Responsibility for Veterans

My preceptor in child psychiatry at the University of Kansas (Wichita) was easily the most respected psychiatrist in the region. Former chief of the residency training program, he was not at all the fanatically-publishing academic type I would find in psychiatric departments elsewhere.

He was eminently practical. Nearing retirement and clearly at the top of his game, he was known to be someone who really did straighten out troubled kids.

Me, there were times he gently chided me because of my theoretical and academic concerns which were not always of practical use.

Like when I changed a kid’s diagnosis from “autism” to “pervasive developmental disorder,” which resulted in no change in this unfortunate child’s treatment whatsoever.

I was surprised when he did not recommend any text on child psychiatry (which he said was about ten years behind the knowledge of adult psychiatry, anyway).

I cannot remember the name of the thin paperback he told us to read and assimilate, which we would discuss.

The point was simple — the message typical of the culture of the prairie “heartland” that surrounded us.

Children had to know that they were important and that their contributions were important.  In pioneer days, a child could, for example, hold a wheel in place while it was fastened to the wagon by an adult.  The child’s contribution was crucial to the task, and had to be performed according to directions. If the child’s contribution to the task had not been correct, the joint would be weak and the wagon could fall apart at that joint and somebody — most likely close and beloved — could get hurt.

This importance was such that the child would “behave.”

No playing to parental roles or authority was necessary.  The concept of “punishment” did not seem particularly necessary.

The central concept was getting the child to understand that actions had consequences.

This is in contradistinction to parents telling children to retreat to their rooms, generally filled with toys, and to stay out of the way of their parents.

This actually fosters the child in the contemplation of mischief as a way to get attention.

It seems to me that as we get away from the concept of the individual as working as part of a family unit, and invest in the concept of being part of a corporation or even a government, we get farther and farther from this simple and powerful concept of individual responsibility.  We diffuse, even refuse, the idea of personal responsibility, and throw such things upon groups, internal investigations, and the vague idea that things will get better.

Worse, we come up with broad emotional appeals and mindless promises that cover up any question of individual responsibility.

We come up with statements like this one from Secretary of Veterans Affairs Gen. Eric K. Shinseki regarding the scandal of covering up a cold-blooded policy of denying veterans medical care in a timely manner. I am a veteran.  I have worked as a VA physician and psychiatrist.

This statement is rubbish.

I have seen military internal investigations by the Inspector General when I was on active duty as a Captain in the U.S. Army at Fort Bragg, North Carolina.

Without commenting on the system in lurid detail, I have got to raise one question that it does not take psychiatric training and experience to ask.

Does anybody actually believe that any (government) agency charged with investigating its own potentially criminal negligence is going to find itself guilty and requiring punishment?

It has been suggested that veterans awaiting appointments, first at an Arizona VA and then at other VAs, have had to wait so long for appointments that some died in the process.

In the lesson to a child on the prairie about responsibility of holding a wheel about to be attached to the wagon, doing it improperly could result in an injury to someone the child would care about, and might even be dependent upon.

How about death?  Death of a loved one has got to be the worst possible life experience — especially if it seems to be “against nature.”  Death of the young before the older, because of some bureaucracy or social cause that many neither understand nor respect.  The consideration should be to respect life.

I know about this.  I lost a younger brother who ought not to have died.

Nobody knows more about death than veterans.

I have quite a vivid memory of the day of my “in-processing” into the military.  I was asked what kind of a funeral I wanted if I died on active duty.  It was hard for me to believe that the Army “promised” to turn up a Rabbi and give me the traditional Jewish funeral I requested even if I were assigned to the Sinai peninsula, but promise they did. Of course, in that theoretical situation, I probably would not know whether they kept their promise or not.

I was 30-ish. Eighteen-year-olds (who may never have even considered the fact of their mortality) are asked the same questions and have to answer, on their day of “in-processing.”

Oy!

Veterans who die waiting for a medical appointment at the VA are no less dead than combatants who die in active duty. I do not think their families miss them any less.  It may be harder because there is no “honor” and no taps on a trumpet and surely no 21 gun salute.

Shinseki’s statement attributes the problems to “employee misconduct.”  He uses the kind of idiom that any veteran is accustomed to hearing.  The “fellow veterans” and “nationwide audit” to understand” and comply with VA appointment policy.

Some veterans have told me that VA care is better than it once was — others say the opposite.  My last experience as a VA doctor was about a dozen years ago, and I was aghast at what I found.  I can only hope things are better now.

Gen Shinseki surely is not taking responsibility for what has gone wrong.  I am not convinced anybody will.

The problem sounds a lot bigger than “employee misconduct” since by any and all accounts, it seems to be reported in more than one VA, so there is likely to be a systems problem.

With our multiple theaters of military action abroad in this young 21^st century, we have surely managed to create plenty of returning veterans needing services.  Since I have heard nothing at all about increasing the size of medical staffs, (and that one I would know about, I think) I expect that long waits are a symptom of short staffing.  This is common.

America has probably never honored its veterans as much as it could.  I really don’t think that people think enough about this issue, and probably do not think of it at all, when they cite how much money we spend on waging war abroad.

Official government history of the VA provides the kind of self-congratulatory statements we can only expect from government agencies.

We are the best and most comprehensive system in the world?

We said so.

We have some principles to guide us while our secretary of veterans’ affairs is working on things that sound good, but where does the money for them come from, and who will oversee compliance?

Here is a history of the current situation.

The important thing is not blame.  It is not who is fired from the VA and why.  It is not “paid leave.”

I can’t say that I particularly care if Shinseki resigns.  He sounds like a typical bureaucrat.  At the level he works at, he will just find another job suitable for a bureaucrat.

Many VA employees are veterans themselves, and God knows veterans have enough trouble finding jobs, anyway.

Somebody really should take personal responsibility for what seems to have been some kind of “order” or command to deny services, and later to cover up the conspiracy.  This is very unlikely to happen.

Somebody knew about this and did not blow the whistle on it.  We need a culture that honors whistle blowers, without sweeping issues, and the lies that often cover them.

The answer to so many issues I see, including this one, is the value of an organization or some kind of personal honor above human life and well being.

No other species does this to themselves.

My optimism comes from the fact that individuals often do noble and optimistic things for other humans.

For Americans to become the intelligent populace that Thomas Jefferson wanted us to be, we need to see through emotional appeals and bureaucratic self-protection strategies.

We need to take care of American humans who put themselves on the line for us.

Not bureaucracies of governments, but real members of our species who believed in our nation enough to put themselves on the line.