Unfriendly Fire-4

Michael Yates and son Kamren

Though Jones resists comparisons to a detective, psychological care involves detection from the client’s first words.  “We try to ascertain clues in their demeanor,” Jones explains.   “We look at past reports if they are available.  We try to get a sense of what kind of risk the soldier might pose, to himself, herself, or anyone else.” 

Why are you here?  the psychiatrist asks.   What is the presenting problem?   What can I—what can we—do to help?

Almost weekly, Camp Liberty’s combat stress unit faced a volatile situation, Jones says.  Somebody overdosed.   Someone else threatened to kill their commander.

Serious as it sounds, however, “most of these crises were not due to mental illness,” he explains.  “Most were situational.  Almost always, we were able to return the soldiers to duty.”

Jones is back to choking up, especially when he describes the weight of the consolidating force, as the Iraq conflict wound down, base fields scattered in country folded up, and reassigned personnel descended, en masse, on whatever and whomever was left.   

Part of pushing back on that weight, and keeping his own gyroscope balanced, meant assuring that soldiers with situational crises not flee.  

“We were so consumed working with troops who were so hot, so volatile, people might wonder how we could keep them in a theater of war,” Jones explains.  “But when it came down to it, we dealt well with most issues: people facing criminal charges;  people at the boiling point with co-workers in their command; people with serious, harmful ideations.” 

Russell’s defense team claims he fell into the latter category.   

Medical evacuation helicopter

But Jones saw no symptomatic evidence of suicidal or homicidal ideations.  “Some ideations are intense and acute, others fleeting.  But most have real, verifiable symptoms.  Someone might slit his wrists or take pills.  Someone else might fire a weapon.”

Until the massacre, John Russell did nothing.  He only said.

“You can’t just say ‘I’m suicidal’ and expect to be evacuated,” Jones says. “It doesn’t work that way.”

“Evacuation,” as the name implies, is a big deal:  a retreat in the face of an oncoming storm;  a pullback of arms and troops;  and the backward—as opposed to forward—movement of a single soldier, from the frontlines to a unit clinic; from his or her unit to the combat support hospital (CSH);  from the CSH to a base hospital in Germany; from Germany to Walter Reed Army Medical Center in Washington, D.C.

Each successive move backward changes the soldier and places the unit in harm's way, Jones explains.  

A soldier’s diagnosis tends to get amplified, even exaggerated, as he or she moves farther and farther back from the front.  “A kind of diagnostic fog sets in,” Jones says.  

The original diagnosis is based on charts, notes, personnel, communications, and observations that are harder to retrieve and review with each successive step away from the soldier's original location.   People are constantly on the move, and communications—electronic, written, and otherwise —is in continual FUBAR flux.  

The subsequent diagnosis (away from the front) is based on this uncertain communication and a changing sense of self, from soldier in uniform to patient in hospital gown.   

The foggy upshot:  a situational stress diagnosis in the field can morph into a psychosis diagnosis in a hospital back home. 

Evacuations—even of single soldiers—also involve risk and coordination, of vehicles, helicopters, and troops.  Jones recalls hearing about evacuations in so-called “soft shelled Hummers”—Humvee military trucks with canvas tops trundling across blowing sand and enemy eyes.

“They drive through towns with all the doors off, each soldier with a firearm facing a potential sniper—behind clotheslines, through windows, up in balconies where they can’t see anything but shadows,” Jones explains.  “Any movement in a theater of war exposes people to attack.   It’s just not something you do without serious justification.”

You can’t just say you need to be evacuated out of the Army, in other words, so caregiver deception can become a high and dangerous art.   Soldiers seeking exits will go to the mat with physicians, psychiatrists, and anyone else they think can write the magic prescription:  a medical or psychiatric discharge. 

Russell wanted out of the Army, but he was calm in comparison to most discharge seekers.  “Other than minor incidents of heated words exchanged, there was nothing,” Jones says.  “No trouble.  No administrative actions.”

At the end of Russell’s Sunday appointment, no screaming, yelling, or untoward behavior.  “He was almost casual,” Jones says. 

Next
1, 2, 3, 4, 5, 6