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.
http://www.informationclearinghouse.info/article11172.htm
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