The Military Psychiatrist

As the movie M-A-S-H makes chillingly clear, war, the killing art, and medicine, the healing art, are fundamentally incompatible. Whether to patch the wounded soldier so that he may live to kill again or be killed presents an ethical dilemma to some doctors. Because of this dilemma, Dr. Howard Levy, inducted into the U.S. Army Medical Corps, chose to serve three years in prison at hard labor rather than teach dermatology to a group of Green Berets (TIME, June 9, 1967).

For the psychiatrist in uniform, the problem can be even more distressing. Within the spirit of his profession, how can he morally justify his military duty, which is to "adjust" to the brutalities of combat a mind that has rejected those very brutalities? In a crisis of conscience similar in many respects to Physician Levy's, Daniel Switkes, 28, a psychiatrist drafted into the service, has asked to be restored to civilian status. Switkes has seemingly lost his case. Last week, after a federal district court in New York City refused his appeal to continue stay of orders, he found himself awaiting shipment to Viet Nam as a general medical officer rather than a practicing psychiatrist.

Within the Unit. This disposition, which Switkes' superiors say is based on his medical background and training, answers none of the questions that the young captain began raising as soon as he was assigned to psychiatric duty at Fort Knox. Because the Army sets the welfare of the unit above that of the individual, Switkes argued, the psychiatrist is forced to pervert his true role as a therapist. In military service, he says, "the well-adjusted personality becomes the one which can function within the unit, not the one at peace with itself."

Furthermore, said Switkes, he was routinely expected to violate one of psychiatry's most sacred tenets, privacy of treatment, by reporting the content of psychiatric sessions to his superiors. In fact, there is little room for privacy in the military approach to psychotherapy, principally a system called "mental hygiene consultation," in which the soldier-patient is visited by a team consisting of his immediate superior (usually a non-com), his commanding officer and a psychiatrist. It is often those very superiors who are at the root of the soldier's problem. To Switkes, this was less therapy than "group intimidation," in which the attending psychiatrist plays merely a consultant role. Disposition of the case rests not with him but with the C.O.

Daniel Switkes is only one dissenting voice among some 300 psychiatrists now serving in the Army. But he is by no means alone. Yale's Robert Jay Lifton, a research professor of psychiatry and a former Air Force psychiatrist in Korea, says: "I think that when a psychiatrist represents any institution, that in itself creates problems. The psychiatrist has some need to further the interests of the institution, possibly at the expense of the best interests of the patient."

When the institution is war, says Lifton, psychiatry may be forced to turn against itself. To a degree, this is true of all wars, but it is excruciatingly true of the Viet Nam War. If the combat veteran suffers anxiety, guilt or confusion over his role, the psychotherapist should, ideally, help the G.I. examine his actions and emotions more closely and feel them more acutely. "But if the psychiatrist were to do so," Lifton says, "most G.I.s in Viet Nam whom he treated would refuse to continue fighting." Hence, as Emory University Psychiatrist Peter Bourne has said with conviction, "Military psychiatry is a contradiction in terms."

In defending itself against such challenges, the military pleads a much larger purpose than the emotional well-being of the individual soldier. As long as armies exist, that defense possesses a certain logic. Says Colonel Matthew D. Parrish, chief of Army psychiatry and creator of the mental hygiene consultation approach: "The mission of Army psychiatry is to serve the mission of the Army," not the individual. The individual, indeed, is seen by the military as merely part of an organism, of a fighting team, the effectiveness of which is threatened by the loss of any member. Thus the psychiatrist's role is to restore the health of the unit by bracing its weak spots. In the end, this position is justified only if war itself can be justified.

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