How I Got Here

I guess I made a deal with the devil to end up on this deployment. I only just returned from a seven-month tour (eight months if you include training) in Iraq last September. The mandatory “respite time” after a deployment of 6-8 months happens to be one year so I would have been eligible to deploy again at this time anyway had I not volunteered. The deal is as follows: I volunteered for a new assignment that terminated my three year tour in Guam one year early and moved me from being a staff psychiatrist in a hospital to being a regimental surgeon for a Seabee unit. Had I remained in my staff psychiatrist position I would have been virtually guaranteed to have deployed again in a combat stress control role with the Army or Marine Corps for 7-8 months sometime within the next two years. I opted for this assignment because it was shorter and predictable. Of course I had an interest in the Seabees as well. Wearing fatigues to work instead of my usual polyester khaki, and being based in California were additional contributing factors.
Given the prolonged nature of the conflicts in Iraq and Afghanistan the need for mental health care is profound and the task of providing the care can be exhausting, not to mention dangerous. Earlier this year a mental health patient on an American base in Iraq shot and killed five people (including the psychiatrist) in a combat stress control clinic. The shooter did not commit suicide and faces trial. I have no doubt that he will go for the PTSD defense.
Don’t be fooled by my new title of ‘surgeon’, I have not changed specialties. The moniker is used to designate the regimental medical officer. My job is to oversee medical issues for four active duty battalions, an underwater construction unit, and a maintenance unit, and four reserve construction battalions. The regimental surgeon position is an example of “operational” medicine rather than clinical medicine. My patient care will be limited in favor of administrative work. In effect I will be working in a health policy, health care administration, and preventive medicine role. My master’s degree in public health should be beneficial.
While a psychiatrist in the position of a battalion surgeon is not advisable given the potential need for trauma care and the more up to date primary care skills, the inherent “people skills” that a psychiatrist should have mastery over are useful in a regimental setting. Negotiations and meetings seem to take on a different tack when a psychiatrist is in the room. People always seem worried that they are being “analyzed” and so might be more restrained when a psychiatrist is present. While I may in fact be analyzing someone’s behavior and mannerisms, it is surely poor form to then verbalize those thoughts. Ultimately only a patient/client (i.e. someone who wants to get a professional opinion) should be given an interpretation let alone a diagnosis. Moreover it is a common fault of mental health practitioners to make a spot diagnosis based on a brief encounter or some stereotyped behavior. The more responsible path is to get all the necessary data before making a diagnosis. As an example, I often have to remind aspiring psychiatrists and psychologists that behaviors of a person in distress can mirror those of a personality disorder. As the latter diagnosis can have serious implications, including a discharge from the military, all other explanations for the behavior should be examined before a personality disorder diagnosis is given.
A second good reason for having a psychiatrist at the regimental level is that some of the major concerns arising from the current war on terrorism are combat/operational stress and traumatic brain injury. The two conditions warrant their own future postings but needless to say they are the clear domain of a psychiatrist. The visibility of a regimental surgeon can ensure that these concerns are given proper attention.