In the past few days, contributing writers for the TIME blog Battleland shared their thoughts about the recent death of Dr. Peter Linnerooth, a psychologist, formerly with both the Army and the VA, who shot himself on January 2, 2013. Their comments are worth sharing in full.
On Monday, January 14, 2013, contributor Bingham Jamison wrote the following, in Caring for Those Who Take Care of Our Troops:
What can you say when a mental health expert — who is married to a mental health expert — can’t get the requisite counseling help he needs to survive?
Dr. Peter J.N. Linnerooth’s story is as cautionary as it is haunting – hopefully it will shed much needed light on the tragic consequences of PTSD, and the overwhelming need (and moral obligation) for our government to marshal the very mental health resources for which Dr. Linnerooth so tirelessly advocated.
A former Army captain and mental-health professional whose mission in Iraq was to care for troops on the battlefield suffering from combat-induced anguish, Dr. Linnerooth succumbed to his own personal struggle with PTSD and depression when he took his own life Jan. 2. A Bronze Star recipient for his noteworthy service in Iraq, Dr. Linnerooth was a consummate advocate for providing comprehensive mental health resources to those in need, for both the warriors who fought and the clinical psychologists who healed them.
Yes, even military psychologists (“the Healers”) need help sometimes – in interviews with TIME and the New York Times several years ago, Dr. Linnerooth described the community of military psychologists, of which he was a part, as being overworked, understaffed, and prone to professional burnout. He acknowledged that the very trauma military psychologists are charged with treating can, if they aren’t careful, destroy the Healers from the inside out. With nauseating foresight, in describing the demons faced by military counselors just like him, he unknowingly foretold his own heartbreaking destiny.
How many tragedies like this must we endure before the government gets serious about providing the VA with the resources it so desperately deserves? Our veterans, their Healers, and the nation they both serve warrant better.
If our country is willing to send its young men and women off to war, then it damn well better find the will to care for these warriors, and their Healers, when they come home.
Then, on Tuesday, January 15, 2013, Elspeth Cameron Ritchie, another regular contributor to the blog, whose work I have previously mentioned in posts such as The Ethics of PTSD Disability, or “Meet Brandon, the Rational Soldier, wrote:
The tragic case of former Army psychologist Captain Peter Linnerooth reveals that wars don’t spare those there to help their comrades.
There have been numerous reports on suicides in active duty troops. Another report is hitting the streets Tuesday about the highest (again) suicide rate in U.S. military history — 349 suicides in 2012.
Less has been written about the effects of the suicides on their caretakers. When a patient suicides, as happens too often, it is devastating for their caretaker. Lots of investigations, reviews of records, self-recrimination: should I have done something differently?
“When my patient shot his wife and then himself, it made me feel how hard it is to predict, in a population chronically at high risk, who will ultimately lose control and who won’t,” says Dr. Chris Nelson, a civilian psychiatrist at Camp Lejeune, N.C. “You go into the clinic thinking, `Is he next?’”
Military mental health workers—Army, Navy and Air Force psychiatrists, psychologists, social workers and others—also face combat situations. When they return home, instead of returning to a lighter garrison schedule, they find themselves back in the clinic again. There they listen and treat the Soldiers and Marines, re-living the tales of war and gore. Caregivers are clearly not immune to the strain on their marriages, and the tension of not knowing then they will deploy again. Quietly they joke about their own Post-Traumatic Stress Disorder.
Leadership knows about these stressors and strains and tries to do something about them. Back in 2008, the Army surveyed its own workers for compassion fatigue. Overall, the medical force was doing well. A notable exception was for mental health clinicians, especially those who had deployed. While Dr. Linnerooth deployed and ended up with PTSD, he never lost a patient to suicide. “He was often called to the aftermaths of suicides, to provide counsel, etc.,” says Brock McNabb, who served alongside him in Iraq as a combat medic. “But never lost one of his own guys.”
Unlike Dr. Linnerooth, who repeatedly sought help, most clinicians are resistant to going into therapy themselves. They fear, as do all Soldiers, the effects on their careers. They know about the electronic health record, which allows other people with the right credentials to access all health records.
After 11 years of war, it is a very tough world for military mental health clinicians, many with PTSD themselves. They are a tough lot. They weep quietly, or not. But how long can they keep it up?
I cannot comment credibly on the situation for military mental health professionals. Their world is a more complicated one than mine, one in which competing demands of personal need and mission readiness vie for preeminence in every decision about what to do with a particular soldier, sailor, airman, or Marine. As an outsider, though, I will say it does seem to me that the latter trumps the former far more often than not; indeed, I have personally met former military whose careers were ruined by an admission of need for help.
The top brass may be trying, in other words, to reduce the stigma of mental health treatment, but at the ground level, life does not, to my eyes, appear to have changed much (although see a very encouraging blog post from today, from Sgt James Gibson, currently deployed in Afghanistan, entitled Nightmare). After four years of my own hearing such stories, it still seems like the same old, same old is going on, all press releases, high-profile conferences, and endless PowerPoint presentations to both the commissioned and noncommissioned personnel notwithstanding (although, again, Sgt Gibson gives me hope!).
Dr. Linnerooth, however, was a veteran. There is absolutely no reason whatsoever that his mental health treatment should have impacted his career. The Assistant Chief of Staff for Mental Health Services at any VA facility in the nation offering such services has the authority to approve treatment for any veteran who needs mental health services that cannot be provided at the local facility–and, I might add, that includes the authority to approve for services that should not be provided as well, e.g., cases in which a combat-veteran mental health provider would otherwise have to go into therapy with a colleague whom the veteran-patient might have to see every day somewhere in the hallways of the hospital.
The process is called “fee-basing.” It’s private, efficient, and straightforward. I know: I do some of the fee-basis reviews at my hospital.
Please understand: this is not to say that colleagues in general either should not or do not treat each other. When a level of trust between two people is present, anybody can find a way to deal with bumping into one’s therapist in the cafeteria, even daily. For decades psychoanalytic candidates have attended classes taught by their training analysts–as well as later, after completion of their analyses, have gone on to sit on committees with those same analysts, maybe for years on end. When two people are committed to the process of making life better for one of them, one just makes those things work.
Having that such an option, though, and requiring that option are different matters altogether.
Colleagues at the VA, for example, have to write notes in the electronic health record. (God forbid that wouldn’t happen, after all, both for good reasons [continuity of care among clinics and treaters, for example] and not-so-good reasons [The Joint Commission, the Sauron-eye of healthcare, and State Medical Boards say so]). Those records, fortunately, are specially-monitored by the Privacy Officer of every facility–and believe me, monitored they are.
Still, all is takes is a keystroke to get into the full record, and once that damage is done, it’s done.
It is true that many VA are located in areas where there are Vet Centers, treatment centers that are only loosely affiliated with the Veterans Health Administration. We on the VA end do not have access to those records. Many, many VA’s, however–especially those located in rural areas or those that are associated with community-based outpatient clinics (CBOCs)–do not have easy access to such care.
That notwithstanding, I’m going to make a bold statement that will likely get me into trouble, but there you have it: mental health providers are not “routine”patients, and they need more than “routine”care, no matter where. I’ll even make the claim more controversial: this is especially the case for mental health providers who are combat veterans.
No, I do not have evidence-based data with sufficient statistical parameters to say that, so there. I do, however, have two anecdotal (that dreaded word again) sets of experiences that convince me of the statements’ truth.
First, I have my own therapy as a guide. Fortunately I worked with a senior clinician for a number of years who understood well the pitfalls of treating “treaters.” We therapists are human, after all: if there is a way that we can put off feeling what we have to feel in life, we will. And what better way to do that then . . .
Spouting off psychological theory! Coming up with our own hypotheses for what is wrong with us! Knowing without a doubt what we need and what we don’t need!
I was so lucky: I had a therapist who was kind, yet who kindly wouldn’t put up with that nonsense.
My therapist, you see, was never going to let me forget my greatest fear, a fear common to so many of us and, if I may be so bold, especially to many therapists: my fear of being vulnerable and connected. I tried every which way to avoid that, but given that a). he’d already done his own therapeutic work, and b). he’d heard all the subterfuges before, my pitiful attempts at control came, alas, to naught.
Second, I have treated treaters. Although such work is quite rewarding–it ain’t necessarily easy.
Not only must treater-therapists be aware of all the usual “tricks of the trade” that treater-patients bring to their therapy hours, they must also watch out for the constant temptation on their own part to overidentify with their treater-patients. Because in these situations therapists and patients have similar interests, often similar backgrounds, perhaps even similar temperaments, sharing similar vocabularies and similar ways of thinking, it is oh-so-tempting as a treater-therapist to assume that one knows much more about one’s treater-patient’s mind and soul (and future) than is quite often the case.
But then, if I might one more time be so bold, there is the added challenge of treating combat-veteran treater-patients. How so?
1. In my experience, many, many graduates of modern treatment programs usually assume that therapeutic relationships are ultimately for the service of therapeutic technique. Even though you’re not going to find a therapist anywhere, of course, who is going to say that therapeutic relationships do not matter, you are nevertheless going to be hard-pressed to find many who see the relationship as the therapy, i.e., who believe that most techniques used in therapy are, in essence, primarily time-fillers and mini-experiments to give both parties something to do while the unfolding of the relationship does what it needs to do to heal.
2. Therefore, many combat-veteran treater-patients can even be less predisposed to discussing vulnerabilities than are their non-treater battle buddies. Many have been trained to believe that they know something that should suffice to heal (why spend all that time in school otherwise, right?). They enter therapy, therefore, even more prone to feelings of failure than do their buddies.
Granted, at one level they know that they cannot heal themselves. But many still feel that ideally they should have been able to do so, i.e., that there exists somewhere in this universe of ours a Master-Combat-Veteran-Therapist who never needed to rely on anyone, who was nonetheless able to come up with and then apply to his/her own life what s/he already known about how to recover from trauma. It is that Master-Therapist-Other to whom many combat-veteran mental health providers, even without consciously acknowledging it, are comparing themselves.
And they find themselves coming up wanting.
Because many (if not most) left their training programs believing that the healing comes primarily from the knowing, and only secondarily from the relationship, they are even more prone to not showing their treater-therapists what’s really going on. It ends up a double-whammy for them: like any patient, they try to avoid dealing with their feelings of vulnerability and need for connection. In addition, though, they have to avoid dealing with their feelings about not already knowing what to do about those feelings.
But that’s not all.
Once treater-patients get through all that (which may or may not be quickly, depending on the treater-patient’s history), once they finally can express what is on their hearts and minds, treater-therapists get their own double whammy: they get the feelings and experiences of the treater-patients and of all the other combat-veteran patients that the treater-patients, as part of their work, have already absorbed.
In other words, as a treater-therapist, I never have just one person in the room with me. I have to deal with two sets of trauma at the same time: my treater-patients’ and those of all their patients. It’s basically de facto group therapy, but only with two people in the room, especially if the treater-patients are, at some point in the future, going to be seeing any of the patients whose emotions and experiences the treater-patients have already absorbed into their souls.
Have I convinced you that it might be useful to think of treating combat-veteran mental health providers with something more than “business-as-usual,” whether or not such business-as-usual treatment is “evidence-based”?
These combat-veteran professionals are, in my experience, the best of the best. They have given and continue to give their heart and souls to their military and combat-veteran patients. Never forget: they are all military, so these treaters very much feel, at a profound, deep level, that they are not just serving “clients,” but rather are serving their very brothers and sisters. They are intense. They are passionate. They bring their “do your best” mentality into all that they do, with a sense of mission that many mental health professionals have never even conceived of having.
My point is a simple one, and I’ll state it bluntly: not every Tom-Dick-and-Harry therapist is ready to take on a combat-veteran treater, and every combat-veteran treater deserves the best that they can get.
Bottom line: there are plenty of senior therapists out there who are up to the challenge of working with these brave men and women. Even if they are not living down the street from treaters, that’s what God created Skype for. It’s quite easy enough to set up local follow-up for any medication issues, and treaters, no matter what their theoretical orientation, can take advantage of the thoughtful caring of any good, senior therapist no matter where in the world the latter is. Trust me on that one.
VIP Healers deserve VIP treatment. Period. They’ve served their time. We the People should be willing to pay for such services, and the best don’t come cheap. In my opinion, too bad, so sad. Get over it.
Bad enough that we have thousands of combat veterans scattered around the world who have to deal with the trauma of War. We the People have also created situations in which good men and women have to bear their own trauma as well as the traumas of others, day in, day out, for years. No paycheck suffices to cover that. None.
We the People owed better to Peter Linnerooth. Let us not continue to fail to give the same to his brothers and sisters in “psychic-arms.”
In his memory.