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To heal or to patch? Military mental
health workers in Iraq
By
Stephen Soldz
11/29/05 "ICH"
-- --
The Wall Street Journal has a new article on the role of mental
health professionals in treating war trauma in Iraq [Therapists
take on soldiers' trauma in Iraq]. The military has caught on to
how these workers can aid the war effort and has increased their per
capita numbers. Rather than seeking the best treatment to help
traumatized soldiers recover from their stressful and horrific
experiences, these professionals attempt to patch soldiers in order
to return them to combat. As the article illustrates in its lead
paragraph:
Lt. Maria
Kimble, an Army mental-health worker, runs a two-person counseling
team out of a small plywood office here. As part of a "combat stress
detachment," her job is to help soldiers cope with the horror of the
battlefield -- so that they can return to it as soon as possible.
Ethical questions are raised, and then ignored by these workers, who
after all, are primarily involved in serving the war effort:
"There are a
lot of ethical questions about it," says Col. Levandowski. "The oath
I take as a physician is to do no harm," he says. But "ultimately,
we are in the business of prosecuting a war."
Clearly, the best interests of the patients are at best one of
several factors weighed by these professionals:
"I do ache for
these guys," says Col. Levandowski. "But if you send too many
(soldiers) home, the risk is that mental health will be seen as a
ticket out of country."
Success is measured as much by
whether a soldier returns to combat as whether (s)he feels better.
Speaking of her treatment of a soldier affected by witnessing
bombings and bomb scenes:
Lt. Kimble
says that his condition is probably staying level. "Anyone dealing
with post-traumatic stress disorder should have a calm, safe
environment and not have to go back to such traumas," she says.
Sgt.
Parkinson, however, will likely finish his deployment, which ends in
the spring. By the standards of Iraq, Lt. Kimble says that is a
success.
Since these mental health professionals give greater priority to the
needs of the military for manpower than to the needs of the of the
soldiers the6 treat, this “treatment” raises serious ethical issues.
Using common sense interpretations, the treatment is in
contradiction to the ethical codes of most mental health
professions. Thus, the American Psychological Association
Code of Ethics says:
Psychologists
strive to benefit those with whom they work and take care to do no
harm. In their professional actions, psychologists seek to safeguard
the welfare and rights of those with whom they interact
professionally and other affected persons, and the welfare of animal
subjects of research. When conflicts occur among psychologists'
obligations or concerns
Surely, returning a traumatized soldier to combat where he may be
retraumatized does not satisfy the “do no harm” provision. The
American Psychological Association does exempt those whose work
requires them to perform in violation of its ethics, if the
psychologist takes steps to resolve the conflict between orders and
the Ethics Code. Do psychologists working in Iraq taken those steps?
I doubt it.
The American Psychiatric Association has the
Principles of Medical Ethics With Annotations Especially Applicable
to Psychiatry. These Principles are clear that a physician “must
recognize responsibility to patients first and foremost.” It
further states “a physician shall, while caring for a patient,
regard responsibility to the patient as paramount..” In cases of
conflict between law and the best interests of the patient, “A
physician shall respect the law and also recognize a responsibility
to seek changes in those requirements which are contrary to the best
interests of the patient.” Do military psychiatrists carry out their
“responsibility to seek changes” in policies that can return
traumatized patients to combat? As the Wall Street Journal article
indicates, the answer is usually “no”.
The
Code of Ethics of the National Association of Social Workers
goes further than the APAs in requiring social workers to notify
clients of any conflicts between their interests and the interests
of other organizations such as the military. The Code says that “Social
workers' primary responsibility is to promote the well-being of
clients”
However, the Code does recognize potential conflicts between loyalty
to clients and to “he
larger society or specific legal obligations.”
However, in cases of such conflicts, “clients
should be so advised.”
One wonders how often military mental health workers advise soldiers
that their primary loyalty is to the larger military and not to the
individual soldier they are “treating.” Do they let the soldiers
know that their welfare matters only to the degree it is consistent
with returning the soldier to his/her unit? Unlikely.
Interestingly, while the social workers’ Code states that social
workers “respect
and promote the right of clients to self-determination and assist
clients in their efforts to identify and clarify their goals,”
the Code goes on to state:
Social workers
may limit clients' right to self-determination when, in the social
workers' professional judgment, clients' actions or potential
actions pose a serious, foreseeable, and imminent risk to themselves
or others.
One wonders how many social workers in the military, like Lt. Kimble
from the Wall Street Journal article, have ever considered that
returning a soldier to combat may “pose
a serious, foreseeable, and imminent risk to themselves or others?”
Surely, returning to a position where you stand a serious risk of
dying or being injured constitutes a risk to self. Additionally,
having a traumatized soldier on the streets of Iraq must often “pose
a serious, foreseeable, and imminent risk to … others.”
Were any of those soldiers lethally firing upon Iraqi civilians at
roadblocks returned to combat after being “treated” by one of “combat
stress detachments?”
Additionally, other soldiers may be put at risk by having the
comrade beside them preoccupied by flashbacks or nightmares of
previous horrors.
[In writing about the social workers’ Code, I do not mean to
criticize the National Association of Social Workers, which has
taken a strong position against he war from the beginning. See their
October 7, 2002
Letter to President Bush, the NASW document
A Legacy of Peace; The Role of the Social Work Profession, and
their strong May 14, 2004
Letter to Senator Warner,
Chair of the Senate Armed Services Committee protesting abuse of
POWs.
Would that other national mental health organizations, e.g., the
American Psychological Association or the American Psychiatric
Association, had taken such strong stands.]
These Ethics Codes are only binding on members of the organizations
promulgating them. If any of the mental health professionals serving
in Iraq are members of these associations, they are technically
subject. For example, if
Lt. Maria
Kimble is a member of NASW, she would be subject to the NASW Code,
on pain of loosing her membership. However, these codes are
considered to be standards for ethical conduct for the profession in
general.
I am not a
strong supporter of ethics codes, as they are frequently
bureaucratic statements designed to protect the profession from bad
publicity or increased regulation rather than to truly protect the
public from wrongdoing. However, having adopted these codes, one
sign of their being taken seriously by these professional
organizations would be that action was taken against egregious
violations by those in service to the powerful, such as those
professionals serving in the military.
In additions
to the NASW positions mentioned above, these association have felt
obligated to take positions in the wake of the Abu Ghraib horrors
and in response to participation of psychologists and psychologists
in the abuses at Guantanamo, the American Psychiatric Association
has announced that psychiatrists should never participate in
coercive interrogations, while the American Psychological
Association bowed to the powerful and took a weaker position,
stating “psychologists do not direct, support, facilitate or offer
training in torture or cruel, inhumane or degrading treatment”
[http://www.apa.org/monitor/sep05/taskforce.html] but, like the US
government, this APA carefully avoided defining “torture or cruel,
inhumane or degrading treatment.”
To my knowledge, none of these major professional associations has
directly addressed the obvious ethical conflicts involved in mental
health professionals aiding the military by helping patch up
soldiers only to send them back to suffer potential further injury,
mental and/or physical, in combat. While it would be unlikely for
these organizations to bite the hand that feeds them and directly
take on the military – after all, the American Psychological
Association has had a division of military psychology since 1945 –
progressives can pressure these organizations to require member
professionals serving in the military to be up front with soldiers
as to their multiple and conflicted loyalties. Veterans and GI
organizations can alert soldiers to the dual loyalties of those
offering to “help” them. These organizations, and mental health
professionals can help establish alternative organizations,
independent of the military, to help traumatized soldiers when they
get home. Beyond that, it remains for the antiwar movements, and the
citizenry at large, to fight against the wars that create these
ethical conflicts.
Stephen Soldz (mailto:ssoldz@bgsp.edu)
is psychoanalyst, psychologist, public health researcher, and
faculty member at the Institute for the Study of Violence of the
Boston Graduate School of Psychoanalysis. He is a member of
Roslindale Neighbors for Peace and Justice and founder of
Psychoanalysts for Peace and Justice. He maintains the
Iraq Occupation and Resistance Report web page and the
Psyche, Science, and Society blog.
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