Return to duty – or treat PTSD?

Captain Stevens is an Army psychiatrist stationed at a forward operating base in Afghanistan. Army units under his care encounter frequent combat and many soldiers are serving their second, third, or fourth tours of duty. Line commanders have made it crystal clear—through informal channels—that they need “every soldier” in the fight. Captain Stevens evaluates a number of soldiers in his clinic with post-traumatic stress disorder (PTSD); in some instances his patients were diagnosed with PTSD during previous combat tours and their symptoms are worsening. In several instances Captain Stevens has determined that a soldier is medically unfit for continued service and recommended that he or she be returned to the U. S. for treatment. In many cases, the commanding officer (CO) has rejected these recommendations and ordered the service member back into action. The CO calls Captain Stevens in and chastises him for being too conservative and applying “ivory tower” civilian norms for distress to a combat population. He says, “you can diagnose them all with PTSD if you want to but your job is to shore them up and return them to duty whenever possible; this is a combat zone captain, our threshold for “crazy” is a bit higher out here. The reasons should be obvious to you, we’re at war.”