As May 1968 approached my feelings were mixed. I was proud and excited to be graduating from medical school. For the rest of my life my name would be followed by M.D. I was also nervous (o.k. scared) because I was now going to have primary responsibility for patient care. I would at times be the only doctor in the emergency room or maybe even in the hospital where I would be a medical intern and where I would moonlight every Monday night for 3 years. I would literally have life and death responsibility. But I was also confused and concerned about the war in Viet Nam and the draft. Most medical school graduates had to go into the military one way or another. I didn’t believe in the war and I had no intentions to be sent there – I said l would move to Canada rather than go to risk my life for a war I didn’t and still don’t believe was right. But it’s cold in Canada. What about Mexico – I took Latin and German, no habla Espanol.
Fortunately I applied for and got permission to complete all my training and then go into the Air Force for 2 years. The way we were compensated for 12 years of advanced education was to be given rank. So I became Major Wayne Jones. Of course career military officers who had spent years climbing up the ladder were really pleased with me and my fellow physicians getting to start with rank. I actually made myself even more conspicuous my first day by putting my gold leaves on backward. I had requested assignment in San Antonio where they had 2-3 Air Force bases including a teaching hospital atmosphere.
It was a mixed blessing that I was assigned to Sheppard Air Force Base in Wichita Falls, Texas. At Sheppard we had the largest psychiatric hospital facility in the world with 120-150 beds. It turned out to be a great learning experience – especially long interviews with prisoners of war released when the war ended. Some of them had spent over 10 years in solitary confinement.
On the other hand, Wichita Falls, shall we say, is not a tourist attraction. One of my favorite memories is sitting in one of the best restaurants in town – Kings’ Quest. It had linoleum floors, vinyl table cloths and a wine selection that included a $150 bottle of wine – needless to say I never tried it.
After 2-3 days of basic training, yes, "days", I reported to duty as the officer and physician in charge of a 30 bed unit. Several times per week we received new patients from acute psychosis to behavioral problems. We had to keep things moving but our task was made more difficult because of administrative obstacles.
In medical training I was driven by 2 goals – the highest level of scientific understanding of symptoms, illnesses, and treatments and the most practical ways of helping people make their lives and stress symptoms better. In the Air Force the overwhelming emphasis was on the practical administrative options.
My first morning I met my head nurse, Ray. He was short, somewhat overweight and very friendly. He would become my greatest ally. To him we were like a large family. He believed in the community approach to psychiatry. For the next 12 months we would be like two parents with a very large family. Ray and I had a few things in common – we were both conscientious and had a sense of humor – although I was more inclined to the dramatic or occasionally the outrageous. He was also a Major but he had earned his rank over a long Air Force career. I never felt that he resented me getting instant rank and I always felt the appropriate respect as the medical "captain of the ship". We mostly complemented one another. He was more sensitive and I was more practical. He had a more maternal, cooperative, communication oriented personality, I was more typically paternal, competitive, decision making, and performance oriented. We shared pride when one of the "kids" shaped up or grew up and went on to do good things. We shared a sense of failure when one made bad choices and ended up in some not ok outcome. He wanted patients to say how they felt. I wanted patients to improve their thinking and behavior. Not that he was too soft nor I was insensitive. We of course played "good cop bad cop" on occasion.
My first decision was to move morning rounds from the nursing station behind closed doors to the day room where everyone would participate. Getting input from everyone was especially helpful in an atmosphere where a lot of patients were not there by choice or they had a very specific agenda, e.g., getting out of the Air Force. Patients learned that if they shot straight with me and helped me understand what was going on with others in the milieu that I would go the extra step in helping them. On the other hand, if they were primarily negative, manipulative, dishonest, or splitting they would learn that I could make their life miserable – I had the "power of the pen".
During our larger daily family meetings I was able to use skills I learned in doing group therapy. If the group was mainly attacking someone verbally I would be supportive of the patient. If the group was enabling or being supportive of inappropriate behavior I would be confrontive and tough. The balance usually worked out well.
I would frequently give mini-lectures during our morning "family" meetings. This helped to train the staff – nurses and psych techs (corpsmen) and to teach some basic principles to the patients. It was then that I discovered my passion for teaching. I also learned at the risk of sounding immodest, that like Geena Davis said after her first holdup in "Thelma and Louise", "I think I’ve got a knack for this shit".
One of the most useful ideas I came up with is that there are 3 types of thinking:
I didn’t have any problem with patients talking about their feelings or about fairness and logical thinking as long as they realized it was irrelevant in our context. As you can imagine in our morning group sessions we had a lot of laughs – and that in my opinion still is one of the best remedies there is for the stress and strain of often harsh reality.
I had to learn to do things the opposite of my training – a lesson in flexibility. I was taught to start with symptoms and then put them in the context of current life events, past history, family history, and medical problems. With all this information I would formulate a diagnosis. Then I would explore treatment and disposition options. Unfortunately life is mostly gray with infinite possibilities. But in the military it had to be black or white. We only had two options for patients – back to work or discharge. I found that it worked better to first decide what option is in the best interest of the patient and the Air Force and what diagnosis would justify that option. What information do we need to emphasize and what information do we need to play down to justify the diagnosis? I would of course wait until I saw how the patient responded to treatment, got along with peers, and responded to those in authority. Were they trainable, educable, inspirable or were they hopeless causes? One advantage to the subjectivity of psychiatry is that it allows for a certain flexibility.
During the Viet Nam war we had the draft so a lot of people didn’t want to be there and most importantly they couldn’t just quit. To go home early they had to either be medically disabled or get an administrative discharge. Neither would look good on their record. We could sometimes get someone reassigned to a different base or different duties but if the patient’s talents and interests didn’t fit with the needs of the Air Force they were out of luck. If I gave someone a medical discharge I had to be able to prove they had the problem before they came in, otherwise they would be compensated – sometimes for the rest of their life. This was not necessarily in their best interest – not to mention a tremendous drain on federal funding. Some young men joined the Air Force with no history of mental problems and because of horrible experiences became disabled. An example of this is one man who talked his best friend into joining with him only to have his friend die on the battlefield in his arms. He was entitled to compensation. But what about the person that joined the Air Force because he had nothing going for him? He was a poor student, couldn’t hold a job, and had no friends. Guess what, he was a failure in the Air Force and felt stressed by the pressure and expectations. He doesn’t deserve compensation but he also doesn’t deserve an administrative discharge because that’s like a criminal record. It is also hard to prove that he was “mentally ill” before he came in or even now. He has more of a personality disorder – not really a mental illness. There were many cases where there wasn’t a clear cut good option – for the patient or for the Air Force.
I learned a lot about myself and I grew as a person and as a physician during my 2 years in the Air Force. I became a much better team player and I developed a greater ability to be decisive. I also found out how inefficient and ridiculous bureaucratic systems could be. It seemed to me that whether your hair touched your ears and whether your mustache extended beyond your mouth was more important than how you performed your duties or what you contributed to the team and to the cause. But that’s because hair length is objective – any idiot can tell if your hair meets regulations – it’s not up for debate. It’s an indication of your overall attitude about military regulations and willingness to be disciplined. Maybe so, but mainly I thought it was "crap".
How do you solve a problem in the Air Force? Give a course in it and make it mandatory. A great example during my first year was the problem of racial tension. My personal feeling is that racists like other bigots need to be taken out of the gene pool. I don’t believe that our founding fathers intended for us to extend freedom of speech to groups like the KKK who not only teach prejudice but incite hatred and violence. But in the Air Force they didn’t ask my opinion they made me attend a one week all day series of lectures and group discussions. The groups were led by a race relations expert. What is an expert you might ask? In the Air Force it’s someone that has a certificate that they completed a course in it. So I would spend a week being taught by a young man who had a bachelor’s degree in psychology and a certificate while my 30 bed unit was left unattended. In their infinite wisdom they mixed officers, master sergeants, just enlisted men, pilots, etc. all together in groups of about 25. They made one critical error. They said at the outset it’s ok in here to say anything. I thought "what the hell" – I’m stuck here I might as well have a good time. I remember one comment I made that it seemed hypocritical to me to preach equality but make it against the regs for me to take one of my corpsmen from the unit into the officer’s club. Whoops, see how easy it is to slip into "logic think".
Then there’s the ole RHIP (rank has its privileges). In the non-commissioned ranks from private to corporal to various levels of sergeant I noticed a distinct trend. The higher you went, the less you had to do and the more the person just under you would cover. So the senior master sergeant didn’t have to do anything except an occasional meeting to talk about all the things that he was suppose to be doing. He could drink all day, play cards, run around and no one would ever say anything. Now occasionally an underling would be moved by the unfairness of the system and would blow the whistle. In less than a week he would be standing in snow up to his chest guarding an airplane in North Dakota or some other totally undesirable assignment. Everyone who put years and sweat into building rank wanted to be able to look forward to its ultimate pay off. Nobody was allowed to mess with the system.
All in all it was reassuring. With all the focus on the irrelevant like hair and race relations courses and inefficiency of the system I knew that our military could never take over the country – they would be hard pressed to conquer Wichita Falls, Texas.
So what were the main things I learned? With proper leadership most people can be productive and feel good about themselves. Some people are hopeless. Good leadership means treating everyone with respect, communicating openly and clearly and setting a positive example. Working as a team and having a sense of humor can make any experience a positive one. Bureaucratic systems seldom inspire greatness. What makes this country great is free enterprise. We all have the right to screw up. We have the freedom of choice and in the end hard work is usually rewarded. But mainly, we all have the right to criticize or just "bitch" and that can relieve a lot of stress.
One thought on “The Making of a Psychiatrist: My Air Force Experience During the Viet Nam War”
Dear Dr. Jones,
I just finished reading your article on the Air Force, and the things you learned from that time.
The “symptoms”( ha! ha!) you described that have helped shape the kind of Doctor you are, meant alot to me. I have experienced in our years together so much of what you described.
Thank you. You “keep it real”. The one thing you did not mention, the patient’s point of view of the way you do things, well, as your long time patient, I feel qualified to tell you from at least one patient’s perspective, what that Point of view is. I have always felt that you really did care. The greatness in that is knowing that the patient’s you have whose Dx is much more serious than mine are being treated with dignity. You show that goal in even the way you call for one to take responsibility for the Life that belongs to them. Based on severity of that individual’s illness and ability to do that, of course. You have never made me feel patronized. You have called me on a couple of things. That can always sting a little, but like a shot it goes away in seconds and I have always known that what you have said is true. The only reason you do that is simply for _my_ health and progress. There is simply nothing else for you to gain. You have never acted like a “Dr. God” which seems to be an affliction with most Doctors these days.
I am quite aware that I have not been the least frustrating patient to deal with, or the most probably. Thank you for sticking with me as I have struggled and worked so very hard to get a handle on all this and then put it into practice. Not there yet! However, at the risk of sounding melodramatic, I can’t imagine where I would be, or if I even would be at all, without the luck (blessing?) of you being the only Psychiatrist I was ever referred to. Thank You, again.
Oh, in the article you seperated “mental illness” from “Personality Disorders”. I have wondered about that myself, a lot. Would you please describe the Difference on your website. It is extremely important to me. That certain person who has spent almost 11 years trying to destroy me is at it again and the Austin D.A. called me after watching him on video tape. ( At least someone in Law finally believes my Life could be in danger. Offered me Police protection… ) I did not ask her about protection from all the Dx’s already caused or brought out or whatever, from the extreme Trauma he has caused my family and is still going strong to achieve. )She said that I sounded awfully healthy and centered for a woman who has been dealing with, for a decade, the man she saw on tape. See? – Thanks! haha!! Sincerely, Mary