Bringing the Uniform Out of the Closet

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Don't Ask Dont Tell

The unveiling of the of American Psychiatric Association’s fifth edition of its Diagnostic and Statistical Manual of Mental Disorders – the key reference in how mental-health professionals diagnose mental ailments – dominated the headlines at the APA’s annual gathering in San Francisco last week.

But it wasn’t the only thing going on.

I’d like to highlight a fascinating symposium: Bringing the Uniform out of the Closet: Artistic and Clinical Perspectives of Gay Military Life Before and After “Don’t Ask, Don’t Tell,” sponsored by the Association of Gay and Lesbian Psychiatrists.

Documentary photographer Vincent Cianni presented evocative photos and troubling stories from gay service members in his montage, Gays in the Military: How America Thanked Me. It was clear that what was supposed to be an improvement – 1993’s “Don’t Ask, Don’t Tell” policy — was anything but, for most gay service members.

I reviewed gay mental health issues over the last 30 years, the first 28 of which I served as an active-duty Army psychiatrist.

I began my career at Walter Reed as a psychiatry resident about the time that the Army began to test all personnel for HIV (then the HTLV virus). We would get planeloads of newly-diagnosed Soldiers, which the psychiatry residents screened upon arrival for thoughts of suicide. They continued on to the nurturing staff of Ward 52, whose members helped them cope with the impact of their diagnosis.

We were always careful never to put anything about homosexuality—or other ways that they may have gotten HIV—because of concern about their careers. Nevertheless, confidentiality remained a huge issue.

As military officers, we were supposed to report if someone was committing homosexual acts. As psychiatrists, we maintained discretion and did not (unless there was danger to self or others). However there was often confusion as to exactly what were the rules, and patients generally did not disclose “sexual identity” concerns to us.

Of course, many military psychiatrists were gay. In a hospital setting, sexual identity often was an open secret to other staff. However, out in the “real Army”, in South Korea, or Fort Hood or Somalia, being discovered as being homosexual carried real risks. You could be hazed by fellow Soldiers or discharged under a Chapter 15 for homosexual acts.

I was in Somalia when “Don’t Ask, Don’t Tell” became policy. Several of my colleagues there were gay. They feared an upsurge of homophobia and possible violence. I did not see it then, but certainly over the years there has been harassment, continued discharges for homosexuality, and some deaths.

“I was nearing retirement, which made me nervous, because if you get discharged before retirement, you get no benefits,” one recalled. “I was the commander at a hospital.”

Fast forward.

In 2010 I was on a working group looking at the possible effects of ending “Don’t Ask, Don’t Tell.” The initial conversation focused on whether having gays serve openly would mean that so-called “battlefield transfusion” could not be done because of concerns about HIV-tainted blood. I pointed out that everybody in the military got screened frequently for HIV. Besides, in a mature theater, Soldiers get evacuated quickly to a combat hospital where the blood supply is all pre-screened.

Being a psychiatrist, I also pointed out the positive mental health effects of not having to hide your sexuality and personal life. No one knows how many suicides in the military have been related to fears of being “outed”, but intuitively it seems like it must have been a factor.

Prior to giving the talk, I also checked with my colleagues who are still in uniform about the impact of the change in policy on their practice. Most military psychiatrists felt little had changed; gay service members are still being discrete, psychiatrists are still circumspect about what they put in their medical records; units still maintain good order and discipline.

Nevertheless for the gay service members on the panel and in the audience, they described lifting of “Don’t Ask, Don’t Tell” as an enormous relief. They can bring their uniforms, and themselves, out of the closet.