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Psychiatrist warns of potential for violence among returning Marines

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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, in Salon, 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."

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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.

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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.'"

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Stephen Soldz is psychoanalyst, psychologist, public health researcher, and faculty member at the Boston Graduate School of Psychoanalysis. He is co-founder of the Coalition for an Ethical Psychology and is President of Psychologists for Social Responsibility. He was a psychological consultant on two of (more...)

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To address mental trauma is to attack the very pur... by Peter Duveen on Tuesday, Nov 17, 2009 at 8:31:39 AM
Standard operating procedure: when you don't want ... by Dave Kisor on Wednesday, Nov 18, 2009 at 12:02:01 AM