Showing posts with label military. Show all posts
Showing posts with label military. Show all posts

May 26, 2013

Military sexual assault scandal unearths "illegal" psychiatric diagnoses

If you haven't been following the sexual assault scandals in the U.S. military, tune in: It’s yet another arena where bogus psychiatric diagnoses are playing a sordid role.

Women soldiers who report sexual assault are diagnosed with psychiatric conditions such as borderline personality disorder or bipolar disorder that get them drummed out. Not only are their careers ruined, but they are denied benefits and sometimes must even repay any bonuses they got for enlisting.

Because the symptoms of these "preexisting" disorders overlap with the emotional sequelae of trauma -- anger, fear, depression, anxiety, avoidance -- it can be hard to tell the difference.

Women in every branch of the U.S. military are being disproportionately discharged with personality disorders, according to an investigative series, Twice Betrayed, in the San Antonio (Texas) Express-News. The Air Force has the widest disparity: Women make up 20 percent of the force, but 35 percent of personality discharges.

Sometimes, as in one case featured in the Express-News series, military psychologists and psychiatrists are being influenced by officers in the accused's or accuser's chain of command to view accusers as mentally unstable and/or sexually promiscuous.

In a report on "illegal" psychiatric diagnoses, the Vietnam Veterans of America say that in addition to rape victims, many combat soldiers with organic brain trauma or posttraumatic stress disorder continue to be drummed out of the military with bogus personality disorders and adjustment disorders that block their disability benefits, despite Congressional efforts to crack down on this abuse (for example, by requiring that the diagnoses be issued by psychiatrists or PhD-level psychologists).

It was a bit incongruous to find myself sitting in an Air Force courtroom, consulting on a sexual assault case, when the news broke that the chief of the Air Force's Sexual Assault Prevention and Response program had been arrested for sexually assaulting a female stranger in a parking lot.Talk about the fox guarding the hen coop.

That bizarre twist came on the heels of a headline-grabbing survey documenting skyrocketing rates of sexual assault in the military: An estimated 26,000 soldiers were sexually assaulted in 2012, up from 19,000 the year before. Women in the military face about twice the risk of sexual assault as civilian women (one in three versus about one in six). And only a tiny fraction of assaults -- 3,374 last year-- are reported.

That's likely due to the fact that women who do report rape are shunned, disbelieved, and retaliated against, and their assailants are rarely punished. The seven-month investigation by Karisa King of the San Antonio Express-News found that only about 10 percent (302 of 2,900) of the accused were court martialed, with only 177 sentenced to confinement. (The airman in my case was one of those rare few, but then again he was a low-level airman, not an officer. And it probably didn't help his case that all of these scandals were busting out that very week.)

It’s no coincidence that the San Antonio paper ran the series: Outside that city sits the sprawling Lackland base, the Air Force's basic training center for enlisted personnel. In an unfolding investigation there, at least 33 training instructors are suspected of sexually assaulting 63 or more trainees.

If this latest scandal isn't enough to convince people of the link between sexual violence and a climate of hostile masculinity (as researchers such as Neil Malamuth have been arguing for decades), I don't know what is. On the other hand, if psychologists in the sex offender treatment industry got their hands on these training officers, they'd probably label them with some fictional disorder like "paraphilia not otherwise specified (nonconsent)" that decontextualized their behaviors beyond recognition. 

Consulting in a military court martial one week and a sexually violent predator civil commitment hearing the next, I can't help but notice how mental illness strikes in clusters, afflicting sexual assault victims in one setting and offenders in the other. The clue that situational exigency is in play is that in neither case is the diagnosis about helping the supposed sufferer. It's all about punishment, with diagnosis as the weapon.

I highly recommend the series, Twice Betrayed. An in-depth report by the The Vietnam Veterans of America on the misuse of psychiatric diagnoses in the military, Casting Troops Aside, is HERE.

August 21, 2012

Evaluating vets for disability: Recommended reading

As thousands of U.S. vets stream back from the battlefields of the Middle East with physical and/or psychological problems, more and more forensic practitioners are being called into service to perform disability evaluations. Veterans who suffered illness or injury due to military service are eligible for disability compensation. But first, they must meet eligibility requirements, which typically include undergoing a disability evaluation (referred to as a "Compensation and Pension examination" or "C and P" in VA parlance).

Not surprisingly, the majority of psychiatric evaluations are for PTSD.

A group of psychologists and psychiatrists who conduct such evaluations has put together a reading list of recommended resources for evaluators. Although one obvious audience is the mental health staff of the Veteran's Administration, the group is also reaching out to clinicians in private practice who conduct mental disability evaluations with veterans, either directly for the veteran or via private companies who have contracts with the VA.

For questions about this reading list, please contact Mark D Worthen, PsyD, who has blogged here before and led the effort to compile the list. Dr. Worthen is also co-author of the only article published in a peer-reviewed journal that describes how to conduct mental disability evaluations with veterans.

Best of all, many of these resources are available online; just click on the embedded links.

ARTICLES AND BOOK CHAPTERS ON PSYCHOLOGY AND PSYCHIATRY

Foote, W. E. (2008). Evaluations of individuals for disability in insurance and Social Security contexts. In R. Jackson (Ed.), Learning forensic assessment (international perspectives on forensic mental health) (pp. 449–479). New York: Taylor and Francis Group.

Moering, R. G. (2011). Military service records: Searching for the truth. Psychological Injury and Law, 4(3-4), 217-234. doi:10.1007/s12207-011-9114-3

Rubenzer, S. (2009). Posttraumatic stress disorder: Assessing response style and malingering. Psychological Injury and Law, 2(2), 114–142. doi:10.1007/s12207-009-9045-4.

Strasburger, L. G., Gutheil, T. G. and Brodsky, A. (1997). On wearing two hats: Role conflict in serving as both psychotherapist and expert witness. American Journal of Psychiatry, 154(4), 448–456. (Available online.)

Worthen, M. D. and Moering, R. G. (2011). A practical guide to conducting VA compensation and pension exams for PTSD and other mental disorders. Psychological Injury and Law, 4(3-4), 187-216. doi:10.1007/s12207-011-9115-2.

ARTICLES ON THE LAW

Allen, M. P. (2011). The law of veteran's benefits 2008-2010: Significant developments, trends, and a glimpse into the future. Veterans Law Review, 3, 1-66. (Available online.)

Ogilvie, B. and Tamlyn, E. (2012). Coming full circle: How VBA can complement recent changes in DoD and VHA policy regarding military sexual trauma. Veterans Law Review, 4, 1-40. (Available online.)

Ridgway, J. D. (2011). The splendid isolation revisited: Lessons from the history of veterans’ benefits before judicial review. Veterans Law Review, 3, 135-219. (Available online.)

Ridgway, J. D. (2012). Erratum to: Mind reading and the art of drafting medical opinions in veterans benefits claims. Psychological Injury and Law, 5(1), 72-87. doi:10.1007/s12207-012-9119-6. (Available online.)

BOOKS

Cocchiarella, L. and Gunnar, B. J. A. (2001). Mental and behavioral disorders. In Guides to the Evaluation of Permanent Impairment, 5th Edition. Chicago: American Medical Association Press. [Although there is a 6th edition of this text, most jurisdictions still refer to the 5th edition]

Institute of Medicine and National Research Council (2007). PTSD compensation and military service. Washington, DC: National Academies Press. (Available online.)

Kennedy, C. H. and Zillmer, E. A. (Eds.) (2012). Military psychology: Clinical and operational applications, 2nd Edition. New York: Guilford Press.

Rogers, R. (Ed.). (2008). Clinical assessment of malingering and deception (3rd ed.). New York: Guilford Press.

COURT CASES

Jones v. Shinseki, 23 Vet. App. 382 (2010). (Available online.)

Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). (Available online.)

GUIDELINES

American Academy of Psychiatry and the Law (2008). AAPL practice guideline for the forensic evaluation of psychiatric disability. Journal of the American Academy of Psychiatry and the Law, 36(4), S3–S50. (Available online.)

Committee on Ethical Guidelines for Forensic Psychologists (2011). Specialty guidelines for forensic psychologists. (Available online.)

VA PUBLICATIONS

Department of Veterans Affairs (2001). C and P clinicians guide. (Available online.)

Department of Veterans Affairs (2002). Best practice manual for posttraumatic stress disorder (PTSD) compensation and pension examinations. (Available online.)

WEBSITES

National Center for PTSD

MST SharePoint (VA intranet only). In particular, see the PowerPoint presentation, MST C and P exams and the VBA Training Letter - Adjudicating Posttraumatic Stress Disorder Claims Based on Military Sexual Trauma.

Veterans Law Library

Caveat: This list is not an official recommendation of the U.S. Department of Veterans Affairs.

October 11, 2010

Prominent forensic psychologist hired in Ford Hood massacre case

The defense team for Army psychiatrist Nidal Malik Hasan has retained prominent forensic psychologist Xavier Amador. The New York-based expert has been involved in several high-profile cases involving the military, including those of PFC Lynndie England (of Abu Ghraib infamy) and U.S. Army sergeant Hasan Akbar, who killed two fellow officers and wounded 14 soldiers in Kuwait in 2003. He was also a defense expert in the trial of would-be 9/11 hijacker Zacarias Moussaoui.

Amador's hiring came amid hints that Hasan might be resistant to defense efforts to develop evidence of possible mental issues, according to a report in yesterday's Dallas Morning News. The defense dismissed a previous forensic psychologist due to "irreconcilable differences."

The defense team has successfully delayed the military's efforts to have its own panel of psychiatric experts evaluate Hasan. The military's sanity board will evaluate Hasan to determine whether he had a severe mental illness at the time of the shooting, whether he knew right from wrong at the time of his alleged actions, and whether he is competent to stand trial.

Some experts say Hasan may resist any insanity defense due to his medical training and his desire to be seen as motivated by his faith, according to the in-depth report by Lee Hancock of the Dallas Morning News.

Hasan faces the death penalty in the shooting deaths of 13 people at Fort Hood. His Article 32 evidentiary hearing is set to begin Tuesday.

Military suicides skyrocketing

Meanwhile, in the wake of last November's massacre, stressful conditions continue unabated at sprawling Ford Hood in Texas. So far this year there have been 20 suspected suicides, out of at least 125 in the Army overall, according to a report in today's New York Times. The record level of mental breakdown among U.S. soldiers is being attributed to the longevity of combat deployment. Also, after nine years of war, the military is accepting less stable individuals and is increasingly short on qualified mental health personnel.

Critics say that even when service members are identified as severely depressed, they are often just prescribed medication rather than given meaningful help.

Today's New York Times article on military suicides is HERE.

Hat tip: Ken Pope

November 13, 2009

Salon on "silly" Fort Hood media coverage

Award-winning journalist Mark Benjamin over at Salon has penned a keen analysis of the biased and woefully off-base tenor of media coverage of last week's Ford Hood shooting spree, focusing on incendiary terms like "terrorism" and "political correctness" rather than the real issues:
The media's silly Fort Hood coverage*

By Mark Benjamin

Everyone wants to debate terrorism and political correctness, but the real story is the failure of Army medicine

The conventional narrative of the Fort Hood shootings, one week later, has been distinguished by the reporting of unconfirmed -- and sometimes incorrect -- details and the drawing of dubious conclusions. The only thing that suggests the current story will withstand the test of time better than the initial Pat Tillman myth (that he died in combat, rather than by friendly fire), or the overheated tale of heroism by Jessica Lynch in 2003 (which Lynch herself protested), is that two basic facts seem clear: The shootings certainly happened, and given the number of eyewitnesses, it's almost certain that Maj. Nidal Malik Hasan did it....

First, the ongoing factual unraveling of the narrative. As the New York Times reported this Thursday, initial information seized on by talk shows that Sgt. Kimberly Munley, a petite police officer, bravely brought down Hasan in a hail of gunfire in which she was also wounded was, well, also not true. Munley, it seems, just got shot. Senior Sgt. Mark Todd actually shot Hasan to the ground and cuffed him after Munley had already been wounded.

Also on Thursday, the Washington Post raised solid questions about previous reports that Hasan had tried to get out of his military service because of what he saw as a growing schism between his religious and military duties....

Despite some print publications attempting to keep track of these kinds of facts, a lot of media folks continue to ask the wrong questions and/or provide some of their own unlikely, or unsubstantiated, answers.

The Monday after the shootings, I got my first taste of how the story was embarking on a life of its own as I settled into a chair at one of MSNBC's Washington studios to do Dylan Ratigan's "Morning Meeting."

"One question being asked, among many, is whether political correctness stalled the response to possible warning signs from Maj. Hasan," Ratigan said in his introduction....

Too much political correctness in the military? You know, the place where they fire you if you admit you're gay? The Army has its share of challenges, but in a decade of covering the military, I certainly haven’t come across any evidence that the institution is somehow paralyzed by the burden of gratuitous political correctness. And while that might provide a convenient way for Army officials to explain, anonymously, why nobody prevented Hasan from killing 13 people -- "We are just too afraid of criticizing Muslims" -- I haven’t seen a shred of evidence to suggest this might be true.

The cover of Time magazine depicts another befuddling sideshow to the Fort Hood story. The cover is a picture of Hasan with the word "Terrorist?" over his eyes. "It is a story about why Maj. Hasan is a terrorist," Time managing editor Richard Stengel explained on MSNBC's "Morning Joe" one week after the killings.

I'd heard this one before -- the debate about whether we should label Hasan a terrorist, or the shooting as an act of terrorism. Right-wing media host Laura Ingraham railed at me on this subject on her radio show this week after I had referred to Hasan as being partly motivated by a "religious thing," but I had failed to use the word "terrorism." "I say that you won’t call it what it is," she shouted, "which is terrorism!" (I had called it "Muslim extremism" but that wasn't good enough for Ingraham.)

The obsession with that label "terrorist" seems beside the point. The real question is why the shootings were allowed to occur, and who, exactly, dropped the ball -- not what we call it all afterward….

The passionate determination to hang the "terrorist" label on Hasan, or rail against "political correctness" in the military, are just more symptoms of media stars more excited about hot-headed debate than covering the real story. And the real story may be sadly familiar: It looks like Army medicine blew it, once again.
Benjamin's full analysis, well worth reading in its entirety, is HERE.

Mark Benjamin is an award-winning investigative reporter with Salon.com's Washington bureau. Since 2001, Benjamin has focused on national security issues with an emphasis on the plight of returning veterans and detainee abuse. He was hailed for exposing problems caring for veterans at Walter Reed starting in early 2005 and also obtained for Salon the Army's entire Abu Ghraib investigative files.

*Excerpts posted with the written permission of Mark Benjamin

Hat tip: Bruce Miller