Memorializing Psychiatrists in the Military

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IN MEMORIAM

In the brief transition from this year’s American Psychiatric Association Annual Meeting and Memorial Day, memories of my time as a military psychiatrist emerged. I soon realized that I had never included a psychiatrist who spent significant time in the military in my blogs that eulogize inspiring psychiatrists. Now is the time to make up for that. Here are a couple of them who passed away in recent years, and whose work still has relevance for us.

Gerald D. Klee, MD and LSD

Dr. Klee died in 2013 at the age of 86. He was renowned for participating in experiments with LSD and other hallucinogens at US military stations in the 1950s. The Army had negotiated contracts with the University of Maryland for this research, well before Timothy Leary and other citizens achieved notoriety for their use of LSD. Other related experiments involved various other drugs and chemical warfare agents.

These experiments elicited widespread ethical controversy, primarily because the soldiers didn’t know what they were getting. That would be a current informed consent violation, but expectations for that ethical principle were different back then.

LSD was slipped into soldiers’ cocktails at parties. Dr. Klee was there to help for “bad trips.” Long term follow-up was apparently not considered.

Before the experiments started, Dr. Klee took the LSD himself to experience its effect. I felt that same empathic pull when I gave myself Thorazine in my first year of residency to experience the adverse effects reported by patients.

Dr. Klee also felt that the results could have potential benefits for the Cold War as a chemical weapon. Later, he tried to persuade President Nixon to renounce its use as a chemical weapon, to no avail.

LSD, of course, was later to be put into the highest category of controlled substances, virtually excluding it from research study. Recently, however, new research on therapeutic implications is in process and micro-doses are being used to self-medicate for anxiety and depression.

Gordon Livingston, MD and Vietnam

Dr. Livingston was a West Point graduate and Army physician who died at the age of 77 on March 16, 2016. Serving during the Vietnam War, he was discharged as an “embarrassment to the command” for distributing a satirical prayer at an Army ceremony: “Help us to bring death and destruction wherever we go.”

He found apt metaphors for life in his military experience. There included sayings that appeared in his bestselling book, Too Soon Old, Too Late Smart.¹

Any relationship is under control of the person who cares the least.

The statute of limitations has expired on most of our childhood traumas.

Before he was a physician in the Army, he was an infantry officer, serving as a parachutist. Before leaving Vietnam, he received a Bronze Star for helping to capture a wounded enemy soldier behind lines.

Perhaps his war experiences led him to then train in adult and child psychiatry at John Hopkins. He became Chief of Psychiatry for 34 years at the Columbia Medical Plan, an early Health Maintenance Organization (HMO), the precursor of managed care. In many ways, HMOs were similar to the health care system in the military. Both serve a population of people for all their physical and mental health needs.

Perhaps, too, his experience with military deaths prepared him just a bit for the suicide of his 22-year-old son, who had bipolar disorder, and that of his 6-year-old son from leukemia. He wrote the book Only Spring: On Mourning the Death of My Son about the latter experience.² Dr. Livingston concluded that there is never any “closure” for such profound losses, and he recommended that the word should not be conveyed to parents who lost children.

My Military Experience

I was especially drawn to these 2 psychiatrists because of my own military experience, where I also experienced profound ethical choices. My first one also involved the Vietnam War.

I was in medical school at Yale from 1967 to 1971. By 1970, I had 3 choices regarding the war: do nothing and risk being drafted and sent to Vietnam as a general physician; try to get a Conscientious Objector (CO) exclusion (which my lawyer father thought could be obtained); or try to get accepted into the Berry Plan, which would delay my service obligation until after I finished psychiatric training in 1975. I was going to go for the CO until I felt it was morally dishonest. I did not like the Vietnam War, but I was not against all wars. So, just before midnight on the last day possible, I changed my decision and sent in my Berry Plan application.

I was accepted and served in Anniston, Alabama, sort of another country in my perspective, from 1975 to 1977. There, too, were ethical dilemmas. I, and another physician right out of training, were the only psychiatrists on base, shades of the Peter Principle of being shoved too high for one’s competence. In civilian life, that step can be refused, like in the offer of an administration position, but refusal in the military is fraught with severe repercussions.

We were asked to approve discharges for presumed homosexuality when homosexuality was still in the DSM; I used every measure I could to get around such a recommendation. Later, I was reminded of such evaluations when asked to comment on a patients’ desired disability status, another situation of role diffusion and/or conflict. We were at a base where there were rumors of chemical weapons being stored; I ignored that.

Like Dr. Klee, I also found the closed military community to have some resemblance to HMOs and ended up being a Medical Director of an academic not-for-profit managed care system in the 1990s. The ethical challenge was always how to ration the available funds and resist the temptation to reduce care to cut costs. When my involvement became public, I was called a “Nazi” and “evil” by some psychiatrists, even though I thought I adhered to ethics and had documented evidence of improved patient outcomes.³

I greatly admire these 2 psychiatrists, and any others, for what must have been anguishing professional ethical dilemmas, as well their post-service contributions to society. You learn things in the military that you can’t learn-and maybe don’t want to learn-anywhere else.

In more recent time, the greatest ethical challenge was whether military psychiatrists would participate in torture. Psychiatrists resisted; psychologists did not. Yet, I was left wondering what I would do regarding torture if a loved one were in danger and torture might reveal useful information.

I thought my experience in the Army was invaluable and perhaps these psychiatrists did, too. I get teary-eyed whenever the military is honored or the Army song is played. Nowadays, with the draft gone, the choice to serve is optional.

If you know of any other inspiring psychiatrists who served in the military, especially career military psychiatrists, please let us know. We should honor them.

References:

1. Livingston G. Too Soon Old, Too Late Smart: Thirty Things You Need to Know Now. Philadelphia: De Capo Press; 2004.

2. Livingston G. Only Spring: On Mourning the Death of My Son. New York: Marlowe & Company; 1995.

3. Moffic HS. The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare. San Francisco: Jossey-Bass; 1997.