United States. Congress. House. Committee on Veter.

Viewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 online

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when issues such as power, self-esteem, real helplessness, and arbitrary judgments of good and evil in
association with aggression are omnipresent Hypermasculinity and risk-taking behavior in defiance of
castration anxiety can ultimately lead to personality disintegration in these occupations. Unfortunately,



individuals who possess thest traits and defenses are often attracted to an occupation that may seductively
promise omnipotent control, infimte saCTiiice, and the ultimate in risk and aggression in the guise of grandiose
ideals In addition, there is always the imminent threat of aimihilation by another human being


Efforts to reduce the number of psychiatric casualties in police and military organizations by denial
or neglect of illness can lead to reckless and even negligent statistical challenges Dr Spragg. division
psychiatrist for Australian forces in Vietnam, reported the resistance to evacuation implicit in the US Army's
plan of immediacy and expectancy The Pentagons one-year limit on minimum tours of duty in Vietnam
led to a basic evacuation philosophy; young men can take anything for a year Anything, perhaps, but the
brutality, command ambiguities, corruption, and confusion of terrorism and counterterrorism in Southeast
Asia Certainly, a large percentage of the improvement in the psychiatric casualty rate of Vietnam compared
to previous wars was accomplished at the cost of a high incidence of delayed stress disorders among Vietnam
veterans today Likewise, well-meaning police pension boards courageously buck the current trend towards
increasing numbers of stress disability pensions by ordering sick and dangerous police officers back to duty.
Police officers have been inappropriately and prematurely returned to duty while still suffering from the effects
of postshooting traumatic stress disorder and myocardial infarction. The naivete of these boards and their
medical consultants as to the psychological effects of police work, including its specific issues of extreme
autonomic arousal, discretion to kill, and inevitably strenuous fights is astounding Such statistical
manipulations of police medical retirement statistics inevitably convert stress dysphoria into conduct
disturbances, more amenable to the disciplinary dispositions of authoritarian administration than the politically
sensitive exposure of police disability pensions. Agam, resistance to treat stress disorders for fear of statistical
exposure of an administrative failure, as in Vietnam, merely transfers the problem of stress disorders from
commimd responsibility to civilian institutions such as public assistance, the Veterans Administration,
probation services, and the private medical sector.

Acceptance of the fact of stress disorders within these occupations and referral for appropriate clinical
services requires top-level command suppori for in-bouse clinical staff and line supervisors. If staff clinicians
are afraid of top management's disapproval of regular and perhaps frequent referral for necessary psychiatric
treatment, stress disorders jeopardize the entire organization. One has to only imagine the cost to Western
security caused by the mental illness of West Germany's Chief of Counterintelligence who recently defected
to East Germany for allegedly personal reasons. Seriously disturbed troops too frequently were returned to
duty in Vietnam, jeopardizing the lives of comrades, civilians, and themselves, and compounding emotional
conflicts ia medical personnel responsible for their well-being.

Inappropriate dispositions can be as damaging as no dispositions. Ignoring autonomic hyperarousal
problems, rehving, and survival guilt in recunent drug and alcohol rehabilitation programs can dry out the
kindling for a smoldering, underlying stress disorder and precipitate a fulminating illness.

In true stress disorders, an unbiased clinical judgment must be made about the relative importance
of acute trauma or cumulative stress versus premorbid personality disorder in the emergence of dysphoria,
impulsive behavior, social maladjustment, and cognitive dysfunction. If it is determined that the major
contributor to aberrant behavior or dysphoria is the premorbid existence of a personality disorder and that a
particular stress is a minor factor, then a medical disposition that might encourage secondary gain or even
malingering is contraindicated. If, however, aberrant behavior develops insidiously or acutely following
unique, chronic stress circumstances or acute trauma, then clinical attention must be timely and adequate,
including in some cases removal from duty and even hospitalization to prevent potentially destructive behavior
or further ego deterioration. Malingering and secondary gain are important considerations in the management
of these patients, particularly in the noxious environment of combat and lucrative disability pensions, but the
immediate problems of affective restriction or volatility, disabling depression, social withdrawal, impulse



dyscontrol. and hyperarousal are first priorities for the clinician These issues may not be first priorities for
pension adjudicators and commanders who are vigilant for pension abusers and cowards respectively

Abreaction of intense affect accompanied by management of excessive swings in affect, autonomic
arousal, and impulse behavior is central to psychotherapy and psychopharmacotherapy of these patients
Isolation from the environment that threatens to overwhelm the patient's ego may be necessary to prevent
cognitive deterioration or destructive loss of impulse control Isolation from the threatemng environment must
be balanced, however, against the patient's need for social support from peers and vulnerability to feelings of
abandonment, guilt, and alienation if not returned to duly The therapist s tolerance for the patient s intense
affect and his fantasies of destruction or destructiveness are necessary as are skillful titrating of anxiolytic and
antidepressant medications to suppress reliving, insomma. autonomic hyperarousal, impulsive behavior, and

Inderal is effective for reliving and hyperarousal Tofranil and MAOI's are useful for nightmares and
dysphoria Short-term use of Benzodiazopines for anxiety or panic are indicated as are neuroleptics for brief
reactive psychoses Gradual return to duty is indicated when the patient's status no longer jeopardizes either
the patient or the organization's well-being and function As obvious as the recommendation for gradual
reentry seems in this complicated era of police and counterterrorist operations, there are oftentimes inadequate
admiiustrative controls for fitness determinations with the single exception of the Human Reliability Program
вЦ†for nuclear weapons handling in the United States Armed Forces


Early identification of stress disorders is the most promising area of prevention Line supervisors can
be taught to recognize personality changes in their subordinates that are early indicators of stress disorders.
Withdrawal, loss of humor, and marital conflict often signal the development of a disturbance in intimacy
leading ultimately to the numbing of full-blown Posttraumatic Stress Disorder or occupational burnout.
Numbing and more subtle premonitory disturbances of intimacy are responsive to the patient's fear of
emotional arousal and can result in the disruptive approach and avoidance behavior more typical of Borderline
Personality Disorder psychopathology. Irritability, excessive stimulation, or depression can easily be observed
by a supervisor. Impulsive behavior such as excessive force, sadism, substance abuse, and gambling can also
be observed and may be early indicators of stress disorders. Insomnia and somatic complaints such as low-
back pain, chest pain, concerns about blood pressure, gastrointestinal distress, and frequent respiratory
infections are very common early warning indicators. 'When educated to these early warning indicators, front-
line supervisors will refer their officers for clinical evaluation, either in-house or to an outside clinician, if
they believe such referrals will not result in disapproval by upper-level command.

The varying cultures of police and military organizations demand a variety of early identification and
referral procedures that minimize the threat to a person's career when labeled a psychiatric case; in some
departments, these officers are labeled "220's" after the $2 20 fee the police were paid for transporting mental
patients to the hospital Gossip, mutual distrust, and suspicion of malingering and cowardice abound within
police and military organizations and make the process of identification and dimcal referral a sensitive one
for line supervisors and climcal staff alike

Some police departments require climcal evaluations and crisis oriented psychotherapy immediately
following use of deadly force, and the subject officers welcome the opporturuty to assimilate the abnormal
experience of intentionally killing another human being at close range The St. Louis Police Department has
utilized a charge of resisting arrest to flag potential problem officers for climcal evaluations. The U.S. Air
Force marks the medical files of all personnel handling nuclear weapons, as well as members of their family,
with red triangles in order to alert physicians to potential medical and psychiatric problems that could lead
to stress disorders in these critical personnel The Human Reliability Program has been in effect for some
years and was designed to reduce the risk of a nuclear accident, it appears to be working Limitations to early



identification and referral come more from the culture of an orgaiuzation and its definition by lop coi
personnel than visibility of telltale symptoms Standards for exposure to trauma could be developed the
profile high-risk individuals such as those who have experienced severe losses m line of duty, lulled
range, or witnessed extreme bruialization Such standards could be developed in a fashion similai
Holmes /Rahe Stress Assessment by interviewing a large number of police officers and combat veiera
aslung them to rate the intensity of a variety of traumas from their own experience


The selection of top command personnel is where the entire process of prevention begins 1
commands attitude towards psychology, human bemgs. and psychiatric disability begins the proi
prevention of stress disorders Likewise, command personnel can end any hope of early recogmtion o
disorders if they are threatened by psychological issues or helplessly prejudiced against them There
a potential built-in contradiction between the type of individual that is going to seek this type of p-
because of a need to control himself/herself and others and the opportunity to vicariously act out v
antisocial impulses or ommpotent needs through the officers.

Achievement is difficult to assess in military and police organizations and difficult to reward b
of the lack of financial incentives Nonetheless, conunand personnel should be individuals with
qualifications as chief executive officers and must come from sound and competent chief executive backgi
rather than 'good ole boy" up through the ranks background. The successful Beirut terrorist act and
but certainly not all, police and military fiaKoes are preventable. It is essential to identify the
characteristics of top commanders, and it must be decided whether they need to come up through the
as police officers or military academy graduates or be selected strictly on the basil of personality ci
Promotion policies need to address the preference for truly good leaders over those unfairly favored b<
of particular career routes in certain units and schools, such u military academies, submarine tervic<
major crimes investigations or proficiency in examinations sometime* gained while studying at the a
of buddies absorbing their workloads in the field. Affirmative action is a delicate and sensitive issue

Upper command personnel must do what they can to avoid the 'Catch 22' syndrome that put!
line personnel in irreconcilable conflicts. There is no way. for example, that a city can improve police-c
relations at the same time it is pushing its officers to write seven traffic tickets a day. This policy is eztn
widespread, ruins officers, and ruins organizational morale. Line personnel cannot be encouraged in unw
orders to be excessively aggressive and then be penalized when they overreact. For example, if patrol of
are supposed to contain prostitution in a ceriain area, it must be directly communicateid to them fror
command, and top command must take equal responsibility for repercussions of this aggressive enforce
activity Top command must be sensitive to the demoralization caused by black marketeering when its t:
discover tons of their own most modem equipment, including the much-needed poncho liners in Viet
within enemy arms caches. To prevent public scandals in the military and police organizations, frequ
these organizations are "scandalproofed' at the risk of creating increased distrust, paranoia, and suppre
of innovation. Scandalproofing reqmres an increase in command personnel in order to avoid narrow cha:
required for upward directed payoff systems Unfortunately, too much brass can cause too much bureau
with Its consequent stifling of innovation and delegation of authority in a morass of internal political cor

Upper management must communicate goals to its personnel and front-line supervisors and no
react to crises : crisis-based management is inevitable in military and police organizations because of the n
of their operations- -crises Still, a strategy is required, and any strategy, if sensible, is better than none
example, police departments could present a strategy of keeping murderers or vulnerable people such as ;
kids off the streets. Military commanders could formulate and execute unambiguous strategies of protr;
war with limited goals to be fought with special forces or use of maximum fire power that denies refug
the enemy Top command personnel must be sensitive to the causes they are asked to delegate to
personnel. The value of protecting Central America or Southeast Asia from Communist insurgency mu



perceived by field personnel as a tangible ideal, or it should be delegated to other agencies. Too often Vietnam
veterans become disillusioned, feeling like they were mercenaries. It roust be decided m the complex
counterinstugency environment of the nuclear stalemate whether large uruis with maximum fire power or small
scale counterinsurgency operations will be used. Strategic decisions need to be made instead of ambiguous
commitments to multiple divergent strategies as was the case in Vietnam.

Tactics must be a constant subject of discussion within police and military organizations because there
is no concrete answer to the ultimate issues of deadly force. Issues such as shoot /no shoot, visibility of
shotguns in police cars, tactics of suppressing sniper fire in an urban environment or containing a fleeing felon
must constantly be debated within the organization This helps to create an honest enviroiunent for decisive
action when it ultimately is needed: too often persoimel in police and military actions are left alone to make
their own decisions against a backdrop of unsupportive Monday morning quarterbacking, leading to a
profound sense of abandonment

Commanders must constantly be concerned about their personnel's safety, whether it is in the police
or the military environment. Overly aggressive "high diddle diddle up the middle" operations m Vietnam
were disastrous in terms of generating casualties and ultimately were probably responsible for the phenomenon
of fragging in Vietnam. It may make good television to apprehend a bank robber redhanded in the course of
a robbery, but it will preserve life and limb to apprehend him after the robbery. Commanders must decide
on the basis of preserving human life in their own unit as to whether it is necessary to lake a hill immediately
or whether it can wait until resistance is reduced.

Control of one's self and the envirotunent is an important issue in occupational mental health, but
particularly important in police and military service. Traiiung and recurrent training are certainly important
mechanisms to provide personnel with confidence in their ability to control their enviroiunent. Gear,
unambiguous, nonhypocritical statements regarding drug and alcohol abuse within police and military
organizations, of course, is necessary. The hypocrisy regarding this issue is legion: Alcoholic commanders
can hardly convey an appropriate model for their personnel Similarly, physical health must be encouraged,
and, therefore, police officers cannot be expected to safely participate in high-speed chases or engage in
multiple street fights following triple bypass cardiac surgery Maintenance of equipment is necessary in order
to convey to persoimel that top command cares about what happens to them. Brakes that fail, deadly weapons
found in the back seats of police cars at shift changes, and inferior weapons convey devaluing messages of
expendability to personnel who need to control their environment and do little to maintain their sense of

Line supervisors must not only be administrators, but must be willing to accompany their personnel
in the field In order for them to do this, they need to sense not only trust from their personnel, but also
support from their command, and the command structure itself has to be validly perceived as being under
control of itself A military and police organization just cannot function properly if it is run by an alcoholic
commander, and this is too often the case

Information systems must provide timely and accurate information Hoarding of information in
internal power struggles, as well as breaching of security, can be devastating in these organizations when
personnel need to know as much as possible about what they are expected to do and what to anticipate If
an officer divulges battle plans to an enemy prostitute or servant when intoxicated, he should be publicly tried
for treason Such breaches happened too often in Vietnam and cost a lot of lives and probably were rarely,
if ever, prosecuted If an administrator or officer blows a raid that jeopardizes lives and morale, the individual
who breaches security should be prosecuted Rumors and disinformation within orgamzaiions must be
raomtored. they frequently start with malicious leaks at the very top as well as in the locker room.
Disinformation is a sophisticated military tactic today and appears to be emphasized by Eastern Block
countries, countermeasures need constant development.



signs of stress disorders Again, special attention must be paid to minority persormel and women who are
relatively new to certain areas of police and military operations today There needs to be more research in
the area of polygraph, stress interviews, and personality assessment to determine efficacy of these procedures
in predicting future behavior. It is our personal experience that stress interviews are probably underutilized
as predictive measures, and too much faith is placed in polygraphs, which can be beaten by the skillful

Special assignments such as counterinsurgency, narcotics, vice, undercover, and homicide need special
attention because of personality vulnerabilities that predispose to psychiatric disorders. For example, the
individual who is attracted to narcotics because of the legitimate antisocial life it promises is an accident
waiting to happen Efforts should be made to limit the length of assignment in these fields, because it is
unlikely that any person can live a double life for very long unless he or she is a particularly asocial
individual, again the type of individual not needed in police and military organizations.



MAY 4, 1994









Mr. Chairman, distinguished members of this Subcommittee
on Oversight and Investigations, House Committee on Veterans'
Affairs, I take great honor and appreciation with this direct
opportunity to share my views, personal and professional,
with regard to veterans incarcerated. Thank you for both
your time and interest in my synopsis regarding this group of
"Forgotten Warriors" among our national veteran population.


Shall we light the candle, or
cont inue to curse the darkness . . ,

Crime and punishment, as you know, are increasingly issues
riddled with social pain, public challenges and analytical
complexities. In fact, today, few social issues draw as much
attention or as many polemics. Affecting all Americans,
crime shakes the community sense of security and tarnishes
our national reputation. Unfortunately, the prevention of
crime seems to continuously elude the grasps of our criminal
justice systems .

State and federal prisons are tasked with two (2) primary
liabilities: 1) INCARCERATION - to protect society from the
criminal offender by incapacitation; and, 2) REHABILITATION -
of those convicted of a felony during sentenced terms of
imprisonment in an effort to foster and promote "productive
citizenship" upon individual's release and reintegration to
our mainstream society.

American prison systems (state and federal) are experiencing
severe overcrowding of inmate populations. This intensifying
dilemma has been particularly recognized in compromising each
system's ability to provide adequate, reliable and/or cost
effective rehabilitation opportunities for their populations.

Consequently, in contrast to the goals and objectives set
forth by our courts (during punishment phase determinations),
overcrowded prison systems have become "warehouses" of inmate
populations - cutting costs of progressive rehabi 1 i tat i onal
programs in order to provide more security for their masses.

The nation's prison systems, overall, as they are uncovered
today, have failed to rehabilitate criminal offenders during
terms of commi tment /i ncarcerat i on or make for a much safer
American society. We, as Americans, can not allow this to
cont i nue .


For immediate point of record, in March of 1992, the United
States Department of Justice/Federal Bureau of Prisons (DOJ/


BOP) Central Office stated that approximately nineteen point
two percent (19.2%) of the total federal prison population
was found to be veterans. In March of 1993, after a radical
change in administration of this agency's Central Offices, to
include the previous Director's replacement with Dr. Kathleen
Hawk, it was suggested that this number of veteran population
in federal prisons had been reduced in volume.

In my experiences as the National Liaison, Vietnam Veterans
of America, Incorporated, for Veterans Incarcerated since
1991, I have found that in those states which have made an
effort to identify veterans prison populations of their
systems, that generally between sixteen (16) to twenty-three
(23) percent (%) of their populations are found to be that of
veterans .

Clearly, based on these numbers and identifiable statistics,
today there are between 180 .000 to 200 .000 veterans within
the state and federal prison systems of America.

A very large number of these veterans incarcerated are now in
prison serving sentences which may be directly linked to
symptoms of Post Traumatic Stress Disorder and secondary
chemical dependency or substance abuse/addictions.

Consistently, it has been found that among veteran prison
populations the incidence of drug and/or alcohol abuses and/
or addictions is much higher than that of the non-veteran
inmate populations. In 1992, the DOJ/BOP published a report
stating that approximately forty-four {kk) to forty-six (^^6)
percent of the total federal prison population, without such
notation or distinctions as to veteran or non-veteran status,
were incarcerated as a result of substance abuse/addiction.
In several state prison systems it has been identified that
as many as sixty-eight (68) to seventy-two (72) percent of
the veteran prison population had drug and/or alcohol abuse/
addiction problems, prior to arrest and conviction, which

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Online LibraryUnited States. Congress. House. Committee on VeterViewpoints on Veterans Affairs and related issues : hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, One Hundred Third Congress, second session, May 4, 1994 → online text (page 12 of 23)