Courage, Research and Leadership

Elsewhere I have defined courage as the “ability to face unpleasant facts.” Often research uncovers facts that might be perceived as unpleasant or things that we wished we didn’t know. Good leaders never stand in the way of conducting research that might reveal unpleasant facts, flinch from facing those facts, or interfere with their reporting. Sadly, however, there are a few senior leaders within the military that panic when confronted with unpleasant facts. Rather than displaying the courage required to confront the facts to improve the functioning of the military, they instead use their rank and position to bully or intimidate the “messenger” to change their message or to block others from knowing about the message.

When leaders don’t like the findings of a research study they typically do three things, usually in this order. First, these leaders will attack the methodology of the research: the measures, the sampling strategy and/or the data analyses. Next, they will attack the interpretation of the research findings. And finally, when all else fails, the unhappy, and fearful, leader will launch a personal attack on the investigators of the study. As a researcher who has been through this process a few times, you know that when the final event happens that your study is in pretty good shape. The release of the findings from the fourth Mental Health Advisory Team (MHAT) assessment will serve as an example.

I was the Science Officer on the first MHAT under Colonel “Pat” Patterson, who did a brilliant job leading the first team. Later I was selected to lead the fourth MHAT. The fourth MHAT would be different than all of the others. It would be the smallest MHAT, comprising only three team members: myself, Major Dennis McGurk (now a lieutenant colonel who served as the Senior Science Officer on the team) and Specialist Matthew Baker (who left the Army shortly after this deployment as a sergeant). The fourth MHAT would utilize in-theater support to assist in survey distribution and administration. And the entire report would be written in theatre, with a detailed outbrief given to key deployed leaders prior to the team leaving theater.

The fourth MHAT would also differ in two other important ways. General Casey, the commander of the multinational forces in Iraq (MNF-I), instructed me as the leader of the fourth MHAT to include battlefield behavioral ethics questions on the upcoming assessment. He further instructed me to include Marines that were under his command in the assessment.

Now, I knew that both of these issues could lead to potential problems in the reporting of the findings. First, there was a possible legal issue of including battlefield ethical questions on the survey. And second, there was the issue of the Army including Marines in what many believed to be an Army assessment.

Colonel Brian Allgood, the Command Surgeon of MNI-F and the office that our team would be assigned during the MHAT assessment, told us not to worry about the legal issues as he would staff the battlefield ethical questions with the MNF-I legal team, which subsequently, much to my surprise, found no legal issue with the questions. Regarding the inclusion of the Marines in the study, Allgood stated that the Marines were under the command of Casey and that Casey had directed the inclusion of the Marines, case closed.

Soon after our mission was completed in Iraq, I had returned to the States to begin the series of briefs to the senior military and civilian leadership within DoD. Shortly after returning home, Allgood was killed in a helicopter crash; Colonel Elspeth Cameron Ritchie, the Army Psychiatry consultant, phoned me personally to give the news.

Before any findings of the MHATs are released, all key leaders are briefed on the study findings and recommendations. Thus, there are no surprises. Before leaving Iraq, I personally briefed Generals Casey and Mattis the Deputy Commander of MNF-I, who was also the senior Marine Corps general in Iraq, on the MHAT study. Both accepted the findings and recommendations and stated that they felt the findings represented their own impressions of the mental health status of the forces in Iraq. In addition, we also briefed Commander (now Captain) Paul Hammer, the Navy psychiatrist in charge of providing mental health support to the deployed Marines. Hammer totally supported the findings and recommendations and stated that he hoped our report would garner him the additional resources that he had been asking for but was denied.

When Vice Admiral Arthur, the Navy Surgeon General, discovered that we included Marines in our MHAT assessment he was furious, although in conversations with Captain Robert Koffman it was never clear why. Our assumption at the time was that he was upset because he had not been consulted before including Marines in the assessment. Yet, the Marines in our study were not under the command of Arthur so he had no authority over them. After speaking with Allgood, he told me not to worry about the Navy and make sure that the findings got released. It was shortly after this conversation I learned of Allgood’s death.

After briefing the Army Surgeon General, Lieutenant General Kiley, who directed his staff to begin the immediate implementation of the study findings, we next briefed Arthur. The brief with Arthur would take place in his office at the Navy Bureau of Medicine and Surgery in Washington, DC. Accompanying me on this brief was Major McGurk and Colonel Charles Hoge, my boss at the Walter Reed Army Institute of Research (an Army psychiatrist and the world’s expert on military mental health.) Arthur had arranged for three of his naval medical Admirals and seven Navy medicine Captains to be present. Throughout the brief, Arthur, along with his medical officers, attacked the reliability and interpretation of the study findings. They also attacked our interpretation of the findings, along with our recommendations, using vague and nonspecific objections.

When I asked Arthur how the recommendations should be changed to address his concerns, Arthur made it clear that he did approve of the study findings being released, as the Marines would demand that the Navy provide more medical personnel to support the deployed Marines, which he did not want to do. Author then stated to me that I didn’t have his approval to release the MHAT findings. I respectfully informed Arthur that this was not a decision brief requesting his approval to release the findings, but a courtesy brief to inform him about the study findings and recommendations. Arthur became very angry, with his face and neck turning visibly red. After the brief concluded, Arthur didn’t thank us for the brief; and he refused to shake my hand when I extended it to him.

Following our briefs to the Army and Navy Surgeon Generals, we briefed the Army and Navy secretaries. During the brief with Secretary of the Navy, Arthur tried to get the Navy Secretary to block the release of the findings based on the battlefield ethics questions. Arthur didn’t mention the additional Navy support that he feared the deployed Marines would demand. The Secretary of the Navy had no interest in blocking the release of the findings, and in fact challenged Arthur to do more to take care of the deployed Marines and those Marines who had already returned home. In particular, the Secretary wanted to know specifically what the Navy was doing to address the mTBI and PTSD in returning Marines, adding, “Please don’t tell me you are waiting to see what the Army does.” To which, Arthur responded he was waiting on the findings of an Army study! The Secretary was not amused. The Secretary of the Navy thanked me for the brief and gave me a Secretary of Navy coin, which I have somewhere in a box in my basement with all of my other military coins.

Next in the briefing chain was the Assistant Secretary of Defense for Health Affairs, who is the most senior DoD civilian medical officer. Once again, Arthur showed up with a few members of his naval medical staff intent on blocking the release of the study findings. Unbeknownst to Arthur, however, the current Assistant Secretary of Defense for Health Affairs was Dr. “Trip” Casscells, my battle buddy in Iraq. I briefed Casscells on the study findings while in Iraq, and he was a strong supporter of getting the study findings out. Indeed, Casscells greeted with me a hug and began the meeting by heaping loads of praises upon me. Thus, Arthur’s attempt to gain Casscells support for blocking the release of the study findings was again thwarted. Casscells also presented me with his office’s military coin at the end of the brief.

The last scheduled brief was with the Commandant of the Marine Corps, General Conway. This would be Arthur’s final attempt to block the release of the findings. Conway had assembled numerous members of his senior staff including the Assistant Commandant of the Marine Corps and the Sergeant Major of the Marine Corps, among others to hear our brief. While Arthur didn’t attend this brief, he did send several naval medical Admirals and Captains, many of them the same ones who were present at the early brief at the Navy Bureau of Medicine and Surgery, with specific instructions to convince the Commandant to block the release of the report. Once again the Navy challenged the study findings based on sampling, analyses and interpretation. Some of the Navy officers present continued to challenge the study’s validity even after the Commandant said that he was not interested in hearing any more comments about those concerns. Towards the end of the brief Conway became so frustrated with the Navy’s obfuscation and refusal to address the recommendations in the brief that he physically turned away from them and turned to me for guidance on how the Marine Corps should proceed.

Since no date had been set for the release of the study findings, Arthur continued to try to block the release of the study findings through technical and bureaucratic maneuvering. Arthur might have been successful except for the actions of Conway. Conway e-mailed the study findings to all the general officers and senior sergeants major in the Marine Corps. Here is an excerpt from the e-mail Conway sent that was provided to me by a Navy friend:

Generals and SgtsMajor;

I believe we’re facing an emerging issue, and I want to apprise all of you about it, and marshal your efforts to most properly address it. Three things have come together to bring this challenge to my attention. The first two are as a result of the most recent Mental Health Advisory Team (MHAT). It’s attached to this email below. I took the brief from the study group members yesterday, though I saw earlier versions of this brief several weeks ago... This brief is important is the first assessment that looked at Marines as well as soldiers. This study was done in support of OIF 05-07. While there is a lot of positive information in the brief, I am most interested in slides 21-25. These slides speak directly to battlefield ethics—how Marines think and act under the stresses of combat, and their attitudes toward the treatment of civilians, LOW *Law of War, and ROE *Rules of Engagement compliance. I am concerned with what we see here .

Let me be very clear here: I am not interested in ‘fighting the study,’ or arguing about the technical nuances of the population sample size, the location of the Marines interviewed, or the MOS spread. I am convinced that in broad outline, this is an honest, sincere, and faithful effort that accurately captures what our combat-hardened Marines think and do.

As a measure of my confidence in this report, I am encouraging the MHAT to continue to work Marines into their studies in the future, as I fully support their important work.

—From an e-mail sent by General Conway, Commandant of the Marine Corps (20 April 2007)

Wow! Talk about a letter of endorsement. Conway got it. He understood that no study is perfect, yet importantly he understood that critical decisions can still be made with less than perfect data. Conway was focused on taking care of Marines and the Corps. Indeed, during the brief to Conway, COL Ritchie asked the Commandant if he was worried about how the media would respond to the Battlefield Ethics findings. To which Conway responded, “I am not concerned about what the media will do; the media will do what the media does. I am concerned about Marines.” Despite this resounding support of the study’s findings by Conway, some within the Navy medical department still maintained that the Marines didn’t support the release of the study’s findings. Over the objections of the Navy medical department, the findings were released two weeks later in a joint Army-Navy press release on 4 May 2007 in the Pentagon.

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