November is rolling...

I'm getting ready for the November mission schedule. As it stands we have four scheduled missions and of these four, only two of them fall into the "bad" category. I'm going to get one "bad" mission out of the way this week.

I am strangely light-hearted about this travel. I think it's a combination of decreased "critical incidents" and the fact that it is November. This will be our last full month of missions. December should be a half month, since I won't want to risk either of us going to an isolated FOB after mid-December, getting stuck, and delaying our end of deployment tasks or actually delaying re-deployment.

It has gotten colder. Cold is relative, but we are having daytime highs in the low 60's and nighttime lows in the 30's or high 20's. There's snow in the mountains. When we travel now we have to bring the heavier sleeping bag, fleece, and people are even breaking out the Gore-Tex.

With the colder weather, drop-in traffic in my clinic has slowed somewhat, although it still rare that a day goes by without a customer. Most of my business consists of "back home" issues—relationships, money, family problems. I also get all the blowback from disciplinary issues. I think this unit has inconsistent standards when dealing out war-zone justice, but a generalization is that the lower your rank, the harsher your punishment will be. Unfortunately the lower ranking guys have the poorest coping abilities, the least power, and the most stress. So they end up in my office.

In the non-distressed population, there is definitely a stigma associated with talking to the psychologist, or the combat stress doc. They have good fun yelling at me across the FOB: "Hey doc, I'm stressed! Can I make an appointment?" One of the lieutenants, who works for the commander occasionally comes with a message — he hesitantly knocks, comes part-way through the door. I tell him he can come in but he says, half-joking, that he doesn't want anyone to think he's actually coming to talk to combat stress—"I don't want anyone to think I'm crazy sir."

I tell him that it's too late. "I already know you're crazy because you joined the fucking Army."

That joke gets a lot of mileage here but I don't like to use it much. I don't like the "crazy" jokes because I think it reinforces the persistent idea that you only see a psychologist when everything has fallen apart, when you have no place to turn, when insanity seems imminent. I preach here and at home that it is better to manage problems before they get too bad.

Actually, Soldiers seem generally less concerned about mental health treatment impacting their careers than Airmen. Airmen worry about flying status and security clearances, and in the Air Force there is less acceptance of adjustment problems, meaning that you are more likely to get kicked out. I don't have statistics to back this up, but the Army seems more embracing. I could say that the Army is inspired by a certain Emma Lazarus poem inscribed in Upper New York Bay.

Most of my traction with Soldiers has been via sleep medicine. I conspire with the medics to send sleep complaints to me, and I do my evaluation, educate them, put them on a stimulus control or sleep restriction plan and most of them get better. If I have been thanked for anything here, it has been for helping people sleep better. And that's no small thing in this place.