Having taken a number of psychiatry courses in medical school and having a psychologist for a father, I know enough about “personality disorder” to have a pretty good idea that the discharge of more than 5,600 U.S. Army and 22,500 total military soldiers with that diagnosis (which conveniently relieves our government of the obligation to pay them disability or ANY medical benefits) has been the result of something much more sinister than mere incompetence on the part of however many military physicians are involved. And I’d bet money that the percent of those diagnoses that are phony are a lot closer to 100% than 99%. I’m serious, and that’s not an exaggeration. Let me explain.
Personality disorderThe term “personality disorder” is a psychiatric term of vague meaning and even vaguer causation. The
Wikipedia has a pretty good discussion of it, capturing it best with the phrases “deeply ingrained, maladaptive, lifelong behavior patterns” and “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it”. What could be vaguer than that? By that definition couldn’t someone like Nelson Mandela have qualified? Being strongly against apartheid in South Africa certainly constituted behavior that deviated markedly from most “cultural expectations”; and the fact that his behavior landed him in prison for several years certainly could qualify that behavior as being maladaptive.
Notwithstanding its vagueness, the following are pretty well accepted characteristics of “personality disorder”: 1) If there is a known cause for the problem, it is
not a personality disorder; 2) It is a life long pattern, becoming manifest by adolescence or early adulthood; 3) There are no accepted objective tests for its diagnosis; and 4) There is no good treatment for it.
I have never seen statistics on the frequency of “personality disorder”, but if such statistics exist I think they would be close to meaningless, unless more specific criteria were used to make the diagnosis. It is simply a very poorly understood and subjective diagnosis, and many psychiatrists and psychologists consider the diagnosis to be close to meaningless.
Brief summary of expose in The Nation on how our military uses the diagnosis to screw our troopsThe recent article in
The Nation by Joshua Kors, “
How Specialist Town Lost His Benefits”, is very good and very revealing. It is centered around specialist Jon Town, who suffered a severe injury while stationed in Iraq, which left him with long standing headaches, partial deafness, nightmares, memory loss, and depression. Though none of those things are accepted consequences of “personality disorder”, that was the diagnosis he received from the U.S. Army. That diagnosis relieved our government of the obligation for paying him disability benefits or any future medical benefits. And it also allowed them to retrieve the better part of $15,000 in bonus pay from him, for his unfulfilled commitment. The stated rationale for all that is that “personality disorder” is a pre-existing condition, and therefore the Army should not be responsible for making amends for it.
The article goes on to quote five different U.S. Army officials who defend the policy and the Army’s use of it as “appropriate”. It also quotes severe criticisms of the Army’s use of the policy, from two veterans’ activists, a civilian psychiatrist, and two U.S. Army lawyers (anonymous, of course). The criticisms are all right on target and the defenses of the policy by the Army officials all sound like something you might hear from Tony Snow, Ari Fleischer, or Bill O’Lielly. Most revealing are the insights from the anonymous Army lawyers, since they have an inside take on the situation:
“Commanders want to get these guys out the door and get it done fast … So they’re telling the docs what diagnosis to give to get what discharge.” The lawyer says he knows this is happening because commanders have told him that they’re doing it…
A second lawyer says he’s watched the same process play out at his base. “What I’ve noticed is right before a unit deploys, we see a spike in 5-13s (personality disorder discharges), as if the commanders are trying to clean house… they’re kicking them to the curb instead of treating them.”
Both lawyers say that once a commander steps in and pushes for a 5-13, the diagnosis and discharge are carved in stone fairly fast. After that happens, one lawyer says he points soldiers toward the Army Board for Correction of Military Records… Few cases are challenged successfully or overturned later, say the lawyers…
My personal experiences with similar issuesI joined the U.S. Army reserves in the summer of 2001 (prior to September 11). I believe it was 2003 when I was diagnosed with a disease of my motor neurons, which resulted in atrophy of my muscles, especially in my legs, with consequent instability of my hip joint, arthritis of my hip, and substantially reduced mobility. My diagnosis is a variant of Lou Gehrig’s Disease (otherwise known as Amyotropic Lateral Sclerosis, or ALS), except that my disease progresses much slower than ALS and is unlikely to be fatal. It has not substantially interfered with the quality of my life, except that I now play tennis much less often, in order to slow down the damage to my hip joint, which will eventually need to be replaced. In fact, my disease may have substantially improved the quality of my life, by preventing me from being sent to Iraq.
I subsequently applied for a medical discharge from the Army Reserves, but I didn’t receive any response from them for several months. Then one day I received a call from an Army official who told me that the Army was ready to grant me a general honorable discharge. I told him that I had applied for a medical discharge, and I would rather have that because my understanding was that only a medical discharge would prevent the Army from recouping the bonus money that I had received. He assured me that the Army would not request the bonus money back in either case, and that the general discharge would be quicker than the medical discharge. So I told him that if that was the case then a general discharge would be fine.
A couple of weeks later I received a letter from the Army granting me a general honorable discharge, but telling me that I had to repay them my bonus money. Since I had never agreed to those terms I appealed that decision and sent them the required letter from my neurologist, which explained my diagnosis and the physical limitations that it entailed. The Army Board for Correction of Military Records (noted in the above
Nation article) subsequently disapproved my appeal with no explanation. When I requested an explanation, they told me that I hadn’t proven that I was medically unfit for duty.
This whole episode sounds very similar (though less dramatic) to parts of
The Nation article, except that in my case, instead of diagnosing me with “personality disorder” they simply gave me no diagnosis at all, and they didn’t even examine me. Here is the applicable part from the article:
If a soldier dismissed under 5-13 hasn’t served out his contract, he has to give back a slice of his re-enlistment bonus as well… One military official says doctors at his base are doing more than withholding this information from wounded soldiers; they’re actually telling them the opposite: that if they go along with a 5-13, they’ll get to keep their bonus and receive disability and medical benefits…. The doctors are telling them, this will get you out quicker… What they don’t realize is, those things are lies…”
I had previously served in the U.S. Air Force for five years, 1977-82, as a Flight Surgeon, which meant that I was responsible for providing medical care to flying crews and their families. I don’t recall ever being pressured by my superiors to make a specific diagnosis during my Air Force service – but we fought no wars during that period of time, and George W. Bush wasn’t our Commander in Chief then.
There was only one situation I faced as a Flight Surgeon that was anything similar to that faced by today’s physicians who are pressured to make phony “personality disorder” diagnoses. That situation involved the military’s ban against gay men. We had been told during our Air Force training that if we ever encountered a gay military man during the performance of our official duties we were obligated to report it up the Air Force chain of command. I don’t recall ever thinking about that issue until the day that I was confronted by it.
A patient of mine was diagnosed with gonorrhea, and it was my responsibility to identify his sexual contact(s) so that they could be located and given prophylactic treatment, in order to prevent them from getting sick and spreading the disease further. But my patient wouldn’t give me the name of his contact(s). I argued with him about that for perhaps 15 minutes, and finally I told him that if he refused to give me his contact information I would have to report him to his commander. That’s when he told me that he was gay, and if I reported him he would be discharged from the military and lose all the retirement benefits he had accumulated over 14 years of service. Since I couldn’t bear the thought of doing that to someone, I let it pass after receiving a promise from him that he would notify his sexual contact.
The decision I faced is similar to the decisions faced by physicians being pressured to make phony diagnoses of “personality disorder”
only in the respect that both types of decisions involve the potential to do terrible harm to a soldier, in the process of complying with military orders or pressure. But the two situations are also very different, in that in my case I wasn’t asked to do something blatantly dishonest, and also what I did didn’t require courage since my superiors never even knew about it. On the other hand, I imagine that it would require quite a bit of courage for today’s military physicians to resist the substantial pressure to make these phony “personality disorder” diagnoses. I’ll bet that those with consciences are going through hell.
How do we know that almost all of these diagnoses are phony?But I haven’t explained yet why I feel so certain that virtually
all of the military “personality disorder” diagnoses are phony. When I contend that almost all of these diagnoses are phony I don’t mean to imply that none of the 22,500 soldiers discharged for “personality disorder” actually had a personality disorder. However personality disorder is defined, there would have to be at least some soldiers in that large group who met the diagnostic criteria. What I’m saying is that of those 22,500 soldiers who actually had personality disorders, their personality disorder was not the reason for their discharge – rather they were discharged for some other reason, but given the diagnosis of personality disorder in order to save money for Halliburton… I mean the U.S. government, in order to help pay for its tax cuts for the wealthy and lucrative no-bid contracts for its cronies.
In order to realize the validity of that statement all one needs to do is consider the recruiting practices of the U.S. military today. The point is that “personality disorder” poses no barrier whatsoever to recruitment, as shown
by this statement:
There was "a significant increase in the number of recruits with what the Army terms 'serious criminal misconduct' in their background" – a category that included "aggravated assault, robbery, vehicular manslaughter, receiving stolen property and making terrorist threats." From 2004 to 2005, the number of those recruits rose by more than 54 percent…
I said earlier that the diagnostic criteria for personality disorder are quite vague. That is true, but whatever definition is used, certainly most soldiers included in the above noted categories of recruits have very substantial personality disorders – by any definition. Since serious personality disorders are obviously no barrier to recruitment, how can they be used as an excuse for discharge? They can’t be – in a rational world. The only rational conclusion is that the U.S. military does not discharge soldiers for personality disorders. The whole thing is one big sham.
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