To Squander the Fighting Strength? Personal Experiences with Preventive Psychiatry and the Dilemma of Wartime Public Mental Health
Remington Lee Nevin*
My colleagues who have known me throughout my controversial military career and beyond, and who know in particular of my work on the antimalarial drug mefloquine (marketed in the US previously as Lariam), could be excused for assuming this was an early interest of mine. In fact, my work on the mental health effects of antimalarials began relatively late, and then initially only as an aspect of a much broader and newfound interest in public mental health that matured only during my first wartime deployment.
I am frequently asked if there was a specific patient or patient experience during this deployment that led me to my work in these areas. I reply that to assume as much is to misunderstand the public mental health perspective. The practice of public mental health deemphasizes the significance of individual clinical anecdote for the subtler but vital truths found in the dry statistics describing the health of populations. To practice public mental health is to not miss the forest for the trees.
In January 2007, I found myself serving as a Preventive Medicine physician newly reassigned to the headquarters of the 82nd Airborne Division. Our forces were to expand combat operations into dozens of remote locations throughout Afghanistan’s restive eastern provinces, and although the public’s attention was then mostly focused on the “surge” into Iraq, I knew that our units would be greatly tested by the rudimentary living conditions and the vast expanse of isolated, threatening territory under their command. The deployment would be, at the least, a stressful experience for our troops, and any healthcare—including mental 'Remington Lee Nevin is a former Army Major. This chapter focuses on events in Afghanistan in 2007, while he served as a Preventive Medicine Physician assigned to the 82nd Airborne Division
R.L. Nevin, M.D., M.P.H. (*)
healthcare—beyond that provided by a medic or physician’s assistant, would likely be hours away via a harrowing helicopter ride over rugged terrain.
The “hurry up and wait” that dominated the early days of my deployment had given me time to ponder how I had come to that point—a patch of the 82nd Airborne Division on my left shoulder, preparing to live and work for months as a staff officer in the foothills of the Hindu Kush mountains.
I had grown up sensing a potential career path in the fictional portrayals of US military medicine that were popular at the time, such as television’s M*A*S*H series, and the dramatic film “Outbreak.” After college, I elected to take advantage of the free post-graduate educational and career benefits available through the US Army’s medical training programs, confident that my college interest in statistics would be a good foundation for a career in military public health research, where I intended to focus mostly on infectious diseases.
I matriculated at the tuition-free Uniformed Services University of the Health Sciences (USUHS) School of Medicine in 1998 soon after college graduation, expecting an unremarkable 7-year period of obligated service owed of every USUHS graduate after residency training.
This was 3 years before the events of 9/11. In the weeks and months that followed that day, as the reality of the changing military situation became evident, I sensed that my career in military public health would take me not to the comforts of a major research center, but to “line” units on overseas deployments. I began trimming my hair shorter and visiting the gym with a little more regularity, and sought out opportunities to gain credibility with the combat units I expected to be assigned to as the Army prepared for the possibility of a “Long War.” I took a month of my final year of training at USUHS to attend the US Army’s Airborne School, becoming Airborne qualified (earning “wings” for my uniform) just prior to graduation and beginning my internship at Womack Army Medical Center, Ft. Bragg, NC.
There, I trained briefly under the physician who would become the future senior medical officer (or “Surgeon”) of the 82nd Airborne Division, also headquartered at Ft. Bragg. Half a year into my internship training, I informed him of my acceptance to the Preventive Medicine residency, at which time he presciently advised me that he believed we would be working together again soon. Indeed, 3 years later, he would recommend me to be the 82nd Airborne Division’s Preventive Medicine physician for his unit’s upcoming deployment to Afghanistan. As my orders temporarily reassigning me to the unit directed, we reunited at Ft. Bragg days before boarding the charter flights that would take our unit to Bagram Airbase.