The military is only one example of a hierarchical system of management.
But the US Army hierarchy has refined the system to such a fine point it seems the General Officer Corps has, after 11 years of continuous combat operations, deified itself into a stage of haughty, shameless arrogance to a pedestal of conceit and condescension where these officers are totally presumptuous, seemingly convinced they can venture beyond their province of narrow military knowledge and make medical pronouncements and decisions that are ignorant and dangerous.
Indeed, they have become the quintessential avatar, the earthly embodiment of the all-knowing omnipresent divinity.
There is no better example of their hubris than the presumptuous interference of the “command” into the mental health care of soldiers. It goes beyond ignorance to a malevolent discrimination against service members who have psychiatric or behavioral problems. “Command Interest” is the dreaded term I have come to hate. There are glaring public examples that have not raised public concern, and there are personal examples of this phenomena I will share.
Readers may recall some mention of a surge of suicides among US troops in a previous submission to this blog. An example of this epidemic of suicides received from one member of the General Officer Corps demonstrates their stupidity and malevolence. As reported by Robert Burns, AP National Security Writer, on June 8, 2012, “Many senior military officers do not grasp the nature of the suicide problem,” but it is clear they wade into this profoundly complicated problem with absolutely no knowledge or experience that would qualify them to make any decisions or pronouncements. Burns noted “a glaring example of that became public when a senior Army general recently told soldiers considering suicide to ‘act like an adult.’” [View article online.]
Maj. Gen. Dana Pittard, commander of the 1st Armored Division, last month retracted – but did not apologize for – a statement in his Army blog in January. He had written,
“I have now come to the conclusion that suicide is an absolutely selfish act….I am personally fed up with soldiers who are choosing to take their own lives so that others can clean up their mess. Be an adult, act like an adult. And deal with your real- life problems like the rest of us.’”
It is of interest that the Joint Chiefs of Staff disagreed with Pittard. However, he continues in his command position and continues to express “Command Interest” in the mental health disposition of service members who somehow come into his command. He can and does direct where they will go and who will take care of them. In fact he can determine if they get treated at all. Indeed, like all those who exert “Command Interest,” he determines what will happen next, which may or may not have anything to do with what is best for the care of the soldier.
This coming Monday I will receive a service member on the unit I serve as medical director, because the same General Pittard has an interest in him. From the information available I believe we will be able to help the service member. Unfortunately “Command Interest” is also directing what will happen to the soldier when we finish our treatment program. The future of this soldier will be decided by what will please Major General Pittard; Army promotions and careers will depend on Pittard being pleased. It should be noted the general has no credentials in any medical field. There are at least two explanations for the Command decisions being made. First, the general is being advised by minions who are seeking his favor and we already know his position on soldiers with mental health problems. And second, it is not about climbing the career hierarchy but mostly about the arrogant and presumptuous bias of the general expressing “command interest.”
It would be nice to hoist the General by his own petard, if you will. But he is only following the policies of his superiors. As noted in a previous submission, the Army reacted to public criticism of conditions at Walter Reed Army Medical Center by having General Peter Chiarelli create the Warrior Transition Battalions. General Chiarelli, now retired and beyond accepting responsibility for the stupid mess he has created, fostered the Army policy supporting the notion line officers should practice medicine without being licensed. There are numerous examples of this Army policy, which includes suicide prevention. Writing in a blog published in the New York Times on June 26, 2012, Philip Lisagor exposed his ignorance with the following statement: “A few years ago the Army took the aggressive position that suicide prevention should be taken away from its Medical Department and given to the ‘line’– the commanders of troops. This was accomplished by placing the deputy chief of staff of the Army at the time, General Peter Chiarelli, in charge of suicide prevention….the Army needs to take this concept of command responsibility one step further.” [View article online.]
Dr. Lisagor wants to make commanders, commissioned and non-commissioned officers, accountable for soldiers’ suicides: “The accountability and transparency of enumerating suicides and attempted suicides on [command] evaluations would push these leaders to be increasingly active in ascertaining the mental well-being of the troops under their command.” And trampling all over their civil rights I might add.
I would ask Dr. Lisagor the following question: How is it working, this aggressive takeover of the Medical Corps? Not so good in my estimation and it has not been going so well since General Chiarelli was given his charge. And it seems the Medical Corps command does not have the cojones to stand up to the command hierarchy. But it is the troops who have to bend over and take it from the commanders who make medical determinations out of ignorance. Another glaring example of this stupid policy is the way the Army manages the out of control epidemic of substance abuse. ASAP, Army Substance Abuse Program, does not come under Medical Command, but under Chiarelli ASAP is in the control of line commanders.
Thus the tragic story of the soldier who asked for a higher level of care, which was recommended twice, but while under the influence the soldier killed a policeman and then killed himself. His commander denied my request for admission to the hospital twice. How is that working for you General? Dr. Philip Lisagor was a cardiothoracic and trauma surgeon, a retired Army colonel; with ample bona fides and combat surgery experience. I wonder how he would have responded if a line commander had told him who he could operate on.” But he thinks the answer to the horrible record of mental health and substance abuse care in the Army is to turn it over to line commanders, like General Pittard, who discriminate against soldiers with mental health and substance abuse issues and trample all over their confidentiality and other civil rights. Yes, it is in the name of “command interest.” The concealed truth is command interest is dangerous and hurts soldiers who are seeking help.