War Stories: Psychiatrists on the Front Lines

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Listening to war stories on the front lines imposes its own burdens on the military psychiatrists there.

Two of the most powerful workshops at the recent American Psychiatric Association annual meeting were the panels of psychiatrists talking about their personal experiences in war zones.

They were part of the Military Track, a growing trend at the APA’s Annual Meeting, with a total of 45 military and VA-related sessions under a single umbrella. The news is often full of the travails of deployment of regular Service members, but military psychiatrists and other medical personnel have also deployed multiple times.

The first of these sessions was Women at War and the second Personal Experiences in the Combat Zone. Each featured five speakers, with many of those who served discussing their deployments to Iraq or Afghanistan.

As we assembled, Army captains Christine Wolfe hugged Christina Rumayor, who had last seen each other when they did the “left-seat, right seat” orientation ride in Sharana, Afghanistan, in 2012. I had audience members introduce themselves, and they included military and civilian psychiatrists, as well as several military spouses who were considering entering the service. A quartet of young Navy psychiatric residents attended, to learn how to prepare for their upcoming deployments.

The speakers, including Army Lieut. Colonel Chris Ivany (who has my old job at the Office of the Army Surgeon General), described their work in theater and the diagnoses of service members they saw. The pictures of psychiatrists in battle dress uniforms in front of a tank added context for the civilians in the audience.

They also shared personal reactions to having been separated from family, rocketed by mortared shells, and taking care of severely wounded service members and Iraqi and Afghanistan nationals. Other psychiatrists, including Army Major Sebastian Schnellbacher, reflected about being a father or a mother when deployed. How do you parent from a war zone?

The female psychiatrists were in the glass-bowl atmosphere of the theater of war, where every movement was scrutinized. Female Soldiers had to travel everywhere with another female, to minimize the chances of sexual assault. This sounds like it makes sense, but it severely limited their movement, and their ability to bond with fellow troops. “I could not go into the CHU (containerized housing unit) to play cards,” one said, “because of was the only female.”

I was reminded of my experience in Somalia, when females were ordered to bunk only with other females. Since I was the only female in the 528th Combat Stress Control detachment, that meant leaving my buddies for an unguarded tent with women I did not know, mainly civilian interpreters.

I emphasized the hygiene needs of the female Soldiers, which basically means adequate places to urinate, e.g., bathrooms. There has been much discussion of women in combat, and whether they have the strength to handle a heavy load. In my opinion, managing needs about menstruation, and avoiding urinary tract infections, are more relevant and urgent  (men always get uncomfortable when I talk about these matters),

Nicole Richter, a pharmacist and wife of a three-times deployed Navy psychiatrist, spoke of her experience holding down the home front while her husband was deployed. Her husband, Lieut. Commander Ken Richter, was wounded the first time he deployed. Then he returned to almost the same place for another deployment. Communication got better over time, but the fears and anxiety about getting killed did not.

Dr. Robert McLay read from his book, At War with PTSD, about spending Memorial Day, 2008, in Fallujah, when the pictures of all the fallen Marines flashed across the screen. He surprised himself then he choked with his emotions. He was not alone. I was brushing back tears as I moderated.

Both workshops had a vigorously-engaged audience, as did all of the topics in the Military Track. The sessions seemed almost cathartic for the speakers, as they shared their personal experiences in the combat zone.

One significant question from the audience was “How can we take care of these psychiatrists, who have seen and done so much?”

My answer was simple: “Stress management classes only tell you to not drink or smoke too much, and exercise. They already know that. What you can do, is invite them to give a talk. Let them share their experiences, as we did today.”

Military psychiatry has been through a rough 12 years since 9/11. It was heartwarming that the American Psychiatric Association gave some of them a chance to tell their stories.