Farm Boy Turned Military Psychologist: A Summary of War Deployment Experiences, Struggles, and Coping

Layne D. Bennion

I froze when I heard the KA-BOOM. This sound was different from the periodic detonation of incoming mortars and rockets. This was during daylight; it was more powerful, somehow deeper. The metal frame building shivered, dust oozed out of the walls. I glanced at my mental health technician through the office doorway. She was staring back at me, not moving. I primed myself to drop out of my chair and roll under the table if anything else happened. We were both motionless, waiting. After a minute, nothing changed. I got up and glanced across the hallway. The logistics sergeant looked out of the supply room. “Whoa” he mouthed silently. Minutes passed. Nothing else happened. Slowly everyone went back to their work routines. I sat back down at the computer, but I couldn’t focus on my patient documentation. I shook my head, “What am I doing here in Iraq?” I thought. I smiled at myself and recall that not that many years ago, I had left home and headed off to college. A kid raised outside a small remote town, driving a 25-year-old car with four or five colors of paint, undercoat and rust. I had a big plan; become a civil engineer. I had thought maybe I would work at an engineer firm in the big city two and a half hours from home like my oldest brother did. But, years later, here I am in Iraq, in a war zone, a military clinical psychologist. How life twists and turns.

Approximately 30 min after the big boom, an overhead announcement informed us a massive VBIED (Vehicle Bourne Improvised Explosive Device) had detonated outside a security gate followed by an unsuccessful insurgent attack. Fortunately none of ours were killed in the incident. I happened to hear days later, from a patient,

Note: While I am attempting to convey the stories of the men and women I had the honor of working with and learning from, out of respect for privacy I have changed identifying details.

L.D. Bennion, Ph.D. (*)

ISO TBI Clinic, Ft. Belvoir Community Hospital, Ft. Belvoir, VA 22060, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it © Springer International Publishing Switzerland 2017 E.C. Ritchie et al. (eds.), Psychiatrists in Combat, DOI 10.1007/978-3-319-44118-4_2

the blast was so potent they found not a shred of the driver of the VBIED and only a few parts from the vehicle: the engine block, an axle, and a pretzeled steering wheel.

When 9/11 happened, I had no premonition that what became my 20-year “marathon” as a military psychologist was just past the warm-up stage. I had joined the military, frankly, for financial reasons. I was a young husband and father. We were saddled with student debt from my graduate degree programs. At the time, our immediate financial future seemed to stretch barrenly ahead of us. For my school mates, the most typical path forward would be a 1-year low-pay clinical internship with moves at both ends, and then finding a job after internship. In addition, one would have to find the time and energy to complete a Ph.D. dissertation and then study for and pass the national licensing exam. My decision to join the military meant a relatively high-paying internship, a guaranteed job after internship and family medical coverage. It also meant that I, a farm boy, was launched onto an international pathway.

Over the years, each time the decision surfaced to leave or stay in the military, I found myself thinking about the men and women wearing the uniform and the high percentage of them who dedicated their lives to making the massive bureaucracy function. I also thought how sometimes I was able, in small ways, to help the men and women who smooth that process.

Immediately post-9/11, the military medical system was energized, but chaotic. There had been plans on paper to manage large scale deployments for years. Reality, particularly as the initial surge settled into a long-term process of deployments, was apparently unaware of those carefully laid plans. I came to understand over and over again, it is the smart, dedicated individual service members who make the military work-individuals from “paper-pushers” to “fuel guys/gals” to “wrench turners” to “eye-in-the-sky watchers.” The military really does work hard to prepare all levels of medical personnel for work in the field. But, once on the ground, the reality is always different.

Deployed life is distilled down to the basics: work, eat, sleep, pee, poop, and a minimum of personal chores. At some sites, there is even a no-pay laundry service, assuming you don’t mind losing a t-shirt or a sock once or twice a month. Some individuals find deployed life disturbing and stress-filled. Deployed life strains every resilience “muscle” they have; every day is a challenge not to fold into oneself and abandon responsibilities. Others thrived in the simplicity of deployed life. Some actually prefer deployed life and are reluctant to return home.

Unexpectedly, a portion of my days were not so different from the work I did every day at stateside assignments. Individual airman, soldiers, sailors and marines come in to share and hopefully shuck some of their burdens: hobbling stressors, too-skinny sleep patterns, or buckets of glitches with spouses or children or friends. Yep, just like my office stateside ... if every square inch of horizontal space was spritzed with dust and fine sand 2-3 times per day, the walls were either canvas or cheap plywood, the space was squeezed down to half, furniture was folding tables instead of desks, seating was either plastic shackable lawn chairs or canvas sling chairs or cheap couches covered with burlap-like fabric which wheezed dust every time someone sat down.

The textbook definition of “mental health” doesn’t apply during deployment. I was regularly called upon to deal with or advice in situations someone thought was “mental health.” There were many examples. Not too many weeks into the deployment, a medical technician started crying and ran out of the ER during an influx of bloodied soldiers. A day-shift leader who wanders through the clinic at odd hours night after night. But when anyone asks him shouldn’t he be sleeping, “Oh, no, I’m good ... just checking in.” The distraught buddies of a soldier who died from huffing compressed air. The angry-beyond-words nurses who were handed an unidentified small bundle from a Special Ops helo and it turned out to be a toddler with a severe head injury. Why didn’t they tell us they were flying in a child? The muttering, glaring unit members of a wounded service member who had gathered outside the medical building. They found out the insurgent, who reportedly shot their battle buddy and was currently in trauma surgery, had been shot in the leg, was captured, and was now in the ER receiving care for his own gunshot wound.

To me, above are examples of normal people trying to manage when the craziness of war tromps on their daily life, not the pathology or mental illness popping out. But, all those incidents listed above were “my people” and figuring out a way to help was part of my responsibilities. No textbook held any answers. No classroom or seminar had addressed such problems.

Often I found myself thinking back to various personal and professional mentors who had kindly eased my life. What would they do in this situation? What would they say to console this soldier? Help me think of what to say to a teenager, who just a few hours previously, had witnessed his friend breathe his last after a rocket-propelled grenade detonated against the cab of their truck pulverizing his friend’s face and leaving his skull mushy and misshapen? Tell me how to help a young medical tech who had been assigned to monitor and be with a mostly unresponsive patient with a severe head injury. A patient who was going to die in the next few hours because there was no additional medical treatment to give and there wasn’t a chopper available to fly him to a major medical facility.

Another new role was dealing with a common concern: “I need to go home, I can’t do this anymore.” This complaint came in many boot sizes and colors. In most cases, my job was not to send them home, but to find a way to help them find a smidgen of motivation to pick up the pieces of their life and carry on in spite of the danger, fatigue and disillusionment.

Of course, there were ample “no-kidding” mental health problems to manage. Mild depression and anxiety was around every tent corner. Many service members had such garden-variety symptoms from simply managing the task of staying alive in a mostly unpredictable combat zone.

Other situations were more subtle requiring careful building of relationships. For example, a soldier in his mid-20s came in for sleep problems. Reportedly he was accomplishing his job and had a reasonable reputation with the command. According to the mental health technician who initially interviewed him, this soldier was “odd ... was off,” more than just lack of sleep. A social worker met with the soldier a few times and then asked if I could see him to provide a fresh perspective. We did some psychological testing, but it wasn’t particularly helpful in this case.

After a few sessions with this soldier, he began to disclose to me, bits and pieces about the daily voices and moment-by-moment commentaries he heard. Initially, I thought perhaps these “voices” were part of his religious and cultural upbringing, essentially self-talk perceived as the “voices” of spirits or ancestors who he felt guided him. But, over time, the data began to line up that he was psychotic—not flagrantly, but enough that some of his decisions were nudged by the voices. The content of his voices were relatively benign, i.e., at the time weren’t telling him to endanger himself or others. But, after consulting with my social work colleague and another psychologist by phone, I contacted the soldier’s command and recommended he be medevac’d out of the combat zone for additional inpatient observation and evaluation. Stateside, such a case may not need such urgent intervention. But in a combat zone, this young man carried a loaded weapon every day. No one knew, no one could predict if or when the voices might change.

An airman in her late-20s who initially came in as she perceived she was being treated poorly by others in the work place. She had volunteered for the deployment. She was very invested in the mission, doing her job meant a tremendous amount to her and in her mind working hard off-set some perceived failures in her past. It took me a while to appreciate all the contributors to her situation. It was true she was on the receiving end of insensitive comments. However, it was also true she was rather socially inept and mostly “did not get” subtle feedback. Hence her coworkers had become increasing blunt in their comments to her. One of her supervisors was quite clear in his opinion she needed to be sent home as she was more of a hassle than a help. Over the course of many weeks and more detailed discussion with some of her coworkers and other supervisors (with patient permission), we found ways for her better navigate the interpersonal demands of working with others as well as taking better care of herself. The end result was not exactly work-place harmony, but the balance of hassle vs. help shifted in a positive direction.

The immediate reaction to a suicide attempt with a broken shaving razor by a cook was straight-forward: remove the “sharps,” get him to medical care, put the now-patient on suicide watch and set the process in motion for a medevac to get him to a facility with inpatient psychiatric services. The less-than-straight-forward part was his coworkers who came together after the suicide attempt: upset, crying, feeling hopeless. Their supervisor came to me. Several of the patient’s coworkers had tried to help this troubled young man and were now feeling horrible and asking “What went wrong?” I talked with the supervisor for a time and together we thought carefully about the coworkers, their values, their personalities and outlined a plan to meet as a group.

Although the exact pathway was unclear, the goal of helping that group of food service workers come together as a team was clear. As most of the coworkers were quite religious and attended church together, I asked one of the chaplains to join us. We found a space to meet and gathered the 10-or-so coworkers. The supervisor started off the meeting introducing everyone, the chaplain offered a prayer, and several of the coworkers offered their own prayers. As a group we talked, shed some tears, shared, prayed some more, sang a few hymns.

Over approximately one and half hours, we nudged the conversation toward what would help the group grow together and what might help the young man (who was still local awaiting a medevac flight). Several of the group floated ideas how to support each other and manage through the rest of the deployment cycle. One of the workers who was closest to the young man wanted to write him a letter explaining what they hoped for him as he got help. This was well received and ended up being a trove of letters the supervisor and the chaplain delivered to the tearful young man before he was bundled off on a flight for additional care.

Deployed life as a psychologist was not just attempting to help other cope with depression or stress. Being a part of a medical team meant many new roles for a psychologist.

At irregular intervals casualties (wounded) were choppered in or driven in; mostly from two or three Army outposts some miles away. At those times, everyone took on additional tasks and were busy for handfuls of hours. Almost everything else in medical stops when medevac choppers are incoming with two or more patients. If there were multiple wounded coming, a call went out for “All Medical.” Within minutes dozens of uniformed hands arrived by foot, by Hummers, fire trucks, and pickups with extra personnel ranging from chaplains to off-duty firefighter teams to Special Forces docs and medics. For myself, these events usually meant donning bug-eyed goggles, ear plugs and gloves as part of a team to crouch-run up to the side of the chopper (don’t stand up in case the wind shifts and the rotors dip giving you your last haircut down to your cerebellum). To carefully and nonjarringly, off-load litters overflowing with bloody, bandaged soldiers and weighted down with an additional 50-100 lbs of armor, O2 bottles, IV bags, and portable vitals machines.

We hustled them into the ER where metal stanchions were slid under the litter, and we eased back through the incoming flock of gowned/bespectacled/gloved/ bootie-ed medics who swooped in to do dozens of tasks. Someone cuts off uniforms, while others check various pulses, call out vitals, sponge away bloody grit, examine God-made and bomb-made orifices, assess the mental status and responsiveness of the patient, feel along limbs for bony outcroppings and long bone edges, call out for lab tests and X-rays, weave into the throng with bags of blood and fluids, unwrap hasty field bandages oozing blood, and unpack gore-soaked tampons from gaping shrapnel holes (yes, tampons is what many field medics found work very well to pack the holes blasted into flesh).

On average, somewhere around half of wounded were then prepped and intubated for surgery where the surgical team removed bits of metal or gravel from interior flesh, realigned shattered bones, stitched up perforated internal organs, augured in metal pins to hold broken bones straight, grafted in Erector-Set-looking external fixators which held limbs and joints in correct healing position, tied in shunts to reattached severed ends of arteries to keep blood perfusing severely damaged limbs, and surgically finished partial blast amputations. Lots of hard-to-forget cases of young men and women whose life course was violently altered in milliseconds.

I did have an unusual opportunity for a psychologist—a product of being in the right place at the right time, or the wrong place and time depending upon your perspective. Typically the triage team has a photographer snapping pictures to document traumas, procedures and types of treatment (pictures showing the faces of patients are removed or edited later for privacy purposes). The medical photographer was pulled for another task in the ER. As she headed for her new task, she handed me the camera and pointed at the shutter button. After a few what-am-I- doing moments, I started shooting pictures of the action in the ER trying to get those grim-faced, sweat-dripping-down-foreheads medical action shots. As a patient was being prepped for surgery, the surgeon saw me with the camera, “you’re photographing today? Be in the OR in 5 minutes.”

Initially I thought I should hand off the camera, but reminded myself where else would I get an opportunity to witness first-hand trauma surgery. Somehow I convinced myself I could do this without passing out or vomiting. Someone helped me find booties, hat, surgical smocks, and gloves and into the OR I went. I was a fly-on- the-wall observing the surgeons, anesthesiologist, OR nurse and surgical tech. This type of surgery is not exactly gentle—it’s tense, bloody, pokey, proddy, messy, and gloppy. The surgeons abruptly changed tactics as they began to appreciate the depth the damage, with intense discussions of the dynamics of patient’s status all the while continuing to dissect and prune away damaged tissue, pump in fluids, call for lab work and bark medical short-hand and terminology I only vaguely understood. What I clearly understood was the weight of responsibility the team felt, in spite of minor differences of opinion, in keeping this man alive while he see-sawed between medical stability and body systems shutdown. Some 60 min later, they got the patient moderately stabilized and “packaged up” for his medevac flight to a larger facility. I did make it through to the bloody end of the surgery, with the help of some deep breathing and having a job to focus on. I even helped mopping up of the pools of drying blood under the OR table and the bloody boot prints coloring the most frequent pathways through the OR.

We also had the opportunity to attend the too many memorial services for Army troops. Medical is included as we often have had a part in the final moments of the deceased’s life. The basic format of Army memorial services is spelled out by tradition. Everyone comes early and sits solemnly while music quietly plays. The DVs (distinguished visitors) (Colonels, sometimes Generals, one or two representatives of local Allied forces) come in last.

Centered in the front on a small platform, is one or two or three pairs empty boots, rifle(s) propped up vertically, muzzle end down, helmet(s) capping the butt end of the weapon and the deceased’s dog tags dangling from the trigger guard. The four items which are never far from a soldier. Generally a Chaplain starts the service with a few words of welcome. A fellow soldier reads a brief biography of a brief life. A handful of the deceased’s brothers-in-arms read prepared talks generally focused on the deceased’s qualities and accomplishments, then a few gently told stories highlighting their humanness, such as the now-dead soldier who several months previously had been bitten by a spider while he was sleeping. It was not medically serious, but did swell some and create a small abscess. His buddy told him that type of spider was very territorial, was aggressive and was obviously living in his CHU (trailer). Reportedly, the soldier spent his entire off-day, moving everything out of his CHU, shaking, inspecting, sweeping, cleaning, painting, and chalking all the seams. The crowd quietly loves these little stories of jokes successfully played on each other, these macho stories of kinship and band-of-brothers love.

The company commander offers a remembrance and eulogy—once in the form of a letter written to the deceased’s 3-year-old son. A now fatherless son who would grow up knowing his father treasured being a dad, all his warrior buddies knew about love for his son and that his father was honored soldier who died doing his job to protect his brothers. Sometimes there is a musical number. Some among these hundreds of grim-faced, burly soldiers had surprisingly beautiful and soulful voices. Then a 21-gun salute and the playing of taps. Then the deceased’s 1st Sgt stands and begins roll call: “Alpha company ... 2nd platoon ... Roll Call.” As the last names ring out, a soldier stands and barks back “Here 1st Sgt.” When the 1st Sgt reads the deceased’s name, there is a long silence. Again the 1st Sgt calls out the missing soldier’s rank and name. Again silence. And a final third time, with clear enunciation and in measured tones the decedent’s rank and full name rings out. Followed by ... a long silence and a trickle of tears.

The ceremony ends with the DVs slowly marching up in rows of three or four, standing for a moment heads bowed, sometimes reaching out to briefly grasp the dead man’s dog tags or lay a hand on his helmet. Then they come to attention, offer a slow measured salute, execute a careful right or left face and slowly march away. This process continues for up to an hour in near absolute silence as three or four or five at a time come forward and friends and company mates salute each final sacrifice.

There are also some funny times in the midst of blood and near-death . like the massive soldier who came in with both arms broken/crushed during a vehicle rollover. He was rumbling with pain as the medics poked and prodded to find out where he still had feeling and circulation. When they rolled him on his side to assess his back, his groin cover fell off and the female doc said “Ok, folks, let’s keep his dignity covered” and he was able to joke in his deep baritone “It’s OK ... (groan) ... I know it’s small ... I ain’t ashamed.” Later 6-7 people tried unsuccessfully to lift him off the litter to get X-ray film sleeves underneath him. He finally said “I can do it ... just tell me when” and he did, jack-knifing his mid-section a few inches off the creaking stretcher while the techs levered the film trays underneath him.

Of course, mental health workers are not immune to stressors, or to their own reactions to austere conditions. In fact, mental health folks along with those in other helping professions are vulnerable to “I’m Superman/Superwoman” or work-a- holic attitudes. Then all-too-often the military loses an entirely exhausted provider who exits at next opportunity.

For myself, coping took several forms: an endlessly supportive and independent spouse, a sense of helping others at least some of the time, the semi-meditative process of low-intensity long cardio workouts, alone time or “escape” time (reading, movies and ping-pong even if we played on warped and chipped tables), having a personal project to work on (e.g., professional studies) and relationships.

This latter one is tricky. One needs connection to others, but at the same time, as a mental health worker one has to be aware this-or-that work colleague could be your next patient. Balancing these needs can be done many ways. The first month or so of deployment is filled with subtle jockeying of various group dynamics as the group settles into a work unit—an ebb-and-flow which would fascinate Yalom [1] and other group process thinkers. To me, those first weeks are a time to maintain a polite friendly distance while social alliances form and settle. Perhaps just my view, but being strongly associated with one or another “clique” can hinder mental health work and being seen as somewhat independent from this or that social group can be helpful.

For myself, I tried to have numerous “having fun” acquaintances, a handful of selected closer relationships, and a few “buddies.” The latter were usually one of the chaplains. Chaplains typically outnumber the mental health providers. Amongst that group of men and women was always one whose life perspective, but not necessarily faith and spiritual viewpoint, was comfortably close to my own.

Another relationship theme which some dealt with admirably and others miserably is the aspect of everyone-being-in-everyone’s business. Not surprisingly, the intensity of working/sleeping/eating/ joking/showering/ toileting in close quarters for months on end with no means of escaping or relaxing for an evening or weekend results in people talking, wondering and rumor-mongering. In addition, in some ways, work interactions become much more sexualized than in work environments at home stations. I suppose in large part this is because whatever perfectly healthy sexual relationships or other tension-reducers one previously had, those are unavailable while deployed.

This sexualized aspect was variously experienced as ranging from “high school hormones raging all over” to “we’re gonna die anyway so let’s have a bit of fun” to a true family sense of being “brothers and sisters in arms.” Inevitably male-female relationships of any type receive a lot of comment and attention—deserved or not. There were always a small percentage who had difficulties appropriately coping with and managing those drives. Some coped poorly and engaged in outlets which hurt families and loved ones far more than being separated for months. Some coped by becoming the morale “police”, with the lofty goal of vigorously stamping out any possible iota of bawdy behavior.

Personal opinions ranged from “even if nothing was going on one should always avoid the appearance of XYZ” to “it doesn’t matter whether they were or not, they’re adults, it’s no one’s business.” As with many real life situations, in my view, there are no simple answers. Except that mental health care givers need to work extra hard to manage this side of their reactions because the perception of an “infidelity,” real or not, deserved or not, spreads like fire in drought and shuts down the motivations of individuals seeking care.

In the end, what did I learn? The primary driver of human beings is relationships. We fight, we love, we work, we sacrifice ... mostly because we think, we feel, it will is either our responsibility or will benefit our connection to another human being.

Given a choice would I do it again? I have thought about that question many times since 9/11. Some days I would and along the journey, I would try to worry less and appreciate more. Other days, I think I would go back in time, put more late-night hours into Engineering 101 and make sure I passed the damn course.

Reference

1. Yalom ID. The theory and practice of group psychotherapy. 4th ed. New York, NY: Basic Books; 2000.

Dr. Layne D. Bennion is a retired USAF psychology/neuropsychologist. This chapter combines events and experiences from three deployments: Diego Garcia, 2001 into 2002; Iraq, 2003-2004; and again in Iraq, 2006-2007. All deployments were in multiservice settings.

 
Source
< Prev   CONTENTS   Source   Next >