My
opinion piece for The Quint on the ‘World Suicide Prevention Day’:
Ironically, one of the strongest
organisations of our nation, our pride- the Indian Army, is downright timid in
certain respects. I say so since this sturdy and powerful establishment has not
had the moral courage to admit its deteriorating physical and psychological
profile over the years, perhaps in order to maintain a certain kind of image in
the public, but for what? And with what consequence?
The inherent stress and strain of military
life is universally recognized and we have discussed it here at The Quint before. India is no different. The rigours
of military duty coupled with distance from one’s family takes a toll on the
health of troops, thereby exploding the myth that defence personnel enjoy a
better health profile than civilians. Closer home, studies show that military
personnel die a decade earlier than civilian employees but then such studies
are kept dormant and are not put in the spotlight as they should be. But it
seems that the focus is more on brushing this aside and delinking it from
military service and blaming ‘domestic reasons’ rather than admitting that
stress and strain of service is taking a toll on the health of uniformed
personnel and also leading to a rising rate of Post Traumatic Stress Disorder
(PTSD) and suicides. Of course, this is intertwined with even the rising rate
and aggravation of physical diseases since the thread of stress and pressures
of military service commonly runs across.
It goes without saying that the
Indian society has failed its soldiers. When a soldier is away on military duty,
his or her mind is not at ease. The mind wanders. The mind is where the family
is, the mind is where the local goon is troubling the parents, the mind is
where the children are struggling for admissions, the mind is where the
property is usurped by the neighbour but the administration or police do not
give a damn. But then all these are ‘domestic reasons’ for the Army, not
realizing that the stress which emanates is a direct result of military service
since the person cannot be there to handle domestic commitments like his
civilian peers. To put it bluntly, these problems would not have emerged had
the person not been in military service- a situation which even the Defence
Minister of the country understands when he writes to State Chief Ministers
elaborating that “frustration arising out of inability to resolve domestic
issues is a major contributing factor to stress”. Still however, at times
the Army’s medical boards or even finance and accounts officers sitting in
their air conditioned offices declare them ‘domestic reasons’ thereby washing the system’s hands off and also denying
such soldiers their disability benefits, a grim reality discussed in detail in
Paragraph 2.2.1 of the Raksha Mantri’s Committee of Experts of which this author too was a
member. The British were better since even in the 1930s, they considered
behavioural and psychiatric disorders in the Indian uniformed forces, including
suicides under certain circumstances linked with service conditions, a stipulation
which exists in the rule book even today but is very conveniently ignored by
the system.
Whatever be the rate of suicide and
such problems in the Army as per our perception- high or low, it’s a problem
the existence of which needs to be accepted. The situation cannot be salvaged
merely by steps such as meditation and yoga and liberalized leave policy or by
training General Duty Soldiers in counselling. The situation can only be
addressed if there is ample confidence in the men and women in uniform that the
civil administration would be responsive back home when the family needs them,
the problem would only be controlled if within the system there is reasonable
catharsis and vent to the grievances of soldiers through more interaction
between seniors and juniors rather than the hackneyed ‘statutory’ and ‘non
statutory’ complaints which are seldom decided in time or with due application
of mind. The problem would only be sufficiently taken care of when it is
admitted that this indeed is an issue that stares us in the face.
Other modern Armies are doing much
better and taking it head on. Soldiers are trained to recognize symptoms such
as emotional outbursts, avoidance of interaction and other unusual behaviour.
It is being imbibed that seeking help is not a sign of weakness. The US Army
has embedded more than 60 behavioural health teams in operational military
establishments consisting of psychologists, psychiatrists and social workers.
In our country, while the Army incorrectly
thinks that their regular soldiers imparted training on counselling or
psychiatrists of the Army Medical Corps can handle it, it is the Indo Tibetan
Police Force (ITBP) which has shown the way and taken the apt progressive step
by recruiting Education and Stress Counsellors, a specialized cadre at lower
ranks specifically meant for the purpose of handling stress. Moreover, the job
of identifying and addressing these issues is that of Clinical Psychologists
and professional Counsellors, not of Psychiatrists. So if a person repeatedly
‘wanders out’ of the unit in a dazed state or displays irritable or erratic
behaviour with his peers or seniors or suddenly starts indulging in binge
drinking, the answer to it may not be a ham-handed ‘red ink entry’ or
disciplinary action or throwing him out of service, but adequate care to
understand the root cause.
To sum up, the following steps are the
need of the day in order to contain the concerns of the rising behavioural and psychiatric disorders in the uniformed services:
A. Inculcating the moral courage of
admitting the deteriorating health profile due to rising stress and strain in
the forces which primarily emanates from a highly regimented lifestyle and time
away from the family coupled with the demanding nature of the job. It must be realised
that admitting the problem is not a sign of weakness.
B. Ensuring that such disorders are not
blamed just upon ‘domestic reasons’ and the organisation takes full
responsibility since mostly there is a direct or indirect link with military
service. Moreover, transgressions by soldiers due to behavioural disorders or
irregular behavioural patterns should not be dealt with by way of punishments
but through counselling or medical care.
C. The States should be made to
understand the gravity of the situation and district administrations be made
aware of the fallout of not addressing complaints and representations of soldiers.
D. Redressal of grievances should be
realistic in the Armed Forces and not merely a formality through the system of formal
complaints that are not decided in time or which are not satisfactorily
addressed. There should be more interaction between senior and junior ranks so
as to allow catharsis and vent to ease troops’ pent up emotions. Electronic
forums introduced by the Indian Air Force and the Army’s Western Command are
good examples of encouraging such interaction.
E. Focus should be on counselling and
clinical psychology and not on psychiatry alone. Not all such functions can be
performed by psychiatrists who are medical professionals and not trained to
handle these issues. Professional Counsellors at Non Commissioned Officer (NCO)
level must be inducted on lines of the ITBP in all uniformed services and
embedded in operational units or formations.
We must realise that the tough looking soldier standing guard
for us is as much human as any other person on the street. He or she is
extraordinary in bravery but very ordinary in other human attributes- has the
same family, the same feelings, the same emotions and the same problems as all
of us and of course the same flesh and blood. It would therefore be a travesty
if the response of the society or the establishment is not commensurate with
his or her impeccable service.
4 comments:
dear major sir,
every article of you is having some new and valuable things to be followed and adopted in army. even civil authorities are having some significant guidelines to deal their employees for creating conducive atmosphere in the work culture, junior and senior proximity brotherly affection must be there to some extent in resolving domestic problem. punishment is the last resort not the first one, once awarded soldier become so ferocious he tends to commit more crimes firstly officers must understand what to do
Unfortunately, anyone diagnosed with any psychiatric disorder will immediately get thrown out from the career ladder. That is why soldiers do not approach psychiatrists even when under great stress or depression. In many cases senior officers have raised AFMS 10 on officers who were even little bit eccentric or stubborn or were found to be under stress. This immediately lables them Pscho patients and that will be end of his career.
Defence personnel pay a heavy price for not being available to their children during their formative years. Most of the bonding between parents and children takes place during the very initial stages of growth of the child as a result of physical touch. That is the time many fathers are not available to their children. various activities in Peace stations have encroached upon private space so much so that personnel prefer a field station rather than a peace station because of various commitments.
If a comparative study is undertaken I believe that due to lack of continuous quality time there would be many non-tangible losses which cannot be made up.
According to the National Institute of Mental Health, Major Depressive Disorder is the leading cause of disability in the US (among ages 15-44) and it is estimated that about 6.7% of the US adult population is affected by Major Depressive Disorder in a given year. While depression may not always commonly be associated with the military population, in the 2011 Survey of Health Related Behaviors among Active Duty Military Personnel (2013), 9.6% of Service Members reported high levels of depression. Even though firm figures are not public in our Armed Forces, the figures may not be quite different from the US statistics. Fortunately, depression is a treatable disorder. Cognitive Behavioral Therapy (CBT) is an empirically-validated psychotherapy that is recommended as a first-line treatment for depression in the VA/DoD Clinical Practice Guideline for Management of Depressive Disorder (2009). CBT is a structured, short-term, present-oriented approach to psychotherapy that helps patients modify unhelpful patterns of thinking and behavior in order to resolve current problems. All commanders at every level must be educated in recognizing this disorder and give psychotherapy at unit level (unit gurdwaras and unit mandirs under the religious teachers) and the field hospitals. Normally if somebody is sent to hospital on form AFMS 10, it is considered as a (social) stigma on the individual and the unit which the individual and the unit commanders must overcome.
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