The Man Who Killed Happy Hour

By EDWARD K. JEFFER

Learn about McNamaras 100,000, soldiers who failed to meet minimal intellectual standards but were given a chance at Army careers. Meet a soldier who won a silver star while wearing a black lace bra under his fatigues. Hear the story of how a British Army in India 19th century water policy was almost resurrected for Desert Storm. Discover why the military stopped pushing cheap booze and attempted to change from an alcohol-positive to an alcohol-neutral culture. Follow the quest for improved services in Army medicine. Relive many interesting vignettes from the 70s, eighties and nineties including insights into several dynamic general officers, including one who postponed a meeting with the Supreme Allied Commander Europe(SACEUR) to chat with doctors at a coffee break. Peek inside the often confusing world of quality assurance. Examine why reduction in rank appears not to work. See how the National Practitioner Data Bank protects patients in the U.S. Read about one attempt to prepare Army doctors and field medics for psychiatric casualties on the battlefield. Find out how a psychiatrist can become involved in a surprisingly wide range of activities related to military life. Marvel over the level of emotions engendered by the question of who should command medical units.
Enjoy articles about Dr. Jeffer from Newsweek, Psychology Today, Army Times, U.S. Medicine, Stars and Stripes, Psychiatric News and the Newport News Daily Press.
Over twenty-six years Dr. Ed Jeffer was involved in drugs and alcohol, the interface of medicine and the law, quality assurance, combat psychiatry and many other areas. He served with both active and reserve components. Working as a staff officer he interfaced with command at all levels and with governors and the Congress of the United States. Many lessons learned are still valuable today and there is something of interest for everyone.

• Language: English
• Publisher: Trafford Publishing
• Release date: Sep 17, 2014
• ISBN: 9781490726557

EDWARD K. JEFFER

Ed Jeffer started out to be an English teacher and writer and wound up in medical school He started out to become a surgeon and wound up as a psychiatrist He planned on a career split between private practice and teaching medical students and instead, spent 26 years in the U.S. Army as a Military physician. Dr. Jeffer had the opportunity to do clinical work, serve on five university faculties, command hospitals and health clinics and serve on the staffs of three combat divisions. Extremely instructive tours were spent as Chief Office of Drug and Alcohol Abuse Control for Europe and the Middle East and the Forensic Psychiatry Consultant for Europe. Also, he was Chief of Quality Assurance for Army Medicine, Psychiatric Consultant for Operation Desert Storm, and Chief Medical Officer for the Army National Guard with responsibility for all 54 jurisdictions. His last eight years were spent in Pentagon assignments. He received a star from the Arkansas National Guard and was to serve as a Special Assistant Adjutant General but fate intervened. Along the way, he held on to his love of writing. He had two plays produced, sold numerous stories, published a novel and more than sixty articles in medical journals. He and his wife have visited the seven continents and over one hundred and fifty countries and reside in Falls Church, Virginia.

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Copyright 2014 Edward K. Jeffer.

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ISBN: 978-1-4907-2587-1 (sc)

ISBN: 978-1-4907-2656-4 (hc)

ISBN: 978-1-4907-2655-7 (e)

Library of Congress Control Number: 2014901720

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TABLE OF CONTENTS

Acknowledgements

Introduction To This Collection

Section I: Are You Suggesting I Shill For Your Flaky Ideas?

The Day They Court-Martialed The Stars And Stripes

In Search Of A Nail: Mental Health Consultation In The Us Army, Europe

Problems Of Organizational Consultation In The Army

Franconia Mental Hygiene Blueprint For The Us Army Europe

Community Mental Health: The Baumholder Experiment

Medical Exercises By The National Guard For Underserved Americans

Urban Mash Unit Brings Care To Needy

Psychiatric Evaluations For Administrative Purposes

The Right Way, The Wrong Way And The Army Way

Letter Of Agreement For A Community Human Resource Center (Sample)

Appendix A To Loa: Human Resource Centers

Appendix B To Loa: Human Resource Centers

Appendix C To Loa: Human Resource Centers

Appendix D To Loa: Human Resource Centers

Appendix E To Loa: Human Resource Centers

Appendix F To Loa: Human Resource Centers

Appendix G To Loa: Human Resource Centers

Schizophrenia Among Wives Of U.s. Servicemen In Europe

Schizophrenia Rate Said High Among Military Wives

Mach Cdr Explains, Maintains Values

Col. Edward K. Jeffer

Changes May Be In The Offing For Military Medical Services

Military Officials Want More Medical Training

Rx: Hospital Works To Improve Services

Section II: Don’t Ask, Don’t Tell And A Silver Star (Sexual Identity In The U.s. Army)

A Case Of Transsexualism In The Military

Section III: The Army Wants To Join You As An Army Of One Being All You Can Be! (Leadership And Management)

The Word Is Quality Not Quantity

A General With The Common Touch

Reduction In Rank: Vestige Of The Past?

Generalizing

Command And The Adversary Principle

Section IV: Show Me Something Better

The Man Who Killed Happy Hour

A War On Drugs Gets A General

Europe’s GI Drug Scene

Deterrence Of Methaqualone Abuse Through Mass Urinalysis

Drug Rehabilitation In The Us Army, Europe: One Division Begins An Alternative Life Style Approach

Section V: Purple Suits, Triage And Whose Turf Is It Anyway? (Military Medicine)

The Defense Health Agency

Commentary

Medical Units: Who Should Command

Command Of Medical Units: Grounding The Paradigm

A Question Of Turf?

Medical Triage In The Post Cold War Era

Psychex: Simulated Mass Psychiatric Casualties During A Field Exercise

Units Tested On Mental ‘Wound’ Plans

Against Medical Advice: Part I, A Review Of The Literature

Against Medical Advice: Part II THE ARMY EXPERIENCE

Military Occupational Specialty Medical Retention Board: Promises And Problems

Total Quality Management And The Army Health Care System

The Medical Units Of The Army National Guard (Arng) And Operation Desert Shield/Desert Storm

Section VI: My Favorite: Dim Sum Of The Mind (Miscellaneous)

The New Myths Of Marriage

The Cinderella Myth And Its Demise

Quality Assurance And Quality Improvement: The 1990S And Beyond

Smoke Doesn’t Just Get In Your Eyes

Overseas Service Given Immunity

The National Practicioner Data Bank: An Introduction

Doctor! Doctor! Who Me?

Also by Edward K. Jeffer

The Malthus Confederation (novel)

Something Ever After (TV miniseries)

Badly Malled (Movie script)

Rhein Main Transfer (Movie script)

King Arthur Doesn’t Live Here Any More and If He Could He Wouldn’t I Suppose (Play)

The Shop That Isn’t There (TV pilot)

The History of the U.S. Army in Seventy Minutes (musical revue)

Dedicated To

Ulrike Seufert Jeffer

Wife, Best Friend, Editor, Health Coach and One Woman Posse

ACKNOWLEDGEMENTS

A S ALWAYS, I want to thank my wife Ulrike Seufert Jeffer for her unflagging support, repeated readings, numerous corrections and valuable suggestions. Over the years I would never have persisted with my writing except for the encouraging remarks of friends and teachers: Especially, Mrs. Beatrice Greenberg of P. S. 164, Dr. Miles Kasendieck of Poly Prep, Dr. Robert Kinsman of UCLA and Mrs. Pearl Marcus.

A list of those in the military to whom I am indebted would be endless but I must make special mention of Dr. (LTC.) Ron Aldrich for his many insights into both the Army and organizational consultation. Dr. (COL.) Nick Rock was a life long friend and mentor. Dr. Bruce Livingston was a strong role model during my residency and again later in my career. LTG Charles Pixley, while serving as Surgeon General of the Army was supportive of Thinking outside the box long before it became a buzz word. Several general officers are especially deserving of mention: BG Roscoe Cartwright, MG (later Gen.) Sam Walker, MG (later Gen.) Glenn Otis, Vice Admiral James Zimble, MG Raymond Rees, and MG J. D. Polk, Mississippi Army National Guard.

Very special thanks to Ulrich Seufert and Andrea Beeson for the cover and back cover artwork and design. I would be remiss if I didn’t acknowledge the extensive technical editing assistance I received from Al Brothers.

IN MEMORIAM

ANDREA BEESON

1956-2013

ORIGINAL PUBLICATIONS AND DATES ARE PROVIDED BELOW. All are reprinted with permission.

A Life Alternative Program for Drug Abuse Medical Bulletin, XXXII (1975), 250-253

Franconia Mental Hygiene Medical Bulletin, XXXII (1975), 207-209

Problems in Organizational Consultation in the U.S. Army Military Review, LIX (Apr. 1979), 35-41

Administrative Evaluations Military Medicine: International Journal of AMSUS, CXLIV (1979), 526-528

The Word Is Quality Not Quantity Army, XXXI (Feb 81), 14-20, copyright the Association of the United States Army

A Case of Transsexualism in the Military Medical Bulletin, XXXI (1974), 57-59

Smoke Doesn’t Just Get In Your Eyes: Overview of the Medical As Well As the Psychological Aspects of Smoking Medical Bulletin, XXXIII (1976), 113-115

Reduction in Rank: Vestige of the Past? Military Medicine: International Journal of AMSUS, CXLI (1977), 867-868

Deterrence of Methaqualone through Mass Urinalysis International Journal of Addictions, XIV (1979), 445-450

A Question of Turf Army, XXXII (April 1982), 6-8, copyright the Association of the United States Army

Psychex: Simulated Mass Psychiatric Casualties During a Field Exercise, with Capt. Vladimir Nacev, MSC and Maj. Timothy D. Sheehan MD, MC, Medical Bulletin, 39 (August 1982), 10-13

Leadership and the Adversary Principle Army, 33 (July 1983), 30-34, copyright the Association of the United States Army

The Man Who Killed Happy Hour Army, 35 (June 1985), 48-51, copyright the Association of the United States Army

Medical MOS Reclassification Board: Promises and Problems Military Medicine: International Journal of AMSUS, 151, (1986) 422-425

The Day They Court Martialed the Stars and Stripes Army, 37 (March 1987), 37-41, copyright the Association of the United States Army

Doctoring More with Less Guest Features Editor, Newport News Daily Press, February 24, 1987, A5

Community Mental Health Revisited: The Baumholder Experience Medical Bulletin, PB 8-88-5 (1988), 28-30

Civilian External Peer Review; Lessons Learned Journal of Quality Assurance (1990), 12-14

A War on Drugs Gets a General Army, 40 (January 1990), 36-39, copyright the Association of the United States Army

Medical Units: Who Should Command? Military Medicine: International Journal of AMSUS, 155: 413-417. (1990)

Total Quality Management and the Army Medical System Military Medicine: International Journal of AMSUS, 156:413-417 (1991)

The National Practitioner Data Bank: An Introduction Military Medicine: International Journal of AMSUS, 157:315-317, (1992)

Quality Assurance and Quality Improvement: The 1990’s and Beyond, Journal for Healthcare Quality, 14:36-40, (1992)

The Medical Units of The Army National Guard (ARNG) and Operation Desert Shield/Storm, The Journal of the U.S. Army Medical Department, 20-22, Mar/Apr 92

"Against Medical Advice (AHA) Discharges: Part I, A Review of the Literature", Military Medicine: International Journal of AMSUS, 158:69-73, (1993)

Against Medical Advice: Part II, the Army Experience 1971-1988, Military Medicine: International Journal of AMSUS, 158: 73-77, (1993)

Generalizing: The Mystique of High Command Army, 41:43-46, (June 1993), copyright the Association of the United States Army

The Army National Guard Medical Service Prepares for the 21st Century, National Guard, 47:26-28, (Sept 1993)

National Guard Medical Exercises for Underserved Americans, Military Medicine: International Journal of AMSUS, 161: 207-210, (April 1996)

Command of Military Medical Units: Grounding the Paradigm, Military Medicine: International Journal of AMSUS, 161:346-349, (June 1996)

Medical Triage in the Post Cold War Era, Military Medicine: International Journal of AMSUS, 159:389-391, (May 1994)

In Search of a Nail: Mental Health Consultation in the U.S. Army, Europe Medical Bulletin, 32:167-169 (June 1975)

Europe’s GI Drug Scene, Newsweek, by Kenneth Labich with Timothy Nater in Bonn and Mary Hager in Washington, July 3, 1978, Page 44

Units tested on mental ‘wound’ plans, by John Savard, The Stars And Stripes, Jan 31, 1981, page 8

Overseas Service Given Immunity, by Nancy Tomich, U. S. Medicine, Vol. 26, Nos. 3 & 4, Feb. 1990, pages 1 & 16

Changes may be in offing for military medical services Newport News Daily Press, July 3, 1988, page 14

MACH cdr explains maintains values Wheel, June 12, 1986, page 9

Military officials want more medical training by Virginia Biggens, Newport News Daily Press, Sep. 26, 1985, page B1

RX: Army hospital works to improve services by Virginia Biggens, Newport News Daily Press, Dec. 24, 1986, page B1-2

Overseas Service Given Immunity by Nancy Tomich, U. S. Medicine, Vol. 26 Nos. 3&4, Feb. 1990, pages 1 & 16

Schizophrenia Rate Said High Among Military Wives Psychiatric News, Jun. 1, 1979,

The Right Way, The Wrong Way, and the Army Way by Patricia Horn and the Editors of Behavior Today, Psychology Today, August 1975, pages 26-28

Psych Ex adds dimensions to ARTEP by Kathleen Ellison, Ironsides, vol. 25, no.13, February 13, 1981

Health-care mission lacks new era vision Army Times, May 28, 1990

The Medical Units of the Army National Guard (ARNG)and Operation Desert Shield/Desert Storm with Col. Shirley L. Jones, The Journal of the US Army Medical Department, PB 8-92-3/4, March/April 1992, pg 20-22

Schizophrenia among Wives of U.S. Servicemen in Europe Presented at The Seventh World Congress of Social Psychiatry, Lisbon, Portugal, Oct. 10, 1978

Urban Mash Unit Brings Aid to Needy. Denver Installation is the first time such a field hospital has been opened to U.S. civilians outside a disaster area. by Ann Rovin, Times Staff Writer: Los Angeles Times, March 15, 1994.

INTRODUCTION TO THIS COLLECTION

W HY AM I bringing out this collection of articles so many years after their original publication? As a psychiatrist I always question my motives about everything and when something requires a fair amount of effort, I tend to quiz myself extensively.

Is this some ill-fated grasping at fame? Being at the right place at the right time has on several occasions already garnered me my allotted five minutes of fame. I think it was Woody Allen who took one of his many shots at deflating helium filled egos when he said in speaking of fame: My cousin Gloria tossed her cookies on the BMT (NY city subway) at the beginning of the week or Sic Transit Gloria Mundi. If I had any lingering doubts about the futility of chasing a place in People Magazine, it was resolved recently when I used Frank Sinatra as an example of something with a college senior, I was interviewing, and she asked: Who’s that?

Do I want to change the world and influence the course of history? Momentous deeds dwindle rapidly in the rear view mirror of passing time. Remember the U.S. Supreme Court made 246 decisions supporting slavery which have slid to zero on the importance scale of historical events. As I’ll mention in the section on medical exercises for the poor and homeless and the one on the Human Resource Center Program in the U.S Army Europe, I have already experienced pyramids vanishing into the desert sands.

Skipping the usually obligatory George Santayana quote on repeating history, I cite George Bernard Shaw, with the hope he is mistaken: We learn from history that men never learn anything from history. On a very simple level, I truly believe that I have been fortunate to be involved in some very interesting and instructive pieces of history and that the lessons I learned are worth reviewing and thinking about again.

Rather than providing a detailed biography which will be of little interest to many readers, I include this brief sketch. I entered Columbia University in pre-law and graduated from UCLA as pre-med. I left USC Medical School intending to be a general surgeon and wound up a psychiatrist. I planned on a career in clinical practice in LA and spent almost 26 years in the U.S. Army.

Let me only illuminate these highlights with the thought that I do feel I have a lot in common, symbolically and existentially, with the owner of a Zippo lighter I collected as a souvenir on a trip back to Viet Nam in 1999. Engraved on the steel case it reads: Killer by day, Lover by night, Drunkard by choice, Soldier by accident.

My father liked to say that a person was better off being lucky than good and I certainly have had my fair share of good fortune, but I also feel I have performed a wide variety of tasks effectively and with resourceful imagination.

Each set of articles has it’s individual introduction so it suffices to say that I have had a range of interesting experiences including work in drug and alcohol programs, the challenge of balancing the needs of patients with those of the government, trying to be inventive about providing mental health services in a variety of settings, developing and implementing programs to improve the quality of medicine, dealing with sexual identity issues, and getting to help develop and find sponsors for what I felt was exciting legislation (Eg. Guardcare and Reserve Dental Plan).

I have for the most part not re-edited the material. Glaring errors have been corrected and anything which might obscure meaning. I have elected not to populate all of the articles with (sic). Also, you will note a certain amount of repetition with anecdotes and principles such as those for combat psychiatry. Not all photos and drawings have been reproduced but enough so as to provide some feeling for the originals. I have omitted all of the bibliographies that accompanied many articles. I have tried to provide the highest military rank attained by individuals. I am certain I have not been 100% successful and for that I apologize. All material written about me by other authors has been credited in at least three places.

Some of the material is dated but much of it still has a freshness that will allow readers to apply the lessons learned to today’s challenges. My main hope is modest. I wish only to do better than the prognosticating ability of General Custer’s physician in the 7th Cavalry who was a dinner guest at the General’s home shortly before the regiment’s departure for the Little Big Horn and its appointment with destiny. Major James M. DeWolf reassured Mrs. Custer and the other guests, One thing is certain. We shall see no Indians this year.

SECTION I

Are you suggesting I shill for your flaky ideas?

*

(SOCIAL PSYCHIATRY AND COMMAND CONSULTATION)

A GREAT DEAL OF what I was engaged in during my twenty-six years of service is included under the rubric of Social and Community Psychiatry. During my training at Letterman Army Medical Center, Presidio of San Francisco, command consultation was heavily emphasized. I was assigned as the consultant to the WAC (Women’s Army Corps) detachments at the Oakland Army Base and The Presidio. Some mention of this is included in the next section. Also, I will discuss the interesting interfaces I developed with AFEES (Armed Forces European Exchange System) and the American Express Tours and Travel Offices.

The Doors Off Policy recommended that commanders remove the room doors of soldiers identified as drug users. This was a consultation effort which proved very challenging and is detailed in the article on organizational consultation. While drug and alcohol activities certainly fall within this general area of endeavor, I have elected to place this material in a separate section.

In this section of the book I have included several articles on my experience as 3rd Infantry Division Psychiatrist. One describes how enlisted paraprofessional counselors were utilized to extend and expand services. A second focuses directly on unit consultation and I call your attention to two letters from the Division Commander as examples of what can happen when good information is provided through open channels of communication. Less successful was my attempt to have a battalion commander present to his peers my idea on retention of mildly impaired soldiers which led to the quote which serves as this chapter heading. Obviously, I had misread the situation.

A major focus during my 3rd ID years was the collocation and coordination of counseling services to include Division Mental Hygiene, Meddac (hospital) Psychiatry and Social Work, Army Community Services counseling, Pastoral counseling and Drug and Alcohol Services. My work and the support of General Willard Latham led to an extension being built onto the Schweinfurt Health Clinic for a Consolidated Counseling Center and an article in the garrison newspaper with the headline The Jeffer Plan comes to Schweinfurt. This local beginning became the basis for an eleven year endeavor to institutionalize the concept for all Army communities in Europe. One example is described in the article about Baumholder. I’ve included a sample Letter of Agreement that was standard for setting-up numerous centers through-out Germany while a regulation was sought to formalize the program. The high point of this effort came when with the backing of Major General Glenn Otis, then Commander 1st Armored Division, I presented a comprehensive scheme for establishing this program with the details of staffing for all of Europe.

When I finished my briefing to the two star top Doctor for USAEUR (US Army Europe), he had two comments: Dr. Jeffer, you could sell ice-boxes to Eskimos. And added: Anyone who’d make a major decision right after a briefing from you would be crazy. With the draw down in Europe this program is mostly OBE (overtaken by events.) Two articles, Problems of Organizational Consultation in the Army, and Command and the Adversary Principle highlight some of the challenges to consultation. I have included a review of the former from Psychology Today written after I made a presentation at the American Psychiatric Association Meeting in Anaheim in 1975.

Also in this section is an article, Psychiatric Evaluations for Administrative Purposes which is as relevant today as it was the day it was written. For several years this article was required reading in the Air Force Psychiatric residency program at Wilford Hall Medical Center. Several articles in Military Medicine in the last few years have noted that the dual loyalty of a physician to his patient and the Army continues to offer ethical challenges.

In October of 1978, I presented a paper at the meeting of The World Congress of the Association for Social Psychiatry on the finding that the rate of first break schizophrenia was increased when the spouse was sent to Germany with her husband versus a stateside assignment. I wish I could claim credit for reversing this trend but many programs aimed at supporting the soldier in Europe and his family were already being initiated by various organizations. Of course, this too like so much related to the Cold War is essentially OBE. The review of the presentation from Psychiatric News is included.

While serving as the Chief Surgeon of The National Guard I had many opportunities for consultation. I’ve included an article on the National Guard doing medical training exercises where care was provided for underserved Americans. This required my drafting a law and obtaining sponsors in both houses of Congress. I also participated in developing a law which now provides a dental plan for the Reserve Forces.

Finally, on the flight to Saudi Arabia to take up duties as the psychiatric consultant during Desert Shield/Desert Storm, I became aware that one major chain of command was utilizing a water policy from the mid-nineteenth century British Army in India. This despite the numerous documents which laid out directives for officers and NCO’s to have their men drink beyond thirst utilizing as wide an array of chilled beverages as possible. However, this one chain of command was insisting its soldiers drink only ambient temperature, chlorinated canteen water so that they would be desert tough like the Iraqi Army. Several individuals felt it was more important not to embarrass a senior general officer than ensure proper hydration. Eventually, reason did prevail and command consultation chalked up another victory when General Schwarzkopf reissued the memo reaffirming the policy without embarrassing anyone. Many similar road blocks to those I had encountered twenty years earlier, as described in the previous papers, were still present.

While serving as Commander of the Fort Eustis Meddac (Medical Department Activity) and Mac Donald Army Community Hospital, I tried to provide an interface with the community through articles in the local press. Three of these efforts are provided as well as two interviews from this time.

THE DAY THEY COURT-MARTIALED THE STARS AND STRIPES

ARMY

MARCH 1987

I N 1972, U.S. Army, Europe was not a pretty sight. A decade or Vietnam priorities for the Army had left units in West Germany with a bleak, sometimes desperate, equipment situation. I recall one armored battalion commander who could never, despite Herculean efforts, field more than half or his tanks at one time. Similarly, the widely spread and frequently carelessly flung nets of the Selective Service System had brought some fairly dubious characters into the military. Serving as the division psychiatrist for the 3rd Infantry Division, I had an excellent opportunity to meet many of these soldiers.

There are those who claim that it is only a myth that some judges offered certain criminals the opportunity to enlist as an alternative to prison, Let me reassure these doubters that I personally met several of these young men, and in these cases, the practice had not worked out very well.

An index of my clientele was furnished by then-Lt. Col. Donald R. Morelli who recruited me as part of the division’s drug and alcohol program. Col. Morelli, after a successful tour as the engineer battalion commander, had become the division’s first ADCO (alcohol and drug control officer). He invariably introduced me as "the man who deals with the bottom five percent of the division.

Headquartered in Wurzburg, the 3rd Infantry Division had units stationed in six locations in south central Germany. My usual routine was to spend a day each week at the centers of large troop concentrations and a half day each week or every other week at the places with fewer troops.

In each community, permanently assigned 91Gs-the military occupational specialty for behavioral science specialist—would screen individuals and prepare detailed historical summaries so that I was able to see ten to 15 soldiers each day. I would verify the psychiatric findings or the lack of them and thus complete the assessment for the chain of command. Treatment cases were also seen and monitored.

On a gray, overcast fall day I received a call that a soldier was being brought to see me for a court-martial evaluation. Some urgency was felt to exist as command wished to substantiate a need for pretrial confinement. The charges were assaulting several Germans with some of them severely injured, wrecking a Gasthaus (the German term for an inn or tavern), resisting arrest and assaulting a military police (MP) officer.

An hour later two military policemen escorted a young soldier into my office with his hands handcuffed. Even the most cursory glance explained their obvious apprehension.

The soldier was about six feet six inches tall and probably weighed 280 pounds, all of it muscle. He had a 22-inch neck. His biceps and thighs threatened to destroy the sleeves and legs of his fatigue shirt and pants, respectively. His hair was cut as close as possible without actually shaving the head.

We’d better stay with him, Major. He could be dangerous, was the response I got from the military police buck sergeant when I suggested they leave us alone. I pondered his recommendation as I continued my observation of the young man. He sat on the edge of his chair, slumped forward, forearms on his thighs; head down so that I was looking at the top of his head.

I tried one of my standard opening gambits: "Looks like you’re in a little trouble. He mumbled something unintelligible in the direction of his knees.

Sit up and look at me, soldier, I directed in a firm but kind tone. We can’t have a talk this way. Tell me what’s wrong,

Slowly he raised his head, I found myself looking into large, brown eyes filled with tears which had washed twin pathways down his cheeks. The eyes and the whole expression showed only fear and puzzlement.

I was caught off guard but managed to ask him what he was called, My name is Thurman, sir, but everybody calls me Sonny. I then repeated my questions as to what was wrong. A tiny, quavering voice issued from this behemoth, My grandma is going to be very mad at me.

At this point, I realized that despite the MPs’ grave predictions, I would be quite safe with this young man without either their protection or the necessity for handcuffs. It was not easy, but I finally convinced them to accept my point of view and Sonny and I were alone together.

Utilizing the best methods as taught by the Department of Psychiatry at Letterman Army Medical Center, I repeated the patient’s final words in the form of a question. Your grandma will be very mad at you?

The trickle of tears became a flood. After several minutes of reassurance and soothing, Sonny was able to tell his story. He started with a rather provocative statement.

It’s all the fault of the Stars and Stripes. (After some questioning, it became clear that Sonny was not referring to the newspaper of that name but to a bookstore of the same name run by a subsidiary of the Department of Defense.)

"You see, my grandma told me to be careful, not do anything bad and always listen to the sergeants and do what they say. She said I was never to go out drinking or fooling around with the other guys.

Now in the week, that’s easy ’cause I’m working all day and I’m busy and at night, eat dinner, watch a little TV and go to sleep; but on the weekends usually they don’t let you work, so there’s not much to do. Sometimes I try to watch TV, but most of the time it’s very confusing and I can’t follow what’s going on, except sometimes when I get to watch cartoons on Saturday morning.

"So I go down to the Stars and Stripes every Friday and buy ten new comic books; then I buy a box of Milky Ways at the PX and spend the weekend reading.

You see, the guys in the company are always wanting me to go out with them. They say: Hey, Sonny, let’s go out and grab a beer."

"But I always say, ‘No, I got to do some reading.’ This way, I don’t just say no and look like a bad guy. When I got into all this trouble, though, I went down to the Stars and Stripes at lunch time on Friday like I always do, but it was closed. I waited the whole lunch hour, but no one ever came back.

"I even went back right after work. But he’s always closed then. I couldn’t buy my comic books, so when the guys said ‘Hey Sonny, come on and have a beer with us.’ I couldn’t say anything against it.

"So I went with them, and I said I wanted a coke; but they said I would insult them if they didn’t buy me a beer. I never drink-my grandma told me not to drink, that it’s bad for you-but I said okay and then I drank some beer.

"Then another one of my buddies said he had to buy me a beer and then another guy and I got dizzy and couldn’t think right and I got up to go to the latrine and I bumped into somebody and they Started hitting me so I tried to make them go away, but they kept hitting me but I never hit nobody.

"My grandma told me, ‘Sonny, you must never, never hit nobody.’ I heard people say I hit people, but I swear I never hit nobody.

"I did pick some people up and tried to make them go away. Then a man came with a club and hit me, so I took his club away and broke it in half and then a whole lot of people jumped on top of me.

Now they tell me I’m in real bad trouble and I’m gonna go to jail.

A historical aside is perhaps in order. In August 1966, Secretary of Defense Robert S. McNamara announced a program to lower the Army’s mental standards of admission.

Young men from disadvantaged backgrounds would be allowed to utilize the military as a new chance for success. American society would benefit as large numbers of previously unemployable individuals learned valuable skills and the Army would be enhanced by its access to this previously untapped pool of useful soldiers.

Officially titled the Medically Remedial Enlistment Program, it was commonly known as Project 100,000 from its goal of that number of accessions per year.

In 1969, I. M. Greenburg, the director of Project 100,000 stated that the program had been an unqualified success. Ninety-five percent of these individuals completed basic training compared to the standard of ninety-eight percent. Ten percent failed to graduate from AIT (advanced individual training) as compared to four percent of the rest of the soldiers.

After 20 months of service 52 percent had been promoted to pay grades E4 (corporal or specialist four) versus the Army average of 59 percent, and only 12 percent had been separated from the service compared to the Army’s overall loss rate of six percent by this juncture.

Two years later, a mental hygiene consultation service in Vietnam found that 30 percent of the Project 100,000 soldiers in their catchment area were seen over a six-month period. This contrasted with 2.8 percent of the non-project soldiers seen during the same period of time, Twice as many project soldiers, 40 versus 20 percent, were recommended for administrative separation. Project 100,000 is last mentioned in the Army Annual Review in 1970. Gradually, admission standards returned to their former levels.

By the time I saw Sonny, the social security number had replaced the Army serial number in the Army personnel system and members of Project 100,000 could no longer be identified.

While I was predisposed to believe the young man’s story, I was still skeptical. I did not think he was dissembling, but there are two cardinal rules which I have always tried to remember.

The first goes all the way back to my medical student days and states: Never underestimate a patient.

As a student, I was assigned to one of the psychiatry wards at Los Angeles County General Hospital. One day, I was passing through the dining area as lunch was being served. The stew neither looked nor smelled like food. A nurse was encouraging a patient to eat: Please eat some lunch, Mr. Jones. I’m sure the meal is delicious.

The patient looked up at her with an exasperated expression: Nurse, you shouldn’t try and tell me something like that; I may be crazy, but I’m not stupid.

My second principle had been learned during my first few weeks in the division: Do not be a bleeding heart.

I had arranged a series of courtesy calls on all the brigade and battalion commanders. After listening to my brief message of how I hoped to be of assistance to commanders at all levels, the division artillery commander’s first question took me considerably by surprise. Have you taken down the sign yet?

What sign? I asked.

The one your predecessor had over the door of your clinic stating, ‘Through these doors pass the most abused soldiers in the world.’

I hazarded an opinion that the previous division psychiatrist had not developed an effective channel of communication with the brigade commander.

Major, the colonel responded, the only times I ever communicated with Major Smith (a pseudonym) he was standing rigidly at attention in front of my desk. And I tended at those times to communicate at the very top of my voice.

I have never forgotten this lesson on how easily some mental health workers slip into an adversarial position with the chain of command.

Keeping these principles in mind, I decided to check into the details of Sonny’s story. First, I asked for the military police incident report and the witnesses’ statements.

According to these official documents, the accused (Sonny) had become involved in an altercation with several Germans at a local Gasthaus resulting in one German national suffering a broken arm and a second one suffering multiple lacerations from being thrown through a plate glass window.

This seemed to correspond to what Sonny called making them go away. One of the responding military police officers had had his night stick taken away and broken in half.

As I frequently did in pretrial evaluations, I contacted the soldier’s chain of command. The first sergeant of Sonny’s company had nothing but good things to say about him. He told me that Sonny was a tireless worker who followed each and every order fully and enthusiastically.

He was always polite and had never been in trouble before. He could not say enough about him as a worker.

Apparently, Sonny worked in a warehouse loading and unloading trucks. As the first sergeant put it, "You tell him, ‘Sonny, load crates,’ and he starts at 5:30 in the morning and he doesn’t stop.

"At noon time you say, ‘Sonny, go to lunch,’ and half an hour later he starts again. At 4:30 or 5:00, whenever we get ready to stop, I have to force him out of the warehouse. Never misses a day, never complains, a perfect worker.

If another soldier carries one crate, Sonny carries three. He’s a little slow mentally, maybe you noticed, but I would not trade him for three normal GIs.

The final step was to visit the Stars and Stripes bookstore. I stopped by one morning about 10:30 on my way to the dispensary where my two enlisted counselors had offices.

The store was closed.