Crystal Shelton, CVN’s Vice President for Clinical Programs, previously served as an active duty social work officer in the United States Navy. During her time in uniform, she worked with infantry marines and combat instructors at the Marine Corps School of Infantry offering evidence-based interventions in the clinic and out in the training field. In a two-part series, Shelton puts her experience to work while examining what stress is like for those in service. Part two will run in early July.
Just about everyone who has been in uniform has had an early interaction with mental health in the military: someone — a recruiter or possibly a medical officer at a Military Entrance Processing Station will ask, “any history of mental health issues?” and if you want to stay in (of course you do, you just got here!) you will say “no!” A history of mental health treatment has long been a non-starter for military service. Why? Well, from day one you will be yelled at, made to march sleeplessly through the night, armed, injured, starved, and yelled at some more. You will be given live grenades and expected to throw them in a direction opposite from the people who have been yelling at you. You will be intentionally stressed and stressed some more and once you graduate from your training you will be expected to be emotionally, physically, financially, and mentally ready to follow orders while under fire in a combat zone.
The early stages of a military career are a crucible designed to prepare one to carry out the tasks of national defense. Sometimes these tasks are unimaginably tedious; other times we strap a shoulder mounted rocket launcher to the back of a nineteen-year-old who is only as focused and as psychiatrically sound as any nineteen-year-old in your neighborhood. The pressures of performance, dedication, and focus are immediate in the military: they happen long before the first deployment. Stress is intentionally created and recreated and simple endeavors like stashing gear or taking inventory can feel like high-pressure, life-or-death operations. The logic, well supported I should add, is: complacency kills. So, whether you are taking inventory or loading mortars, Do Not Relax!!!
In the same way, you don’t wait for the first day of a marathon to try out jogging, stress and anxiety are practiced in garrison to be able to respond to it when it matters. This might account for a portion of the elevated number of military suicides in our soldiers, Marines, and sailors who haven’t deployed. It is both a compliment and an indictment of the military as an institution, too, that it does not have a better process for culling out people who display an early tendency to become worn down and injured under stress. Drill Instructors, platoon sergeants, battalion commanders, medical officers — everyone involved with evaluating and maintaining operational readiness in the military — seem to believe the military is genuinely good for most people and discharging someone simply because it’s not a good fit is ultimately a failure on the part of all parties.
Major mental health concerns are supposed to get weeded out fairly early but I have a story for you. I worked in a clinic that served students who had just completed USMC basic training and who were on their way to the second half of their professional education. Understand, these students were fresh off the bus from basic training. In a period of six months I saw not one but two infantry students who were floridly psychotic. Think about that. At least one reader here has thought, man, I thought about joining the military but boot camp just seemed way too hard. Whatever you believed about the early career component of the military, it probably didn’t include a system so orderly and free from abstraction that it could be completed even in the midst of a first-break psychosis. It is a telling story, too, because it reminds us that there is no reliable way of knowing what will injure someone’s psychological health. I can say that for one of the unfortunate young men I had to separate due to psychosis, the order and concreteness were probably the only things that allowed him to maintain himself for so long. Getting yelled at, struggling with task completion, these were of no consequence to him.
By Crystal Shelton
CVN Vice President, Clinical Programs