© Springer International Publishing Switzerland 2017
Elspeth Cameron Ritchie, Christopher H. Warner and Robert N. McLay (eds.)Psychiatrists in Combat10.1007/978-3-319-44118-4_1111. Research at the Tip of the Spear
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School of Social Work, University of Southern California, 1150 South Olive St., Suite 1400, Los Angeles, CA 90015, USA
Keywords
Personal history of warMilitary medicineField research in military medicineBehavioral health care researchPsychological health research in militaryArmy field research in psychologyWar impacts on mental and behavioral healthThe man is the first weapon of battle. Let us study the soldier, for it is he who brings reality to it.
Ardant du Picq, Battle Studies (1821–1870)
Carl Andrew Castro
retired from the Army as a colonel after 33 years of service and is now a professor in the School of Social Work at the University of Southern California. Although the time frame of events described in this essay span over three decades, the key events occur from 2006 to 2007.
This essay is a personal story that spans a period of approximately 30 years, yet focuses on my time conducting behavioral health research during the war in Iraq. It is based on my memory and view of events that transpired before and during the invasion of Iraq and Afghanistan—conflicts that I like to refer to as the Great Wars on Terror. While I have consulted my diary, that is my “little green” pocket memo books, while composing this essay, it is necessarily biased and prejudiced. I am not pretending, nor particularly interested in giving a balanced view, a politically correct view or a view in which everybody looks good. As a result, I may unintentionally (and in some cases intentionally) insult or anger folks. Furthermore, if the editors allow me to get away with it, I will not provide any references for this personal story. Like all personal stories, I will be the hero of my story.
I joined the military as an infantryman when I was 17 years old. My mother signed the “paperwork” allowing me to join the military in the library of my high school, where she worked as the assistant janitor. Within two weeks of graduating from high school, I left home for the first time to attend basic and advanced combat infantry training at Fort Benning, Georgia. Although I reached the rank of sergeant by the age of 19, I never received a good conduct medal, something I still think about to this day.
My First Sergeant, Sergeant First Class Steele, put my name forward for the Army’s green-to-gold program, in which enlisted soldiers go to the university and upon graduation become officers. Upon my departure, Steele told me, “Never forget where you came from, and what this Army is all about. It is about the Infantryman!” Those words have stayed with me now for over 30 years and they still guide my thinking and research. I quickly obtained my bachelor’s degree from Wichita State University in 1984, and 4 years later my master’s and Ph.D. in psychology from the University of Colorado.
11.1 The Value of Research in Making Good Policy and Program Decisions
When I was a major I commanded the US Army Medical Research Unit-Europe located in Heidelberg, Germany; the unit has since closed and relocated to Joint Base Lewis-McCord in Washington. While in this position I deployed multiple times to various locations, including Bosnia, Kosovo, and Kuwait to conduct behavioral health care research. Thus, I understood firsthand the ins and outs of conducting field research. Further, I learned how important medical research is to the Army.
The Army is the leader in conducting military medical research. While many of my colleagues from the other services might take objection to this assertion, the facts speak for themselves. The medical research budget for the Army is twice that of all the other services combined. The number of personnel dedicated to conducting medical research in the Army is four times the size of all the other services combined. As a result of the Army’s commitment to medical research, the contribution of Army scientists has been tremendous. Nowhere have these contributions been more evident than during the decade and half of wars in Iraq and Afghanistan. However, my goal here is not to be a cheerleader for Army medical research, rather to note the Army’s commitment to medical research is the primary reason for the Army’s success. I am convinced that if the other services equally supported their services medical research efforts similar accomplishments would also be seen. The fact that the other services do not embrace medical research to the same extent as the Army means that the Army is and will remain a leader in this area.
Most leaders understand the value of good data in making decisions. Surprising to most is the fact that the biggest supporter of psychological health research is the operational leaders. That is the “trigger pullers ” support psychological health research much more than does most medical personnel, the exception being those medical personnel who actually served in combat arms units such as the brigade or division surgeons or those who served on brigade or division mental health staffs. Folks like Lieutenant Colonels Nadia West (now a major general), Christopher Warner (now a colonel), among many other division surgeons embraced behavioral health research and did their best to support it.
Over the years, I have experienced far too many times folks from the medical community, with little or no operational experience attempting to block or interfere with psychological health research, possessing the misguided belief that senior leaders would never support the “touchy, feely” studies that were being proposed or naively believing that research was a waste of effort and time. Obstacles which were easily overcome once the division or corps chief of staff was briefed on the research study .
In all my years of conducting research, I never encountered a chief of staff or general officer from the combat arms who didn’t enthusiastically support psychological health research, including Major Generals Casey, Abizaid, Campbell, Bell, and Petreus, all who went on to become four star generals. To be sure, psychological health research has also enjoyed continued and uninterrupted support of the Army Surgeon Generals, including Lieutenant Generals Blanck, Peake, Kiley, Schoomaker, and Horoho, whom I have gotten to know personally throughout my military career .
11.2 Conducting Your Wartime Mission in Peacetime
Army research psychologists have been deploying to conduct behavioral health care research for many years prior to 9/11. Research psychologists have deployed to Somalia, Haiti, Bosnia, Kosovo, and Kuwait, just to name the major ones. In addition, research psychologists have also conducted countless data collections in garrison and during training exercises. Thus, when it came time to conduct data collection missions during combat deployments they were ready. However, conducting data collection missions during peacekeeping or humanitarian deployments is very different than conducting data collection missions in a combat environment.
The data collections in Iraq would be the first ever psychological health research missions conducted during ongoing combat operations, yet built upon the sociological research conducted during World War II. This accomplishment cannot be overstated. It was only because of the field and deployed research experiences involving these other types of military operations that research psychologists were so hugely successful in conducting their research mission during combat operations .
11.3 Dying for a Data Point
Many opponents of conducting research in combat operations have stated that “no data point is so important that it is worth dying for.” Yet it is only by conducting such research studies can the health and wellbeing of the service be immediately improved. These critics seem to be saying, “Hey, let’s wait until the current conflict is over, and then conduct a series of lessons learned (usually using only anecdotal data) and then from these anecdotes decide how to fight the next war.” Thankfully this legacy approach to improving military medicine has been soundly rejected by most senior military leaders.

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