HOPE Notes for Veterans Day

Chris/AdobeStock

PSYCHIATRIC VIEWS ON THE DAILY NEWS

“When I looked at him, he seemed exactly the same as me, in the same pain, the same vulnerability, the same fear, the same understanding of the devastation we were going through.” - Asma Kalifa

Today is Veterans Day in the United States. It differs from Memorial Day by recognizing all who have served in the military beyond those who have died in battle.

There now seem to be at least 23 million veterans. I am one of them. I served as a psychiatrist from 1975 1977 in Anniston, Alabama at Ft. McClellan, base home of women in the military and military police. I came straight out of training, having made the difficult decision to not pursue being a conscientious objector out of respect for the service of my father and father-in-law in World War II, as well as my deeper feeling that participation in such wars is necessary for now. I was a Holocaust-connected baby.

It turned out to be a unique learning experience, including our orientation, which emphasized not if there would be another war after Vietnam, but when. That certainly proved to be true.

Part of my education during my service was to try to understand the need for all militaries. Certainly, the safety and security at the basis of the Maslow pyramid of psychological and physical needs is one. Another is how and when to understand anger and rage in reaction to perceived risks and dangers. There are also unique ethical challenges, including the need to follow military orders in regard to patient care, and what is acceptable use of techniques to get information from those detained. Once in a while, there are reports of extraordinary kindness when soldiers unexpectedly meet amidst the brutality.

Generally, there are increased psychiatric repercussions, especially posttraumatic stress disorder (PTSD), which was unknown as a formal disorder in 1975. Over these 50 years, PTSD and its suicide risk has been a daunting challenge for veterans. Now about 22 suicides occur a day. In Israel, as shown yesterday on the Sunday Morning on CBS show, the increasing successful use of hyperbaric oxygen is promising, but not funded in the US and running at about $50,000 self-pay.

Another private psychiatrist wanting to improve the treatment of veterans has been adapting a more holistic model for PTSD and other disorders, including beginning evaluations with questions about the patient’s sense of purpose and meaning in life. These are the same questions I asked patients when my time with patients was cut down by managed care, and the same recommendation that psychiatrist Victor Frankl made coming out of his concentration camp in his perennial best-stellar, Man’s Search for Meaning.¹ This psychiatrist uses a HOPE (Healing-Oriented Practices and Environment) charting note system.²

Hope is also more than an acronym. Hope is realistic optimism coupled with action. Our action as psychiatrists is to use our knowledge for peace. Hope is not only for veterans, but for the general increase of mental disorders in our society over at least the next decade.

Before Veterans Day, my wife, granddaughter, and I went to the Houston Opera production of “Cinderella.” It was Military Appreciation Night, so I wore a military suit. Never before, not even in a white coat, was I met with so many “Bless You” and “Thank you for your service.” It was surprising and moving.

In some ways, both military psychiatry and for-profit managed care can be viewed and experienced like Cinderella, beautiful potential hindered by bureaucracy, cost savings, profit, and our human potential for extreme aggression.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Frankl V. Man's Search for Meaning. Verlag für Jugend und Volk; 1946.

2. Jonas W. Whole health and healthy living newsletter. US Department of Veteran Affairs. November 8, 2024. Accessed November 11, 2024. https://www.va.gov/files/2024-11/WH_HLT_Veteran_Newsletter_Nov2024_0.pdf