The main gate of the local Army reservation is at first glance a formidable security barrier with a 100% ID check manned by generally pleasant rentacops. They do have sidearms and within the rules of engagement they attempt to screen for any threats to the safety and security of the base. If you have a common access card, (CAC CARD) and remotely resemble the picture on the card, civilian or military, you are golden. And you could have an arsenal in the trunk. It should be added there is a sign before the gate warning the driver that firearms are not allowed. But, within 100 yards inside the gate there is a sign advertising guns and ammunition which are sold through the PX (post exchange) system. The message: Why bother to bring firearms on base and risk a very rare inspection when you can legally purchase a variety of lethal weapons, quite safely, within the gates. Keep those guns and ammo in the family, Army Strong. It should be noted my dismay at the irony of legally selling firearms on a military base designed to keep out the disgruntled, violent terrorist is shared by others. Elspeth Cameron Ritchie, MD, MPH, speaking at the Massachusetts General Hospital Psychiatry Academy in July 2011 on risk factors for violence noted “In the soldier population access to weapons is a major risk factor…Colonel Bradley mentioned the other day that we’re not giving the right message when we’re selling weapons in Pxs…We have had some episodes where people have bought a weapon and and the shot themselves or an Army member, sometimes in the PX itself.” (Hello, are you listening Pentagon policy wonks- you ring your hands over violence and suicides in the military and promote access to lethal means. Generally the Pentagon only REACTS when there is a disaster, but when it comes to firearms the reaction is glacial. I guess the disasters at Fort Hood and several other installations were not enough to generate a heartbeat or synapse within the power structure. I will provide two examples that I was personally involved with, one a horrible tragedy and the other we escaped by the skin of our derriere. Another major contributory risk factor to violence in the military, and we are not talking about combat, with suicide or homicide or both in combination, also supported by research by Dr. Ritchie, is substance abuse in its various forms. Alcohol is still the star player in these scenarios, but coming down the back stretch are major players like cocaine in its various forms, PCP and now the ubiquitous Spice, a synthetic cannibinoid that causes all manner of manic and hallucinatory behaviors. Not surprisingly you can buy alcohol on base in various establishments. Alcohol and firearms mean a quantum leap in lethality. Since I work in the Army Substance Abuse Program (ASAP) and in the RTF, in inpatient substance abuse program I have direct experience with two stories that testify to our access to lethal means and the profoundly ambiguous message given by our military leadership. Following are two recent personal examples of the failure to anticipate.
In late September a 27 year old SGT came to ASAP seeking help for help with his uncontrollable use of alcohol. In July he had undergone abdominal surgery for a perforated duodenal ulcer. The operation was uncomplicated but the SGT began to drink again in August. Then in September he went to his primary care physician (PCP) asking for help and he was sent to ASAP. He met all criteria for Alcohol Dependence or Alcoholism. He had experienced multiple black-outs while drinking where he just did not remember where he was or what happened. He had progressive tolerance so that he would drink more and more before he felt the effects of alcohol. He spent excessive time and effort to obtain and consume alcohol despite and this interfered with his duty assignment. He bagen to have sweats and shakes when he could not drink and therefore did drink in the morning. And, he had withdrawl symptoms and signs if he did not drink for 2 days. He would have the “shakes” and would sweat excessively. His PCP sent him to ASAP and several days later I saw the soldier for the first time. He was alert, conversant, pleasant and cooperative. He volunteered that he was frightened over his inability to control his drinking. He admitted he was dependent on alcohol and he understood he required a more intensive level of care. The recommendation was that the patient be admitted to the Residential Treatment Facility (RTF) which is a 4 week that requires he stay in the hospital. The SGT agreed with this plan. However, ASAP is a command directed program and treatment recommendations have to be approved by his unit commander. The medical recommendation was denied by his command. Perhaps it was because he was National Guard and was not permanent party; that is, he was activated to attend a training course on the base. Or perhaps it was the negative bias about substance abusers Regardless, considering what happened, the signals were there, and ignored. It should be noted this soldier did not have depression or mania; no psychosis. There was no history of mental illness. The SGT had been deployed but there were no signs or symptoms of PTSD. So, he was enrolled in the ASAP treatment program and began to attend group therapy in ASAP once per week. He was generally compliant and cooperative. But, not surprisingly, he began to drink again while enrolled in ASAP and this made him “high risk” in the jargon of ASAP and he was required to be seen by the physician again. In late October I evaluated the SGT again, did not find significant mental health problems other than the alcohol dependence. Once again it was recommended he go to the RTF. Once again this was denied by his command. Two weeks later this soldier started shooting at random cars on a highway outside the base and then he shot and killed an offduty policeman who stopped to investigate. Then he killed himself. The results of an autopsy have not yet been released. We do know that the best predictor of future violence is a history of past violence. There is no history of violence in his past. The Army is investigating.