Blog spotlight: Elaine on NYT's reporting on military psychology

Elaine's one of the most difficult to pin down on reposting for spotlights. Her reasons are always along the lines of "Oh, ___ said something better." This week we strong armed her and she agreed we could excerpt part of one of her posts. If you've never checked out her site, Like Maria Said Paz, give it a visit.

"Too long on a variety of topics"

On the topic of therapy, the New York Times has a front page article by Benedict Carey entitled "The Struggle to Gauge a War's Psychological Cost." The article is, obviously, attempting to measure the "psychological" cost. "Capt. William Nash, a Navy psychiatrist" is quoted and I'm troubled by his quote and the reliance upon him to represent the therapuetic community. He is not the only medical professional quoted, but he is the one the article leads with and the one they relay on for the first ten paragraphs.

"You have to help them reconstruct the things they used to believe in that don't make sense anymore, like the basic goodness of humanity."

That's a statement from Nash. While I myself believe in "the basic goodness of humanity," it is not my job to convince any patient of that belief, whether they once believed in it or not. Troops seeking counseling are trying to make sense of their experiences (usually traumatic). This can be a transformative moment for them. It's not my job (or right) to set out to return them to a belief they once held. It is my job to aid them.

His statements (combined) strike me as simplistic and the sort of thing one might have found much earlier in this country from proponents of "the sleep cure." Perhaps Nash is attempting to state that he assists them in reconstructing the past so that they can reconcile the past with their new experiences? That's not how his statements read in total.

It's not the job of a therapist to "return" someone to where they were. A grieving parent, to use an example, does not need to return to a happier time. He or she needs to process the loss and to reach conclusions about their current status. Such a parent certainly doesn't need me aiding them to see "the basic goodness in humanity." Again, I believe in such goodness, but that is my belief and it's really not pertinent to their therapy.

Whether Nash is advocating a quick fix or not, that is how it comes off in this article. To expect that a quick fix can be given to a trauma and that the patient can then be sent back into life as they were "before" is a denial of therapy as it is understood today.

In previous eras, shock therapy, lobotomies and other "cures" promised quick fixes and the returning to "normal." A trauma, by it's very definition, is not something that leaves you. To imply otherwise is to reject the very nature of therapy. You can be assisted in dealing with a trauma but ask any parent who's lost a child, to stay with that theme, and they will tell you that, no, they have not gotten "over" it.

At another point, another military therapist offers that, "The idea is simple. You have a lot more credibility if you've been there, and soldiers and marines are more likely to talk to you."Some. Some are. However, some will seek out therapists who have not been there because they complain of their issues being dismissed for whatever reason. I would agree that the it's more likely that a majority are more comfortable discussing a trauma that occurred while serving with someone who has served; however, a significant minority would feel exactly the opposite.

There is a conclusion implied by the article, in my opinion, that "everything's okay and it's all being dealt with now." I'm not seeing anything to support that in the article other than some good p.r. Since the issue of violence towards others and suicide is mentioned, I am very curious as to what is being done for the family members?

Has the military improved the resources available to family members? It needs to. People who go to war and come back transformed effects the families involved.

The best section of the article, in my opinion, is the following:

Yet for returning service members, experts say, the question of whether their difficulties are ultimately diagnosed as mental illness may depend not only on the mental health services available, but also on the politics of military psychiatry itself, the definition of what a normal reaction to combat is and the story the nation tells itself about the purpose and value of the soliders' service.

That is a large issue and beyond the scope of the article. What is not beyond the scope of the article is interviewing therapists beyond the military establishment. C.I. wrote an entry this morning that dealt with the Times' issues of "balance." (Great entry, read it if you haven't.) As a therapist myself, I would have been very interested in reading some evaluation or critique of the military therapy from outside the official voices and from outside the military.

A very long entry at a time when I'm suggesting everyone give themselves time to breathe. So I'll slap my own wrist and work towards my own goals in the next entry. I'll also thank C.I. and others present for listening to various paragraphs to make sure this post has some clarity.

Mike's motto: The Common Ills community is important and the Common Ills community is important to me. So I'll do my part for the Common Ills community.