Psyche, Science, and Society

CIA ordered to release cold war human research documents

guinea pigsguinea pigsIt is well known that the CIA conducted horrific experiments on many people, including US troops, during the cold war. A group of veterans is suing the government for using troops as human guinea pigs in studies of chemical, biological, and psychological weapons in the MKULTRA, Artichoke, Bluebeard and other CIA programs. The plaintiffs have just won a major victory as the judge has ruled that the CIA must release a broad range of documents on these experiments that they are still trying to hide.

The judge came near to accussing the CIA of lying in order to withhold the documents:

The CIA insisted discovery was unwarranted in its case, because it never funded or conducted drug research on military personnel.
Larson wasn’t convinced.
“[T]his court rejects the conclusion that the CIA necessarily lacks a nexus to Plaintiffs’ claims, and orders the CIA to respond in earnest” to the veterans’ requests, “particularly because defendants have presented evidence that would appear to cast doubt on that conclusion,” he wrote.

Now we need some brave judge to order the CIA to release documents on recent CIA research on detainees.

November 17th, 2010

Levine: Soldiers need critical, not positive thinking

Psychologist Bruce Levine questions the rationale‘ for the Army’s plan to train the entire force in “positive psychology”:

By Bruce E. Levine

While U.S. military psychiatrists are prescribing increasing amounts of chill pills, America’s psychologists are teaching soldiers how to think more positively about their tours in Afghanistan, Iraq, and wherever else they are next ordered to kill the bad guys and win the hearts and minds of everyone else.

The U.S. Army is planning to require that all 1.1 million of its soldiers take intensive training in positive psychology and emotional resiliency. Army Research Psychologist Capt. Paul Lester, who leads the assessment of the program, told the National Psychologist (“Army to Train its Own in Positive Psychology,” July/August 2010), “As far as I can tell this is the largest, deliberate, psychological intervention in human history. . . We don’t know when the global war on terrorism is going to end so we’re preparing to have to be engaged for a long period of time.”

Lester said the program would develop “communication skills, cognitive reforming skills and help soldiers not to catastrophize — don’t think of the worse case scenario about every potential problem.” The program also teaches soldiers to focus on “expressing appreciation” and “correcting negative views of ambiguous events.”

In August 2009, the New York Times reported that Gen. George W. Casey Jr., the Army’s chief of staff, said the total cost of this program would be $117 million. The New York Times was alerted to the program by psychologist Martin Seligman, director of the University of Pennsylvania Positive Psychology Center, who has been consulting with the Pentagon. Seligman’s particular program at Penn is costing the U.S. Army $25 to $30 million, according to the Philadelphia Inquirer, which in its profile of Seligman (May 30, 2010) noted that he “confidently walked the line between grand and grandiose;” and it quoted him asserting, “We’re after creating an indomitable Army.”

Seligman initially thought that training the entire Army would be nearly an impossible chore because of the enormous number of teachers required. However, Gen. Casey informed him that the Army had 40,000 teachers. “You do?” Seligman said. “Yes,” Casey retorted, they’re called drill sergeants.” Now 150 sergeants come to Penn each month to take a course in positive psychology.

At one training session given at a hotel near Penn, according to the New York Times, 48 sergeants in full fatigues sat at desks, took notes, and role played. In one exercise, Sgt. First Class James Cole of Fort Riley, Kansas and his classmate transformed Sgt. Cole’s negative thinking about an order late in the day to have Sgt. Cole’s exhausted men do one last difficult assignment.

“Why is he tasking us again for this job?” the classmate asked, pretending to be Sgt. Cole. “It’s not fair.”

Sergeant Cole gave the “correct” positive-thinking response, “Maybe he’s hitting us because he knows we’re more reliable.”

While positive psychology makes some sense for teenagers who are catastrophizing their first relationship breakup to the point of becoming suicidal, how much sense does it make to teach soldiers who are trying to stay alive in a war zone to put a positive spin on everything? Moreover, wouldn’t soldiers like their officers to consider worst-case scenarios before ordering them into combat? And wouldn’t soldiers like politicians to take seriously worst-case scenarios before embarking on a war? The healthy option to negative thinking is not positive thinking but critical thinking. Barbara Ehrenreich, author of Bright-sided and astute critic of the dark side of positive thinking and positive psychology, points out:

It’s easy to see positive thinking as a uniquely American form of naivete, but it is neither uniquely American nor endearingly naive. In vastly different settings, positive thinking has been a tool of political repression worldwide. . . In the Soviet Union, as in the Eastern European states and North Korea, the censors required upbeat art, books, and films, meaning upbeat heroes, plots about fulfilling production quotas, and endings promising a glorious revolutionary future. . . The penalties for negative thinking were real. Not to be positive and optimistic was to be ‘defeatist’. . . Accusing someone of spreading defeatism condemned him to several years in Stalinist camps.

While the U.S. military has only recently become excited about positive psychology techniques, it has, for the last decade, increasingly used psychiatric drugs to keep soldiers going. One in six service members is now taking at least one psychiatric drug, according to the Navy Times (“Medicating the Military,” March 17, 2010), with many soldiers taking “drug cocktail” combinations. Soldiers and military healthcare providers report that psychiatric drugs are “being prescribed, consumed, shared and traded in combat zones.” While soldiers’ increasing use of antidepressants is troubling enough (as the Food and Drug Administration now requires warnings on antidepressants about their increasing the risk of “suicidality” in children, teenagers, and young adults), what’s as or even more worrisome is the increase of other psychiatric drugs. In the last decade, antipsychotic drug use in the U.S. military has increased more than 200 percent, and anti-anxiety drugs and sleeping pills have increased 170 percent. These kinds of drugs impair motor skills, reduce reaction times, and generally make one more sluggish — or what soldiers call “stupid,” as the Navy Times notes.
While pushing drugs and teaching positive thinking earns mental health professionals money and brownie points with the elite, there is another path for mental health professionals working with U.S. soldiers. First, offer soldiers respect for their critical thinking, even if such critical thinking brings them to conclusions unwanted by their superiors. Second, if soldiers are anxious or angry because they believe that an ego-tripping commanding officer is going to get them killed, do NOT tell them to stop “catastrophizing”; instead take what they say seriously. And if soldiers are depressed because they have seen too much death, instead of directing them to “express appreciation,” try offering genuine compassion. But don’t stop with only compassion. Speak truth to power. Tell politicians who are maintaining America’s wars and planning still others: Don’t kid yourself into thinking positive psychology and chill pills are the answers, especially if soldiers and veterans discover that you deceived them about the necessity and the meaningfulness of their mission. Psychologists should loudly warn politicians, military brass, and the nation that if soldiers and veterans discover that they have been deceived about the meaningfulness and necessity of their mission, it is only human for them to become more prone to emotional turmoil, which can lead to destructive behaviors for themselves and others.

Bruce E. Levine is a clinical psychologist and author of Surviving America’s Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green Publishing).

August 4th, 2010

Army failing with wounded warrior program

Feeling Warehoused in Army Trauma Care Units

By James Dao and Dan Frosch

A year ago, Specialist Michael Crawford wanted nothing more than to get into Fort Carson’s Warrior Transition Battalion, a special unit created to provide closely managed care for soldiers with physical wounds and severe psychological trauma.

A strapping Army sniper who once brimmed with confidence, he had returned emotionally broken from Iraq, where he suffered two concussions from roadside bombs and watched several platoon mates burn to death. The transition unit at Fort Carson, outside Colorado Springs, seemed the surest way to keep suicidal thoughts at bay, his mother thought.

It did not work. He was prescribed a laundry list of medications for anxiety, nightmares, depression and headaches that made him feel listless and disoriented. His once-a-week session with a nurse case manager seemed grossly inadequate to him. And noncommissioned officers — soldiers supervising the unit — harangued or disciplined him when he arrived late to formation or violated rules.

Last August, Specialist Crawford attempted suicide with a bottle of whiskey and an overdose of painkillers. By the end of last year, he was begging to get out of the unit.

“It is just a dark place,” said the soldier, who is waiting to be medically discharged from the Army. “Being in the W.T.U. is worse than being in Iraq.”

Created in the wake of the scandal in 2007 over serious shortcomings at Walter Reed Army Medical Center, Warrior Transition Units were intended to be sheltering way stations where injured soldiers could recuperate and return to duty or gently process out of the Army. There are currently about 7,200 soldiers at 32 transition units across the Army, with about 465 soldiers at Fort Carson’s unit.

But interviews with more than a dozen soldiers and health care professionals from Fort Carson’s transition unit, along with reports from other posts, suggest that the units are far from being restful sanctuaries. For many soldiers, they have become warehouses of despair, where damaged men and women are kept out of sight, fed a diet of powerful prescription pills and treated harshly by noncommissioned officers. Because of their wounds, soldiers in Warrior Transition Units are particularly vulnerable to depression and addiction, but many soldiers from Fort Carson’s unit say their treatment there has made their suffering worse.

Some soldiers in the unit, and their families, described long hours alone in their rooms, or in homes off the base, aimlessly drinking or playing video games.

“In combat, you rely on people and you come out of it feeling good about everything,” said a specialist in the unit. “Here, you’re just floating. You’re not doing much. You feel worthless.”

At Fort Carson, many soldiers complained that doctors prescribed drugs too readily. As a result, some soldiers have become addicted to their medications or have turned to heroin. Medications are so abundant that some soldiers in the unit openly deal, buy or swap prescription pills.

Heavy use of psychotropic drugs and narcotics makes it difficult to exercise, wake for morning formation and attend classes, soldiers and health care professionals said. Yet noncommissioned officers discipline soldiers who fail to complete those tasks, sometimes over the objections of nurse case managers and doctors.

At least four soldiers in the Fort Carson unit have committed suicide since 2007, the most of any transition unit as of February, according to the Army.

Senior officers in the Army’s Warrior Transition Command declined to discuss specific soldiers. But they said Army surveys showed that most soldiers treated in transition units since 2007, more than 50,000 people, had liked the care.

Those senior officers acknowledged that addiction to medications was a problem, but denied that Army doctors relied too heavily on drugs. And they strongly defended disciplining wounded soldiers when they violated rules. Punishment is meted out judiciously, they said, mainly to ensure that soldiers stick to treatment plans and stay safe.

“These guys are still soldiers, and we want to treat them like soldiers,” said Lt. Col. Andrew L. Grantham, commander of the Warrior Transition Battalion at Fort Carson.

The colonel offered another explanation for complaints about the unit. Many soldiers, he said, struggle in transition units because they would rather be with regular, deployable units. In some cases, he said, they feel ashamed of needing treatment.

“Some come to us with an identity crisis,” he said. “They don’t want to be seen as part of the W.T.U. But we want them to identify with a purpose and give them a mission.”

Drugs and Addiction

Sgt. John Conant, a 15-year veteran of the Army, returned from his second tour of Iraq in 2007 a changed man, according to his wife, Delphina. Angry and sullen, he reported to the transition unit at Fort Carson, where he was prescribed at least six medications a day for sleeping disorders, pain and anxiety, keeping a detailed checklist in his pocket to remind him of his dosages.

The medications disoriented him, Mrs. Conant said, and he would often wander the house late at night before curling up on the floor and falling asleep. Then in April 2008, after taking morphine and Ambien, the sleeping pill, he died in his sleep. A coroner ruled that his death was from natural causes. He was 36.

Mrs. Conant said she felt her husband never received meaningful therapy at the transition unit, where he had become increasingly frustrated and was knocked down a rank, to specialist, because of discipline problems.

“They didn’t want to do anything but give him medication,” she said.

Other soldiers and health care workers at Fort Carson offered similar complaints. They said that most transition unit soldiers were given complex cocktails of medications that raised concerns about accidental overdoses, addiction and side effects from interactions.

“These kids change their medication like they change their underwear,” said a psychotherapist who works with Fort Carson soldiers and asked that his name not be used because he was not authorized to speak publicly about the transition unit. “They can’t even remember which pills they’re taking.”

Some turned to heroin, which is readily available in the barracks, after becoming addicted to their pain pills, according to interviews with soldiers and health care professionals at Fort Carson.

“We’re all on sleep meds, anxiety meds, pain meds,” said Pfc. Jeffery Meier, who is in the transition unit and said he knew a dozen soldiers in the unit, including a recent roommate, who had used heroin. “The heroin is all that, wrapped into one.”

Fort Carson officials said that addiction to prescription drugs was no more prevalent in the Army than in the civilian world, and that medication was just one element of a balanced treatment that includes therapy.

But they acknowledged that they had found heroin abuse in the transition unit and said they were trying to reduce the use of opiates and synthetic opiates to prevent addiction, not always with success.

“There is active resistance, because they are addicted,” said Lt. Col. Joel Tanaka, the Warrior Transition Battalion surgeon at Fort Carson. “We’ve learned if we don’t assist them and wrap our arms around them, then they go off post and get these drugs illegally.”

Jess Seiwert offers a cautionary tale. A staff sergeant and sniper who was knocked unconscious by roadside bombs in Iraq, he returned to Fort Carson in late 2006 with post-traumatic stress disorder, burns and a variety of aches. Prone to bouts of rage, he often drank himself to sleep and began abusing the painkiller Percocet.

Medical records show that Sergeant Seiwert’s captain thought he was a danger to his wife and needed inpatient psychiatric care. Instead, the sergeant was transferred into Fort Carson’s transition unit in 2008.

In a recent interview, Mr. Seiwert, now discharged from the Army, said he received minimal therapy in the unit but was given ample medication, including the painkillers he abused. “I should have been in inpatient rehab to get me off the drugs,” he said.

Last summer, just months after being medically discharged, he badly beat his wife while bingeing on alcohol and Percocet. He pleaded guilty to a second-degree assault charge and is likely to face five years in prison.

‘Making Things Worse’

Like private outpatient clinics, Warrior Transition Units aim to provide highly individualized care and ready access to case managers, therapists and doctors. But the care is organized in a distinctly Army way: noncommissioned officers, known as the cadre, maintain discipline and enforce rules, often using traditional drill-sergeant toughness with junior enlisted soldiers.

At the top of the command are traditional Army officers, not health care professionals: Brig. Gen. Gary Cheek, head of the Warrior Transition Command, was an artillery officer, and Colonel Grantham an intelligence officer.

Beneath them is what the Army calls its triad of care. Members of the cadre keep a close eye on individual soldiers, much like squad leaders in regular line units. Nurse case managers schedule appointments and assist with medications and therapy. And primary care managers — doctors, physicians’ assistants or nurse practitioners — oversee care and prescribe medicines.

The structure is intended to ensure that every soldier gets careful supervision and that Army values and discipline are maintained. But many soldiers at Fort Carson complained that discipline and insensitive treatment by cadre members made wounded soldiers feel as if they were viewed as fakers or weaklings.

James Agee, a former staff sergeant who transferred into the transition unit after returning from his second tour of Iraq in 2008, said he frequently heard cadre members verbally abuse medicated soldiers who were struggling to get out of bed for morning formation or stay awake for all-night duty.

“They would say, ‘These guys can’t do this because they are crazy,’ ” said Mr. Agee, who received a medical discharge from the Army. “It would make you feel like you were inferior.”

One Army specialist in the unit, who received diagnoses of post-traumatic stress syndrome and traumatic brain injury, said he was ordered to perform 24-hour guard duty repeatedly against the orders of his doctor. The specialist, who asked to remain anonymous because he feared repercussions, said he experienced flashbacks to Iraq during the long hours by himself.

In many cases, the noncommissioned officers have made it clear that they do not believe the psychological symptoms reported by the unit’s soldiers are real or particularly serious. At Fort Hood, Tex., a study conducted just before the shooting rampage there last November — which found that many soldiers in the Warrior Transition Unit thought their treatment relied too heavily on medication — also concluded that a majority of the cadre believed that soldiers were faking post-traumatic stress or exaggerating their symptoms.

Christina Perez, the wife of a transition unit soldier from Fort Carson, said she got into an ugly fight with a member of the cadre who was furious that she had gone over his head to request additional therapy for her husband, a sergeant first class who had sustained a brain injury during one of two tours in Iraq as a tank gunner.

In a meeting, the noncommissioned officer shouted that Ms. Perez’s husband did not deserve his uniform and that he should give it to her instead, Ms. Perez said in a police complaint. No charges were brought.

Eventually her husband, who has headaches and memory loss, was transferred to an inpatient psychiatric clinic in Denver while he awaits a medical discharge. “All they do is make things worse,” Ms. Perez said of the transition unit.

Last year, The Associated Press reported that the transition unit at Fort Bragg in North Carolina had a discipline rate three times as high as the 82nd Airborne Division, the base’s primary occupant.

General Cheek said the Army’s own survey of other major posts showed that discipline rates in transition units were about the same as in regular units.

He asserted that most cadre members, who receive extra pay and training for the job, do their jobs well, working long hours and spending weekends checking on soldiers. Discipline, he said, is a form of tough love.

“If we are going to maintain safe discipline, all rules must apply,” the general said. “We do have an expectation that our soldiers want to get better.”

Bureaucratic Delays

Sgt. Keith Nowicki was an intelligence analyst who was sent back early from his second deployment to Iraq in April 2008 because of severe post-traumatic stress disorder, said his wife, Ashley. Assigned to the Fort Carson transition unit, he spent nearly a year waiting for his medical discharge.

Instead of getting the help he hoped for, he spent much of the time in the unit alone, growing increasingly angry, drinking heavily and abusing Percocet. In early 2009, he separated from his wife. While on the phone with her in March 2009 he shot himself to death. He was due to be discharged at the end of the month.

Though Ms. Nowicki does not attribute her husband’s suicide to the long wait for his discharge, she said the slowness of the process and the lack of support from the transition unit added to his sense of hopelessness.

“It was just a bunch of red tape,” Ms. Nowicki said. “He would spend days trying to track down his own medical records.”

Army officials acknowledged that wait times for medical discharges at Fort Carson had grown. A major reason is that Fort Carson is part of a pilot program with the Department of Veterans Affairs in which the Army and the V.A. collaborate in evaluating soldiers’ injuries. The collaboration between the two bureaucracies is expected to speed up veterans benefits once a soldier leaves the Army, but it can lengthen the initial evaluation period, officials said.

Michael Crawford has been waiting more than a year for his medical discharge. As his anxiety and depression have worsened, so have his problems in the unit. His rank was recently reduced to private in punishment for overstaying leave and using marijuana.

But things are looking up, his mother believes: he will be able to stay with her in Michigan while awaiting his discharge. His mother, Sally Darrow, has already seen one son commit suicide. She believes that Michael would become the second if he had to return to Fort Carson and the transition unit.

“At home, with family and schoolmates, he’s dealing with things better,” Ms. Darrow said. “He’s not safe there.”

April 26th, 2010

Military still using fake personality disorder diagnoses

Joshua Kors, in the Nation, indicates that the military is still using apparently bogus personality disorder diagnoses to kick out service members without the benefits to which they are entitled. In this article he tells of Sergeant Chuck Luther, a 19-year veteran who reportedly was held in isolation for a month and subjected  to sleep deprivation in order to force him to sign papers accepting the personality disorder diagnosis. After a months,

Luther was called to his commander’s office. Major Wehri was frank. He held the personality disorder discharge papers in his hand. “And he said, ‘Sign this paperwork, and we’ll get you out.’ I said, ‘I don’t have a personality disorder.’ But it was like that didn’t matter,” says Luther. “He said, ‘If you don’t sign this, you’re going to be here a lot longer.’”

The Major, in giving his account of the origins of Sgt. Luther’s, actually contradicts a personality disorder diagnnosis:

The major says Luther’s real story is that of a good soldier who came home for leave, saw his wife’s new haircut and slimmed figure and was driven mad by fears of her infidelity. “When he came back to Iraq, something had changed. He had a negative attitude. He wouldn’t respond to direct orders. His head wasn’t in the game.” Wehri says it became clear to him that Luther was intent on returning home right away, a realization that left him disappointed but not shocked. “Soldiers are conniving,” he says. “They are manipulative. If they get in their minds they want to do something for personal gain, including going home, they’ll go to any lengths to get it.”

While the Major denies that Luther’s military experience caused his problems:

Wehri rejects the idea that the mortar attack and subsequent concussion could have triggered Luther’s woes. “That mortar attack was nothing,” he says. “Insignificant. Maybe he fell down. Sure. I’ve fallen down lots of times.” The major wonders aloud whether Luther is using that injury to justify his instability. He says if he thought the attack was significant, he would have investigated it fully and gotten the ball rolling for a Purple Heart.

Even if [and I mean IF] the Major’s account was true, a condition that doesn’t show symptoms until a person is in his late thirties or older is not a personality disorder. PDs must  last for at least five years for a diagnosis to even be considered. The military’s own account shows that the PD diagnosis is a fraud.

The Major also claimed:

The major says that when Luther’s troubles began, the sergeant’s behavior confounded him. Then, says Wehri, he heard from a commander who said Luther’s family had spoken with him and revealed that Luther had suffered from psychiatric problems before entering the military and had been treated with medication. “Then suddenly it made sense to me,” says Wehri. “This was not new. His symptoms were just popping up now, after he’d kept a lid on them for many years. It all clicked into place.”

The family denies that any such conversation ever took place, or that Luther had earlier psychiatric problems. But, in this case, the truth or falsity of the claims is irrelevant. If Luther had had psychiatric treatment 19 years earlier, before he enlisted, and “kept a lid on them for many years,” by definition, he did not have a personality disorder.

The personality disorder diagnosis ended Luther’s military career. He was shipped stateside and quickly discharged. In the process he learned the result of accepting a personaliy disorder diagnosis:

he was ineligible for disability benefits, since his condition was pre-existing. He would not be receiving the lifetime of medical care given to severely wounded soldiers. And because he did not complete his contract, he would have to return a slice of his signing bonus.At the base, a Fort Hood discharge specialist laid out the details. “He said I now owed the Army $1,500. And if I did not pay, they’d garnish my wages and assess interest on my debt,” Luther says.

Luther was then released into a pelting Texas rain. He called his wife, Nicki, to pick him up. “When I got to Fort Hood he was in the parking lot, alone, wet, sitting on his duffel bag,” Nicki recalls. “He had lost a lot of weight. He looked like…a little boy. I remember thinking, My God, what have they done to my husband?”

He gave 19 years and dumped on the side of the road.

Luther’s case is not unique. As Kors summarizes:

In the past three years, The Nation has uncovered more than two dozen cases like his from bases across the country. All the soldiers were examined, deemed physically and psychologically fit, then welcomed into the military. All performed honorably before being wounded during service. None had a documented history of psychological problems. Yet after seeking treatment for their wounds, each soldier was diagnosed with a pre-existing personality disorder, then discharged and denied benefits.

That group includes Sgt. Jose Rivera, whose hands and legs were punctured by grenade shrapnel during his second tour in Iraq. Army doctors said his wounds were caused by personality disorder. Sailor Samantha Stitz fractured her pelvis and two bones in her ankle. Navy doctors cited personality disorder as the cause. Spc. Bonnie Moore developed an inflamed uterus during her service. Army doctors said her profuse vaginal bleeding was caused by personality disorder. Civilian doctors disagreed: they performed emergency surgery to remove her uterus and appendix. After being discharged and denied benefits, Moore and her teenage daughter became homeless.

Former Senator Obama filed a bill to address the problem. It got watered down to a call for an investigation, which President Bush signed. The investigation, like so many others where the military investigates itself, was a complete whitewash:

The Pentagon’s conclusion: no soldiers had been improperly diagnosed, and none had been wrongly discharged. The report praises the military’s doctors as “competent professionals” and endorses continued use of pre-existing personality disorder to discharge soldiers whose “ability to function effectively” is impaired. The report’s author, former Under Secretary of Defense David Chu, further notes that though the Navy’s official label for the discharge is “Separation by Reason of Convenience of the Government,” soldiers “are not wantonly discharged at the convenience of the Military.”It is unclear how Chu came to these conclusions. The report does not cite any interviews with soldiers discharged with personality disorder, or their families, doctors or commanders. That fact infuriated many military families, as it triggered memories of a 2007 study by former Army Surgeon General Gale Pollock. Pollock had been asked to examine a stack of PD cases. Five months later she released her report, saying her office had “thoughtfully and thoroughly” reviewed them. Like Chu, she commended the soldiers’ doctors and determined that they all had been properly diagnosed. The Nation later revealed that Pollock’s office did not interview anyone, not even the soldiers whose cases she was reviewing [see Kors, "Specialist Town Takes His Case to Washington," October 15, 2007].

“He doesn’t talk to soldiers, and he doesn’t talk to their families?” says Nicki Luther, the sergeant’s wife, her eyes welling with tears. “I heard the same thing from that surgeon general, and I thought, You haven’t been in my house. You don’t know what I’ve dealt with. How dare you sit there and say you’ve investigated thoroughly and found nothing. That’s a crock.”

His life falling apart, Luther sought help from a psychologist, this time, one outside the military:

This time he sought it outside the military. He began seeing Troy Daniels, a psychologist, once a week. One fact was clear immediately, says Daniels. “He did not have personality disorder. The symptoms we were looking at looked more like traumatic brain injury and post-traumatic stress disorder. To take a soldier having problems with vision, hearing and so forth–and to say he has personality disorder–that’s a bogus kind of statement. I don’t even think a master’s student would make that kind of mistake.”While Daniels dismisses the Army doctors’ diagnosis as a “gross error,” he says he was not surprised by it. “I’ve treated hundreds of soldiers over the years, and I’ve seen a dozen personality disorder diagnoses. None of them,” says the psychologist, “actually had personality disorder.”

Yet all of those soldiers, he says, faced serious repercussions because of their discharge. “Many of the soldiers can’t get hired anymore. Every time they go for a job, they’ll have this paper that says they’ve been diagnosed with a personality disorder. Employers take one look at that and think, ‘This guy’s crazy. We can’t hire him.’ For most of the soldiers,” says Daniels, “it becomes a lifetime label.”

After a battle, the VA agreed:

This past December–after VA doctors found Luther to be suffering from migraine headaches, vision problems, dizziness, nausea, difficulty hearing, numbness, anxiety and irritability–the VA cited traumatic brain injury and post-traumatic stress disorder and declared Luther 80 percent disabled. “PTSD, a consequence of the TBI,” wrote one VA doctor, “is a clear diagnosis.”

But the army won’t budge:

The VA rating cleared the way for the sergeant to receive disability benefits and a lifetime of medical care. But it hasn’t changed the Army’s view–or altered Luther’s discharge papers, which still list the sergeant as suffering from personality disorder. The sergeant, in return, has refused to pay back the $1,500 of his signing bonus that the Army says he owes, despite threats to garnish his wages. “I told them, Let me put it this way: as long as I’m breathing of my own free will, I’m not paying you a dime.”

Luther is fighting back, but he is still under attack from someone:

Luther is now the founder and executive director of Disposable Warriors, a one-man operation that assists soldiers who are fighting their discharge and veterans who are appealing their disability rating.Luther’s organization did not receive a hero’s welcome. Soon after founding the group, he discovered a threatening note on his windshield. “Back off or you and your family will pay!!” it read, in careful, black ink cursive. Weeks later, thieves broke into the home of a veterans’ organizer who worked closely with Luther, taking nothing but the files of the soldiers they were assisting.

It is long past time that the scandal of false personality disorder diagnoses stop. Any diagnosis that wasn’t detected in pre-deployment screening should be irrelevant anyway.  These soldiers gave their all. They deserve to be taken care of. Period.

1 comment April 14th, 2010

Psychiatrist warning of violence danger among returned Marines fired

UPDATED AND EXPANDED: In the wake of the Fort Hood tragedy, there have been media reports that mental health staff had been concerned about Major Hasan, but did not report their concerns to higher authorities. Rather, these staff hoped he would disappear, into Fort Hood and then Afghanistan.The press and pundits have been extremely critical of those professionals for failing on act on their concerns.

Meanwhile, Mark Benjamin today tells of a psychiatrist serving the military who did express his concerns about potential tragedy, and was “disappeared” by firing as a consequence. Benjamin tells the story of Dr. Kernan Manion, a civilian contract psychiatrist at Camp Lejeune in North Carolina who repeatedly warned that Marines recently returned from combat zones were in danger of acting violently, whether toward themselves or others.

“A significant number of Navy medical officials and Marine commanders do not get it,” a frustrated Manion said about the situation at Camp Lejeune. “They do not understand the implications of what happens if somebody loses it,” explained Manion, who has 25 years of experience as a psychiatrist and who also specializes in traumatic brain injury — exactly the kinds of skills needed so desperately at military hospitals, because mental problems and brain injuries are the signature wounds of the ongoing wars. “People either commit suicide, commit homicide, get drunk, beat up the wife, all these things. I’ve seen it,” he added. “That is how serious this is and they just don’t get it.”

Dr. Manion followed procedures and expressed his concerns to the chain of command:

In an April 24 memo to his superiors, including Cmdr. Robert O’Byrne, head of mental health for the Camp Lejeune Naval Hospital, Manion describes a frustrated Marine punching a telephone pole with his bare fists outside a treatment clinic, then storming around, cursing, with a piece of lumber with a nail in it, though nothing was done to ensure he didn’t hurt himself, again, or others. In another case, a severely homicidal and suicidal Marine pounded his fists into a table and stormed out of treatment. Yet the hospital, Manion complained to his superiors, made no efforts to discuss these cases or how to better handle similar events in the future.

Manion was instructed by his contractor employer to shut up:

On June 24, a supervisor for the contractor warned Manion to stop making trouble. “Kernan Manion, it is requested that you cease and desist all further correspondence with the government,” the supervisor with NiteLines, Pamela Friend, wrote to Manion.

When he got no response from his employer or the commanders at the base, he took the next step specified by regulations for complaints. He wrote to the various Inspectors General:

On Aug. 30, he appealed to a series of military inspectors general in a written complaint. He warned of an “immediate threat of loss of life and/or harm to service members’ selves or others” if conditions did not improve. He complained of a “complete disregard for … implications for patient safety and well-being.” He decried that officials at Lejeune had ignored “repeated overt and emphatically stated concerns about the very safety and overall welfare of the affected patients.” And he warned that “many patients’ lives are imminently at risk.”

As a result, four days later Manion was fired, effective immediately, with no reason given. His contractor employer told Benjamin that the firing was at the request of the Navy.

While it may be tempting to see a giant conspiracy at work here, I believe the processes involved are more subtle. There are indications that the top military brass and Pentagon officials are genuinely concerned about the rampant trauma, including PTSD among troops returning from combat zones. They have funded studies, instituted screening programs, and increased treatment resources, both on the battlefield and after deployment.

There is, however, little evidence that this concern has filtered down to middle-level officers and officials. The problem is at least partly psychological. Much of the military is still in a “see no evil, hear no evil” mode of massive denial, in which they assume that highly traumatized troops are malingerers. The macho culture of the military, especially the Marines, is threatened by real acceptance that exposure to combat can profoundly damage many otherwise healthy individuals. It is easier to assume that those negatively affected must have had something wrong with them to begin with.  The brass and Pentagon officials would need to take much stronger steps to get officers, NCOs, and officials up and down the chain of command to openly face this serious problem.

Further, to really accept the extent of combat-associated trauma among our troops is to face some of the consequences of our wars without end. The pursuit of these wars depends upon the ability to deny, to oneself and to the public, the immensity of their negative consequences. US officials denied the extent of civilian casualties in Iraq and they deny the extent of trauma their policies are creating among US troops.

Often the denial isn’t total. It is briefly acknowledged and then turned away from with a claim to oneself and to others that the problem is being dealt with. But efforts to improve the mental health of troops while laudable, remain woefully inadequate. The single action that would most improve the situation, to end the repeated deployments to combat settings where the dangers are many and the goals elusive, remains off the table.

In the meantime, Dr. Manion remains concerned about the marines he is no longer allowed to treat:

He still worries. “I don’t like seeing these guys mistreated,” Manion said. “This is akin to somebody dying on the battlefield and not being attended to,” he added. “These guys are saying they are broken and need help, and the system is saying, ‘next, next, next.’”

Mark Benjamin’s article:

Camp Lejeune whistle-blower fired
A psychiatrist who tried to prevent Fort Hood-style violence among Marines about to “lose it” instead loses his job

By Mark Benjamin

Last April, two Marines at Camp Lejeune predicted to a psychiatrist that some Marine back from war was going to “lose it.” Concerned, the psychiatrist asked what that meant. One of the Marines responded, “One of these guys is liable to come back with a loaded weapon and open fire.”

They weren’t talking about Marines suffering from a tangle of mental and religious angst, like news reports suggest haunted the alleged Fort Hood shooter, Maj. Nidal Malik Hasan. The risk they reported at Camp Lejeune was broader and systemic. Upon returning home, troops suffering mental health problems were getting dumped into an overwhelmed healthcare system that responded ineptly to their crises, the men reported, and they also faced harassment from Marine Corps superiors ignorant of the severity of their problems and disdainful of those who sought psychiatric help.

As Dr. Kernan Manion investigated the two Marines’ claims about conditions at the North Carolina military base, the largest Marine base on the East Coast, he found they were true. Manion, a psychiatrist hired last January to treat Marines coming home from war with acute mental problems, warned his superiors of looming trouble at Camp Lejeune in a series of increasingly urgent memos.

• Continue Reading

But instead of being praised for preventing what might have been another Fort Hood massacre, Manion was fired by the contractor that hired him, NiteLines Kuhana LLC. A spokeswoman for the firm says it let Manion go at the Navy’s behest. The Navy declined to comment on this story.

While military officials and the media examine whether the Army missed warning signs that might have indicated an unhinged Nidal Hasan was capable of killing 13 people at Fort Hood, Manion’s Camp Lejeune story is a cautionary tale of what happens to those who blow the whistle on conditions for military personnel with mental problems.

Manion says the April incident with the two Marines was just one of a series of disturbing events and serious problems with mental healthcare he saw at Camp Lejeune, a base that may be best known for a water contamination scandal that led to high rates of cancer and birth defects among Marines and their families who lived there. He was particularly concerned to see that troubled Marines were stricken with the overwhelming impulse to commit suicide or murder, telltale signs of severe combat stress.

In a telephone interview from his Surf City, N.C., home, Manion talked of overburdened staff and inadequate resources at the Naval hospital at Camp Lejeune. The psychiatrist charged that medical officials failed to study and discuss violent events among returning Marines in an effort to prevent further, similar events, and did little planning to improve handling distraught Marines who were killing themselves and others in shocking numbers. In 2008, for example, 42 Marines committed suicide and 146 attempted to do so, according to the Marine Corps.

Coincidentally or not, within 12 hours of Hasan’s shooting spree, Camp Lejeune officials discovered the body of one Marine and took into custody another Marine, Pvt. Jonathan Law, who is accused of killing his colleague. Law, who had served a seven-month tour in Iraq, was suffering from self-inflicted wounds when arrested.

Mirroring reports from military installations across the country, Manion also reported harassment of Marines seeking mental help. The psychiatrist began to worry about the possibility of a major outburst of violence on the base.

“A significant number of Navy medical officials and Marine commanders do not get it,” a frustrated Manion said about the situation at Camp Lejeune. “They do not understand the implications of what happens if somebody loses it,” explained Manion, who has 25 years of experience as a psychiatrist and who also specializes in traumatic brain injury — exactly the kinds of skills needed so desperately at military hospitals, because mental problems and brain injuries are the signature wounds of the ongoing wars. “People either commit suicide, commit homicide, get drunk, beat up the wife, all these things. I’ve seen it,” he added. “That is how serious this is and they just don’t get it.”

Manion believes he likely prevented a “Columbine-style attack” late last April after the two Marines who warned that someone might “lose it” directed him to a third Marine who seemed on the verge of violence. Manion also provided his superiors with documentation showing troubling incidents and neglect for the needs of returning Marines that could easily precipitate violence. Maybe not on the scale of the massacre at Fort Hood, but more like the rampage by a frustrated Sgt. John Russell, who gunned down five fellow soldiers at a military mental health facility in Baghdad last May.

Manion provided to Salon a stack of correspondence with superiors, a virtual crystal ball predicting dire consequences if mental healthcare at Camp Lejeune isn’t immediately improved.

In an April 24 memo to his superiors, including Cmdr. Robert O’Byrne, head of mental health for the Camp Lejeune Naval Hospital, Manion describes a frustrated Marine punching a telephone pole with his bare fists outside a treatment clinic, then storming around, cursing, with a piece of lumber with a nail in it, though nothing was done to ensure he didn’t hurt himself, again, or others. In another case, a severely homicidal and suicidal Marine pounded his fists into a table and stormed out of treatment. Yet the hospital, Manion complained to his superiors, made no efforts to discuss these cases or how to better handle similar events in the future.

“There was — and continues to be — no means of discussion of high-intensity/dangerous cases such as this,” a desperate Manion wrote on April 24. He warned of “immediate concerns of physical safety” at the base’s mental health facilities. Manion wanted to set up special protocols for handling intense situations, such as having specially trained MPs ready to intercede if things got bad, and a plan to hospitalize potentially violent patients quickly. “They dragged their feet on that,” he told me.

Within days that April, Manion intervened with the two Marines who’d warned of colleagues potentially losing it. They directed him to a third Marine who they believed was going to go on a shooting rampage. Manion worked hard to get that Marine into treatment, possibly averting bloodshed. The two Marines involved also reported harassment for working limited duty while seeking mental healthcare for themselves. They heatedly claimed that two noncommissioned officers had recently told them, “I don’t care why you are on [limited duty]. You are nothing but worthless pieces of shit,” according to an April 29 e-mail Manion sent to O’Byrne and others, complaining about such attitudes.

Like many healthcare providers at military bases across the country, Manion technically worked for a military contractor, Spectrum Healthcare Resources, a subcontractor for  NiteLines Kuhana LLC.

On June 24, a supervisor for the contractor warned Manion to stop making trouble. “Kernan Manion, it is requested that you cease and desist all further correspondence with the government,” the supervisor with NiteLines, Pamela Friend, wrote to Manion.

But Manion was still frustrated that Camp Lejeune did not seem to be taking these risks seriously. On Aug. 30, he appealed to a series of military inspectors general in a written complaint. He warned of an “immediate threat of loss of life and/or harm to service members’ selves or others” if conditions did not improve. He complained of a “complete disregard for … implications for patient safety and well-being.” He decried that officials at Lejeune had ignored “repeated overt and emphatically stated concerns about the very safety and overall welfare of the affected patients.” And he warned that “many patients’ lives are imminently at risk.”

Four days later, the contractor fired Manion “effective immediately,” according to his termination e-mail. The note provides no reason for the firing. Manion was directed to clean out his office the next day, under the watchful eye of a chief petty officer, and have no further contact with his patients.

In a statement to Salon, NiteLines said the Navy wanted Manion fired, but did not explain why. “The treatment facility at Camp Lejeune notified (Nitelines) that Dr. Manion did not meet the Government’s requirements in accordance with the contract, and they directed he be removed from the schedule,” it reads.

Salon e-mailed the spokesman for the Naval Hospital Camp Lejeune, Raymond Applewhite, with details of this story and then described some of these facts with him in a follow-up telephone call, requesting an interview with O’Byrne. The Navy did not respond further.

Manion left Camp Lejeune after he got fired, but he did not stop worrying about the potential for violence there. In mid-September, Manion filed a 14-page complaint with the Department of Defense inspector general. On Sept. 29, he warned the Navy’s Bureau of Medicine and Surgery inspector general in writing of “serious mismanagement of post-deployment mental health services that was both endangering patient, staff and community safety as well as severely compromising the quality of care” for returning Marines. Manion noted that the poor care at Camp Lejeune continued despite “the ever present threat of life-threatening violence by distraught service members towards themselves or others.”

Finally, Manion wrote President Obama that same day. “Frankly, in my more than 25 years of clinical practice, I’ve never seen such immense emotional suffering and psychological brokenness — literally a relentless stream of courageous, well-trained and formerly strong Marines deeply wounded psychologically by the immensity of their combat experience,” he wrote to the president. Manion added, however, that at Camp Lejeune, that immense problem was being met with “inadequate treatment” and “callous indifference.”

He still worries. “I don’t like seeing these guys mistreated,” Manion said. “This is akin to somebody dying on the battlefield and not being attended to,” he added. “These guys are saying they are broken and need help, and the system is saying, ‘next, next, next.’”

November 16th, 2009

Mental Health professionals’ letter asks Michelle Obama to investigate diagnostic abuse of veterans

I recently published an article — Diagnostic abuse of veterans and the dilemmas of health professional ethics — [based on reporting by Mark Benjamin and Michael de Yoanna in Salon] on Army pressures for mental health clinicians to not diagnose post traumatic stress disorder [PTSD] in returning soldiers. A group of approximately 130 psychologists and mental health professionals responded to my article by writing Michelle Obama and asking her to look into these charges. Here is their letter:

May 12, 2009

First Lady
Michelle Obama
The White House
1600 Pennsylvania Avenue NW
Washington, D.C.

Dear First Lady,

We are a group of mental health professionals who hope to reach you about an issue concerning the treatment of our veterans.  We are grateful that you have taken an interest in the well-being of veterans and their families, recognizing the weight of responsibility and trauma they may carry during and after service to our country.

In writing we want to call your attention to a concern that official pressures may be interfering with returning soldiers receiving appropriate treatment.  A recent series in Salon by Mark Benjamin and Michael de Yoanna (latest May 5, 2009), reports pressure placed on mental health professionals to under-diagnose Post Traumatic Stress Disorder (PTSD) in returning combat veterans regardless of the clinical reality.  A number of our colleagues who work with veterans have relayed similar experiences of pressure to misdiagnose.

One consequence of this apparent misdiagnosis is that the men and women who served our country do not receive appropriate Veterans’ benefits when their diagnoses do not correctly attribute their emotional problems to their combat experiences. Instead, their problems are attributed either to less severe “anxiety disorders” or to preexisting “personality disorders.”  In addition to potential loss of benefits to which combat veterans are due, misdiagnoses can result in inappropriate treatment and in the veteran being held responsible for part or all of the cost of treatment for conditions caused by combat experience.

As mental health professionals, we are deeply disturbed that pressure is being put upon colleagues to give incorrect diagnoses for reasons antithetical to the best interests of our patients.  Those who suffer serious disorders in the service of our country deserve better.  They deserve the best treatment available.  We are also concerned that this pressure may undermine the ethical foundation upon which the mental health professions are based.

We have included an essay by Dr. Stephen Soldz, co-founder of the Coalition for an Ethical APA and Steering Committee Member of Psychologists for Social Responsibility, which we believe sheds important light on this subject.

We ask you to look into this matter and related issues concerning the mental health treatment of our soldiers and veterans.  We are willing to assist you in any ways we can in this endeavor.

With respect and regards,

Alice Lowe Shaw, Ph.D.
President-Elect Section IX, Division 39
Psychoanalysis and Social Responsibility

Stephen Soldz, Ph.D.
Director, Center for Research, Evaluation and Program Development
Boston Graduate School of Psychoanalysis

Psychologists for Social Responsibility (PsySR), organizational endorsement
700+ members

Thomas Rosbrow, Ph.D.
Psychoanalytic Institute of Northern California (PINC)
San Francisco

Marilyn S. Jacobs, Ph.D., ABPP
David Geffen School of Medicine at UCLA
Dept. of Psychiatry and Biobehavioral Sciences
Los Angeles

Melanie Suchet, Ph.D.
Stephen A. Mitchell Center for Relational Studies
New York City

Lynne Layton, Ph.D.
Harvard Medical School
Cambridge, Massachusetts

Katie Gentile, Ph.D.
Women’s Center Director
John Jay College of Criminal Justice
New York City

Karen Rosica, Psy.D.
Denver, Colorado

Richard Reichbart, Ph.D.
Institute for Psychoanalytic Training and Research (IPTAR)
Ridgewood, N.J.

Rachael Peltz, Ph.D.
PINC
San Francisco

Elizabeth Hirky, Ph.D.
Senior Psychologist
Bellevue Hospital Center
New York City

Julie Gerhardt, Ph.D.
PINC
San Francisco

Ruth Fallenbaum, Ph.D.
Berkeley,  California

Nina K. Thomas, Ph.D., ABPP
NYU Postdoctoral Program in Psychotherapy and Psychoanalysis
New York City

Susan Gutwill, MS, LCSW
Highland Park, New Jersey

Diane Ehrensaft, Ph.D.
Oakland, CA

Brad Olson, Ph.D.
Northwestern University
Evanston, Illinois

Susan Phipps-Yonas, Ph.D., L.P.
Minneapolis, MN

Lorri Greene, Ph.D.
San Diego, CA

Ryan Hunt

Connie Evert, Ph.D.
Philadelphia

Leni de Mik, Ph.D.
Minneapolis, MN

Larry Welkowitz, Ph.D.
Keene State College,
Keene, New Hampshire

Frank Summers, Ph.D., ABPP
Northwestern University
Chicago, Il

Jeanne Wolff Bernstein, Ph.D.
Berkeley, CA

Kenneth Feiner, Ph.D.
NYC

Jancis Long, Ph.D.
President, Psychologists for Social Responsibility
Berkeley, CA

John Neafsey, Psy.D.
Chicago, Il

Thomas S. Greenspon, Ph.D.
Minneapolis, MN

Stephen Botticelli, Ph.D.
NYC

Loren Krane, Ph.D.
UCSF Dept of Psychiatry
San Francisco

Trudy Bond, Ph.D.
Toledo, OH

Armond Aserinsky, Ph.D.
North Wales, PA

Muriel Dimen, Ph.D.
NYC

Donna Bassin, Ph.D.
Secretary APA Division 39, Section IX

Ellen G. Levine, Ph.D., M.P.H.
Castro Valley, CA

Anthony J. Marsella, Ph.D.
Past President, PsySR

Polly Scarvalone, Ph.D.
NYC

Cynthia Colvin, Ph.D.
PINC
Oakland, CA

Laurel Bass Wagner, Ph.D.
Dallas, TX

Stefan R. Zicht, Psy.D.
NYC

Helene Goldberg, Ph.D.

Stephen Benson, Ph.D.
Blue Hill, ME

Maureen Murphy, MSN, Ph.D.
San Francisco

Virginia Goldner, Ph.D.

Nancy Burke, Ph.D.
Northwestern University
University Medical School
Chicago, Il

Elizabeth Hegeman, Ph.D.
Professor John Jay College of Criminal Justice
William A. White Institute
NYC

Leigh Messinides, Ph.D.
Tustin, CA

Peter Shabad, Ph.D.
Chicago

Ann B. Clarkson, Ph.D.
Portland, OR

Mary-Joan Gerson, Ph.D.

Sonia Orenstein, Ph.D.
NYC

Jill Bellinson, Ph.D.
NYC

Stephen Portuges, Ph.D.
Executive Editor, International Journal of Applied Psychoanalytic Studies
Los Angeles

Andrew Tatarsky, Ph.D.
Past president, Division on Addiction,
New York State Psychological Assn.
NYC

Susan Bodnar, Ph.D.
NYC

Todd Essig, Ph.D.
William Alanson White Institute
NYC

Sharon Brennan, Ph.D.

Christy Paliouras, Ph.D.
Astoria, NY

Maureen C. Grix, Ph.D.
The Suffolk Institute
Garden City,  NJ

Maureen O’Reilly-Landry, Ph.D.
Columbia College of Physicians and Surgeons
NYC

David Sloan-Rossiter, Ph.D.
Brookline, MA

Steven Reisner, Ph.D.
NYC

David Thurn, LMSW, PH.D.
NYC

Richard Lasky, Ph.D.
Clinical Professor of Psychology
NYU Post-Doctoral Program in Psychotherapy and Psychoanalysis
NYC

Elaine Gould, Ph.D.
New York

Susan Katz

Richard B. Gartner, Ph.D.
NYC

Eric W. Anders, Ph.D., Psy.D.
Institute of Contemporary Psychoanalysis
Oakland, CA

Linda R. Laughlin, Ph.D.

William A. MacGillivray, Ph.D., ABPP,
University of Tennessee,
Knoxville, TN

Kathryn G. White, Ph.D.
New Haven, CT

Katie L. Fitzpatrick, M.A.
University of Tennessee

Knoxville, TN

Dana Satir, M.A.
Center for Anxiety and Related Discord
Boston, MA

Kathleen W. Erickson, LCSW
(mother of an Iraq War veteran)
Knoxville, TN

Robert K. Albiston, Ph.D.
Past President, Appalacian Psychoanalytic Assn.
Knoxville, TN

Edward R. Ryan, Ph.D.
New Haven, CT

Mila R. Tecala, Lic. SW
Washington, D.C.

Greta H. Gustafson, LCSW
NYC

Mark S. Kane, Ph.D.
Michigan

Margaret L. White, Ph.D.
Upper Montclair, NJ

Christine A. Chapman, LCSW

Cathy S. Nelson, LISW
Ames, IA

Adrienne Harris, Ph.D.
NYC

Erika Vadopalas, LMFT
Coming Home Project
San Carlos, California

Annita Sawyer, Ph.D.
Yale Medical School
New Haven, CT

Steven H. Knoblauch, Ph.D.
NYC

Andrew M. Barclay, Ph.D.

Cathie Bird, MA, Psy.D.
Pioneer, TN

Debra Rothschild, Ph.D.
NYC

Luz Towns-Miranda, Ph.D.

NYC

Darlene DiGorio-Hevner, MA, MSW, LCSW
Ardmore, PA

Arlene Lu Steinberg, Ph.D.
Columbia University
NYU

Don Greif, Ph.D.
William Alanson White Institute
NYC

Spyros D. Orfanos, Ph.D., ABPP
Clinic Director
NYU Postdoctoral Program in Psychotherapy and Psychoanalysis
NYC

Barbara Eisold, Ph.D.
Yeshiva University
NYC

Barbara Blasdel, Ph.D.

Susan R. Greene, Ph.D.
San Francisco Center for Psychoanalysis (SFCP)

Candy Siegel, Ph.D.
Tucson, Arizona

Carolyn Ellman, Ph.D.
IPTAR, NYU Postdoctoral Program
NYC

Robert Keisner, Ph.D.
Professor of Psychology
CW Post/Long Island University
Brookville, NY

Maria T. Russo, Ph.D.
East Hampton, NY

Jerome Siller, Ph.D., ABPP
NYC

Scott W. Smith, M.A.
Doctoral Candidate
Adelphi University
New York

Martha Davis, Ph.D.
Visiting scholar, John Jay College of Criminal Justice
NYC

Stephen J. Ducat, Ph.D.
San Francisco

Debra A. Lopez, MD
Clinical Associate Professor
University of Vermont Dept of Psychiatry
Burlington, VT

Jeffrey F. Johns, MD (former Air Force Psychiatrist)
Oakland, CA

Barbara F. Marcus, Ph.D.
Yale University School of Medicine
Vice President, Board of Trustees and Faculty,
The Western New England Institute of Psychoanalysis
New Haven, CT

Sergio Rothstein, Ph.D.
NYC

Lawrence O. Brown, Ph.D.
Fellow Supervisor of Psychotherapy and Teaching Faculty
William Alanson White Institute
NYC

David G. Byrom, Ph.D.
Co-Director, Family Therapy Institute of Suffolk
Smithtown, NY

Juliet M. Ross, Psy.D.
NYC

Andrew B. Sieff, A.P.N., PMHCNS-BC
Psychiatric Clinical Nurse Specialist
Fayetteville, AR

Mildred Antonelli, Ph.D.
Institute for the Psychoanalytic Study of Subjectivity
NYC

Herbert Gingold, Ph.D.
Co-Founder of the Noir Institute
Kew Gardens, NY

Marc Pilisuk, Ph.D.
Professor Emeritus, The University of California
Professor, Saybrook Graduate School and Research Center
Berkeley, CA

Sharon L. Windwer, Psy.D.
Little Neck, NY

Bonnie J. Lipeles, Psy.D.

Margit Winkler Ph.D.
Supervising Analyst, Wm. Alanson White Institute

Lydia Seggev

Susan Lillich, Ph.D.
Williston, VT

Jules Burnstein, Ph.D.

Ronna Friend, Ph.D.
Eugene, Oregon

Cornelia St. John, MFT
Oakland, CA

Claire Hertz
Institute for Contemporary Psychotherapy
NYC

Linda Schrader, Ph.D.
Bend, OR

Jeff Kaye, Ph.D.
Clinician, Survivors International
San Francisco

Gerald Gray, LCSW
Founder, Center for Justice and Accountability
San Francisco
Co-Founder Institute for Redress and Recovery
Santa Clara University Law School

Philip Hill, Ph.D.

Latika Mangrulkar, MSW, ACSW

Jean Maria Arrigo, Ph.D.

Jonathan Wormhoudt, Ph.D.

Elliot Jurist, Ph.D.

Skye Haberman, Ph.D.

Joanie V. Connors, Ph.D.

Stephen Seligman, D.M.H.
University of California, San Francisco

May 18th, 2009

Wounds of war remain forever, psychologist-veteran argues

Psychologist Armond Aserinsky wrote very movingly to a listserv of his experience as a young veteran conducting interviews with other veterans recently returned from war. His writing highlights the severe emotional toll that war takes on the soldiers we send to fight. Armond has kindly given me permission to reproduce his piece here:

Dear group,

As a recently discharged veteran of the Vietnam War and brand new Psych Grad Student I was offered a special research assistantship that required me to interview the gravely injured soldiers undergoing treatment at The Valley Forge Military Hospital, in Phoenixville, Pennsylvania. Talk about jumping into the pool at the deep end without having had any swimming lessons. But the project leader needed my understanding of and credibility with the military to gain access to this very “sensitive” population.

Let me say that the lessons I learned over those months have never been forgotten. While I know a lot more now than I did back then (in a lot of ways), I’ve never come to regard those raw observations as wrong. What I saw, in a nutshell, is that the military tried to do a very good job patching those young soldiers together PHYSICALLY, but the mental health aspects were woefully undertreated.

During the acute phase of hospitalization, and the months of convalescent hospital care, some efforts were made to engage the patients in various kinds of support groups. While the expertise of the fellow heading up the MH side of the clinical team was well below that of the medical members, that young social worker was a very brave and compassionate man who did some real good. The real problem was not at this point in the treatment process.

What was wrong, and still is, was the complete lack of recognition that these soldiers’ lives had been permanently derailed. The sense of loss, the unremitting nature of the injuries, comes to have a grinding, corrosive effect on the sense of self, on coping, on relationships. What bullets have torn apart is often never really put together, and every wound to the flesh has a mental counterpart that festers in the darkness of denial and ignorance.

I know that today’s soldiers receive miraculous treatments for injuries that killed their predecessors in the field. Yet one gets the same impression now that I had way back when: an injured serviceman is offered “help if he should need it”, as if MH sequela were rare and rather unexpected. Instead of a lifetime program of benefits and active support, the soldier receives a set of patches when obvious tears in his physical or mental fabric develop. “Oh, so you’re drinking a case of beer a night? We’ve got a D & A counselor you can see down here at the V. A.”

Of course the damage to minds is not limited to those who’ve been shot up or partially blown apart. That’s what the letter to Mrs. Obama is meant to address. What I’m proposing is that just about everyone who’s had to be stitched together ought to be regarded as an MH casualty in need of some system of support that doesn’t require a fellow to shoot somebody or fall down drunk before a sliver of help is offered. For those who were lucky enough to get through the bloodbath in one piece, the numbers are only slighter better.

We owe it to take real care of each person who Dick Cheney and all the other chicken hawks sent out to fight their foolish wars. Real care means recognizing up front that if you were “over there” you’re going to have problems, because that’s the nature of being human.

I hope I’m making myself clear. I still carry some wounds from just being involved with the young men who gave their arms and legs for an unnecessary war and were then sent home to limp and ache and suffer for the rest of their lives, as if it were no big deal. “Come back and see us if you’re having problems.”

If. IF?! IF?!

May 9th, 2009

VA moves to fix…. bad publicity

The VA is so deeply concerned about bad publicity, they sent the goons to intimidate a reporter and confiscate his recorder memory card. I sure hope VA Secretary Gen. Shinseki takes action against this thuggish behavior. Many have high hopes that Shinseki will fix a damaged system.

Reporter working on story critical of VA has his equipment confiscated

By Rachel Oswald

A public radio reporter visiting a VA hospital earlier this week to work on a story about veterans’ healthcare was stopped by government officials mid-interview, ordered to leave the hospital and had some of his recording equipment confiscated.

David Schultz, a reporter with a local NPR affliate, WAMU 88.5, was at the Veteran Affairs Hospital in Washington, DC on Tuesday night, covering a townhall meeting on the quality of minority healthcare. In the middle of an interview with one of the veterans at the meeting on the below quality healthcare he was receiving at the hospital, Schultz was told by hospital officials to halt the interview and to turn over his recording equipment.

DC radio station WTOP reports that Gloria Hairston, an internal communications specialist with the VA, was the one to order a stop to the interview.

Hairston was joined by two other VA employees and four armed guards, who stood between Schultz and the exit, in ordering the 26-year-old reporter to hand over his equipment, which included a recorder, microphone and headphones.

“She said I wouldn’t be allowed to leave,” Schultz told WTOP. “I became worried that I was going to get arrested.

Katie Roberts, a spokeswoman for the Department of Veterans Affairs, told the Reporters Committee for Freedom of the Press that Schultz refused to listen to the VA officials’ request for a signed waiver by the veteran he was interview.

Schultz was able to persuade Hairston to just confiscate the memory card of his recorder, instead of all of his equipment.

When one of the veterans who had drifted over to watch the spectacle asked Schultz for his phone number, he was stopped from handing it out by Hairston.

“I started to give it to him and then [Hairston] became irate,” Schultz said. “She said, ‘You can’t give him your phone number. You have to give me all of your equipment or I’m going to get ugly.’”

After conferring with his boss, WAMU news director Jim Asendio, by phone, Schultz handed over his memory card and left the hospital.

“I told him to give them the flash card and get out of there,” Asendio said to WTOP. “I didn’t want this to get out of hand.”

Thus far, attempts by WAMU to retrieve the flash card from the VA have been unsuccessful.

Roberts, the VA spokeswoman, is claiming that Schultz “took advantage of the patient” he was interviewing by not correctly identifying himself as a reporter, an assertion that Schultz disagrees with. She said the VA would return the flash card if the veteran Schultz was interviewing signs a consent form.

Tuesday’s incident has, unsurprisingly, not gone down well with journalists.

“When he was in the Army, the current secretary of Veterans Affairs, Gen. Eric Shinseki (USA ret.), no doubt had occasion to read the riot act to subordinate officers,” writes Art Brodsky of The Huffington Post. “It’s time for him to get into command mode again, and the subjects this time are his incompetent public relations staff, which created an embarrassing nightmare for an Administration dedicated to transparency and openness.”

April 11th, 2009

More on diagnostic abuse of veterans: The coverup and the why

Mark Benjamin and Michael de Yoanna at Salon complete their story on the army’s misdiagnosis of PTSD as other conditions, such as anxiety disorders. [See my earlier take on this story.] Yesterday they described the farce of an Army “Internal Investigation,” a.k.a. coverup of these diagnostic abuse, conducted by officers previously accused of involvement in such abuse!

What also escaped the black pen was the name of the man who presided over the review: Brig. Gen. James Gilman, who commands Great Plains Regional Medical Command, which oversees several Army hospitals, including the one under scrutiny at Fort Carson. Gilman assigned Col. Bruce Crow, the clinical psychology consultant to the Army surgeon general, to supervise the actual investigation….

Crow, meanwhile, was also implicated in the “personality disorder” scandal. As Knorr was writing up his review back in 2007, the Army dispatched Crow to Congress to “set the record straight,” as he told the House Committee on Veterans’ Affairs on July 25, 2007. Crow said the Army would study soldiers dismissed with personality disorders but suggested the Army was doing nothing wrong. He said soldiers with a diagnosis of personality disorder only “feel” they have been wrongly separated from the Army. “I want to assure the Congress that the Army Medical Department’s highest priority is caring for our warriors and their families,” he told the panel.

The investigators did not even talk to the officer accused of applying pressure to misdiagnose:

It appears, however, that investigators did not question the Army officer who Douglas McNinch said had pressured him not to diagnose PTSD. In an interview with Salon, McNinch said the pressure to misdiagnose soldiers came from the psychiatrist who used to head the Department of Behavioral Health at Fort Carson. “His name was Steve Knorr,” McNinch said.

Another officer involved in the investigation was junior to this same Knorr:

Salon has learned that one of the officers conducting the investigation of the tape is a junior officer to Knorr at their shared Army post. Lt. Col. Kris Peterson, chief psychiatrist at Madigan Army Medical Center at Fort Lewis, Wash., assisted Col. Bruce Crow in the investigation of the tape. Knorr is now a health consultant at Madigan.

In typical military behavior, a general announced what the investigation would conclude before it was even conducted.

Cody told Stichman and his associates that an internal investigation of the tape would be conducted. To Stichman’s surprise, Cody then suggested what the not-yet-completed investigation would reveal.

Cody denied that the Army was pressuring doctors not to diagnose PTSD in soldiers. “There is no one in leadership telling doctors to do this,” stated Cody. “This is not Army policy.” Cody called the evidence on the tape “anecdotal.”

In today’s concluding installment, Benjamin explains what is at stake for the military in this alleged behavior, money, a lot of it:

[I]f soldiers are identified as suffering from PTSD and thus disabled, the Army may have to separate those soldiers from the military and pay benefits — benefits that are extensive and can last a lifetime. The direct costs to the Army for treating soldiers with PTSD are potentially astronomical.

If you are a soldier who is officially disabled, you are entitled to collect a percentage of your base pay each month. The percentage depends upon your level of disability. Though this doesn’t happen in every case, the proper disability rating for PTSD is 50 percent, according to an Army memo that is now part of a class-action lawsuit by the National Veterans Legal Services Program. So let’s say, for example, that a 25-year-old private first class was discharged from the Army because of combat-induced PTSD and lived to be 75 years old while collecting benefits at the proper rate of 50 percent. The PFC would receive $784 a month, or half of $1,568 base pay (based on 2009 pay levels) for 50 years. That’s $470,400.

Now take that half-million dollar figure and multiply it by the number of returned troops who may be suffering from PTSD. Almost 2 million men and women from all service branches have served in Iraq and Afghanistan. The academic studies of PTSD cited in the Rand report include estimates of the true incidence of PTSD among Iraq veterans that range up toward 20 percent. A 2004 study in the New England Journal of Medicine said that 19.9 percent of Marines deployed to Iraq and 18 percent of Army troops deployed to Iraq may suffer from “broad definition” PTSD.

When a soldier with PTSD is diagnosed with a less serious illness, his benefits may very well be reduced dramatically.  PTSD is often the result of witnessing bloodshed or nearly dying and is often linked to combat. But if a soldier’s injury is more vague, like anxiety disorder — the condition the Fort Carson psychologist on Sgt. X’s tape said he was being pressured to diagnose in soldiers instead of PTSD — a soldier may struggle to prove that an injury occurred as a result of the war and lose out on tens of thousands of dollars in benefits. A soldier suffering from anxiety disorder may receive some disability benefits, but almost certainly will not receive benefits that total 50 percent of base pay.

Thus, the amounts at stake could be over $100 Billion, depending on what level of benefits are avoided.

Also involved is the insatiable need for manpower to fight this country’s never-ending wars:

A recent Rand Corp. study estimates that nearly 20 percent of those Army troops who have served in Iraq and Afghanistan might suffer from PTSD or major depression. If they were all barred from the battlefield, the Army could lose as many as one out of every five combat troops while trying to fight two wars.

Given what is at stake, it will take tremendous effort to change the system apparently producing these abuses.

April 10th, 2009

Diagnostic abuse of veterans and the dilemmas of health professional ethics

Michael de Yoanna and Mark Benjamin in Salon have just published the first of a three-part series on pressure from the military to not diagnose soldiers with PTSD. They obtained a secret recording of a Denver neuropsychologist confessing to his patient, a sergeant wounded in Iraq, that he is under tremendous pressure to not assign PTSD diagnoses. [Thanks to Salon, you can listen to a portion of this recording here.]

“OK,” McNinch told Sgt. X. “I will tell you something confidentially that I would have to deny if it were ever public. Not only myself, but all the clinicians up here are being pressured to not diagnose PTSD and diagnose anxiety disorder NOS [instead].” McNinch told him that Army medical boards were “kick[ing] back” his diagnoses of PTSD, saying soldiers had not seen enough trauma to have “serious PTSD issues.”

“Unfortunately,” McNinch told Sgt. X, “yours has not been the only case … I and other [doctors] are under a lot of pressure to not diagnose PTSD. It’s not fair. I think it’s a horrible way to treat soldiers, but unfortunately, you know, now the V.A. is jumping on board, saying, ‘Well, these people don’t have PTSD,’ and stuff like that.”

Salon reporters talked with Dr. McNinch, and secretly recorded that conversation, obtaining confirmation of Sgt. X’s experience:

Contacted recently by Salon, McNinch seemed surprised that reporters had obtained the tape, but answered questions about the statements captured by the recording. McNinch told Salon that the pressure to misdiagnose came from the former head of Fort Carson’s Department of Behavioral Health. That colonel, an Army psychiatrist, is now at Fort Lewis in Washington state. “This was pressure that the commander of my Department of Behavioral Health put on me at that time,” he said. Since McNinch is a civilian employed by the Army, the colonel could not order him to give a specific, lesser diagnosis to soldiers. Instead, McNinch said, the colonel would “refuse to concur with me, or argue with me, or berate me” when McNinch diagnosed soldiers with PTSD. “It is just very difficult being a civilian in a military setting.”

McNinch added that he also received pressure not to properly diagnose traumatic brain injury, Sgt. X’s other medical problem. “When I got there I was told I was overdiagnosing brain injuries and now everybody is finding out that, yes, there are brain injuries,” he recalled. McNinch said he argued, “‘What are we going to do about treatment?’ And they said, ‘Oh, we are just counting people. We don’t plan on treating them.’” McNinch replied, “‘You are bringing a generation of brain-damaged individuals back here. You have got to get a game plan together for this public health crisis.’”

When McNinch learned he would be quoted in a Salon article, he cut off further questions. He also said he would deny the interview took place. Salon, however, had recorded the conversation.

Salon got the tape from another medical worker and a Congressional aid, not from the soldier, whom they dub Sgt. X, to protect his identity. The  soldier, surprised that the media got his recording, is afraid that retribution against him will negatively impact his disability claim.

The Army conducted one of those “investigations” so well-known to those familiar with the military and promptly cleared itself. Unfortunately, the Senate Armed Services Committee declined to investigate, though, one might suspect, it was an aid on that committee who gave Salon the tape. Perhaps there is an attempt to create enough public outrage to push the Committee to do the right thing.

This article provides new confirmation of previous reports, several of which are by Mark Benjamin, that the military is seeking to reduce the number of PTSD diagnoses assigned to soldiers. In some cases they have been accused of assigning personality disorder diagnoses, presumed to have existed prior to enlistment, to soldiers more likely suffering from the traumatic effects of war. A personality diagnoses makes the soldier ineligible for veterans benefits, thus avoiding the government assuming the potential high costs of treatment.

The question of what to do with mental health clinicians, like psychologist Dr. Douglas McNinch is complicated. If he, or other clinicians, modified diagnoses to please the powers that be, this is unethical.  Dr. McNinch apparently knows full well that his actions are wrong, yet lacks the moral courage to refuse to play along, or to speak out. His actions arouse little sympathy.

On the other hand, our healthcare system is based upon diagnostic deception. Clinicians often give less or more severe diagnoses in order to get coverage for their patients’ conditions. In many cases this deception is in the patient’s interests, but, other times it is not. Sometimes, rather, the deception is more in furtherance of the clinician’s financial interests. It seems problematic to punish a clinician for giving in to pressure from a dishonorable system. Yet, it also seems problematic that a clinician should get away unscathed for these transgressions.

At present health professional ethics, including that of psychologists, are based upon a model of the individual moral actor doing the right thing. These ethical principles essentially requires every professional to be willing to become a whistleblower. Yet, there is little tradition in the health professions of whistleblowing. We have no whistleblower heroes about whose actions we are taught in our training programs. We participate in no discussion of the  extreme stresses that most whistleblowers experience. And our professional associations have not developed any support mechanism beyond “ethical consultation” for those contemplating risking professional suicide through refusing to play their role in an unethical system.

We know that the health professions failed miserably to respond to a state-sponsored system of torture, a system that was designed by psychologists and required extensive involvement from health professionals, including monitoring of the extent of damage being caused as detainees were tortured, and brutal forced feeding of hunger strikers. As we know, the professional associations failed miserably to respond to this challenge. The American Medical and Psychiatric Associations banned their members participating in interrogations, but remained silent about the monitoring of torture conducted by physicians and the participation of physicians in force feedings that violate professional ethics. The American Psychological Association closed its eyes to the abusive roles that psychologists played in the Bush administration’s torture program, thus providing cover for that program until almost the end of that administration. Professions that failed to adequately confront the moral challenges posed by state-sponsored torture unfortunately cannot be counted upon to deal adequately with other potential state-sanctioned abuses. These professions, and their organized expressions in professional associations, need major reforms to confront the moral challenges of our times.

In any case, the most important result of the current revelations of diagnostic abuse would be to fix an unjust system that is apparently deliberately assigning the wrong diagnoses to returning soldiers, most likely in order to save money. Unjust and unethical systems generate unjust and unethical behavior in those who practice in them. While ethics codes are important, no amount of ethics teaching alone will prevent ethical lapses in powerful unethical systems. At a minimum, health professional associations should be pressured to provide support and training on the responsibilities and the challenges of becoming a whistleblower.

Soldiers who return from war shouldn’t have to face a system out to screw them. Nor should they have to fear retribution for exposing these abuses. It is now up to the administration, the Congress, the health professions, and the public to take action to see that our returning soldiers stop needing lawyers to get the appropriate treatment for the wounds they suffer in our name.

April 9th, 2009