Military Psychiatrists Draw on Past Experiences After Pentagon Attack

Many psychiatrists who rushed to help after the recent terrorist attacks had their first experience coping with the psychological fallout of a major disaster. But members of the Society of Uniformed Services Psychiatrists (SUSP), a district branch of APA, were able to apply years of experience and training to what appeared to most of the world to be an unprecedented situation.

Lt. Col. Elspeth Cameron Ritchie, SUSP’s public affairs representative, said, “The branch was formed because our roles as practicing psychiatrists are somewhat different from those of other psychiatrists.”

SUSP includes members from all branches of the military. They share information and support each other but work within their respective commands, rather than undertaking discrete projects as an organization.

APA President Richard Harding, M.D., thinks the discipline and expertise of its members should not remain unheralded. He said, “They did it right. They responded to many needs simultaneously—reaching out to the victims’ families, finding ways to assist military command in a national response, and organizing outreach activities, which will identify people who need services in the future.” He added, “I am always impressed with the high level of the quality of individual psychiatrists. And, in this situation, our members were working under extraordinary pressure.”

Col. Ann Norwood, associate chair of the department of psychiatry of the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Md., and chair of APA’s Committee on Psychiatric Dimensions of Disasters, said, “The military already has systems in place to deal with disasters. We have a corporate memory.”

Robert Ursano, M.D., chair of the department of psychiatry at the USUHS and a committee member, said, “The attack on the Pentagon left many without their friends, their mothers, their fathers, and their hopes for the future. The deaths and injury were great for a community of 24,000 people.”

Ritchie, who is program director for Mental Health Policy and Women’s Issues in the Department of Defense (DOD), was in a good position to observe the deployment of mental health resources from all military branches and to help spot gaps in service, so that additional resources could be deployed.

She said, “Many of us had known each other for 10 years or more. We had worked together in other disasters such as Somalia. The familiarity with each other and with disaster psychiatry greatly affected our effectiveness.”

The initial response was enhanced by the presence of the Stress Management Augmentation Response Team (SMART) from Walter Reed Army Medical Center in Washington, D.C., whose members had several years of training together to offer a multidisciplinary approach to stress management. SUSP member Lt. Col. Stephen Cozza, chief of the department of psychiatry at Walter Reed, had overall responsibility for SMART and other mental health teams that went to the Pentagon.

Maj. David Benedek, chief of forensic psychiatry at Walter Reed, quickly responded when Cozza asked for volunteers to supplement SMART’s activities. Benedek, who is SUSP’s president, said, “Our team arrived on the 13th. Initially, we were assigned to help with the civilian and military personnel, such as those removing bodies, who were still dealing with the immediate impact of the attack. We went from tent to tent outside the Pentagon, offering our services to the various organizations involved.”

Ritchie added, “Many of those who went into the smoking building to remove debris and body parts were young soldiers, many from the Old Guard, which is stationed at Ft. Myers.”

In the second week after the attack, the team moved into the Pentagon itself, going from office to office to make employees understand the availability of mental health services. Benedek said, “We offered crisis intervention stress debriefings and also provided one-to-one support. We tried to help create an environment in which people were able to talk to each other and to understand that they could express their feelings.”

Ritchie said, “Simultaneously with the deployment of SMART and other mental health teams sent by the Army, Capt. Thomas A. Grieger, M.D., director of residency training for the National Capital Area Psychiatry Training Program, led the Special Psychiatric Rapid Intervention Team at the Navy Annex, which is next to the Pentagon. The people in the Navy Annex heard the airplane, the boom, and felt the vibrations as the plane passed over their building and into the neighboring Pentagon. Many also saw the impact and knew they had lost friends.”

SUSP member Lt. Cmdr. John Kennedy, a psychiatrist at the Naval Medical Center, also worked at the Navy Annex.

Col. William Huleatt, chief of social work at Walter Reed, led the effort to establish the DOD Family Support Center at the Sheraton Hotel in Crystal City, Va., near the Pentagon. Family members of victims were offered a central location to receive information and various counseling services.

SUSP member Ryo Chun, M.D., chief of child and adolescent psychiatry at Walter Reed, said, “We received a call on the third day after the center had been set up and immediately sent staff who are trained in child psychiatry. For the first three weeks after the event, we had three staff members available every day to provide help about enabling children to cope and other kinds of issues. In order to encourage use of the services, we did not open files on people whom we counseled, so there are no paper trails.”

SUSP members Maj. Nancy Black, program director of the Child Psychiatry Fellowship Program, and Lt. Cmdr. Lisa McCurry, M.D., a child and adolescent psychiatrist at Walter Reed, both worked at the center.

McCurry was with the families when they were first allowed to go to the Pentagon. “The area had been closed, but on September 15, a Saturday night, seven busloads of family members were taken from the Sheraton to the Pentagon to see the site for the first time since the crash. Family members brought items to create a memorial.”

SUSP member Capt. Michael Dinneen, chair of the department of psychiatry at the National Naval Medical Center, coordinated efforts on the USNS Comfort that provided support to disaster workers in New York City. The ship was able to pull up close to the World Trade Center site and offer workers hot food, showers, and counseling.

Lt. Cmdr. Charles Milliken was the project officer for Operation Solace, the ongoing effort to provide outreach to persons in need of mental health services. Col. David Orman, psychiatry consultant to the Army Surgeon General, Lt. Cmdr. Charles Hoge, chief of the department of psychiatry at Walter Reed Army Institute of Research, and Lt. Cmdr Charles Engel, director of the DOD Deployment Health Clinical Center at Walter Reed Army Medical Center, worked to develop the plan for mental health services.

Related information can be found on the Web sites of the U.S. Army Medical Research Institute of Chemical Defense at chemdef.apgea.army.mil/textbook/contents.asp, Center for Civilian Biodefense Studies at www.hopkins-biodefense.org/, and the U.S. Army Medical Research Institute for Infectious Disease at www.usamriid.army.mil. ▪