You Must Be Mad, Man

You Must Be Mad, Man

Humiliation, harassment and bullying was very much part of daily life within the Danish military. With full impunity, officers – commissioned as well as non-commissioned – terrorize the conscripted recruits, and whoever breaks down as a consequence is generally being written off as a mental health case and referred to inpatient ‘treatment’ at the Department of Defence’s Crisis and Catastrophe Clinic at Rigshospitalet in Copenhagen (the only state run hospital in the country). A perfectly healthy reaction to inhuman, sickening bullying will from this moment be seen, diagnosed (with life long consequences) and treated as the individual victim’s personal mental health problem. (Original Danish article)

‘What is that, soldier?’

‘It is a piece of dust, sergeant.’

‘Kill it!’

(The recruit kicks at it repeatedly)

‘It’s not dead yet. Continue!’

(The recruit continues)

‘Drown it!’

Peter, patient at the clinic (where I worked in 1988-89) tells how he thereafter was ordered to perform a mock funeral of this piece of dust he had just ‘killed’ – all accompanied by military salutes and presenting of (imagined) arms. Yes, you have understood it correctly, the ‘individual’ who had so brutally been murdered on order by a Danish officer was a piece of dust and the person who had been ordered to perform the ritual was, as a consequence, now a military psychiatric patient.

In civilian life this officer’s cleaning obsession would probably be seen as a severe form of neurotic behaviour, preventing a normal natural life. The sufferer would hopefully be offered psychological help and treatment. However, in the military world of 1992 (and twenty years later I have to fear that there is no reason to believe much has changed) it is the person who reacts mentally on being treated like that who will be considered to be in need of psychiatric treatment.

Experiences like the one described are the direct reason behind numerous admittances at the Defense Department military psychiatric clinic in Copenhagen. That is more or less how the background looks like in almost all cases of patients admitted there.

As most people would understand, this is not an isolated Danish problem but an international problem of massive magnitude, though, unfortunately, largely unrecognized, large ignored – or, if known, broadly accepted as ‘perfectly normal’.

From the earlier Soviet Union, from Iraq, Iran, Cambodia, Mozambique and other countries we have reports about how daily life as a conscripted soldier can be a true hell for hundreds of thousands of young men and half-grown boys. They try to escape, they desert, molest themselves or commit suicide – all of it in order to escape military duty. However, as far as it is known to me, Denmark is the only country that has established a specialist military psychiatric clinic and ward in order to deal with the mental consequences of this training.

In consequence of that it would be natural to believe that if a country has admitted that such serious problems exist, lessons would be learned and measures taken to prevent further damages to yet new generations of growing up men. Unfortunately, reality looks different: individuals continue to be offered ‘therapy’ but there is no sign of a critical look at why these young people end up as patients.

In 1988, due to fear of a military exercise, a nineteen-year-old recruit at the Jutland Dragoon Regiment last year persuaded a soldier comrade to help break his (own) arm. By doing so the soldier escaped the exercise, but on 13 June 1989 a [civilian] court sentenced him to 14 days in prison. Crime: self mutilation, destruction of public property.

No doubt, military-style discipline and justice, combined with humiliation, bullying, bad tone, harassment and degradation are the main reasons behind every admittance to the military psychiatric ward.

Growing up, young men – as their female counterparts – are taught to solve disputes in a peaceful and non violent way; they are encouraged to develop a critical and constructive mindset, ask questions and take initiatives. However, having learned that, from one day to another all these values all of a sudden are belittled, taunted and made useless.

‘You, fucking idiots, you better just forget all you ever learned out there in the civilian shit; from now you do what you are told and shut up. Halfwits!’

Yes, from now on the recruit is more or less reduced to being a number; in many cases he will lose every trace of self-esteem he might have had, and on top of that he will have to get used to being talked to and treated in a disdainful, (for a civilian) completely unacceptable way.

‘Do you have everything with you for the exercise, soldier?’

‘Yes, Sergeant, everything is there.’

The sergeant then pulls out all the content of his bag and strew it on the floor. Thereafter the soldier is shouted at in front of his comrades because he is now not ready to go. ‘You are Jutland’s biggest Idiot!!!’

Exposure to contradicting orders causes confusion, fear and insecurity in most any human being and, not surprisingly, this is a well known and often practiced military strategy used to break down the mental resistance of even the strongest individual. The method has numerous varieties but common to them all is that it leaves the victim completely defenseless.

When soldier’s personal bunk beds and lockers are inspected, something that could happen at anytime, night and day, the items – personal belongings as well as what is state property – will have to be found stored in a meticulously perfect way. Sometimes, literally, a ruler has to be used. However, even this order is up to the interpretation of the individual officer who happens to perform the inspection. If being inspected by one officer it has to look one way, if inspected by another in a slightly different way. As it will never be possible to know who is coming next, this is one of the favoured methods when it comes to creating fear and anxiety. The tiniest error, and all the clothes and other belongings will be pulled out of the locker and spread on the floor. Thereafter the soldier can start all over, piling them on the shelves in absolute perfect lines – and hope for leniency at the tormentors’ return.

The mentioned scenario is classic, but it can affect just any situation – anywhere and at anytime. Do never feel safe. As his unit was inspected before an exercise, Sören was found with a hair on his chin that had escaped the razor. He was sent back to remove it. On return he was told off, scolded for being late.

One can induce fear in humans by never letting them know what is permitted and, in case it sometimes is, when. Fear, anxiety and uncertainty will also be the result in a young person if he is being ridiculed and laughed at in front of his comrades.

Often the whole unit is being used to bully an individual. Most common here is to order everybody to boo whoever has made the tiniest mistake. A worse variety of such strategy is the concept ‘this week’s pig’. That is a title that is used by some of the instructors and also here there are small variations in practice. At one site it is being done this way: if something is not perfectly in order the soldier in question is being ticked of in a special book. The one who has most ticking offs at the end of the week will then be awarded this title and exposed as a ‘pig’ for the week to come. In order for his new status to be clearly visible a special sign is hung on his dormer bed, and another of cloth is to be worn on his shoulder straps. These things are not to be ascribed to immature junior officers. There is a clear consent all the way up in the system. If it wasn’t, this kind of bullying could not continue to happen.

Every year, around 7,000 young Danish men start conscripted military service. Of these, around two to three percent are subsequently rejected on mental health grounds, and, before that happens, they have almost all been patients at Rikshospitalet.

The military psychiatric clinic has two functions: first, it is there to offer treatment and therapy to military personnel suffering from a crisis or mental disorder; second, it assesses soldiers [mental] ability to serve. Only in exceptionally rare cases we are here talking about other military personnel than conscripts. During my time at the clinic I did not experience one single such case.

An admission lasts normally between ten and fourteen days and will be followed by the issuing of a written psychiatric assessment. This assessment will be the main document on which a military commission, that meet every Wednesday in order to evaluate individual conscripts ability to continue their service, will base their decision.

Only in very few cases patients with real psychiatric conditions are admitted on the ward. The estimate is that this is the case in only two or three cases on an annual basis. Patients who suffer from a mental crises due to a catastrophic experience are also rare. In my time at the clinic I did not experience any of these kind of patients. However, I experienced so many more of another category: the victim of state sanctioned bullying.

The typical patient at this clinic is not difficult to describe. There is a clear majority of young men with only basic schooling. The number of young men who have been subjects to special support at school are over represented among the clientele, as are those with no vocational training and who are unemployed. Research has also shown that that the group has a significantly bigger use of alcohol and hashish than other youths and that this use has been accelerated during the military service.

Many of these young men have volunteered for military service, often because of unemployment but also in the hope that military training and life would stabilize their personal life. [Due to diminished need for conscripts – because of reductions due to the end of the Cold War – the conscripted soldiers are now to a large degree economic volunteers. Therefore, this is increasingly the fate of those who for whatever reason have failed in school. As they ‘volunteer’, others no longer need to be exposed to the harassment.] It didn’t do that. Instead, after only a brief time in service, these young men have developed psychological and psychosomatic symptoms: anxiety attacks at night, depression, continuing diarrhea, worsening irritability, sleep disturbances, and interrupted sleep where they wake up drenched in sweat. Suicidal thoughts are common. Some have tried to kill themselves or have performed self-molestation. Typically, they are now extremely nervous, and present often at admittance with high blood pressure. This condition is normally stabilized the day after, or as soon as the patient realizes that he here is treated as a human being.

Tom, who had been arrested at numerous occasions after absenting himself had repeatedly molested his own body in order to escape service – typically he had on purpose sprained his foot to make himself unable to serve. Another young man, Tom, couldn’t stand the thought of having to shoot at goals depicting human beings and had turned the aggression on himself instead. Kenneth had seen no other way out of his hell than to cut his wrist with a kitchen knife. Other young people react with outward aggression and often it happens that their girlfriends have become the victim of violence.

Mental suffering caused by military service is not only a problem for a minority group. A survey at one garrison of all conscripted recruits has revealed chocking though not surprising results. When filling in anonymous questionnaires, over half of young men admitted to being excessively irritable and suffering from frequent bouts of headache. One third of the men taking part in the survey claimed they regularly felt heart palpitations and stomach pain, showing itself in nausea, loose and frequent bowel movements and an excessive need to urinate. Half of those surveyed felt like smashing it all and twelve percent said that they had actually done so in one way or another. Close to half of the young people surveyed felt that ‘everything was meaningless’.

Patients at Rigshospitalet tell about experience one would refuse to believe were true had the stories not been so consistent. As a conscripted soldier myself I have been called ‘rat’ and other less flattering words, and it was all fully legal and sanctioned by the state (in this case the Swedish). These experiences have taught me that all this is fully accepted by decision makers in society. Nobody cares about the result of the state sanctioned harassment. The following examples are all from my time at the military psychiatric clinic.

Right from the start, one of nineteen-year-old Mikkel’s fellow recruits had been appointed scapegoat of the unit. After this young man had broken down (and sent to Rikshospitalet) a replacement was found. Now it was Mikkel’s turn. From now on he was blamed for just anything that went wrong. He was reproached for things out of his control and he was told off and humiliated for every little short coming of his own. It seemed, no matter what he did, it was wrong. Mikkel started to absent himself from service, which led to arrests and military detention on three occasions. A stay in one of those cells meant a day in complete seclusion with nothing to divert oneself with, no reading, no radio, nothing – allegedly, so it is being defended, because of the risk the prisoner might commit suicide. The cell was in a traditional way furnished by a (in daytime) folded up bed, a wooden chair and a small table. However, little effect had that had on the young man. As he said, he only feared being brought back to the unit.

A unit had gathered at the exercise yard for the day’s duties. Soon after it starts to rain. Some of the soldiers react naturally by starting to take on their rain-gear. The sergeant screams at them and they are ordered to pack it back down. It continues to rain, they are soon all soaked, and now, after half an hour, the order comes: rain-gear on!

Only the individual officers’ own ability to invent and create sets a limit to what kind of harassment the victims will be exposed to, but it all contributes to the destruction of a sound and mentally healthy human being and it creates (often life long) anger and aggression. There are not many who would remain unaffected of being repeatedly told that ‘your mother is a fucking whore, your father a fucking fag and your sister a drug addict. Or, how about ‘if you had only ended up as a stain on the bed sheet instead [of being born]’ being shouted at a vulnerable adolescent youngster?

In his coming-up short lunch brake, Per was ordered to present his bunk bed and locker for inspection (see above for additional harassment). Reason for depriving him of his lunch? He had defended a comrade who had been called ‘a fucking feminine fag’. At another occasion, he was ordered to blacken the soles (sic.) on his boots after he had meticulously cleaned the floor. He was then ordered to put them back on and walk on the floor, and act that was then followed by a dressing-down for idiotic behaviour. Per suffered from an aching tummy and run constantly to the toilet.

When arriving to the clinic the young people in most cases are extremely worried, nervous and scared. They fear for what they are now facing. This is hardly surprising as within the military the ward is commonly referred to as bedlam, the cuckoo nest, or plainly as the madhouse – the place where you will end up among the other lunatics if you cannot tolerate the discipline and adapt.

In many cases the new patient has spent the previous days or weeks on the run after absenting themselves. They can have been arrested by the military police or they might have been through the regular detention system. In quite a few cases those from the latter category would speak about those days as a relieve; at last they were safe. In there their tormentors couldn’t reach them.

A late evening, twenty-year-old Johnny telephones the ward. Again he has absented himself from his unit; he is terrified for what is going to happen. One of his comrades have been helped to get out of the military by the military psychiatric clinic, he tells me. It is now Johnny’s hope that we could do the same for himself. ‘Please, let me come. What if the military police finds me? I am so scared.’

The day after, a local jailor in a small Jutland town is on the phone. To him Johnny had said that he, at the time he was arrested, had been on his way to look for help in Copenhagen. This was confirmed by a ticket with reservation for the night train that the police had found on him. For Johnny, a friendly (civilian) jailor had become an interim source of security and comfort. This young man was in the end helped to escape from his harassers with the help of the psychiatric ward. It cost him a psychiatric diagnosis, but at the time he was more than happy to pay that price.

Each new patient at the ward will be followed by an assessment of his personality written by his commander. Typical expressions in these documents are: ‘the soldier reacts with defeatism when subject to mental and physical exertion’; ‘the soldier is destructive of the troop morale,’ and ‘the soldier cries when under pressure’.

After being admitted, the new patient will go through a procedure that we could call standard. The patient will now be treated by doctors, nurses and occupational therapists. The program consist of group meeting, painting groups, excursions, cooking and baking and individual talks with the doctor whose job it is to write the assessment on which the rejection is to be based.  As the patients psychosomatic symptoms almost always disappear almost immediately after the reason for them has been removed (the military environment) these people must be seen as the most easily to offer therapy. However, this is only if we forget for a little while the longterm deeper mental damages which will remain, and which will be extremely difficult to get rid of.

If the patient wishes to be rejected from further service, which is the case in almost every case, the decision about that will be taken at the above mentioned meeting of a special military board that converges every Wednesday. An individual case will normally be presented after around 14 days at the ward. During my year at the ward I only experienced one person whose intention it was to go back to duty and who fought hard to achieve that. This person was mentally ill. In all other cases, the whole idea with the admittance was to achieve rejection from further service.

In order for that to happen a psychiatric diagnosis is required. Normally one of the following WHO classified diagnosis’s will be used: 301 80 or 793 01. The first stands for a personality disorder in the category ‘immaturity’. The number 793 regards the group ‘cases under observation’ and 01 refers to ‘currently not mentally abnormal’. This is equivalent to say that the person (can) have been abnormal at an earlier point (the obvious reason for him having been admitted to a psychiatric ward) and could become so again. These two diagnosis and ‘adjustment difficulties’ are practically the only possibility for the (civilian) doctor to help a human being in need.

All this can have serious permanent effects on the individuals future. Today it is requested that if a person is applying for a career within the police forces, or if he wants to become a fire fighter or driver of a local bus in the capital, he has to have served as a conscripted soldier or, at least, he must have been declared suitable for such service. Also an application for a career as a civil servant, no matter what level, would request that the history as a soldier is fully declared. Any earlier psychiatric crisis can make it difficult or impossible to achieve such position. Also, any insurance company will ask for the same information before accepting an application for a life insurance. An earlier crisis can have the result that insurance is refused or that special conditions are being introduced – such as increased premium and loss of right to a holiday with payment during illness. In that case the consequences for having been admitted at the crisis ward can be life long.

How can it be that we as public health workers do not react when there is such an obvious connection between cause and suffering? Is it because we have an easy and comfortable job that we are eager to keep? After, all, with a stroke of the pen, the clinic could be made obsolete and in no need for. If people knew what goes on and if the political will was there, it would all end. In other words: speak up and lose your safe job.

‘It is not difficult to be a nurse when the patients are well’, a colleague once uttered. Another expressed that she felt nausea knowing that we were giving ‘therapy’ to people who had just reacted in a perfectly normal way. Alright, who is sick then? Is it the individual young man who adapts himself to a training where the teaching is concentrated on killing and maiming and the methods to a large degree consist of harassment? Oh, no, he is considered mentally sound and healthy while the person whose body and mind react is in need of therapy.

A specialist in children psychiatry recently expressed it this way when he talked about modern children and their situation: ‘it is the boys who are underprivileged and who draw the shortest straw; it is the boys for whom there is no place and who are being expelled. It is the small boys who are not mature enough to start school and who, because they never got a chance from the start, ends up in need of special-need education or loose out altogether.

It is very likely that it is the slightly older version of these boys who one day will end up fitting the description of the military clinic’s typical patient. This is how they are officially described: ‘[they are] patients who because of their character constellation and social background have developed a type of personality that leads to problems with adaptation in various contexts which then can lead to a crisis with psychosomatic symptoms.’

I am disappointed that health personnel have chosen to close their eyes for the obvious causes behind this suffering and I am disappointed that the same people this way put the blame on the individual victim and on his social background.

Normally we do not accept violence in society. Murder is seen as the most severe of crimes. To kick somebody else’s private parts in order to finish him off – on top of that while he is laying down, and only to save bullets – could easily end up on first pages in the news and would and should be seen as a disgusting act of savagery. Many years after it happened to myself, I still feel ashamed. How could it be that I, as a conscripted soldier, did not flatly refuse to practice on a dummy this horrible and utterly repulsive technic? Isn’t it remarkable how so many of society’s normal rules about what is right and wrong make a complete U-turn as soon as somebody is ‘asked’ to pull on the uniform. And isn’t it remarkable that the one who still thinks as a civilian, he is now a ‘nut case’?

Health personnel have a duty to whistle-blow when they come across unacceptable conditions which causes human suffering. It is not enough just to help the individual victim. Dansk Sygeplejeråd [the Danish Council of Nursing] has declared that they at any time will stand up for peace and human rights [this includes §5 of the UN Declaration of Human Rights], but we need to see action.

As professionals we have to see ourselves in a greater perspective. I am sure the problems are even greater elsewhere, but in order to be allowed to express our opinion about other countries and to be taken seriously we will have to sweep in front of our own door first. It can be very good with good intentions and declarations but in reality it is activity that counts. Or? Maybe it is just too bad to break one’s own arm in order to escape practicing killing?

Lars G Petersson, Sygeplejersken  1992