Taking Their Couches to Iraq

Since he retired from the Army Reserve seven years ago, Charles Ham’s life has taken on a relaxed rhythm: At 67, he sees patients in the cool, quiet office of his psychiatry practice. He visits with his grandchildren. He mows the lawn.

So it was a surprise to hear from the Army’s human resources command last September: As a former Army psychiatrist, Ham was in a category of specialist both scarce and crucial for the war in Iraq.

Ham told the officer to try to find younger doctors to send, but to call him back if they couldn’t find a substitute. They called back in December, and again in April. That time, Ham volunteered for duty.

Combat psychiatrists have been part of every conflict since World War I. But it’s been more than 30 years since they were needed in as large numbers as they are in Iraq, where a team of Army researchers last year found that nearly one in five soldiers had symptoms of depression, anxiety or traumatic stress.

Army spokesmen say there is no shortage of mental health personnel in Iraq. Between 70 and 95 mental health professionals -- psychologists, psychiatrists and social workers -- are in Iraq at any given time, plus 100 to 130 paraprofessionals, such as mental health technicians, said Sgt. Maj. Jaime Cavazos, an Army spokesman.

Most of the Army’s 70 active-duty psychiatrists have been or will be deployed in Operation Iraqi Freedom. The gaps are filled with volunteer reservists and retirees -- who are often reluctant to serve because of comparatively low pay and the challenge of practicing according to different principles, said an Army psychiatrist who spent 15 months in Iraq.

The system is “stretched thin and with no end in sight,” said Capt. Robert Cardona, chief of community mental health services at an Army hospital in Ft. Sill, Okla., in an e-mail exchange. “These civilian positions are difficult to fill and go unfilled.”

Since the beginning of the Iraq war, 26 doctors and three dentists have volunteered and been deployed to Iraq, according to an Army spokesperson. Last fall, the Army sent out postcards to a scattering of psychiatrists who had served in the military, asking them to volunteer for 90-day tours of duty.

One of those postcards reached 68-year-old John Wicks in Athens, Ala. Wicks served two years of active duty as a Marine and 18 years in the Alabama National Guard. He practices in a state mental hospital, where he treats patients with severe mental illnesses such as schizophrenia and bipolar disorder.

Wicks carried the card around in his pocket for some time before sending it in, he told a local reporter.

“He thinks it is the last big gift he can give,” said his wife, Jan Wicks, 62. “It’s so important to him. And he is a courageous person. I couldn’t scream and cry and hang on to his pants.”

Paul Hill, 71, of Temple, Texas, also received one of the cards. Hill served as a flight surgeon during Vietnam and retired from the Army 23 years ago.

In an interview from Ft. Bliss, Texas, before his departure for Iraq, Hill said a colleague wrote urging him to reconsider his decision. But after treating World War II and Vietnam veterans with post-traumatic stress disorder at the veterans hospital in Waco, Texas, Hill wanted the chance to intervene earlier, helping younger soldiers.

“People have said, ‘Why on earth are you doing that?’ The answer is, I just want to help,” Hill said.

Hill and Wicks were issued pistols and spent a day on a firing range in the scorching Texas heat. They were by far the oldest soldiers among the 300 headed overseas.

“The other guys are really amazed,” Hill said. “We were out on the range, and one guy said, ‘I watched you walking up the ramp and you looked like you were 25 years old.’ ”

For nearly a hundred years, psychiatrists like these have left their practices for the alien environment of war. The transition is not only physical but philosophical, requiring them to balance the needs of individual soldiers against the goal of keeping them in the fighting force.

Many psychiatrists -- especially those coming from civilian practices -- are troubled by that shift, said Army Col. James Stokes, a combat stress control officer.

Under the extreme circumstances of war, they see soldiers with symptoms that might call for diagnosis and medical treatment at home; at war, the same people often return to duty after a period of rest. Doctors worry about making errors or even committing malpractice, Stokes said.

“They have to have a major mind-set change,” Stokes said. “There is some risk involved in that.”

In Columbia, S.C., Ham has spent the summer pondering the possibility of one last war.

After 41 years in the Army Reserve, he has been activated twice in wartime: During the Vietnam War, he spent two years screening soldiers at Ft. Polk, La., before they left for Asia.

Then, during the Persian Gulf War, he treated soldiers for 5 1/2 months at Ft. Jackson in South Carolina. He has paid little or no attention to military affairs since he retired, he said.

“I have no idea what their new philosophy is,” he said. “I hope they tell me before I go.”

During the Vietnam War, Ham spent much of his time giving psychological tests to draftees who hoped to get out of service. Sometimes 30 or 40 young men would be lined up outside his office in the morning, complaining of nerves or psychological difficulties. One man, he remembers, came to him with a case of complete amnesia; when that failed to get him a waiver, he said he was homosexual. When MPs arrived to return the man to his unit, he ran into a wall, cutting his face.

Ham, who was raised on a cotton and tobacco farm in the northeastern part of South Carolina, can respect a conscientious objector. But he did not have much sympathy for shirkers then, and he doesn’t now.

“I just wondered if that guy should be allowed to live in this country when other kids are dying,” he said.

What he feels now, waiting for his deployment orders, is not far off from that.

“I did not call them, they called me,” Ham said. “But, ma’am, if they say they might need me, I will go.”