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Military psychologists desk reference 1st Edition Bret A.
Moore Digital Instant Download
Author(s): Bret A. Moore, Jeffrey E. Barnett
ISBN(s): 9781299708617, 1299708617
Edition: 1
File Details: PDF, 1.52 MB
Year: 2013
Language: english
MILITARY PSYCHOLOGISTS’ DESK REFERENCE
This page intentionally left blank
Military
Psychologists’
Desk
Reference
Editors
Bret A. Moore
Jeffrey E. Barnett

1
3
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide.

Oxford New York

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UK and certain other countries.

Published in the United States of America by

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© Oxford University Press 2013

All rights reserved. No part of this publication may be reproduced, stored in a

retrieval system, or transmitted, in any form or by any means, without the prior
permission in writing of Oxford University Press, or as expressly permitted by law,
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Inquiries concerning reproduction outside the scope of the above should be sent to the Rights
Department, Oxford University Press, at the address above.

You must not circulate this work in any other form

and you must impose this same condition on any acquirer.

Library of Congress Cataloging-in-Publication Data

Moore, Bret A.
Military psychologists’ desk reference / edited by Bret A. Moore, Jeffrey E. Barnett.
p cm
Includes bibliographical references and index.
ISBN 978–0–19–992826–2
1. Psychology, Military—Handbooks, manuals, etc. I. Barnett, Jeffrey E. II. Title.
U22.3.M589 2013
355.0019—dc23
2013006571

Views expressed in this book are those of the authors and do not necessarily reflect official policy or position of the
Department of the Army, Department of the Navy, Department of Air Force, Department of Veterans Affairs, Department
of Defense, or the United States government.

9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
 In memory of Peter J. Linnerooth, Ph.D.; A great friend, dedicated father,
courageous Army officer, and compassionate psychologist
—BAM

In memory of LTC Timothy B. Jeffrey, Ph.D., ABPP; A great leader, role model,
mentor, and friend
—JEB
This page intentionally left blank
 CONTENTS

Foreword xi 6 Personality and Military Service 26

patrick h. deleon and jay m. stone michael r. devries and
emile k. wijnans
Preface xv
7 Impact of Military Culture on
Acknowledgments xvii the Clinician and Clinical Practice 31
william l. brim
About the Editors xix

Contributors xxi PART II: MILITARY

PSYCHOLOGY SPECIALTIES AND
PART I: HISTORY AND CULTURE PROGRAMS

1 Early History of Military Mental Health 8 Aeromedical Psychology 39

Care 3 pennie l. p. hoofman and
brian l. jones wayne chappelle

2 History of Military Psychology 8 9 Assessment of Aviators 44

c. alan hopewell pennie l. p. hoofman and
wayne chappelle
3 History of Psychology in the
Department of Veterans Affairs 13 10 Military Neuropsychology 48
rodney r. baker mark p. kelly

4 Demographics of the US Military 18 11 Combat Operational Stress and

richard l. dixon jr. and Behavioral Health 53
jean m. dixon mark c. russell and
charles r. figley
5 Military Culture 22
lynn k. hall

vii
viii contents

12 Forensic Psychology in the Military 24 Professional Education and Training for

Setting 57 Psychologists in the Military 116
paul montalbano and don mcgeary and
michael g. sweda cindy mcgeary

13 Operational Psychology 62 25 The Department of Defense

thomas j. williams Psychopharmacology Demonstration
Project 122
14 Working with Special Operations morgan t. sammons
Forces 66
l. morgan banks 26 Psychologists on the Frontlines 127
craig j. bryan
15 Command and Organizational
Consultation 71 27 Provision of Mental Health Services by
paul t. bartone and Enlisted Service Members 133
gerald p. krueger richard schobitz

16 Human Factors Engineering and Human 28 Professional Burnout 138

Performance 76 charles c. benight and
michael d. matthews roman cieslak

17 Clinical Health Psychology in Military 29 Suicide in the Military 143

Settings 81 m. david rudd
alan l. peterson
30 Women in Combat 148
18 Hostage Negotiation in the dawne vogt and amy e. street
Military 86
laurence miller 31 Psychotherapy with Lesbian,
Gay, and Bisexual Military Service
19 Mental Health Advisory Teams 91 Members 152
a. david mangelsdorff matthew c. porter and
veronica gutierrez
20 Comprehensive Soldier Fitness 96
donna m. brazil 32 Military Psychologists’ Roles in
Interrogation 158
larry c. james and lewis pulley
PART III: ETHICAL AND
PROFESSIONAL ISSUES
33 Interacting with the Media 161
nancy a. mcgarrah and
21 Multiple Relationships in the Military
diana l. struski
Setting 103
jeffrey e. barnett
34 Preparation and Training as a Military
Psychologist 165
22 Managing Conflicts between Ethics and
peter j. n. linnerooth and
Law 107
brock a. mcnabb
w. brad johnson
35 The Impact of Leadership on Mental
23 Mixed-Agency Dilemmas in Military
Health 170
Psychology 112
richard l. dixon jr.
w. brad johnson
 contents ix

36 Training Initiatives for Evidence-Based 46 Substance Use Disorders among Military

Psychotherapies 174 Personnel 227
jeanne m. gabriele and joseph westermeyer and
judith a. lyons nathan a. kimbrel

37 Unique Challenges Faced by the National 47 Traumatic Brain Injury 232

Guard and Reserve 178 melissa m. amick, beeta homaifar,
michael crabtree, and jennifer j. vasterling
elizabeth a. bennett,
and mary e. schaffer 48 Aggression and Violence 237
eric b. elbogen and
connor sullivan
PART IV: CLINICAL THEORY,
RESEARCH, AND PRACTICE
49 Sleep Loss and Performance 241
william d. s. killgore
38 Prevalence of Mental Health Problems
among Military Populations 187
50 Sleep Disorders 246
sherrie l. wilcox, kimberly finney,
vincent f. capaldi ii and
and julie a. cederbaum
melinda c. capaldi
39 Challenges and Threats of Combat
51 Grief, Loss, and War 251
Deployment 192
kent d. drescher
heidi s. kraft
52 Early Interventions with Military
40 Postdeployment Adjustment 197
Personnel 256
david s. riggs
maria m. steenkamp and
brett t. litz
41 Combat and Operational Stress
Control 202
53 The Psychosocial Aspects and Nature
kristin n. williams-washington
of Killing 260
and jared a. jackson
richard j. hughbank and
dave grossman
42 Trauma and Posttraumatic Stress
Disorder 207
54 Military Sexual Trauma 264
blair e. wisco, brian p. marx,
elizabeth h. anderson and
and terence m. keane
alina surís
43 Anxiety Disorders and Depression in
55 Prescription Opioid Abuse in the
Military Personnel 211
Military 269
nathan a. kimbrel and
jennifer l. murphy and
eric c. meyer
michael e. clark
44 Serious Mental Illness in the Military
56 Psychosocial Rehabilitation of Physically
Setting 217
and Psychologically Wounded 274
david f. tharp and eric c. meyer
walter erich penk and
dolores little
45 Substance Use in the US Active Duty
Military 221
robert m. bray
x contents

57 Working with Military Children 278 64 Aging Veterans 311

michelle d. sherman and avron spiro iii and michele j. karel
jeanne s. hoffman
65 Spiritual Resiliency in the Military
58 Impact of Psychiatric Disorders and Setting 316
Psychotropic Medications on Retention william sean lee and
and Deployment 283 willie g. barnes
david s. shearer and
colette m. candy 66 Posttraumatic Growth 321
richard g. tedeschi
59 Technology Applications in Delivering
Mental Health Services 288 67 Ways to Bolster Resilience across the
greg m. reger Deployment Cycle 325
donald meichenbaum
60 What We Have Learned from Former
Prisoners of War 293
PART V: RESOURCES
brian engdahl
68 Common Military Abbreviations 331
61 Clinical Research in the Military 296
bret a. moore
stacey young-mccaughan
69 Comparative Military Ranks 334
62 Measuring Resilience and Growth 301
bret a. moore
lynda a. king and daniel w. king
Index 337
63 Transitioning through the Deployment
Cycle 306
sherrie l. wilcox and
michael g. rank
 FOREWORD

Psychologists in today’s military wear mul- in the door with psychological screening and
tiple hats and are required to be well versed gained a solid foothold with clinical practice.
in numerous areas of the modern-day profes- From operational psychology, forensic psychol-
sion of psychology. Some of these varied roles ogy, and health psychology to neuropsychol-
include clinician, scientist, researcher, educator, ogy, research psychology, and organizational
consultant, expert witness, advocate, commu- psychology, the modern-day military psychol-
nicator, coach, mentor, and leader. The breadth ogist is involved in nearly all aspects of the
of the profession’s contributions is simply profession of arms.
extraordinary. This comprehensive Desk The military and its sister federal agen-
Reference provides a convenient and visionary cies—the U.S. Department of Veterans Affairs
overview of many of these topics, as written (VA), the Federal Bureau of Prisons, and the
by leading experts in their respective fields of U.S. Public Health Service—have long offered
military psychology. For those with an appre- psychology unique and exciting opportunities
ciation for the future, it provides an intriguing to function to the fullest extent of its train-
road map for where the civilian psychology ing and professional vision. Over the years
community may very well evolve. The psychol- the federal sector has increasingly become the
ogy of tomorrow will mature from what was employer of choice for new graduates and has
not that long ago essentially “mom and pop” been on the cutting edge in adapting to what
small private practices into integrated, multi- must be considered unprecedented change in
disciplinary systems of care with an increas- response to the advent of technology into the
ing emphasis on demonstrated mission-based, health care arena (e.g., telehealth, electronic
objective outcomes. Services will be patient- health records, comparative effectiveness
centered, holistic, and individually tailored, research, etc.). In the training arena, the mili-
whether they are considered clinical, consul- tary, along with psychology’s leaders within
tative, or operational in nature. Psychologists the VA, have essentially defined the field of
in today’s military find themselves working in postdoctoral education for the profession. In
ever-expanding settings, delivering novel ser- so doing, the federal sector has become a cata-
vices, with varied populations that would have lyst for substantive policy discussions within
been entirely unthinkable to the forefathers of the American Psychological Association (APA)
early military psychology who got their foot governance, leading to extensive modifications

xi
xii foreword

within the national education (especially for the successful therapeutic relationship,
accreditation) and practice communities. one must appreciate that “confidentiality”
This thought-provoking Desk Reference must be conditional within a military context.
provides an insightful overview of the depth Similarly, although in the private sector and
and breadth of psychology’s involvement civilian life concerns regarding “stigma” are
over the years within the Department of unquestionably significant, just how signifi-
Defense, as well as its willingness to address cant may have a different consequence within
new and evolving challenges; for example, the military, especially when seeing a psy-
women in combat, suicide in the military, and chotherapist may be perceived by superiors
most recently psychology’s roles in inter- as jeopardizing a critical mission. The reader
rogation and psychotropic management. The will also quickly come to appreciate that there
fundamental mission of the military has not are many subtle cultural nuances within the
changed—it remains to protect our national military—that each of the service branches is
security. And yet, the military itself has rather different—that assigned units and operational
dramatically changed over the years. Today’s missions can make a real difference. Rank and
military is an all-volunteer force with many years of experience—not to mention multiple
of those placing themselves “in harm’s way” deployments—may be seen as windows into
coming from the Reserve and National Guard. what may perhaps be fundamentally different
There are increasing numbers of women in treatment populations.
leadership positions, with the US Army hav- Given the modern-day realities of limited
ing selected its first female (and first nurse) as financial and staffing resources, psycholo-
its Surgeon General. The landscape of warfare gists practicing in today’s military and federal
is changing (cyber war, remotely piloted air- sectors must seek innovative ways to deliver
craft, etc.), requiring psychologists to research their services in cost-effective, efficient, and
and address the stressors unique to these new evidence-supported ways. Community-based
theaters of operation. The role and contribu- prevention, technology-enhanced interven-
tions of military families have become a sig- tions such as tele-mental health, group thera-
nificant priority for operational consideration. pies, time-limited psychotherapies, embedded
It is also the case that since 9/11 today’s mili- mental health, and primary care consultation
tary is facing an entirely different type of are just a handful of examples of strategies cur-
enemy compared to previous conflicts, under rently being used to expand the reach of pre-
very unusual if not unprecedented circum- cious mental health resources. It is critical to
stances. The signature wounds of this con- the future of the profession that psychologists
flict are heavily psychological in nature, for continue to conduct rigorous research studies
example, recovering from head trauma due and continually evaluate the effectiveness of
to unexpected blasts, psychological stress programs and interventions to scientifically
(posttraumatic stress disorder, or PTSD, being inform their decisions and guide the way to
an obvious example), and strategically address- improved outcomes.
ing the beginning stages of reentry into civil- Military psychologists are uniquely
ian life for the Wounded Warriors and now trained and postured to lead the field in these
equally important, their families. multifront efforts and to share their “lessons
What is perhaps the most significant con- learned” from experiences in the battlefield,
tribution of this publication for the civilian home front, clinics, classrooms, laboratories,
reader is the manner in which the unique- courtrooms, and offices. Whether the popu-
ness of the military culture is systemati- lations served are active duty, reserve, civil
cally incorporated into each of the chapters, service, family members, veterans, or retir-
thereby providing that all-important under- ees, as a microcosm of society the evidence
lying context for what is being discussed. For obtained from the military experience can
example, although for many clinicians abso- often generalize to the larger community
lute “patient confidentiality” is the bedrock from which the military is drawn. Continued
 foreword xiii

support from and partnerships with private Patrick H. DeLeon

industry, academia, civic leaders, profes- Uniformed Services University of the
sional organizations, and other influential Health Sciences
stakeholders will be crucial to these efforts. University of Hawaii
Most important is maintaining the critical Former President, American Psychological
trust of those who serve our nation, includ- Association
ing their families.
[The views expressed are personal and do Jay M. Stone
not represent those of USUHS, the USAF, or Uniformed Services University of the
the Department of Defense] Health Sciences, USAF
This page intentionally left blank
 PREFACE

The psychological well-being of the men and and contexts. A profession that was once seen
women returning from the wars in Iraq and as esoteric and mysterious has been normal-
Afghanistan is one of the most discussed ized and integrated into the national health
and contemplated mental health issues in our care discourse.
country today. Every week scores of articles Because of the depth and breadth of mili-
on the topic are published in popular news- tary psychology and its far-reaching influence,
papers, magazines, and top scientific journals. it is imperative that not only the military clini-
Television and radio news programs fill much cian have access to a comprehensive resource
of their time debating the “epidemics” of PTSD covering this vast and expansive field, the
and traumatic brain injury in our returning nonmilitary clinician, researcher, educator, and
veterans and the potential fallout of a less than policymaker should also have access to the
adequate military and Veterans Administration most relevant and up-to-date information in
mental health system. However, this is only the field. We believe Military Psychologists’
a small glimpse into the world of the service Desk Reference meets this need.
member and an even smaller one into the pro- The general format of Military Psychologists’
fession of military psychology. Desk Reference may be familiar to the reader.
Military psychology as a specialty within It is based on the original and very success-
psychology has been around since the turn of ful Psychologists’ Desk Reference edited by
the 20th century. It is likely one of the most Koocher, Norcross, and Hill (2004) and also pub-
diverse specialties within the field and includes lished by Oxford University Press. Consisting
numerous subspecialties, work settings, and of nearly 70 brief, focused, and practical chap-
career trajectories. In addition to addressing ters, the Military Psychologists’ Desk Reference
issues like the aforementioned PTSD and trau- highlights the most salient information in the
matic brain injury in service members and vet- field, which is summarized by leading experts
erans, military psychology is positioned and within the military, Veterans Administration,
equipped to influence such issues as psycho- and civilian sector.
logical resilience, extended family stress, the The first section of this volume provides a
role of technology in health care delivery, and brief overview of the history of military and
ways to increase human performance under VA psychology, basic military demographics,
harsh conditions within a variety of settings and invaluable information related to military

xv
xvi preface

cultural issues, both with clinical and non- used military abbreviations and acronyms
clinical implications. Section two covers the and a chapter that displays the various ranks
major psychological specialties within the field used by the US Army, Navy, Air Force, Marine
to include military neuropsychology, avia- Corps, and Coast Guard.
tion and operational psychology, combat and It is our belief that the Military
operational stress, human factors engineering, Psychologists’ Desk Reference will become the
command and organizational consultation, and authoritative guide within the field of military
others. It also covers the unique roles psychol- psychology. With over 100 of the field’s lead-
ogists play in supporting Special Operations ing experts in their respective areas, this vol-
Forces. Section three provides information on ume addresses both broad and narrow aspects
a number of professional issues in military of military psychology. However, the book is
psychology such as ethical challenges, scope by no means complete. Information relevant to
of practice, professional education and train- those who serve and support military person-
ing, challenges of women in combat, working nel is continually changing. And considering
with the media, professional burnout, and the the vastness of the field, we have undoubtedly
controversial topic of psychologists’ involve- inadvertently neglected to include relevant
ment in interrogations. Section four includes information. As a remedy, we have created an
numerous chapters on clinical theory, research, e-mail account so that readers can share their
and practice issues such as treating PTSD, sui- thoughts and suggestions on how to make the
cide, resilience, violence, trauma assault, trau- next edition stronger.
matic brain injury, sleep disorders, and many
others. Section five closes out the volume with Bret A. Moore and Jeffrey E. Barnett
a chapter that includes the more commonly [email protected]
 ACKNOWLEDGMENTS

There are many people who make a book like only as good as those who write the chapters.
this a reality. We would like to thank Sarah We are indebted to Gerald P. Koocher, John
Harrington and Andrea Zekus from Oxford C. Norcross, and Sam S. Hill III for allow-
University Press and Prasad Tangudu from ing us to adapt the format for our book from
Newgen Knowledge Works for all of their their very successful Psychologists’ Desk
hard work and support during the publica- Reference. Last, but certainly not least, we
tion process. We are grateful for the many thank our families for enduring the many late
experts in military psychology who agreed to (and early) hours in front of our computers.
contribute to this volume. An edited book is Editors are only as good as their loved ones.

xvii
This page intentionally left blank
 ABOUT THE EDITORS

Dr. Bret A. Moore is the founder of Military Divisions 18 and 19 of APA, respectively. His
Psychology Consulting and adjunct associate views and opinions on military and clinical
professor in psychiatry at University of Texas psychology have been quoted in USA Today,
Health Science Center at San Antonio. He is the New York Times, Boston Globe, TV Guide,
licensed as a prescribing psychologist by the and on NPR, the BBC, CNN, CBS News, Fox
New Mexico Board of Psychologist Examiners News, and the CBC.
and board-certified in clinical psychology by the
American Board of Professional Psychology. Dr. Jeffrey E. Barnett is a professor in the
Dr. Moore is a former active duty Army psy- Department of Psychology at Loyola University
chologist with two tours of duty to Iraq total- Maryland and a licensed psychologist in inde-
ing 27 months. He is the author and editor of pendent practice in Annapolis, Maryland. He
nine other books, including Treating PTSD in is board certified by the American Board of
Military Personnel, Handbook of Counseling Professional Psychology in clinical psychology
Military Couples, The Veterans and Active Duty and in clinical child and adolescent psychology
Military Psychotherapy Treatment Planner, and is a distinguished practitioner of psychol-
Living and Surviving in Harm’s Way, Wheels ogy in the National Academies of Practice.
Down: Adjusting to Life after Deployment, The Dr. Barnett is a former Army psychologist
Veterans and Active Duty Military Homework who was the first psychologist in the Army’s
Planner, Pharmacotherapy for Psychologists: Special Operations Command serving as
Prescribing and Collaborative Roles, the group psychologist for the 160th Special
Handbook of Clinical Psychopharmacology Operations Aviation Group (Airborne). He
for Psychologists, and Anxiety Disorders: A was a paratrooper, rappelle master, airborne
Guide for Integrating Psychopharmacology pathfinder, and the first graduate of the Army’s
and Psychotherapy. He also writes a biweekly high risk survival, evasion, resistance, and
newspaper column titled Kevlar for the Mind, escape (SERE) course.
which is published by Military Times. Dr. Barnett is a past chair of the ethics
Dr. Moore is a Fellow of the American committees of the Maryland Psychological
Psychological Association and has been Association and the American Psychological
awarded early career awards in military psy- Association. At present, he is a member of
chology and public service psychology from the ethics committee of the American Board

xix
xx about the editors

of Professional Psychology and serves on the (2008, with W. Brad Johnson) and Ethics Desk
Maryland Board of Examiners of Psychologists. Reference for Counselors (2009, with W. Brad
Dr. Barnett has numerous publications and Johnson). He is a recent recipient of the
presentations to his credit that focus on eth- American Psychological Association’s Award
ics, legal, and professional practice issues for for Outstanding Contributions to Ethics
mental health professionals to include editing Education and its award for Distinguished
one book and coauthoring six. His recent books Contributions to the Independent Practice of
include Ethics Desk Reference for Psychologists Psychology.
 CONTRIBUTORS

Melissa M. Amick, Ph.D. Elizabeth A. Bennett, Ph.D.

Psychologist, Spinal Cord Injury Service; Professor of Psychology, Washington & Jefferson
Investigator, Translational Research Center for College, Washington, PA
Traumatic Brain Injury and Stress; VA Boston
Robert M. Bray, Ph.D.
Healthcare System, Boston, MA; Assistant
Senior Program Director, Military Behavioral Health,
Professor of Psychiatry, Boston University
RTI International, Research, Triangle Park, NC
School of Medicine, Boston, MA
Donna M. Brazil, Ph.D.
Elizabeth H. Anderson, M.R.C.
Psychology Program Director, Department
VA North Texas Health Care System, Dallas, TX
of Behavioral Sciences and Leadership,
Rodney R. Baker, Ph.D. United States Military Academy, West Point, NY
Department of Veterans Affairs (Retired),
William L. Brim, Psy.D.
San Antonio, TX
Deputy Director, Center for Deployment
L. Morgan Banks, Ph.D. Psychology; Associate Professor, Medical
Operational Psychology Support, LLC and Clinical Psychology, Uniformed Services
University of the Health Sciences, Bethesda, MD
Willie G. Barnes, D.Min, CFMFT
Chaplain, Colonel (ret.), Army National Guard, Craig J. Bryan, Psy.D., ABPP
Consultant, Defense Suicide Prevention Office, Associate Director of the National Center for
Educator and Clinician Veterans Studies, Salt Lake City, UT; Assistant
Professor in the Department of Psychology, The
Paul T. Bartone, Ph.D.
University of Utah, Salt Lake City, UT
Professor and Senior Research Fellow, Center
for Technology and National Security Policy, Colette M. Candy, Ph.D.
National Defense University, Washington, Supervising Psychologist, Department of
DC; Adjunct Research Professor, University of Behavioral Health, Madigan Army Healthcare
Bergen, Norway System, Tacoma, WA
Charles C. Benight, Ph.D. Vincent F. Capaldi, II, Sc.M., M.D., MAJ, MC
Director CU: Trauma, Health, and Hazards Center US Army, Assistant Professor, Department of
and Professor of Psychology, University of Psychiatry, Uniformed Services University of
Colorado, Colorado Springs, CO the Health Sciences, Bethesda, MD

xxi
xxii contributors

Melinda C. Capaldi, Psy.D., CPT, MSC Brian Engdahl, Ph.D.

US Army, Clinical Psychologist, Bethesda, MD Counseling Psychologist and Faculty Member,
Brain Sciences Center, Minneapolis Veterans
Julie A. Cederbaum, Ph.D., MSW, MPH
Health Care System; Clinical Professor,
Assistant Professor, University of Southern
Department of Psychology, University of
California School of Social Work, Los Angeles, CA
Minnesota, Minneapolis, MN
Wayne Chappelle, Psy.D., ABPP
Charles R. Figley, Ph.D.
Senior Aeromedical Clinical Psychologist, USAF
Paul Henry Kurzweg Distinguished Chair, Tulane
School of Aerospace Medicine, Wright-Patterson
University, New Orleans, LA
AFB, OH
Kimberly Finney, Psy.D., ABPP, ABMP
Roman Cieslak, Ph.D.
Clinical Associate Professor, University of
Senior Research Associate, CU: Trauma, Health,
Southern California, Los Angeles, CA
and Hazards Center, University of Colorado,
Colorado Springs, CO; Associate Professor, Jeanne M. Gabriele, Ph.D.
Department of Psychology, University of Social Local Evidence-Based Psychotherapy Coordinator,
Sciences and Humanities, Warsaw, Poland G.V. “Sonny” Montgomery Veterans Affairs
Medical Center, Jackson, MS; Assistant Professor
Michael E. Clark, Ph.D.
of Psychiatry and Human Behavior, University
Pain Section Leader, James A. Haley Veterans
of Mississippi Medical Center, Jackson, MS
Hospital, Tampa, FL; Associate Professor,
Department of Psychology, University of South Dave Grossman, Lt. Col., USA (ret.)
Florida, Tampa, FL Director, Killology Research Group
Michael Crabtree, Ph.D. Veronica Gutierrez, Ph.D.
Professor of Psychology, Washington & Jefferson Counseling Psychologist in San Marcos and
College; Director and Chief Clinician, Washington Oceanside, CA.
Psychological Services, Washington, PA
Lynn K. Hall, Ed.D., LPC, NCC, ACS
Michael R. DeVries, Ph.D. Dean, College of Social Sciences, University of
Operational Psychologist, US Army Special Phoenix, Tempe, AZ
Operations Command, Fort Bragg, NC
Jeanne S. Hoffman, Ph.D., ABPP
Jean M. Dixon, M.S.N. Ed., RN, CCM Chief, Pediatric Psychology Clinic, Department
Active Duty Case Manager, Navy Region of Pediatrics, Tripler Army Medical Center,
Mid-Atlantic, Reserve Component Command, Honolulu, HI
Medical Hold Department, Norfolk, VA
Beeta Homaifar, Ph.D.
Richard L. Dixon Jr., M.Ed., MMAS Clinical Psychologist, Boston VA Health Care
Analyst, Lieutenant Colonel, US Army System, Boston, MA; Assistant Professor,
Reserve, Joint and Combined Operational Department of Psychiatry, Boston University,
Analysis, Suffolk, VA; Sergeant, Tucson Police Boston, MA
Department, AZ
Pennie L. P. Hoofman, Ph.D.
Kent D. Drescher, Ph.D. Director, Aeromedical Psychology, US Army
Health Science Specialist, National Center for School of Aviation Medicine, Ft. Rucker, AL
PTSD, VA Palo Alto Health Care System;
C. Alan Hopewell, Ph.D., MP, ABPP,
Psychologist, The Pathway Home: California
MAJ, US Army (ret.)
Transition Center for the Care of Combat
Director of Neuropsychology and Behavioral
Veterans, Yountville, CA
Health, Traumatic Brain Injury Clinic,
Eric B. Elbogen, Ph.D., ABPP-Forensic CRDAMC, Ft. Hood, TX
University of North Carolina-Chapel Hill School
of Medicine and Durham, VA, Medical Center
 contributors xxiii

Richard J. Hughbank, D.M., MAJ, US Army (ret.) Heidi S. Kraft, Ph.D.

Assistant Professor in Criminal Justice and Clinical Psychologist, San Diego, CA
Homeland Security, Northwestern State
Gerald P. Krueger, Ph.D., CPE
University of Louisiana, Natchitoches, LA
Adjunct Assistant Professor of Military
Jared A. Jackson, Ph.D. Psychology, Uniformed Services University of
Clinical Psychologist, Captain, US Army the Health Sciences, Bethesda, MD
Larry C. James, Ph.D., ABPP William Sean Lee, D.Min., B.C.C.
The School of Professional Psychology, Wright Chaplain, Colonel, Joint Force Headquarters
State University, Dayton, OH Chaplain, Maryland Army National Guard,
Baltimore, MD
W. Brad Johnson, Ph.D.
Professor of Psychology, US Naval Academy, Peter J. N. Linnerooth†, Ph.D.
Annapolis, MD; Faculty Associate, Johns Independent Practice, Mankato, MN
Hopkins University, Baltimore, MD
Dolores Little, Ph.D.
Brian L. Jones, Ph.D. Psychologist and VA Medical Center
Major, United States Air Force, 70th Intelligence, Administration Department of Veterans
Surveillance & Reconnaissance Wing, Fort Affairs (ret.)
George G., Meade, MD
Brett T. Litz, Ph.D.
Michele J. Karel, Ph.D. Director, Mental Health Core, Massachusetts
Psychogeriatrics Coordinator, Mental Health Veterans Epidemiological Research and
Services, VA Central Office, Washington, DC; Information Center (MAVERIC), VA Boston
Associate Professor, Department of Psychiatry, Healthcare System, Boston, MA; Professor,
Harvard Medical School, Boston, MA Boston University, Boston, MA
Terence M. Keane, Ph.D. Judith A. Lyons, Ph.D.
National Center for PTSD at VA Boston Healthcare Team Leader, Trauma Recovery Program, G.V.
System and Boston University School of “Sonny” Montgomery Veterans Affairs
Medicine, Boston, MA Medical Center, Jackson, MS;
Associate Professor of Psychiatry and Human
Mark P. Kelly, Ph.D., ABPP-CN
Behavior, University of Mississippi Medical
Program Director, Postdoctoral Fellowship in
Center, Jackson, MS
Clinical Neuropsychology, Walter Reed National
Military Medical Center, Bethesda, MD A. David Mangelsdorff, Ph.D., M.P.H., FAPA,
FAPS, FAAAS
William D. S. Killgore, Ph.D., LTC, MS, USAR
Professor, Army-Baylor University Graduate
Director, SCAN Laboratory, McLean Hospital,
Program in Health and Business Administration,
Belmont, MA; Associate Professor of Psychology,
Fort Sam Houston, TX
Harvard Medical School, Boston, MA
Brian P. Marx, Ph.D.
Nathan A. Kimbrel, Ph.D.
National Center for PTSD at VA Boston
Clinical Research Psychologist, VISN 17 Center
Healthcare System and Boston University
of Excellence for Research on Returning War
School of Medicine, Boston, MA
Veterans, Waco, TX; Assistant Professor, Texas
A&M Health Science Center, Temple, TX Michael D. Matthews, Ph.D.
Professor of Engineering Psychology,
Daniel W. King, Ph.D.
Department of Behavioral Sciences and
Research Professor of Psychology and Psychiatry,
Leadership, U.S. Military Academy,
Boston University; VA Boston Healthcare
West Point, NY
System, Boston, MA
Nancy A. McGarrah, Ph.D.
Lynda A. King, Ph.D.
Cliff Valley Psychologists, Atlanta, GA
Research Professor of Psychology and Psychiatry,
Boston University and VA Boston Healthcare
System, Boston, MA †
Peter J.N. Linnerooth unfortunately passed away
before this book was completed.
xxiv contributors

Cindy McGeary, Ph.D., ABPP Lewis Pulley, M.S., PsyM.

Associate Faculty–Research, Department of The School of Professional Psychology,
Psychology, University of Texas at Arlington, Wright State University, Dayton, OH; Captain,
Arlington, TX US Air Force
Don McGeary, Ph.D., ABPP Michael G. Rank, Ph.D.
Assistant Professor in Psychiatry, University Clinical Associate Professor, Director,
of Texas Health Science Center San Antonio, San Diego Academic Center, School of Social
San Antonio, TX Work, University of Southern California,
San Diego, CA
Brock A. McNabb, MSW
Department of Veterans Affairs, Honolulu, HI Greg M. Reger, Ph.D.
Deputy Director, Emerging Technologies Program,
Donald Meichenbaum, Ph.D.
National Center for Telehealth and Technology,
Distinguished Professor Emeritus, University of
Joint Base Lewis-McChord, WA
Waterloo, Ontario, Canada; Research Director
of the Melissa Institute for Violence Prevention, David S. Riggs, Ph.D.
Miami, FL Director, Center for Deployment Psychology,
Research Associate Professor, Uniformed
Eric C. Meyer, Ph.D.
Services University of the Health Sciences,
Clinical Research Psychologist, VISN 17 Center
Bethesda, MD
of Excellence for Research on Returning War
Veterans, Waco, TX; Assistant Professor, Texas M. David Rudd, Ph.D., ABPP
A&M Health Science Center, Temple, TX Co-Founder and Scientific Director, National
Center for Veterans Studies; Dean, College
Laurence Miller, Ph.D.
of Social and Behavioral Science, Professor of
Independent Practice, Boca Raton, FL; Adjunct
Psychology, University of Utah
Professor of Psychology, Florida Atlantic
University, Boca Raton, FL Mark C. Russell, Ph.D., ABPP
Chair, Psy.D. Program, Antioch University
Paul Montalbano, Ph.D., ABPP (Forensic),
Seattle, WA
Deputy Director, Postdoctoral Fellowship Training
Program in Forensic Psychology, Walter Reed Morgan T. Sammons, Ph.D., ABPP
National Military Medical Center, Bethesda, MD Dean and Professor, California School
of Professional Psychology,
Jennifer L. Murphy, Ph.D.
San Francisco, CA
Clinical Director, Chronic Pain Rehabilitation
Program, James A. Haley Veterans’ Hospital, Mary E. Schaffer, Ph.D.
Tampa, FL; Assistant Professor, Chief, Training and Research Division,
Department of Neurology, University of South Department of Behavioral Medicine,
Florida, Tampa, FL Brooke Army Medical Center, San Antonio, TX
Walter Erich Penk, Ph.D., ABPP Richard Schobitz, Ph.D., CDR, USPHS
Professor, Psychiatry and Behavioral Sciences, Chief, Training and Research Division, Department
Texas A&M College of Medicine; Consultant, of Behavioral Medicine, Brooke Army Medical
Department of Veterans Affairs, VA Center, San Antonio, TX
Rehabilitation Research and Development
David S. Shearer, Ph.D.
Alan L. Peterson, Ph.D., ABPP Clinical and Prescribing Psychologist, Director of
Professor, Department of Psychiatry, Chief, Behavioral Sciences, Family Medicine Residency,
Division of Behavioral Medicine, Director, Dept of Family Medicine, Madigan Army
STRONG STAR Multidisciplinary PTSD Healthcare System, Tacoma, WA
Research Consortium, University of Texas
Michelle D. Sherman, Ph.D.
Health Science Center at San Antonio, San
Director, Family Mental Health Program, Oklahoma
Antonio, TX
City VA Medical Center; Core Investigator, South
Matthew C. Porter, Ph.D. Central Mental Illness Research, Education and
Assistant Professor, California School of Clinical Center (MIRECC); Clinical Professor,
Professional Psychology, Alliant International Department of Psychiatry and Behavioral Sciences,
University, San Diego, CA University of Oklahoma Health Sciences Center
 contributors xxv

Avron Spiro III, Ph.D. Jennifer J. Vasterling, Ph.D.

Research Professor, Departments of Epidemiology Chief of Psychology, VA Boston Healthcare
and Psychiatry, Boston University Schools System, Boston, MA; VA National Center for
of Public Health and Medicine, Boston MA; PTSD, Boston, MA; Professor of Psychiatry,
Research Career Scientist, VA Boston Boston University School of Medicine,
Healthcare System, Boston, MA Boston, MA; Lecturer, Harvard Medical School
Maria M. Steenkamp, Ph.D. Dawne Vogt, Ph.D.
Clinical Research Psychologist, VA Boston Women’s Health Sciences Division, National
Healthcare System, Boston, MA Center for PTSD, VA Boston Healthcare System;
Associate Professor, Division of Psychiatry,
Amy E. Street, Ph.D.
Boston University School of Medicine,
Women’s Health Sciences Division, National
Boston, MA
Center for PTSD, VA Boston Healthcare System;
Associate Professor, Division of Psychiatry, Joseph Westermeyer, M.D., M.P.H., Ph.D.
Boston University School of Medicine, Staff Psychiatrist, Minneapolis VA Medical
Boston, MA Center; Professor of Psychiatry, University of
Minnesota, Minneapolis, MN
Diana L. Struski
San Antonio, TX Emile K. Wijnans, Ph.D.
Clinical Psychologist, United States Army Drill
Connor Sullivan
Sergeant School, Ft. Jackson, SC
Research Assistant, Department of Psychology,
University of North Carolina, Chapel Hill, NC Sherrie L. Wilcox, Ph.D., CHES
Research Assistant Professor, University of
Alina Surís, Ph.D., ABPP
Southern California, Los Angeles, CA
Chief of Psychology, Mental Health Service, VA
North Texas Health Care System; Thomas J. Williams, Ph.D.
Associate Professor, Psychiatry, University Professor, US Army War College, Carlisle, PA
of Texas Southwestern Medical Center,
Kristin N. Williams-Washington, Psy.D.
Dallas, TX
Clinical Psychologist, Upper Marlboro, MD
Michael G. Sweda, Ph.D., ABPP (Forensic)
Blair E. Wisco, Ph.D.
Board-Certified Forensic Psychologist; Director,
National Center for PTSD at VA Boston Healthcare
WRNMMC Forensic Psychology Fellowship;
System and Boston University School of
Deputy Director, WRNMMC Center for
Medicine, Boston, MA
Forensic Behavioral Sciences, Fremont Bldg,
Bethesda, MD Stacey Young-McCaughan, RN, Ph.D.
Professor, Department of Psychiatry, Division of
Richard G. Tedeschi, Ph.D.
Behavioral Medicine, University of Texas Health
Professor of Psychology, University of North
Science Center, San Antonio, TX
Carolina Charlotte, Charlotte, NC
David F. Tharp, Psy.D.
VISN 17 Center of Excellence for Research on
Returning War Veterans, Waco, TX; Associate
Professor, Texas A&M Health Science Center,
Temple, TX; Lieutenant Colonel (Dr.), United
States Air Force Reserves
This page intentionally left blank
PART I
History and Culture
This page intentionally left blank
 EARLY HISTORY OF MILITARY
1 MENTAL HEALTH CARE

Brian L. Jones

Mental health care providers in the military fol- exhibited in all previous military conflicts, they
low an uncommon charge in comparison to their were addressed by other names. The changes
civilian counterparts. Issues such as differing in terms used to denote combat-related stress,
arenas of practice and ethical quandaries only while interesting from a historical perspective,
scratch the surface of the complexities found in also enrich our understanding of how viewing
being a military officer and a mental health care these symptoms differently and more accu-
provider. Despite the efforts of military mental rately over time spawned the development of
health providers and the current federal bud- military mental health care.
getary emphasis placed on the mental health The term “nostalgia” was coined by Swiss
of military forces and their family members, physician Johannes Hofer during the 17th
the state of military mental health care has not century and referred to homesickness with
always been this robust (Laurence & Matthews, the belief that symptoms derived from a sol-
2012). It is difficult, if not impossible, to discuss dier’s desire to return home. In the 18th cen-
the development of mental health care in the tury an Austrian physician, Josef Leopold
military without simultaneously noting that Auenbrugger, wrote about nostalgia, listing
each step was paved during a particular time in the symptoms as sadness and being taciturn,
this nation’s history of war. listless, and isolating (Jones, 1995). During
the Napoleonic wars PTSD symptoms were
termed “exhaustion.” During the American
TRAUMATIC STRESS IN WAR Civil War, terms like “soldier’s heart” and
“effort syndrome” were coined. The symp-
Posttraumatic stress disorder (PTSD) was toms during World War I (WWI) and World
added to the formal diagnostic nomenclature War II (WWII) were identified as “shell shock”
in 1980, though psychiatric symptoms stem- and “battle fatigue,” respectively (Kennedy,
ming from stress-related combat have always Boake, & Moore, 2010). As the culture slowly
existed. History is replete with indications of began to develop an understanding of people
war-related difficulties (uncontrollable shak- returning home from war with psychologi-
ing, heart palpitations, going blind on the cal wounds, during the Vietnam War service
battlefield) all the way back to ancient Greece. members with such wounds were said to be
Epizelus is recorded as going blind on the bat- suffering from “post-Vietnam syndrome.” The
tlefield after a man next to him was killed in a gradual emergence of mental health services in
war between the Greeks and Persians (Jones, America evolved over time hand in hand with
1995). While symptoms of PTSD were likely the sociocultural political climate in terms of

3
4 part i • history and culture

understanding the psychological effects one account for a soldier exposed to shelling and
might experience subsequent to the brutality subsequently developing blindness or a pecu-
of war. liar gait, detaching from activities of daily liv-
ing, and/or suffering from amnesia. However,
this notion was quickly abandoned when it
was discovered that soldiers never exposed
PRE–WORLD WAR I to shelling experienced the same symptoms
(Jones, 1995). Suddenly, this constellation of
Although operational psychology practices
symptoms was viewed as a psychiatric prob-
(often referred to as PSYOPs) were employed
lem, and applicable psychiatric care was offered
during the American revolutionary war,
near the front. The intervention of PIE (prox-
there was little to no attention given to the
imity, immediacy, expectation of recovery) was
possible mental health difficulties attribut-
developed and utilized to decrease the number
able to the exposure to trauma during war
of shell shock cases unable to return to fight-
(Kennedy & McNeil, 2006). It wasn’t until the
ing the war (Kennedy & McNeil, 2006). The
American Civil War that documentation of
concept of PIE is understood as a foundational
mental health disorders was initiated. A great
intervention in combat-related stress, and
deal of documentation considered substance
at least some variation remains in use by all
abuse problems, which were rampant due to
branches of the military today.
the management of pain from amputation by
way of narcotics (Watanabe, Harig, Rock, &
Koshes, 1994). The brutality of the Civil War
contributed to significant psychiatric trauma.
WORLD WAR II
Nostalgia was the second most common diag-
nosis made by Union doctors. New terms The advent of WWII saw another increase
were coined, including “soldier’s heart” and in the use of military psychologists utilized
“exhausted heart.” Like “nostalgia,” these new in formalized screening (testing, assessment,
terms explicated the symptoms exhibited by etc.). Unfortunately, the emphasis placed
emotionally distraught soldiers, particularly on screening meant that there was little
paralysis, tremors, sudden changes in mood, emphasis on forward deployed mental health
and a deep desire to return home. The advent care workers. Failing to capture any lessons
of neurosurgery during the Civil War was learned during WWI about combat-related
seminal in distinguishing maladies that had an stress reactions, the belief at the time was that
organic basis from those more psychological in they could screen out those individuals pre-
nature (Jones, 1995). disposed to such reactions. The terms “com-
bat fatigue” and “combat exhaustion” both
underscore the thinking at the time, which
WORLD WAR I (WWI) was that these symptoms were largely due
to long deployments. While there was a sig-
Although the “official” birth of military psy- nificant increase in the number of early dis-
chology occurred during WWI and psycholo- charges due to combat-related stress, there
gists were utilized at the time, their duties was finally an appreciation of the importance
mostly centered on activities such as testing, of mental health intervention on the battle-
assessment, and selection. However, in terms field and preparing military personnel for the
of military mental health care, it was during psychological consequences of engaging in
WWI that physicians in the military began to combat (Kennedy & McNeil, 2006).
notice the traumatic reactions of soldiers. Initial This was also the period of time during which
thought centered on the idea that an actual military psychologists were first assigned to
shock to the nervous system had occurred. hospitals. As WWII came to an end, it was clear
Hence, the phrase “shell shock” was used to that physicians could not adequately manage
 1 • early history of military mental health care 5

the overwhelming numbers of service mem- was an increase in service members returned
bers needing mental health care. Psychologists to duty. The end of the Korean War saw the
were able to fill this void and proved to be Army focus its attention on organizational
propitious in delivering quality mental health principles (motivation, morale, leadership) and
care (i.e., individual and group psychotherapy), psychological warfare, while the Navy and Air
especially in Veterans Administration (VA) Force began to focus on performance enhance-
treatment settings after the conclusion of the ment, specifically through the study of human
war (Ball & Peake, 2006). factors (Kennedy & McNeil).
Just as after WWI, the end of WWII saw
the demobilization of psychologists. However,
the growing consensus among decision mak- VIETNAM WAR
ers was that a benefit to having a psycholo-
gist in the military is the power of influence, During the Vietnam War, military psycholo-
which might not be available from a civilian gists continued to serve in combat zones,
psychologist working within the military applying the well-established principles of
system. Consequently, in 1947 psychologists combat stress intervention practiced during
were given permanent active duty status as WWI, WWII, and the Korean War. Compared
military members (Kennedy & McNeil, 2006). to these previous wars, there appeared to be a
Similarly, although utilized in a civilian capac- reduced amount of traditional combat-related
ity prior to this time, by the end of WWII social stress in Vietnam. These symptoms were
workers were granted active duty status as again described as “combat fatigue.” However,
military officers. Also of particular note during there was more attention given to problematic
this time period, the addition of “gross stress behavioral issues than to mental health diag-
reaction” to the formal diagnostic nomencla- nosis, as service members were seen as exhib-
ture provided clinicians a common frame of iting character disorders (Kennedy & McNeil,
reference for service members suffering from 2006).
the stressors of combat. Problems with abusing and being depen-
dent on alcohol, narcotics, and other sub-
stances have existed in most militaries
KOREAN WAR worldwide since historical records have been
kept. However, the war in Vietnam was char-
By the time the Korean War started in 1950, acterized by it. Part of this can be attributed
the prior half-century had witnessed the incre- to the zeitgeist of the 1960s and early 1970s
mental development of the military mental in the United States, which was much more
health care provider from civilian to active indulgent and lenient regarding the use and
duty during wartime to regular active duty. abuse of substances. Likewise, there was a
Beginning in the Korean War active duty concomitant increase in alcohol and drug
mental health providers found themselves in rehabilitation. Prior to the 1970s, attempts
positions not encountered before (stationed to solve these problems in both military and
overseas, in combat zones, on hospital ships, nonmilitary settings were woefully inad-
etc.). Unfortunately, because of the hasty begin- equate because of the belief that substance
ning of the war, there were not the appropriate abuse and dependence emerged from a lack
support units in place. This meant that the les- of discipline. Not understanding the “disease”
sons learned from WWI and WWII in terms component of substance use disorders, treat-
of forward deployed mental health interven- ment options gave way to a variety of other
tion were not available at the beginning of the mechanisms to address this apparent derelic-
war (Kennedy & McNeil, 2006). The immedi- tion of duty. This changed in 1971, when the
ate impact of this lack of intervention was sig- treatment of substance use disorders became
nificant, but as the practices of combat stress a reality with the assistance of a congressional
intervention were gradually employed there mandate (Watanabe et al., 1994).
6 part i • history and culture

The Vietnam War was unique in multiple and Desert Storm. Likewise, a phenomenon
ways. The combination of jungle warfare, cruel known as “Gulf War Illness” or “Gulf War
and inhumane experiences upon capture, poor Syndrome” has plagued veterans from this
unit cohesion due to staggered deployment war (Kennedy & McNeil, 2006). An enigmatic
rotations, and a largely nonsupportive public constellation of medically inexplicable physi-
created an atmosphere ripe for the develop- cal and psychological symptoms, this condition
ment and sustainment of PTSD. It is no sur- continues to persist in complicating the lives of
prise that there is an increase in rates of PTSD veterans and baffling researchers and clinicians
experienced by veterans of that war. In addi- in terms of determining the etiology and best
tion to the rising rates of PTSD, the ending of course of treatment.
the war in Vietnam brought with it an under-
standing that a more systematic approach was
necessary in responding to critical incidents
GLOBAL WAR ON TERROR (GWOT), OVERSEAS
that were not combat-related, namely train-
CONTINGENCY OPERATION, AND BEYOND
ing accidents and suicide (Kennedy & McNeil,
2006). Responding to critical incidents in this For almost the entirety of the first decade of
manner continues today with each service the 21st century, service men and women
forming its own practices: Special Psychiatric spent time supporting Operations Enduring
Rapid Intervention Team (SPRINT) in the Freedom (OEF) and Iraqi Freedom (OIF). Both
Navy; Traumatic Event Management (TEM) operations were part of the GWOT, which offi-
in the Army; and Traumatic Stress Response cially became known as Overseas Contingency
(TSR) in the Air Force. Operation under the administration of US
President Barack Obama. At the time of this
writing OIF has concluded, while operations
THE FIRST GULF WAR in OEF continue. For both operations the prin-
ciples of forward deployed mental health care
Though the First Gulf War lasted just under have been and continue to be implemented,
seven months, both operations Desert Shield reducing the number of psychological casual-
and Desert Storm contained significant com- ties associated with combat. Despite the thriv-
bat stressors not encountered in previous wars. ing practice of mental health care in combat
Exposure to chemical and biological weapons, environments, veterans of both OEF and OIF
extreme desert conditions such as sandstorms, suffer from PTSD. Also, because of the type of
and greater numbers of enemy forces threat- weaponry used, traumatic brain injury (TBI)
ened to increase the possibility of psycho- is one of the signature wounds of both opera-
logical casualties due to combat-related stress. tions. This has presented another difficulty for
Forward deployed mental health care was once clinicians and researchers in terms of develop-
again utilized as well as a psychologist serving ing the appropriate treatments to target and
for the first time aboard a Navy aircraft carrier manage the sequelae of complicated physical
(Kennedy & McNeil, 2006). The availability and psychological symptoms, which are often
of these services, as well as the brevity of the comorbid with PTSD (Kennedy et al., 2010).
war and small number of American casualties, Though this chapter has focused primarily
is likely the reason that there were a reduced on the emergence of military mental health care
number of service members unable to return in its relation to wars over the last century, it is
to fighting due to combat-related stress. worth noting the current state of affairs. What
Unfortunately, the availability and good started as rudimentary mental health principles
response of mental health care could not in forward deployed locations designed to get
account for the delayed incidence of PTSD, service members back to combat (i.e., PIE) has
which has continued to increase over time in blossomed into a thriving and robust panoply
veterans of both Operations Desert Shield of available services to military members, their
 1 • early history of military mental health care 7

families, and retirees. There is no question that while continuing to provide the appropriate
mental health care in deployed locations requires treatments for active-duty members and their
creativity and adaptability to address the relevant families.
needs of service members (Ball & Peake, 2006).
However, the majority of military mental health
care providers find themselves in other settings. References
Providing direct care to active duty members and
their families, consulting with leaders about unit Ball, J. D., & Peake, T. H. (2006). Brief psychother-
apy in the U.S. military: Principles and applica-
cohesion or other organizational concerns, rec-
tions. In C. H. Kennedy & E. A. Zilmer (Eds.),
ommending whether or not a service member is Military psychology: Clinical and operational
fit for duty, and giving a briefing about suicide applications (pp. 61–73). New York, NY:
prevention are all activities that one military Guilford Press.
mental health care provider might engage in Jones, F. D. (1995). Psychiatry lessons of war. In
over the course of a single day. Moreover, he or R. Zajtchuk & R. F. Bellamy (Eds.), Textbook
she has to be willing and able to engage in these of military medicine: War psychiatry (pp.
activities in an outpatient clinic, on an inpatient 1–33). Washington, DC: Office of the Surgeon
psychiatry ward, as part of a primary care staff, General, US Department of the Army.
on a ship, as a member of a disaster team, or in Kennedy, C. H., Boake, C., & Moore, J. L. (2010). A
a classroom. history and introduction to military neuropsy-
chology. In C. H. Kennedy & J. L. Moore (Eds.),
Historically speaking, the inherent difficul-
Military neuropsychology (pp. 1–28). New
ties in our nation’s wars have challenged mental York, NY: Springer.
health care providers to search for innovative Kennedy, C. H., & McNeil, J. A. (2006). A history
ways to manage the stressors of those in com- of military psychology. In C. H. Kennedy & E.
bat and learn the invaluable lessons of previous A. Zilmer (Eds.), Military psychology: Clinical
wars (Ball & Peake, 2006). From each conflict and operational applications (pp. 1–17). New
in our nation’s history has emerged the inge- York, NY: Guilford Press.
nuity to learn from past oversights and capture Laurence, J. H., & Matthews, M. D. (2012). The hand-
the essence of how to better manage the men- book of military psychology: An introduction.
tal health needs of those serving our country. In J. H. Laurence & M. D. Matthews (Eds.), The
It is now imperative for those in the field to Oxford handbook of military psychology (pp.
1–3). New York, NY: Oxford University Press.
consider the changing landscape of warfare
Watanabe, H. K., Harig, P. T., Rock, N. L., & Koshes,
(cyber war, remotely piloted aircraft, etc.) and R. J. (1994). Alcohol and drug abuse and depen-
carefully think through the stressors unique to dence. In R. Zajtchuk & R. F. Bellamy (Eds.),
these new theaters of combat. Simultaneously, Textbook of military medicine: Military
there must be concentrated attention given to psychiatry: Preparing in peace for war (pp.
the development of more advanced methods 61–90). Washington, DC: Office of the Surgeon
of treatment delivery (e.g., telepsychology) General, US Department of the Army.
 2 HISTORY OF MILITARY PSYCHOLOGY

C. Alan Hopewell

PSYCHOLOGISTS JOIN THE WAR TO END ALL interest, but psychologists were soon involved
WARS in the infancy of aviation personnel selection
and training.
In an abridged addition to his 1890 seminal After a successful trial program, Camp
work The Principles of Psychology, William Greenleaf was established at Fort Oglethorpe,
James described his hope that by treating psy- Georgia, for centralizing and standardizing
chology as a natural science, he could help the training of psychology officers and techni-
“her” become one (James, 1890). It was at that cians, using. The Army Alpha tests were used
point that psychology as a formal discipline for group assessments and the Army Beta tests
stood on the verge of changing military opera- for illiterates. By May of 1918, there were 24
tions forever. induction camps with psychological companies.
The outbreak of World War I saw the United Eventually, 1,750,000 soldiers were examined,
States Army grow from an undertrained peace- an astounding 47% of the entire Army. As
time reserve force of 190,000 to one of 3,665,000 part of this rapid mobilization, a young corpo-
in only 20 months. In 1917 a committee from ral with a newly minted Master’s degree was
the National Research Council proposed that trained by Captain Edwin Boring. Put to work
Surgeon Major General Gorgas commission screening soldiers at Camp Logan, near Corpus
psychologists as active duty officers in order Christi, Texas, David Wechsler later adapted
to implement the newly devised mental test- the Army Alpha Test, transforming it into the
ing techniques to address the problems of rapid Wechsler-Bellevue Intelligence Test.
military induction, the need to screen for men- By war’s end, the psychology companies
tal defects or psychiatric problems, and to make were being asked to do more and more, to
assignments. General Order 74 commissioned include forensics, clinical consultation, solve
the president of the American Psychological problems in training and morale, and devel-
Association, (APA), Robert Yerkes, as a Major, oping strategies for forward psychiatry and
and commissioned the first 16 active duty psy- interventions for combat stress. In addition,
chologists as first lieutenants. A somewhat par- the Committee on Classification of Personnel
allel effort was also developed by Walter Scott was formally incorporated into the military at
and Walter Bingham with the Committee on the initiative of the General Staff. By late 1918,
Classification of Personnel, as they were uncer- remaining psychological staffs were working
tain of the “theoretical” nature of Yerkes’s in collaboration with the Division of Physical
project and wanted to implement practical, busi- Reconstruction of the Surgeon General’s
ness-oriented programs. The Navy showed no Office. This established psychology’s role in

8
 2 • history of military psychology 9

areas of physical disability, to include many of should be recalled that troops were only in com-
the brain injuries suffered in the war. In this bat on the ground in Europe for ten months,
regard, psychology as a whole succeeded much thus providing little actual “ground time” for
more than Yerkes probably could have imag- a conflict, which otherwise lasted four years for
ined, setting the stage for its resurgence during US forces so most psychologists were found in
World War II. the United States, England, or further behind
the combat lines in the Pacific.
Clinical interrogations of the senior Nazi
MILITARY PSYCHOLOGY “REBOOTS” FOR leadership interned at war’s conclusion were
WORLD WAR II extensive, this being the discipline’s first
encounter with “detainee ops.” The Wechsler
As war once again broke out in Europe, many and Rorschach were first administered by psy-
of the lessons learned from World War I were chology technicians to 56 senior surviving Nazi
quickly “rebooted” for World War II. One hun- leaders during their top-secret incarceration at
dred and forty psychology officers were initially the Palace Hotel in Mondorf, Luxembourg, a
commissioned as First and Second Lieutenants mission known as “Operation Ashcan.” After
assigned under the Personnel Research Section they were transferred to Nürnberg for their
to induction stations. By the spring of 1942, final trials, psychologist G. Gilbert used the
six clinical psychologists had been directly data collected along with his subsequent inter-
commissioned as first lieutenants to the then views for a comprehensive study of Nazi per-
existing Army General Hospitals. Colonel W. sonalities, although he had first been assigned
C. Menniger eventually implemented more as an intelligence officer (Dolibois, 1989).
uniform procedures with an ultimate allotment Those most in need of psychological treat-
total of 346 officers, to include five enlisted ment at the conclusion of hostilities were
Women’s Army Corps (WAC) candidates who the prisoners of war, either captured aircrews
were commissioned as psychologists. in Europe or mostly the survivors of the
The Air Force Aviation Psychology Program Philippine assaults. Underappreciated at the
of 1941 began to accept Army enlisted person- time, it is now estimated that half of those
nel and to test and to train them for the Army captured in Germany and Japan during World
Air Corps. The Army Research Institute (ARI) War II developed posttraumatic stress disor-
for the Behavioral and Social Sciences had been der. Most received little in the way of formal
established somewhat earlier, in 1939, with its treatment. The majority of captured aircrews
historical roots going back to World War I. in Europe were held at “Stammlager,” where
These two groups, the “clinical” officers and conditions were at least partly tolerable. But
the “behavioral/applied scientist” psycholo- hundreds were also incarcerated at Buchenwald
gists, therefore, began to shape what we today as well as other extermination camps. Many of
recognize as Army and eventually military these latter troops, along with the POWs held
psychology as a whole. by the Japanese, were more severely tortured
The Army General Classification Test, the and were specifically targeted for liquidation,
Wechsler-Bellevue Intelligence Scale, and the especially after the Dresden air raid (Edwards,
Stanford Binet Intelligence Test for the first time 2012). Most of the treatment that could be
became authorized tests of intelligence under conducted with these more seriously damaged
the guidance of TB MED 115. TB MED 155 POWs was done back in US hospitals.
similarly addressed brain-damaged and aphasic However, whether returning from combat,
patients and authorized the use of the Goldstein- repatriated, or freed at the end of the war, almost
Scheerer Test of Abstract and Concrete Behavior. all troops from either the European or Pacific
Personality assessment emphasis, however, once Theaters spent 2–4 weeks aboard ships return-
again was placed upon the attempted prescreen- ing to CONUS, where they invariably “talked”
ing the attempted prescreening of those who to other soldiers or sailors about their experi-
might develop stress disorder. In addition, it ences (Settles, 2012, personal communication).
10 part i • history and culture

Although many World War II military person- Association for Applied Psychology. The fol-
nel are known after the war for “not talking” lowing year Army psychologists obtained
about their combat experiences, the informal permanent active duty status, and in 1949 the
“talking therapy” conducted aboard ship did first internship programs were established. In
contribute to an eventual understanding of how 1946 Congress established the Office of Naval
important such cathartic therapy could be. Research, which included behavioral science,
Army psychology training was eventually and as the Air Force became a separate service it
authorized at the Adjutant General’s School created the Human Resources Research Center
at Fort Sam Houston with 24 officers starting in 1948 to carry on the work of the Army Air
in October 1944, and a total of 281 in the end Force Aviation Psychology Program.
graduating. With the current interest concern-
ing traumatic brain injury due to blast injuries
experienced in the Wars on Terror, it is of inter- KOREA
est to note that of the 88 hours of instruction,
four hours were devoted specifically to “Brain- The exploding conflict on the Korean penin-
Injured Patients.” Many of these students later sula soon saw psychologists in new positions
became prominent neuropsychologists. in service overseas, in the combat zones them-
At war’s end, Edward Boring, having served selves, and on hospital ships. With the benefit
as a Captain under Major Yerkes, edited an of experience, this time psychologists pushed
influential text dividing the “psychological for the application of combat stress princi-
business of the Army and Navy” into seven ples. The new emphasis upon these theorems
major categories, many of which still underlie saw the return to duty rate increase from the
modern military psychology (1945, p. 3): World War II levels of only 40% to rates of
80% to 90%. Combat stress operations were
• Observation—accuracy in perception carried out by the 212th Psychiatric Battalion,
• Performance—action and movement; the which led to the award of the first Bronze Star
acquisition of skills; efficiency in work and Medal to a combat operational psychologist,
action Richard H. Blum, although the award was not
• Selection—classification; the choice of the made until 2005.
right man for the right job Partly due to the nature of the war, other
• Training—teaching and learning and the significant advances now began to occur in the
transformation of attitudes into accom- areas of Operational Psychology. New tech-
plished skills niques of communist “brainwashing,” con-
• Personal adjustment—the individual’s tinuous propaganda, reeducation, and types
adjustment to military life, his motivation, of torture which even the Japanese had not
his morale, and his reaction to stress and inflicted, also resulted in marked psychological
fear revisions to the burgeoning survival schools.
• Social relations—leadership; the nature of Rates of having a mental health condition
panic; the relations with peoples of different rose to 88% to 96% among the surviving
races and customs American POWs from Korea. This, along with
• Opinion and propaganda—assessment of later experiences from the torture suffered
public opinion and attitudes—psychological in the Vietnamese “hotels” led to extraordi-
warfare nary changes in survival, evasion, resistance,
and escape (SERE) training. Established by
In February 1946 the School of Military the United States Air Force at the end of the
Neuropsychiatry was moved to Brooke Korean War, SERE was extended during the
General Hospital, a Chief Clinical Psychologist Vietnam War to the Army, Navy, and Marines.
was established to oversee operations, and Most higher level SERE students are military
Division 19 of the APA, Military Psychology, aircrew and special operations personnel con-
was in part spawned from the American sidered to be at high risk of capture.
 2 • history of military psychology 11

Psychological warfare (PSYOPS) also began unique combination of military and psycho-
to be used with more effect, and in 1950 the 1st logical expertise to the work of rebuilding
Loudspeaker and Leaflet Company arrived in the Army from the standpoint of the provi-
South Korea to begin operations. Following the sion of mental health services and to meet the
war, the Army finally began to devote significant Medical Corps motto “to conserve the fighting
resources to the areas of motivation, leadership, strength.”
PSYOPS, and human/ecological systems. By now, Army psychologists generally
were assigned mental health treatment duties
at either Army Medical Centers or Army
Community Hospitals under the auspices of
VIETNAM MEDCOM, or to FORSCOM units. Earlier,
psychologists tended to spend most, if not all,
As the Vietnam War lengthened and person-
of their entire career in one or the other capac-
nel issues became critical, the Armed Services
ity, but starting in the 1990s, it became more
Vocational Aptitude Battery (ASVAB) was
common for these officers to switch between
implemented in 1968. This has provided a con-
MEDCOM and FORSCOM assignments, thus
sistent aptitude tool that has come to be heavily
broadening career experience and opportuni-
relied on by military psychologists, especially in
ties. These years saw the growing numbers
studies of brain injury. Also building on the prin-
of trained neuropsychologists either commis-
ciples of forward mental health lessons of Korea,
sioned or trained as officers, along with the
a number of psychologists served in the combat
establishment of the long-term studies of trau-
zones of Vietnam, and psychologists were sta-
matic brain injury (TBI) through the Defense
tioned aboard naval ships. This era saw the for-
Veterans Brain Injury Center with military
mal adoption of the diagnosis of Posttraumatic
psychologists as critical contributors to this
Stress Disorder (PTSD), as well as a better under-
long-standing project.
standing of the subclinical concepts of Combat
The Uniformed Services University of the
Operational Stress (COS). However, since most
Health Sciences (USUHS) was established
veterans were not career soldiers and were
by Congress in 1972 and by 1978 offered
discharged after their tour of duty, the major-
a Clinical Psychology Ph.D. This now also
ity of treatment for both PTSD and substance
includes a Ph.D. in Medical Psychology for
abuse was done by the Veterans Administration
military students. Walter Reed, Brooke, and
and not by military psychologists themselves.
William Beaumont Army Medical Centers
Although the initial estimated rates of PTSD
began to train interns. Naval internships were
were proven to be too high (Frueh et al., 2005),
established at Bethesda and the Naval Medical
the lack of treatment, the public shunning of
Center San Diego, and the Air Force internship
the veterans, and the deliberate mistreatment
was begun at Wilford Hall, Lackland Air Force
of PTSD survivors for political purposes left
Base.
thousands of Vietnam Veterans scarred for years
The eruption of regional conflicts such as
after the conflict ended (Spinrad, 1993).
the Baader-Meinhoff bombing of USAFE head-
quarters at Ramstein, the conflicts in Bosnia,
Panama, the first Gulf War, and so forth, saw
AFTER VIETNAM military psychologists as being integral to the
development and implementation of forward
Following the war, a number of line officers were combat mental health provision and counter-
able to attend civilian psychology programs terrorism techniques. The Psychology at Sea
and were then able to transition to the Medical program has seen the assignment of psycholo-
Service Corps and serve as fully qualified gists to carriers to help reduce the previously
psychologists. These officers, along with both alarming number and very difficult to accom-
ROTC graduates and officers directly com- plish medical evacuations of naval personnel at
missioned from graduate programs, brought a sea to an astonishing 1–2% level.
12 part i • history and culture

THE WAR ON TERROR AND BEYOND Neuropsychologists set up increasingly

sophisticated assessment and management
Although few realized it at the time, the 1979 strategies for TBI patients. Innovative research
embassy hostage crisis in Iran (partly handled by in TBI continues to expand, such as with com-
military psychologists), the crises in Lebanon, puter programs and hand-held devices.
and the 1990 Gulf War with Iraq proved to be The nature and continuation of combat
among the opening steps to the Global War on operations brought several thousand detainees
Terror (GWOT), which engulfed the United into military custody during operations, and
States on September 11, 2001. During the Gulf numbers of psychologists were, therefore, also
War, despite the low number of combat stress needed for detainee operations, both in Iraq
casualties, after-action analysis indicated that and Afghanistan (Kennedy, Malone, & Franks,
if significant casualties had occurred, mental 2009). Kennedy et al. (2009) noted that this is
health teams would have found it very difficult the first wartime scenario in which detained
to carry out their mission. These teams were enemy combatants have been provided unfet-
not adequately staffed, equipped, or trained tered access to mental health evaluation and
in peacetime to perform their wartime role. treatment services during their detention,
The full outbreak of the GWOT proved this much of that being provided by psychologists.
analysis to be prescient, and subsequently pro- With the continuing innovation and mod-
duced unprecedented strains on the provision ernization of 21st century military psychol-
of mental health services of the military from ogy, Robert Yerkes’s vision of psychology as
9/11/2001 until the present. James’s “natural science” which could change
Expanded military training programs helped the composition and function of the entire
to produce officers to meet these challenges. military, has come to fruition in ways that the
Neuropsychological training had been done for original 17 active duty military psychologists
years at Madigan Army Medical Center, and could scarcely have imagined.
formal neuropsychology fellowships were even-
tually established at Walter Reed Army Medical
Center in 1991 and at Tripler Army Medical References
Center (TAMC) in 1995. The same year also saw
the establishment of the Psychopharmacology Boring, E. G. (Ed.). (1945). Psychology for the armed
Fellowship at TAMC. Navy and Air Force offi- services. Washington, DC: Infantry Journal.
cers are more often sent to civilian training insti- Dolibois, J. E. (1989). Pattern of circles: An ambas-
sador’s story. Kent, OH: Kent State University
tutions for fellowship and advanced training.
Press.
Advanced fellowships now generally include Edwards, E. C. (2012). The lost airmen of
Neuropsychology, Child Psychology, Behavioral Buchenwald. Stalag Luft III Reunion, 17 April,
Medicine, and Forensics. The mid-1990s also Dayton, Ohio.
saw the initiation of the Department of Defense Frueh, B. C., Elhai, J. D., Grubaugh, J. M., Kasdan, T.
Psychopharmacology Demonstration Project B., Sauvageot, J. A., Hamner, M. B., . . . Arana, G.
(PDP), in which ten initial military psycholo- W. (2005). Documented combat exposure of US
gists were trained and credentialed for prescrip- veterans seeking treatment for combat-related
tive privileges. By 2006, other officers, now post-traumatic stress disorder. British Journal
bolstered with state medication licenses, had of Psychiatry, 186, 467–472.
begun to enter active duty. These officers have James, W. (1890). The principles of psychology. New
York: Holt.
been assigned both to combat areas and state-
Kennedy, C. H., Malone, R. C., & Franks, M. J.
side, serving as very effective force multipliers. (2009). Provision of mental health services at
With combat and counterterrorism operations the detention hospital in Guantanamo Bay.
still continuing over 11 years later, much of the Psychological Services, 6(1), 1–10.
effort of military psychology has been in terms of Spinrad, P. S. (1993). Patriotism as pathology: Anti-
forward combat operations, with heavy reliance veteran activism and the VA. Journal of the
on reserve units and their mental health assets. Vietnam Veterans Institute, 2(1), 42–70.
 HISTORY OF PSYCHOLOGY IN THE
3 DEPARTMENT OF VETERANS AFFAIRS

Rodney R. Baker

Psychologists in the Department of Veterans director. A highly respected physician, Hawley

Affairs (VA) have joined their military psy- had served as chief surgeon in Europe during
chologist colleagues in providing transition WWII and had been recognized as helping
mental health care for those leaving the mili- the military offer exceptional care to soldiers
tary and becoming veterans ever since the end on the battlefield. Bradley and Hawley were
of World War II (WWII). As the end of that successful in getting Congress to pass legisla-
war was nearing, President Harry S. Truman tion that they needed to revitalize the VA, and
knew that millions of active military personnel on January 3, 1946, President Truman signed
would be coming home as veterans. He asked Public Law 293, which made major changes
General Omar N. Bradley, the popular and suc- to the organization of medical care in the VA
cessful commander of the 12th Army forces in (Baker, 2012). The legislation provided new
Europe in WWII, to use his organization and health care departments in the VA’s Central
people skills to assume leadership of the then Office in Washington, DC, that were responsi-
Veterans Administration to prepare the VA to ble for establishing and monitoring the quality
provide the best possible medical care prom- of care in VA hospitals in medicine, surgery,
ised its veterans. rehabilitation, psychiatry and neurology, and
Bradley accepted the challenge knowing that other health care disciplines. The legislation
it would not be easy. The VA health care system also authorized the VA to enter into training
was poorly organized, and extreme shortages affiliations with medical schools to train and
existed in personnel, as many doctors, nurses, supervise interns and residents assigned to
and other health care providers had enlisted in the VA and help ensure the quality of care for
the military. As of June 30, 1945, 74% of the veterans. By the end of the year, the VA had
2,300 doctors in the VA were actually on active established affiliations with 63 of the nation’s
military duty assigned to provide health care 77 medical schools.
in veterans’ hospitals. Many of those doctors In the spring of 1946 James Grier Miller, a
would end their service to the VA with dis- Harvard-trained psychiatrist and psychologist,
charge from the military (Baker, 2012). accepted an appointment to head clinical psy-
Bradley knew he would need others to help chology. Miller successfully argued that the VA
him and turned to some of those he served needed doctoral-trained clinical psychologists
with and trusted during his command in with experience in providing treatment and
the WWII European theater. One of his first assessment services for veterans and received
appointments was that of General Paul R. authority to hire 500 clinical psychologists
Hawley to serve as the VA’s first chief medical (Baker & Pickren, 2007).

13
14 part i • history and culture

THE VA PSYCHOLOGY TRAINING PROGRAM programs in its hospital, using doctoral coun-
seling psychology staff, and the following year
At the end of WWII, psychology was primar- added 55 training positions for graduate students
ily an academic and research discipline and few in counseling psychology. For fiscal year 1956,
members of the profession were being trained 771 clinical and counseling psychology graduate
to provide clinical services. The directory of the students were appointed to part-time training
American Association for Applied Psychology positions in the VA (Baker & Pickren, 2011).
listed 650 members in applied settings in the In a 10-year review of the training program,
entire country (Baker & Pickren, 2007). Miller 80% of the graduate students in the program
would need to recruit three-fourths of that went to work for the VA after their training,
number to fill the 500 doctoral psychologist even without any required payback work obli-
positions he had been authorized to hire. gations (Baker & Pickren, 2007). The program
Miller knew that the VA would have to clearly succeeded in helping the VA meet its
train the psychologists needed to fill these recruitment goals for treatment-experienced
positions. He convinced Bradley that the leg- psychologists. It can be noted that the vast
islation authorizing the VA to establish train- majority of all students in universities after
ing affiliations with medical schools would also WWII were veterans themselves, most receiv-
allow affiliation agreements with universities ing their education with G.I. Bill of Rights
who were training clinical psychologists. He legislation, and many in psychology graduate
proposed that psychology graduate students training eagerly sought acceptance into the VA
would be employed as part-time staff with training program hoping to help fellow veter-
a training assignment of delivering clinical ans. The wish to help their fellow veterans in
services to patients under university faculty a training capacity turned into a later desire to
supervision. His plan was approved, and in work with veterans as VA staff psychologists.
1946, the VA funded 225 training positions in
psychology that paid students an hourly salary.
Miller recognized that not all graduate pro- THE GROWTH OF VA PSYCHOLOGY
grams in clinical psychology were providing
training in psychological service delivery. He As VA psychology trainees and staff entered the
asked the American Psychological Association mental health programs in the VA, the influ-
(APA) to identify universities that provided ence and importance of psychology steadily
that training, a list that he would use to select grew. The immediate post-WWII era demands
students for the new training program. In the made on the VA were to provide treatment to a
fall of 1946, 22 universities on the resulting large and growing hospitalized veteran popula-
list had proposed 215 students for training tion in which patients with serious mental ill-
that the VA accepted and hired. The following ness occupied 58% of available beds (Baker &
year, APA formalized a process of helping the Pickren, 2007). From 1946 to 1988, psychology
VA identify universities for the VA psychol- responded to these demands in three major
ogy training program and 470 students were areas. First, psychologists increased the number
accepted and funded for the 1947 training year. of health services for patients, especially noted
Baker and Pickren (2007) noted that because in the promotion and use of group psychother-
of these actions the VA is generally acknowl- apy. Second, they played critical roles in mov-
edged to be responsible for APA developing its ing the VA from an exclusive use of inpatient
professional psychology accreditation program treatment to starting outpatient mental health
for universities and, later, for accreditation of clinics. Last, they helped develop nontraditional
sites providing internship training for clinical treatment approaches for the mental health
and counseling psychologists. care of veterans.
The number of part-time VA psychology The development of nontraditional treat-
training positions grew to 650 in 1950. In 1952 ment approaches defined the reputation for
the VA began developing vocational counseling innovation that VA psychology enjoyed in
 3 • history of psychology in the department of veterans affairs 15

the 1960s that has continued to the present. From 1970 to 1981, the number of special-
The need to treat large numbers of veterans ized treatment programs in the VA continued
in the post-WWII era, for example, led psy- to increase. Mental health outpatient clinics
chologists in mental health clinics to explore almost doubled, as did day treatment centers,
the potential for use of group psychotherapy. and a fourfold increase in new day hospitals
By 1960, group therapy had been found effec- served to meet the more intensive care of acute
tive for treating veterans, even surpassing the psychiatry outpatients. Specialized inpatient
effectiveness of individual psychotherapy in and outpatient alcohol abuse and drug depen-
many cases, and the VA published a “Manual of dency programs also saw substantial growth
Group Therapy” written by two VA psycholo- (Baker & Pickren, 2007).
gists and a psychology consultant. Described In the 1970s, the large number of Vietnam-
by Baker and Pickren (2007), the manual not era veterans seeking treatment for post-
only reviewed the theoretical bases for group traumatic stress disorder (PTSD) presented a
psychotherapy but also was one of the first unique problem for psychologists and other
publications to give practical advice in conduct- mental health professionals. Other than in
ing effective group psychotherapy sessions. Its the military, the PTSD treatment experience
chapters discussed topics ranging from differ- in the non-VA sector was essentially limited
ent kinds of groups and desired outcomes, time to treatment for trauma resulting from sexual
and frequency of group meetings, preparing the assault and natural disasters, and military and
patient for group therapy, and handling hostile, VA psychologists had to draw on their own
dependent, silent, and talkative patients. The resources in starting treatment programs to
manual helped establish a sound theoretical meet the needs of veterans with combat-related
and therapeutic basis for group psychotherapy, PTSD.
and in the 1980s, the number of patients receiv- The care of Vietnam veterans brought sev-
ing group psychotherapy services in the VA eral other problems to the VA. Improvements
continued to grow and exceeded the number in military care on the battlefield resulted in
receiving individual psychotherapy by a factor many more survivors with serious physi-
of three (Baker & Pickren, 2007). cal disabilities, which prompted the VA to
The nontraditional treatment approaches increase the number of rehabilitation and spi-
being utilized by VA psychologists in part nal cord injury programs. Vietnam veterans
emerged from their awareness of the limita- also felt alienated from mainstream society
tions of the reliance of psychiatry on its histor- and believed, correctly in many cases, that VA
ical roots in psychoanalytic theory and practice, employees shared the public’s ambivalence,
limitations especially noted with the serious even anger, with the US government’s support
psychiatric problems of the veteran population. of that war that carried over to its veterans.
Psychologists joined their non-VA colleagues Even the existing WWII veterans in the VA’s
in looking at behavioral and other therapeutic care were not overly friendly with the new
applications for care. In 1965 the VA sponsored veteran population.
a conference to examine the latest treatment In 1971 a psychologist leader in VA’s Central
approaches psychologists used with their Office in Washington, Charles A. Stenger,
patients. The papers presented included work served as Chair of the VA’s Vietnam Veterans
on attitude therapy, token economy programs, Committee and was called on to organize a
day treatment centers, and therapeutic milieu series of conferences on treatment issues for
programs. Also highlighted were the activi- Vietnam-era veterans. The conferences high-
ties of psychologists working with different lighted the unique problems of Vietnam vet-
patient populations in such treatment areas as erans, and participants were challenged to
renal dialysis, open-heart surgery, automated generate initiatives and create programs to
retraining of patients with aphasia, and other address these problems. Out of these confer-
medical programs of the general VA hospital ences, over 30 inpatient PTSD treatment units
(Baker & Pickren, 2007). and almost 100 PTSD outpatient clinics were
16 part i • history and culture

started. Each of these programs almost univer- major roles in internship training and accredi-
sally included psychologists as staff in devel- tation. By 1985, 84 VA training programs were
oping these programs. accredited by APA, and in 1991, one-third of
The VA was designated a cabinet level depart- all APA accredited internship program were
ment in 1989 and renamed the Department of VA based. The VA started funding psychology
Veterans Affairs. The 1990s saw a continued postdoctoral training programs in 1991 in sub-
growth of mental health treatment programs stance abuse followed by postdoctoral training
for veterans that created important roles for in geriatrics, PTSD, and psychosocial rehabili-
psychologists in new programs for treating tation. When APA began accrediting postdoc-
homeless veterans, in psychosocial rehabilita- toral training programs, the VA assumed a
tion programs with work therapy and residen- major role in promoting that level of training
tial rehabilitation care, and in traumatic brain and accreditation. In 2005 the VA represented
injury centers. The number of women veter- almost half of the APA accredited postdoctoral
ans seeking care in the VA had been steadily training programs for adults in the country.
increasing along with the increased role of At the end of 1988 the VA employed over
women in the military. Over 60,000 female 1,400 psychologists in its 172 medical centers
veterans received health care in the VA in fis- and associated outpatient clinics. That year,
cal year 2004, many receiving that care in new the annual mental health treatment survey
women’s health or sexual trauma treatment listed 1,241 programs in its hospitals, almost
clinics (Baker & Pickren, 2007). all of which included psychologists in a full-
In addition to their treatment activities, or part-time staff capacity (Baker & Pickren,
psychologists were major participants in VA 2007). In addition to general psychiatry pro-
research programs directly related to improv- grams, the list included inpatient and outpa-
ing patient care. The list would include early tient programs in the treatment of alcohol and
research projects in the VA’s pioneering use drug dependence and inpatient and outpatient
of cooperative research programs involving treatment of PTSD. Also included were mental
multiple hospitals following the same research health outpatient clinics, day treatment centers,
protocol. Because of their training in research, day hospitals, vocational assessment and com-
psychologists assumed national administrative pensated work therapy programs, services for
leadership in these projects and participated at homeless veterans, biofeedback and pain clin-
the local hospital level in cooperative research ics, neuropsychology evaluation clinics, sexual
topics ranging from evaluating the effective- dysfunction clinics, and sleep disorder clinics.
ness of psychotropic medications to coopera-
tive research in tuberculosis. Psychologists
followed participation in these early research VA PSYCHOLOGY TODAY
programs with key research in suicide, life-span
topics and problems of the elderly, neuropsy- The 1990s saw the growth of traumatic brain
chological assessment and brain functioning, injury centers and psychosocial residential
and PTSD. During the 1950s, VA psycholo- rehabilitation treatment programs. Ten Mental
gists participated in as many as 500 studies Illness Research, Evaluation, and Clinical
a year, many emerging from the dissertation Centers (MIRECCs) were funded from 1997
research of psychology students. In 1956 psy- to 2004 in regional areas across the country to
chologists and their trainees were involved conduct specific research in the mental health
in 409 of 653 mental health research projects problems of veterans most needing attention
and, in fact, were conducting one-third of all (Baker & Pickren, 2007). The focus of these
research in the VA, both in mental health and centers ranged from treatment of PTSD to
non-mental-health treatment areas (Baker & psychosocial rehabilitation to problems of the
Pickren, 2007). elderly veteran. The MIRECCs also had addi-
The successes and resulting support of the tional internship training positions for psy-
VA training program led the VA to assume chology graduate students as well as training
 3 • history of psychology in the department of veterans affairs 17

positions for students in other mental health the end of the 2011 fiscal year, 3,741 doctoral
training professions. psychologists were providing mental health
The contributions of VA psychologists services to veterans. In addition to staff psy-
to the health care of veterans today include chologists, 437 predoctoral psychology interns
some unique challenges not encountered in and 245 postdoctoral interns were receiv-
other wars. The improvements in health care ing training and adding services to veterans
by the military for those wounded in combat, (A. Zeiss and R. A. Zeiss, personal communica-
already noted for Vietnam veterans, contin- tion, February 2, 2012).
ued to improve. In the prolonged second Iraq The service of VA psychologists to veter-
war and the war in Afghanistan, however, the ans in clinical treatment programs, research,
improvement in military care had increased and training can only be introduced in this
the numbers of severely wounded veterans brief chapter. If history serves as prologue,
with multiple and complex trauma. The com- the past service of VA psychologists for care
plexity of injury led the VA to create in 2005 of our nation’s veterans promises a future
four regional polytrauma centers, where psy- with similar excellence of care for veterans.
chologists joined other health care special- Military mental health providers aware of this
ists to coordinate needed rehabilitation care rich tradition can, without hesitancy, refer and
for these veterans. Treatment of pain and the encourage their patients leaving the military
sequelae of head injury, irreversible physical to seek care in the VA.
disability, and the resulting emotional prob-
lems of patients treated by psychologists in
these centers complemented their efforts in References
providing needed counseling to the wives, hus- Baker, R. R. (2012). Historical contributions to veter-
bands, children, and parents of these veterans. ans’ healthcare. In T. W. Miller (Ed.), The Praeger
The VA continued to build polytrauma cen- handbook of veterans’ health: Vol. 1: History,
ters, opening the latest in 2011. Psychologists veterans eras & global healthcare (pp. 3–23).
were additionally providing similar rehabili- Westport, CT: Praeger Security International.
tation services to veterans in traumatic brain Baker, R. R., & Pickren, W. E. (2007). Psychology
injury sites and spinal cord injury units closer and the Department of Veterans Affairs: A
to the veterans’ home after discharge from the historical analysis of training, research, prac-
tice, and advocacy. Washington, DC: American
regional polytrauma centers.
Psychological Association.
Over the last several years, Congress has Baker, R. R., & Pickren, W. E. (2011). Department
recognized the debt owed to veterans with of Veterans Affairs. In J. C. Norcross, G. E.
mental health problems and has added sig- Vandenbos, & D. K. Freedheim (Eds.), History
nificant funding for VA mental health pro- of psychotherapy: Continuity and change (2nd
grams. At the end of the fiscal year 2005, the ed., pp. 673–683). Washington, DC: American
VA employed 1,685 doctoral psychologists. By Psychological Association.
 4 DEMOGRAPHICS OF THE US MILITARY

Richard L. Dixon Jr. and Jean M. Dixon

THE COMBINED US MILITARY as well as the rank and responsibility that an

individual has agreed to.
The US Military is made up of six branches. Active Duty service members make up the
However, only four branches are routinely iden- largest component of the Navy, Marines, Coast
tified and tasked with the mission of defending Guard, and Uniformed Public Health and approx-
the United States’ interests abroad. The larg- imately half the service numbers in the Army
est and oldest branch of service is the Army, and Air Force. The remainder of each component
comprising Active Duty, Reserve, and National is composed of reserve members. Reservists are
Guard soldiers. The next-largest branch is the discussed below. Active Duty members are those
Air Force, comprising Active Duty, Reserve, who have agreed to be available 24 hours a day,
and National Guard airmen. The third-largest 7 days a week. The Active Duty component of
branch is the Navy, followed by the Marines. each branch of service is tasked with being the
Both of these services comprise Active Duty and primary responder and protector of the United
Reserve members. The remaining two branches States’ interests. The people serving on active
are the Coast Guard and the Uniformed Public duty are stationed both domestically and abroad.
Health Service, which also comprise Active They live in communities composed of other
Duty and Reserve members. To be an effective Active Duty military members and their fami-
clinician, it is imperative that you have a work- lies. The usual time span of active duty service
ing knowledge of the demographic make-up of ranges from 3 to 8 years depending on one’s spe-
the combined US Military. cialty. Most, but not all, service members have
The first concept to be understood is the dif- spent at least 1 year on active duty prior to serv-
ference between the Active Duty, Reserve, and ing in the reserve component.
National Guard components. This can be very The reserve component is made up of service
confusing, even to those who wear the uniform. members who have agreed to be available to aug-
The common denominator for all the Services ment the active duty component as needed. The
is that the individual has voluntarily sworn an size of the reserve component varies with the dif-
oath to defend and protect the Constitution of ferent branches. The Army and Air Force Reserve
the United States. The differences relate to the components are further divided into three enti-
amount of personal time the individual has ties: Reserve, Reserve National Guard, and Active
agreed to give and to the general area (land, air, National Guard. The Reserve entity branches are
or sea) that the individual has agreed to protect further divided into multiple categories based
and defend. Additional variables include the on the amount and location of training that the
benefits that the individual has been promised service member participates in such as: (1) Those

18
Exploring the Variety of Random
Documents with Different Content
 "Niin, myönnän kyllä, että osaan hyökätäkin yhtä hyvin kuin kuka
muu tahansa. Mutta en pidä sopivana tällä haavaa näyttää teille
taitoani, vaikka te kenties pidättekin sitä uskomattomana. Teillähän
on sitäpaitsi tähän asti ollut tapana pujahtaa pakoon, vaikka ei
kukaan ole teitä ahdistanutkaan. Sehän on ollut teidän rakkain
ajanviettonne siitä asti, kun opin tuntemaan teidät."

Hiljaisuudessa, joka seurasi näitä Nick'in sanoja, oli jotakin

traagillista. Muriel oli lyyhistynyt istumaan läheiselle
puutarhapenkille. Hän ei jaksanut mennä tiehensä. Se, mitä hän oli
pelännyt, oli siis käynyt toteen. Nick aikoi kostaa hänelle omalla
omituisella tavallaan. Olisihan hänen pitänyt se jo tietää. Oi, oli
tosiaan sulaa hulluutta pyytää Nick'ia tulemaan.

Ja taasen kuului Nick'in ääni, mutta ei enää samanlaisena. Nyt se

kuulosti osaaottavalta.

"Muriel, kyyneleitäkö?"

Muriel suoristihe nopeaan.

"Ei. Miksi itkisin?"

"Sitä en tosiaankaan tiedä. Sen vain tiedän, että se olisi aivan

hyödytöntä. Ei pidä milloinkaan itkeä ennen aamiaista. Se vie
ruokahalun ja tekee nenän punaiseksi koko päiväksi. Sitäpaitsi ei
teillä ole siihen mitään syytäkään."

"Älkää olko noin naurettava", huudahti Muriel kiivaasti. "Minä en

lainkaan itke."

"Onko se aivan varma?"

 "On."

"Se on hyvä", sanoi Nick. "Koska tuuli käy sieltä päin, neuvon teitä
kuivaamaan silmänne oikein tarkoin, sillä minä aion nyt tulla sinne
katsomaan, miten teidän laitanne oikeastaan on."
LIV.

Suoraa peliä.

Pamppailevin sydämin kuuli Muriel Nick'in lähenevän kevyin

askelin, mutta hän ei kääntänyt päätään, vaikkakaan silmissä ei ollut
kyyneliä. Hänet valtasi vastustamaton halu paeta jonnekin kauas,
hyvin kauas, mutta ponnistaen tahdonvoimansa äärimmilleen istui
hän hievahtamatta.

Notkeana ja joustavana europpalaisessa puvussaan, paljain päin ja

hymyilevillä kasvoillaan kiihkeän odottava ilme saapui Nick hänen
luokseen. Mutta kumartuessaan Murielin puoleen ja huomatessaan,
miten kalpea tämä oli, katosi hymy heti.

Hän laski kätensä Murielin olalle.

"Muriel, mitä…" sanoi hän.

Pitemmälle ei hän ehtinyt. Muriel peitti samassa kasvonsa käsillään

ja puhkesi itkuun.

Nick ei yrittänyt rauhottaa häntä. Ehkä hän piti parhaana, että

tyttö saisi siten keventää mieltään. Mutta hänen kätensä kosketus
rauhotti myrskyn Murielin sydämessä. Se antoi hänelle ihmeellistä
lohdutusta.

Vihdoin tarttui hän molemmin käsin Nick'in käteen.

"Olen niin typerä, Nick", kuiskasi hän vapisevalla äänellä,

"koettakaa olla kärsivällinen kanssani."

Nick'in käsi puristi hänen kättään niin lujasti, että hän huudahti
tuskasta.

"Eikö minulla jo ole riittänyt kärsivällisyyttä liiankin kauan?" sanoi

Nick. "Asiaan, olkaa hyvä!"

Muriel pudisti päätään. Hän ei vieläkään ollut varma Nick'in

suhteen.

"Pelkäättekö?" kysyi tämä taasen.

"Niin, olen niin peloissani."

"Koettakaa katsoa minuun. Koettakaa oikein vakavasti", ehdotti

Nick.

"En voi sitä tehdä."

"Koettakaahan edes."

Nick'in ääni kuului aivan hänen korvansa vierestä ja hän tunsi

Nick'in henkäyksen poskellaan.

Muriel painoi päänsä vielä alemma ja nyyhki taasen hiljaa.

 "Miksi pelkäätte?" kysyi Nick. "Olihan teillä rohkeutta lähettää
minulle terveisenne. Ja pelastittehan te eilen illalla henkeni. Mikä
teistä nyt tuntuu niin vaaralliselta?"

Siihen ei Muriel osannut vastata. Hän tunsi vain omituisen, pelon

vapisuttavan ruumistaan. Rakkaus ja pelko taistelivat viime
taisteluaan hänen sisimmässään. Hänen päänsä oli aivan sekaisin,
hänestä tuntui, kuin olisi hän tulemaisillaan hulluksi. Mutta koko ajan
puristi hän lujasti Nick'in jäntevää kättä. Se oli hänen tukensa, se piti
yllä hänen rohkeuttaan hänen tunteittensa huojuessa sinne ja tänne.

"Mikä teitä pelottaa?" kysyi Nick taasen. "Miksi ette katso minuun?
Eihän teillä ole mitään pelättävää."

Hän puhui lempeästi kuin lapselle, mutta sentään pelkäsi Muriel

kohdata hänen tutkivaa katsettaan, vaikkakin sisäinen minänsä
häntä siihen pakotti.

Nick odotti hetkisen. Sitten huoahti hän syvään ja suoristihe

itseään.

"Te ette vielä tunne omaa sydäntänne", sanoi hän. "Ette tiedä,
mitä tahdotte. Enkä minä voi teitä siinä suhteessa auttaa. On siis
parasta, että menen."

Mutta Muriel puristi yhä lujemmin hänen kättään.

"Ei, Nick, niin ei ole", vastasi hän vavisten. "Tiedän kyllä, mitä
tahdon. Tiedän sen varsin hyvin, mutta… mutta en voi selittää sitä
sanoilla. En voi! En voi!"

"Siinäkö syy onkin?" sanoi Nick.

 Hänen käytöksensä muuttui heti. Hän kumartui taasen Murielin
puoleen.
Ääni oli yhä leikillinen, mutta siinä oli samalla niin hellä sävy, että
Muriel tuskin enää tunsi sitä samaksi.

"Älkää siis koettakokaan, rakas lapsi", jatkoi Nick. "Sanoja ei

tällaisissa tapauksissa tarvita. Nehän on usein niin sisällyksettömiä.
Minä ymmärrän teitä sanoittakin. Kuten tiedätte, on minun varsin
helppo ymmärtää toisia."

Oliko minun siis vallan mahdotonta sanoa sitä? kysyi Muriel

itseltään.
Täytyihän löytyä jokin tapa sen tulkitsemiseen.

Mielenliikutus oli tukahuttaa hänet. Mutta sitten hän yht'äkkiä

tunsi, että taistelu oli ohitse. Hänestä tuntui, kuin olisi hän
huimaavasta korkeudesta heittäytynyt syvään veteen ja tuo hyppäys
vallan huumasi hänet.

Nauraen vapisevaa naurua irrotti hän hieman lujaa otettaan,

käänsi Nick'in kättä ja painoi kuumat huulensa siihen suudellen
pitkään ja tulisesti. Hän oli vihdoin keksinyt tavan ilmaista Nick'ille
tunteensa.

Nick säpsähti ja peräytyi läähättäen.

"Muriel!" huudahti hän murtuneella äänellä ja heittäysi polvilleen

hänen eteensä.

Kietoen kätensä Murielin vyötäisille, puristi hän häntä lujasti

itseään vasten. Kumpikin oli hetkisen vaiti, mutta vihdoin rohkeni
Muriel puhua Nickin painaessa päänsä hänen syliinsä.
 "Nyt voin jo sanoa, mitä tahdon, Nick", sanoi hän, "teenkö sen?"

Nick ei vastannut. Hän tuskin hengittikään. Mutta Muriel ei enää

pelännyt eikä epäröinytkään. Hänen silmänsä olivat auenneet ja
hänen kielensä siteet olivat kirvonneet. Sanat tulivat kuin itsestään.

"Tahdon, että menemme naimisiin… oikein pian", sanoi hän. "Ja

sitten tahdon vielä, että viet minut Neapeliin, kuten kerran, kauan
aikaa sitten aioit tehdä. Ja me olemme vallan yksin vuorilla, vain me
molemmat… kuten silloinkin, muistatko? Tahdotko tehdä sen, Nick?
Sano, tahdotko?"

Mutta Nick oli yhä vaiti. Hänen näytti olevan mahdoton puhua.
Hänen päänsä lepäsi liikahtamatta Murielin sylissä ja käsi oli yhä
hänen vyötäisillään. Muriel odotti hiljaa hänen vastaustaan.

Vihdoin hengähti Nick niin syvään, kuin olisi rinta ollut

halkeamaisillaan ja kohotti päätään.

"Jumalani", sanoi hän, "voiko tämä olla totta?"

Hänen äänessään oli vieras sointu. Hänen tuntui olevan sangen

vaikea puhua. Mutta kun lumous oli ohitse, onnistui hän muutaman
silmänräpäyksen perästä jatkamaan:

"Oletko sinä aivan varma siitä, että tahdot tulla vaimokseni, ettet
jo huomenna kauhistu sellaista ajatustakin? Etkö siis enää pelkää
minua? Tahdotko tosiaan, että otan sanasi vakavalta kannalta?"

"Jos vain tahdot, Nick", vastasi Muriel nöyrästi.

"Josko minä tahdon!" huudahti Nick intohimoisesti. "Muista,

Muriel, että nyt antaudut peruuttamattomasti minun valtaani. Sinä et
enää milloinkaan pääse minusta eroon. Vaikka inhoisit minua koko
sielustasi, niin en enää päästä sinua. Ymmärrätkö sen? Jos nyt tulet
omakseni, kestää se liitto ajassa ja ijankaikkisuudessa."

Hän puhui kiihkeästi ja lopetettuaan vetäytyi hän edemmä, kuin ei

olisi oikein uskaltanut luottaa itseensä.

Mutta Murielia ei enää mikään pelottanut. Hän oli jo taistellut

viime taistelunsa itsensä kanssa. Ojentaen molemmat kätensä
Nickille, sanoi hän:

"Ota minut siis, Nick!"

Nick tarttui hänen käsiinsä ensin toiseen ja sitten toiseen ja laski

ne olalleen.

"Katsohan nyt minuun."

Muriel viivytteli.

"Katso minuun, Muriel", pyysi hän taasen.

Kun ei Muriel nytkään kääntänyt katsettaan hänen puoleensa,

nosti Nick hiljaa häntä leuasta ja pakotti hänen katsomaan eteensä.

Muriel taipui vihdoin. Ensi kerran katsoi hän Nickiä suoraan silmiin
ja hän hämmästyi nähdessään, miten suuret ja ilmehikkäät Nickin
vedensiniset silmät olivat. Mutta samassa räpäytteli Nick taasen
silmiään entiseen rauhattomaan tapaansa ja hän veti kätensä pois
Murielin vyötäisiltä.

"Niin", sanoi hän. "Nyt tämä on suoraa peliä. Ja jos sinä tosiaankin
tahdot minut omaksesi tällaisena kuin olen — tässä ei juuri ole
kehumisen varaa — niin ota minut. Olen sinun."

Ääni takertui hänen kurkkuunsa. Muriel luuli hänen purskahtavan

nauruun, mutta samassa silmänräpäyksessä sulki Nick hänet syliinsä
ja puristi häntä kiihkeästi rintaansa vasten. Nickin silmät näyttivät
salamoivan puoleksi sulettujen silmäluomien alla, hän puristi Murielia
yhä lujemmin. Nyyhkien kietoi Muriel kätensä hänen kaulaansa ja
painoi kiihkeän suutelon Nickin huulille.
LV.

Yhdistyneet.

"Eikö ollutkin hupaista?" sanoi Nick poimien taskustaan rahan

toisensa jälkeen. "Tämähän on jo varsin hyvä saalis! En aavistanut
sinun harjoittavan hyväntekeväisyyttä näin suuressa määrin."

Muriel tarttui hänen käteensä.

"Sinulla ei ole oikeutta pitää niistä ainoatakaan. Sinä olet

keinotellut minulta rahojani. Miten saattoikaan johtua mieleesi
näytellä sellaista komediaa?"

"Se ajatus kai lähetettiin minulle taivaasta", selitti Nick. "Kerronko

sinulle miten se johtui mieleeni? Se tapahtui eräänä myrskyisenä
yönä aavalla merellä matkustaessani tänne Daisyn kanssa. Loikoilin
kannella tähtien kirkkaasti kimmeltäessä ja ajattelin sinua. Silloin tuli
tuo tuuma mieleeni kuin itsestään. Ikävöin kovin nähdä sinua ja
tiesin, että siten et sinä koskaan minua huomaisi. Etkä olisi sitä
tehnytkään, ellen olisi saanut sinun terveisiäsi Daisyltä. Olin juuri
aikeissa kadota taasen, kun sen sain, mutta sitten muutin päätökseni
ja jäin. Bobby Fraser oli osallinen salaisuudestani. Hän tietää
kaikkien ihmisten salaisuudet. Heti kun sain kuulla lady Bassetin
hyvin keksityn tarun buddalaisluostarista, varustauduin taisteluun!
Mutta sinä et näyttäytynyt, kuten muistat. Minun täytyi odottaa,
kunnes sinä tulit ulos. Mutta silloin tapahtuikin tuo eilisiltainen
murhayritys ja minun täytyi paeta. Enhän voinut antautua vaaraan
tulla paljastetuksi. Eikä se olisi ollut sinuun nähdenkään erikoisen
hauskaa. Kas siinä koko liikuttava kertomukseni ja minun mielestäni
ei sinun tarvitseisi kadehtia minua näistä rahoistani, jotka siis saanen
pitää palkintona uskollisuudestani."

Muriel nauroi kyynelten kimallellessa silmäkulmissa.

"Olisin antanut sinulle jotakin paljon parempaa, jos olisin tietänyt,

että se olit sinä."

"Se ei ole vieläkään liian myöhäistä", vakuutti Nick. "Voithan

alottaa heti, jos tahdot. Annahan tänne kätesi, oma tyttöseni. Ethän
enää kieltäytyne pitämästä sormessasi minun sormustani, vai
miten?"

"Ilolla sen teen", vastasi Muriel Nickin pujottaessa sormuksen

hänen vasemman käden nimettömäänsä. Hänen silmänsä olivat
aivan kyyneleiset, mutta Nick ei sitä huomannut, niin kokonaan oli
hän kiintynyt tehtäväänsä.

"Olga raukka!" sanoi hän. "Hän oli niin epätoivoinen antaessaan

sen minulle takaisin. Tuumin, että hänelle olisi lähetettävä
sähkösanoma. Miten sen kerron hänelle? Omnia vincit amor? Hän on
jo kyllin vanha ymmärtääkseen, mitä se merkitsee. Ja jos vielä
lisään: Muriel ja Nick, niin ymmärtää hän kaikki tyyni. Onpa vahinko,
ettei hän voi tulla häihimme. Olisi tosiaan hauskaa nähdä hänen
pienet, iloiset kasvonsa lady Bassetin viekkaasti hymyilevien
kasvojen sijasta", jatkoi hän merkitsevästi nauraen.

"Nick, miksi lady Basset vihaa sinua?"

"Sitä en ymmärrä", vastasi Nick hymyillen. "Niinhän tekevät monet

muutkin. Ehkäpä hänkin lopulta rakastuu minuun. Sitähän ei voi näin
edeltäkäsin sanoa."

"Älä jaarittele, Nick. Miksi et sano sitä minulle?"

Muriel pani kätensä hänen käsivarrelleen.

"En voi sanoa sitä sinulle, rakkaani, siksi, että hän on nainen.
Hänellä sattui kerran sangen epämiellyttävä seikkailu ja minä olin
siihen puolittain syypää. Ja siitä saakka on hän vihannut minua koko
sydämestään."

Muriel alkoi vähitellen ymmärtää.

"Tapahtuiko se eräässä laivassa?" kysyi hän.

Nick loi häneen terävän katseen.

"Kuka sen kertoi sinulle?"

Muriel punastui hieman.

"Bobby Fraser. Hän ei maininnut naisen nimeä. Me… me

puhuimme kerran sinusta."

Nick nauroi iloisesti.

"Kerranko vain?"
 Muriel punastui yhä enemmän.

"Sinä olet hupsu, Nick. Mutta toivon, ettei tuo nainen olisi ollut
lady
Basset. Minusta on niin ikävätä, että hän niin kovin vihaa sinua."

"Minusta se ei ole lainkaan ikävää", vakuutti Nick. "Mutta hänhän

kostikin myrkyttämällä sinun mielesi minua kohtaan. Olen aina
tietänyt, että häntä minun on kiittäminen siitä, mitä tapahtui
Simlassa."

"Ei yksin häntä", sanoi Muriel rehellisesti. "Olin täynnä

ennakkoluuloja sinua vastaan… toisista syistä."

"Tiedän senkin", sanoi Nick pyöritellen hänen kättään edestakaisin

nähdäkseen, miten rubiinit välähtelivät auringon paisteessa. "Sinä
olit kuin pieni arka kaniini, joka pakenee hirveätä petoeläintä. Alotit
pakosi jo tuona viimeisenä iltana Warassa, kuin minä pakoitin sinut
juomaan unijuoman eikä pelkosi vieläkään taida olla tyysten poissa.
Sinun mieleesikään ei liene milloinkaan juolahtanut, että minä olisin
alistunut mihin kidutukseen tahansa jottei minun olisi tarvinnut sitä
tehdä. Mutta sinun ei tarvitse pelätä, että se koskaan enää
uudistuisi", sanoi hän nauraen äkkiä ääneensä. "Minä en saane
mitään pahaa aikaan yhdellä kädelläni, vai mitä arvelet? Näithän itse,
miten minun oli vähällä käydä eilen illalla. Voihan sitä pitää
jonkinlaisena lohdutuksena, eikö totta, rakkahin?"

"Vaiti, Nick, vaiti! Et tiedä, miten onnettomaksi teet minut

tuollaisella puheellasi."

"Rakas lapsi, mitä sanotkaan? Minähän koetin vain esiintuoda

hyviä puoliani sellaisina kuin ne todellisuudessa ovat."
 "Vaiti", sanoi Muriel taasen tuskin kuuluvalla äänellä. "En voi
kestää sitä. Ellei minua olisi, et sinä olisi menettänyt kättäsi."

"Joutavia" sanoi Nick vetäen hänet syliinsä. "Kuka sen on sinulle

sanonut?"

"Tohtori Jim."

"Jim on aasi ja sen aion sanoa hänelle itselleenkin. Älähän nyt

itke, rakkaani. Sen arvoinen ei asia todellakaan ole. Sinun tähtesi
toivon, ettei se olisi tapahtunut, mutta, itse tähteni en siitä lainkaan
välitä."

"Älä siis sitä ajattele minunkaan tähteni", kuiskasi Muriel. "Minä

rakastan sinua siitä syystä vielä enemmän."

"Sittenhän se onkin vain onneksi minulle", sanoi Nick iloisesti.

"Tiedätkö, mitä teemme heti kun olemme mies ja vaimo? Me
nousemme maailman korkeimman vuoren huipulle katselemaan
auringonnousua ja kiittämään Jumalaa."

Muriel katsoi häneen ja naurahti hämillään.

"Nick, sen täytyy tapahtua pian?"

"Aivan heti", vastasi Nick hyväillen hänen tuuheaa tummaa

tukkaansa. "Menkäämme siis puhumaan asiasta sir Reginaldin
kanssa. Hän kai lienee jo noussut ylös ja ellei hän ole, niin olemme
mielestäni asian tärkeyden vuoksi oikeutetut herättämään hänet."

*****
 Lähestyessään kuistia näkivät he sir Reginaldin istuvan siellä
juomassa aamukahviaan, mutta Murielin kauhistukseksi ei hän
ollutkaan yksin. Aika oli kulunut nopeammin kuin hän luulikaan ja
sekä eversti Cathard että Bobby Fraser olivat tulleet sir Reginaldin
luo puhumaan eilisillan näytelmästä.

Murielin ja Nick'in ollessa jo aivan kuistin luona ilmestyi lady

Basset äkkiä eteisen ovelle.

Nick'ia nauratti. Kohtaus oli hänestä perin huvittava.

"Mitä aiot tehdä?" kysyi Nick.

"En tiedä", vastasi Muriel. "Mieluummin juoksisin tieheni."

"Etpä suinkaan", sanoi Nick tarttuen hänen käteensä. "Tule nyt

vain kanssani ja ole rohkea."

Muriel myöntyi nauraen hermostuneesti ja Nick saattoi hänet

juhlallisesti portaita ylös.

Hänen ei kuitenkaan olisi ollut syytä tuntea itseään noin noloksi,

sillä kaikki kuistilla olijat, Bobby Fraseria lukuunottamatta, tuijottivat
vain Nick'iin, kuin olisivat he nähneet edessään jonkin kuolleista
ylösnousseen.

Nick oli siitä huolimatta aivan tyyni. Hän pysähtyi aamiaispöydän

eteen, kumarsi syvään lady Bassetille ja kääntyi sitten sir Reginaldin
puoleen.

"Kaksivuotisen vakavan harkinnan jälkeen", selitti hän, "olemme

nyt päättäneet tehdä välimme selväksi menemällä naimisiin ja
toivomme, että te, sir Reginald annatte meille siunauksenne."
 "Sepä oli tosiaan yllätys", änkytti sir Reginald.

"Niin, sen kyllä ymmärrän", sanoi Nick. "Yllätys se on minullekin.

Mutta vaikkakin olen täysin selvillä omasta mitättömyydestäni,
koetan parastani ansaitakseni tämän osakseni tulevan kunnian. Ja
toivon, että saamme luottaa teidän suostumukseenne ja apuunne."

Taasen kumarsi hän lady Bassetille, katseessaan hieman ivallinen

ilme.

Lady Basset ojensi hänelle kätensä, poskillaan tavallista heleämpi

puna.

"Tämä oli tosiaan aivan odottamatonta, kapteeni Ratcliffe", sanoi

hän. "Mitä teille kuuluu? Ymmärtänette hämmästyksemme. Vasta
muutama päivä sitten kertoi joku, että te olitte mennyt
buddalaisluostariin."

"Se samainen henkilö puhui siis sulaa valhetta, parahin lady",

sanoi Nick. "Toivon, ettei tuo sanoma teitä kovin huolestuttanut. Ja
vakuutan, etten milloinkaan ottaisi niin tärkeää askelta ensin
ilmottamatta siitä teille. Harras toivoni on, että tuleva avioliittoni
aiheuttaisi teille vähemmän mielipahaa."

Lady Basset hymyili teeskennellysti.

"Ah, minun ei tarvinne olla huolissani. Te kyllä tulette toimeen

mainiosti", sanoi hän.

"Niin minäkin uskon, lady Basset", sanoi eversti Cathard. "Ratcliffe

ei hevin antaudu. Se oli aina minun ajatukseni hänestä hänen vielä
ollessaan virassaan."
 "Miss Roscoe", keskeytti hänet Bobby Fraser, "lähettäkää minulle
sana, jos teidän joskus on vaikea käsitellä häntä."

Muriel katsoi häneen rohkeasti.

"Kiitän, mutta sitä en ollenkaan pelkää."

"On paljon luultavampaa, että hän aina tulee olemaan minun

puolellani", huomautti Nick tyytyväisenä, "koska en itse enää ole
taistelukelvollinen."

"Entä mitä olette tehneet koko tämän ajan?" kysyi sir Reginald
äkkiä.
"Tehän olette olleet aivan näkymättömissä."

Nick näytti ylenmäärin ihastuneelta.

"Olen vain antanut ajan kulua", kuului hänen arvoituksellinen

vastineensa. "Se oli kyllä yhdelle ja toiselle hieman yksitoikkoista,
mutta olipa sillä sentään toivottu vaikutuksensa."

Sir Reginald mutisi jotakin ja katsoi kysyvästi puolisoonsa, jonka

hymy teki hänet hieman epävarmaksi.

"Ja nyt aiotte naida miss Roscoen?" sanoi hän.

"Niinpä niin, heti paikalla."

"Vai niin", sanoi sir Reginald hymyillen itsekseen. "No niin, kun
loppu on hyvä, on kaikki hyvin, ja Muriel on jo kyllin vanha
ymmärtääkseen, mitä tahtoo. Onneksi olkoon molemmille!"

"Siihen yhdyn minäkin", sanoi Bobby Fraser lämpimästi.

"Sydämellisimmät onnitteluni."
LVI.

Häämatkalla.

Tähdet kimaltelivat tummalla taivaanlaella. Juokseva vesi lorisi

hiljalleen. Teltassa nukkui eräs mies rauhaisaa unta. Teltan ovella
seisoi nuori nainen.

Tuntui siltä, kuin olisi jotakin suuremmoista ollut puhkeamaisillaan

esiin luonnossa. Ilmassa oli kiihkeätä odotusta. Tunturin
jääpeitteisiltä huipuilta puhalsi kylmä viima rinteitä pitkin. Vesi oli
jääkylmää.

Sitten näytti siltä, kuin olisi säkenöivä miekka halkaissut

avaruuden. Meteori putosi vuorten väliin. Tämä oli kuin merkki
ylhäältä, sanansaattaja, joka toi sanoman, että auringonnousun ihme
lähestyi.

Teltan ovella seisova nainen meni takaisin sisälle. Samassa

huudahti iloinen ja hieman särkynyt ääni:

"Jo valveilla, rakkaani? Jumalat, millainen taivas! Miksi et

herättänyt minua varemmin? Ennätänkö vielä peseytyä?"
 "Ehkä, jos minä saan auttaa sinua pukeutumisessa. Muuten et."

Naisen äänessä oli äidillisen hellä sävy.

"Jospa sen siis tekisit huviksesi. Enkä tahdot toimia

parturinanikin!"

"Ajaa partaasi!" kuului halveksiva vastaus. "Sinulle ei kasva parran

haiventakaan, vaikka kuinka sitä toivoisit."

"Totta sanoit, sinä sydämeni kuningatar. Siksipä en minä

voinutkaan erityisesti kunnostautua upseerina. Toivokaamme vain,
ettei tuo surullinen seikka vahingoittaisi myöskin toiveitani
parlamentaarisella alalla, nimittäin siinä tapauksessa, että todella
sille alalle pääsen."

"Mutta minäpä tiedän, että sinä olet kunnostautunut. Kuulin

kerran" — tämä hieman epäröiden — "että sinä olisit saanut
Viktoriaristin Waran piirityksen jälkeen, mutta ettet tahtonut ottaa
sitä vastaan."

"Kuka sinulle sellaista on uskotellut", kysyi Nick. "Älä usko kaikkea,

mitä kuulet. Nyt olen jo tarpeeksi viivytellyt. Onpa jo aika kiiruhtaa."

"Mutta Nick, se on totta?"

"Mikä niin? Tuoko juttu Viktoriarististä? Tavallaan kyllä. Mutta

voithan toki ymmärtää, etten tahtonut kunniamerkkiä paostani. Eikä
se olisi ollut paikallaan. Sitä paitsi en sitä tehnytkään palkinnon
toivossa."

"Nick, tiedätkö, että minä päivä päivältä yhä enemmän halveksin

itseäni."
 Muriel oli sangen onnettoman näköinen.

"Oma tyttöni, älä puhu joutavia", kuului iloinen vastaus. "Ethän

toki kuvittele, että minä nyt olen tullut katumapäälle?"

Hän meni ulos teltasta kylpylakanaan kietoutuneena ja suuteli

nauraen vaimoaan ohimennessään.

"Kuuleppas, sydänkäpyni, jos vain vetistelet sillä välin, kun minä

peseydyn, annan sinulle vitsaa palatessani. Sitäpaitsi on minulla
sangen iloinen uutinen tiedossani, odota siis kiltisti."

Nick poistui hyräillen kuten tavallista, iloista laulunpätkää. Muriel

kuunteli hievahtamatta tuota hänen mielestään koko maailman
kauneinta laulua. Nick puhui totta, sen hän tiesi. Mitään uhrauksiaan
ei hän nyt katunut.

Nick'in palatessa kylvystään olivat Murielin surulliset mietteet jo

tipotiessään. Taivaanlaki alkoi yhä enemmän vaaleta ja tähtien välke
himmeni.

Yht'äkkiä näkyi suuri tulipallo taivaanrannalla ja tunturien

lumipeitteiset huiput peitti ruusuinen hohde, joka hetkisen perästä
muuttui kullankimmeltäväksi.

Mies ja vaimo seisoivat ääneti, he tunsivat seisovansa pyhässä

paikassa ja sanat olivat niin tyhjiä heidän tunteitaan ilmaisemaan.
Vasta sitten, kun aamuaurinko oli muuttunut kirkkaaksi päiväksi ja
aurinkojumala asettunut ylemmä taivaankannelle, kääntyi Nick
vaimonsa puoleen. Hänen katseensa oli vakava ja harras.

Muriel huoahti syvään ja nojasi päätään miehensä olkaa vasten.

 Nick suuteli häntä otsalle ja naurahti iloisesti.

"Tahdotko nyt kuulla uutiseni?" kysyi hän.

Muriel katsahti häneen kysyvästi.

"Mutta, Nick, eihän posti vielä liene saapunut?"

"Kyllä, se tuli myöhään eilen illalla. Sinä jo nukuit ja näit unta

minusta, siksi en raahtinut sinua herättää."

Hän näytti Murielille kaksi kirjettä.

"Toinen on Olgalta, pieneltä, herttaiselta ystävältämme. Hän

jumaloi yhä minua, niin naurettavalta kuin se kuuluukin. Ja Jim on
puolestaan kirjoittanut pari riviä kirjeeseen. Hän sanoo, että Redland
meitä tarvitsee, ja moittii meitä siitä, että matkustelemme pitkin
maailmaa ja leikimme kuhertelukyyhkysiä emmekä ole kenellekään
hyödyksi. Emme ole hyödyksi, ajattelehan! Ne sanat saa hän vielä
takaisin! Mutta kyllä meidän täytynee jo vähitellen ajatella
kotimatkaa, vai mitä sanoo siitä sydänkäpyseni?"

Muriel nyökäytti päätään syvään huoaten.

"Kai se niin lie. Tohtori Jim on oikeassa. Meidän täytyy jälleen

laskeutua maan päälle, kotkani ja minun."

Nick suuteli hänen hiuksiaan.

"Mutta olipa sentään ihana lentääkin, eikö totta? Me teemme sen

vielä monta, monta kertaa."

"Ellei sitä ennen tapahdu jotakin, joka estää meitä", sanoi Muriel.
 Nick rypisti otsaansa.

"Miksi sanot niin? Koetatko olla lady Bassetin tapainen? Älä

yritäkään, sillä se ei kuitenkaan onnistuisi."

"Nick, miten tuhma oletkaan", sanoi Muriel epäröiden. "Minä olin

jo miltei unohtanut hänen koko olemassaolonsa. Ei, sanoin sen siksi
että… siksi että… voihan aina tapahtua jotakin."

"Kuten esimerkiksi?"

"Mitä tahansa", kuiskasi Muriel tuskin kuuluvasti.

Nick mietti hetkisen.

"Onko se arvoitus?"

Muriel ei vastannut.

Nick odotti yhä.

"Jopa arvaan", sanoi hän vihdoin.

Hiljaa nauraen kietoi Muriel kätensä hänen kaulaansa.

"Nick, sinäpä vasta teeskentelijä olet. Sinä tiesit sen."

Nick heitti kirjeet pois ja katsoi häneen, silmissään sanoin

kuvaamaton ilme.

"Oma aarteeni, sinä ilmaisit salaisuutesi noin punastumisellasi. Kas

niin, älähän nyt ole noin ujo. Ethän toki ujostele minua? Katso
minuun, rakkahin, katso minuun ja sano, onko se oikein totta?"
 Muriel katsoi häntä silmiin.

"On, Nick, se on aivan totta", sanoi hän hellästi hymyillen. "Oletko

iloinen siitä, rakkaani?"

"Olenko iloinen?" toisti Nick syleillen vaimoaan. "Olen onnellisin

ihminen koko maailmassa. Nyt matkustan mielelläni kotiin. Ja sinä
samaten. Meidän on valmistettava pesäämme, ymmärräthän? Siitäpä
mahtanee tulla hauskaa!"

Murielin kasvot säteilivät ilosta.

Sitten muistui hänen mieleensä kirjeet. Ajan kulku oli aivan

merkityksetön siellä vuorilla.

"Entä toinen kirje? Onko se ehkä Will Musgravelta?"

"On kuin onkin", vastasi Nick. "On parasta, että itse luet sen. Siinä
on sinulle terveisiä Daisy on saanut pienen tyttären ja sekä hän että
lapsi voivat hyvin. Daisy on sangen onnellinen ja Will aivan
suunniltaan ilosta."

Muriel oli jo syventynyt Willin ilonpurkausten lukemiseen.

Lukiessaan hymyili hän mutta silmissä kimalteli kyyneleitä. Viime
sivulla oli seuraava lyijykynällä kirjoitettu lisäys:

"Tervehdi Murielia ja sano että kaikki on hyvin ja että teidän on

välttämättä tultava meille jouluksi."

Muriel kääri kirjeen kokoon.

"Olen luvannut viettää joulua heidän luonaan, Nick."

Nick hymyili veitikkamaisesti.

 "Olipa se omituinen sattuma, ystäväni, sillä minäkin olen tehnyt
saman lupauksen. Asian näin ollen me kai voimmekin matkustaa
sinne yhdessä, vai mitä arvelet?"

Muriel suuteli hänen kättään.

"Menemme siis sinne jouluksi. Ja sieltä matkustamme suoraan

kotiin. Kerro se tahtosi Jimmille. Mutta Nick, me laitamme pesämme
kuntoon kahden, vain kahden, eikö niin, oma mieheni?"

"Tietysti, me kahden. Vain sinä ja minä."

"Niin, sinä ja minä", toisti Muriel hiljaa.

*****

Vähän myöhemmin seisoivat he käsi kädessä katsellen kimaltelevia

vuorenhuippuja, jotka kohosivat kuin kultaiset valtikat avaruuksia
kohti.

Oli aivan hiljaista.

He seisovat kahden korkealla asutun maailman yläpuolella katse

suunnattuna vuorille.

Vihdoin sanoi Nick kevyesti, mutta hieman vapisevin äänin:

"Hevosia… ja sotavaunuja…"

Muriel katsoi häneen. Hän ymmärsi Nick'in tarkotuksen ja hänen

katseessaan kuvastui sanoin kuvaamaton hellyys.

Loppu.
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