state of affairs was to fine-tune a repertoire of frankly manipulative skills. I grew chary of taking extensive notes, learned to clothe hurtful diagnoses in benign attire and kept separate files away from the base. I devised convoluted personal codes for recording my musings concerning any particular airman or officer I might be seeing – avoid ing normal channels when dealing with abnormal situations. To do otherwise, commonly hurt someone needlessly. I learned to speak bureaucratese with the best of them while keeping important decisions below the radar.
I was not surprised therefore to recently hear that my cynical assessment from 40 years earlier remained largely valid. In his relatively recent book, “Odysseus in America,” Dr. Johnathan Shay, staff psychiatrist in the Department of Veterans Affairs Outpatient Clinic in Boston put it bluntly. “In the armed forces today, no career NCO or officer can go to mental health without ending his career.” [The Diane Rehm Show, WAMU Washington, D.C. 12 Dec 02].
It was a matter of accepting the rules of the game without insisting that they be believed.
[i] Along the way, there were detours to state reform schools, detention centers, and jails – most holding juveniles – some, adults – in California, Texas, Utah, Oregon, New York, Maryland, Tennessee, Louisiana, North Carolina, Florida, Wisconsin, Virginia, Delaware, Ohio, West Virginia, and Michigan among others. I had usually been asked to assess programs or facilities that were in one way or another, seen as broken and were facing civil rights or class action suits. In the early 90s I served as “monitor’ to a federal court in overseeing its orders relative to overcrowded conditions in the nation’s fifth largest jail system. I was later appointed by the federal court in the District of Columbia to be “Receiver” of that city’s child welfare system.