Military Psychology History

Overview of Military Psychology

Psychological Testing and other wars

Fitness-for-Duty Evaluations

• Fitness-for-Duty evaluations can arise from one of three sources: Self-referral, referral from other medical providers, and command referral.
• Service member rarely presents to a mental health provider as a first response in coping with psychological problems. Friends, family members, and sometimes chaplains are the first line resources for emotional support.
• Service member come to a mental health clinic because they present with problems that significantly affect quality of life.
• The military psychologist need to determine whether the decline in functioning has reached a level at which the service member can no longer adequately perform his or her assigned military duties.
• To determine whether the service member can adequately perform his or her assigned duties, the military psychologist must first understand what the individual's job responsibilities involve.
• The process for assessing a service member's fitness for duty requires a comprehensive evaluation. The primary instruments for this evaluation are the clinical interview and a review of pertinent history and collateral information.
• Military psychologists will also review the member's service and medical records and obtain a history from his or her collateral sources.
• There is a process of getting information for psychological evaluation. Review medical record, contact supervisors in the chain of command, and contact family members.
• Some service members are reluctant to allow their mental health provider to contact family, friends, and or chain of command. This is because of the stigmatization of mental health.
• If the psychologist finds that the individual is unable to adequately perform assigned duties, the psychologist must determine whether a course of treatment is likely to return the individual to full-duty status within a reasonable period.
• The limited duty board (LIMDU), also referred to as temporary limited duty. The LIMDU is determined by the actions of the Medical Evaluation Board (MEB).

• Referrals to the PEB can only come from two sources: LIMDU reports submitted by the service headquarters for PEB evaluation and MEB reports.
• Each branch of service has its own specific guidelines for fitness-for-duty evaluations.
• An informal PEB screens all new cases and performs the initial disability evaluation based on a documentary review.
• Formal PEB the case is examined. The member will have the opportunity to meet with the board and present additional material to support his or her position and may be represented by counsel.
• The case will be decided on the basis of new evidence in addition to previously documented evidence.
• A PEB will not consider a case if the member is being processed for misconduct that may result in punitive discharge.
• if the member is discharged for misconduct, the PEB's actions will be filed in the member's medical records and the PEB process will be terminated.
• Certain diagnoses lead to an administrative separation rather than a PEB process. These include personality disorders, learning disorders, ADHD, and borderline intellectual functioning.
• The ASVAB and other entry-level screening tools appear to be adequate methods of avoiding such cases.

Competency Evaluations

Mental Health Evaluations in a Combat Environment

Discussion Questions

By: Marlene G. Rivera Rodriguez

The Korean War

• The Korean war was the genesis for psychologist. They served in new positions in overseas, in combat zones, and on hospitals ships.
• The Korean war is known for the significant use of torture and brainwashing.
• The U.S. troops were exposed to forced marches, serve malnutrition, inhumane treatment, and continuous propaganda of reeducation on communism.
• Korean conflict are credited for the inception of the Survival, Evasion, Resistance, and Escape (SERE).
• Treating combat stress was forgotten because of the abrupt start of the conflict and the lack of prepared support units.
• Psychologists role in testing did not diminished during the Korean war.
• David Wechsler and Paul Meehl created instruments to select individuals for specif jobs and officer programs continued to be developed.
• After the Korean war, the Army began to devote significant resources to the study of motivation, leadership, morale, and psychological warfare.
• The goal was to increase the performance of military personnel and to increased research in human factors engineering.

You will Learn...

• Early History Of U.S. Military Psychology
• Assessments done (testing when did it start?)
• Recent developments between or among wars
• Determining Fitness-For-Duty
• Who is MEB?
• Who is PEB?
• Command-Directed Evaluations
• Emergency Fitness-For-Duty Evaluations
• What is MEPS?
• Different Screenings
• Mental Health Evaluation in Combat

Early History Of U.S. Military Psychology

WWII-Psychological testing

• The revolutionary war (1775 –1783)- First U.S psychological operations campaign. "Seven dollars a month, fresh provisions and in plenty, Freedom, ease, affluence and a good farm... one would receive three pence a day, rotten salt pork, the scurvy, and slavery, beggary, and want."
• Since then, psychological operations and propaganda in the U.S military have evolved to highly organized endeavors since World War II.
• The U.S. Civil War (1861-1865)-The first to address the effects of combat and war on servicemen and first documentation of substance use problems related to combat.
• World War I (1914 –1918)- Official birth of military psychology in the U.S.
• On April 1917, Robert Yerkes (Head of APA), determined how the American Psychological Association (APA) could help the war efforts. Yerkes commissioned a psychologist as a major in the Army; then, in 1918, 13 officers were commission to work on Division Of Psychology.
• World War II (1939 –1945)- APA underwent significant reorganization with the American for Applied Psychology (AAAP). Division 19 was created.
• WWII worked with all the branches of the Military.

WWII Psychological Testing continued...

The Vietnam War

• In 1943 the Army began using the Minnesota Multiphasic Personality Inventory.
• Increase testing became a problem for who had combat fatigue (Combat stress).
• Between 1943-1945 409,887 U.S. servicemen were hospitalized for cobat fatigue in overseas Army hospitals.
• The War Office Selection Board (WOSB)- more comprehensive testing was involved.
• Hulett (1941)- He reviewed malinger's attitudes in the military to avoid military services.
• Campbell (1943)- He noted that malingerers had psychopathic personalities.
• During WWII, the top 5 metal health diagnostic categories were: neurosis, personality disorders, alcoholism, epilepsy, and insanity.
• These diagnostic categories were a significant impetus for the development of the DSM- 1952
• Head injury rehabilitation reemerged on a large scale as gaining recognition to neuropsychology.
• Aviation Psychology continued to evolved during WWII and helped with the development of the U.S. Air Force.
• In 1947 the Air Force became separated branch of the military and industrial psychology emerged.
• Perception Testing was offered by the Air Ministry psychologist (British). This test was used to assess skills in making final approach and landing air craft.

• Across all three British services, psychologists were involved in the design and interpretation of variety of questionnaires and interviews, WWII was known for service bombers.
• WWII the field of aviation psychology grew drastically affecting practices of civilian airlines and creating new roles for aviation psychologist. Implementation of Assessments.
• WWII- the only war were the first nuclear weapons were used and survivors developed both acute and chronic psychological reactions. Such as: PTSD.
• In the U.S, military psychologist were assigned to hospitals.
• 1946- The first psychology internship programs were established. It enrolled 200 interns, not only as researchers and experts in assessments, but as mental health providers.
• In 1947 military psychologists obtained permanent active-duty status. Two years after, the first military clinical psychology internship programs were established in the Army. The location was Walter Reed General Hospital, in Washington D.C.

• After the Korean war, the U.S. Air Force implemented the Airman Qualifying Examination in 1958 for administration to high school students.
• In 1968, the Army and Navy developed the Armed Services Vocational Aptitude Battery (ASVAB).
• The ASVAB has become an instrument for screening and an aptitude tool for military recruits.
• In the Vietnam War there was an extraordinary amount of substance abuse.
• Also, a higher proportion of character disorders were diagnosed during the war.
• The Vietnamese army also implemented psychiatric services.
• Vietnam was a significantly complex. The psychological impact of all these factors is hypothesized to have resulted in high rates of PTSD. (Many surviving veterans still suffer symptoms).
• Following Vietnam, the military recognized the need for a formal response to noncombat critical incidents, such as death in training accidents and suicide.

Operations Desert Shield and Desert Storm and Peacekeeping Operations

WORLD WAR II

• Military personnel in Operations Desert Shield and Desert Storm faced many combat stressors.
• The Persian Gulf War, for the first time a psychologists was deployed on a Navy aircraft carrier.
• Despite good mental health support, Gulf War syndrome or Gulf War illness, an ambiguous conglomeration of physical and psychological symptoms were unique in the Persian Gulf War.
• The Gulf war syndrome was hypothesized to originate from vaccinations, exposure to toxic substances, and psychological trauma.
• Peacekeeping missions utilized stress control since 1992 by the Operation Restore Hope in Somalia. This made most peacekeepers live in unhygienic conditions, unfriendly populace, and being separated from families.
• Operation Uphold Democracy in Haiti was significant stress among U.S. troops including three suicides in the first 30 days of the mission.
• Operation Joint Endeavor in Bosnia saw an unprecedented number of military mental health professionals on hand for suicide prevention, stress management, and clinical care.
• Other advances in military psychology and in psychology is that psychologists have also treated enemy combatant through the Global War on Terror, in the detention center in Guantanamo Bay.
• In 1994 the inception of prescription privileges. In 2005 the first psychopharmacology fellowship was established at the Tripler Army Medical Center in Hawaii.
• The role of military psychology id to focus on prevention, interventions that involve the individual's chain of command.

• WWII worked with the departments as the National Research Council, Psychological Warfare Services, the Veterans Administration (VA), and The Department of Commerce.
• Boring (1945)- published a comprehensive text on the application of psychology to the military.
• Psychology in the Military enhanced performance and developed psychological informed leaderships abilities during the war.
• The Office of Strategic Services (OSS) now the Central Intelligence Agency (CIA)- was developed along with the first psychological selection program for individuals seeking positions as OSS operatives. (e.g. espionage, counterespionage and propaganda). Modeled the selection procedures used by German Military.
• Skinner and Griffin helped to shape the field of psychology.
• Screening for military services was improved and in 1940 the Army General Classification Test (AGCT).
• After WWII uniform aptitude testing in the military was mandated by the Selective Service Act of 1948.
• 1950 the Armed Forces Qualification Test (AFQT) was used by every serviced brand for screening procedures and instruments
• WWII increased Personality testing

Assessment/Psychological testing

• WWI was an impact to APA and psychological testing.
• The Army alpha- intelligence test which later evolved into the Wechsler-Bellevue Scale then into the Wechsler Adult Intelligence Scale.
• Intelligence Testing 1918- let lewis Terman to emphasize the need for standardized psychological testing.
• The Woodworth Personality Data Sheet- The model for subsequent personality assessment.
• WWI marked the creation of the Specialty of neurosurgery for men who had head Injuries. Created hospitals for Rehabilitation, but it was closed/unsuccessful.
• Aviation psychology was born in WWI- psychological screening of pilots
• Military psychologist role in the UK not only filled as clinicians, but as soldiers/commanders. The U.S will engage in this double role in the Korean war.
• The first intervention for combat stress or Shell-shock
• WWI was the first to use chemicals as war weapons. The "Gas hysteria."

Conducting a Fitness-for-Duty evaluations

Medical Evaluation Board (MEB)

• According to the Department of Defense (DoD), service members must be referred to an MEB if his or her medical condition has prevented return to full duty for 12 months.
• A licensed psychologist, psychiatrist or doctorate level social worker can submit a narrative report.
• MEBs are conducted by the commander of the facility. MEB consist of two officers of any medical specialty (rarely a psychiatrist is in one of those specialties).
• The MEB does not make the final determination of fitness for duty. This is determined by the Physical Evaluation Board (PEB).
• The MEB considers several sources when making a determination: provide narrative summary, a non medical assessment by member;s command, a physical examination, and a line-of-duty determination.
• The MEB makes its determinations based on the diagnosis, prognosis for return to full duty, need for further treatment, and medical recommendations.
• You can appeal the MEB's decision.

Physical Evaluation Board (PEB)

Command Directed Evaluations (CDE) and Emergency Fitness-for-Duty Evaluations

• When mental competency is in question, a competency board is convened.
• CDE are performed when a commanding officer(CO) becomes concerned about the emotional state and subsequent fitness for duty of a service member under their command.
• Evaluations arising from family advocacy cases and alcohol problems are covered under different instructions and not considered CDEs.
• When is feared that the member poses a danger to themselves or others or if they are impaired and unable to make rational decisions, emergency process should be followed.
• Even is the situation constitutes an emergency, it is still expected that the CO will make every effort to consult with a mental health provider before sending the individual.
• The mental health provider will conduct a risk assessment and determine whether the situation is a true emergency.

Suitability Evaluations and Fitness for enlistment and entry into military service

• Mental health separations from the military based on unsuitability are most often due to personality disorders.
• To be considered unsuitable, the personality disorder must impair the individual's ability to performed assigned duties and to work with and take guidance from others.
• Military psychologists must make the determination that mental health treatment will not adequately change the member's suitability status.
• When a military psychologist finds a service member unsuitable for military service because of a personality disorder, and administrative separation is recommended.
• Fitness for military service is assessed for every person who desires enlistment or commissioning. The DoD sets common physical and psychological standards.
• Military Entrance Processing Station (MEPS), individuals undergo a variety of assessments, including an intensive physical exam. At MEPS prospective service members are medically screened and a comprehensive review of their past record is completed.
• There are Overseas screenings, Submarine duty, and Nuclear field duty.

• Do you think standardize testing has been helpful for our field? What about helping our clients out of the spectrum of categories and more dimensional?
• Is it a positive aspect to have psychological screening before and after? Or just before?

Work Setting

Mental Health Evaluations

• Mental health professionals who work in combat zones will often find themselves assisting service members with managing the challenges of separation from family and friends while simultaneously managing the day to day operation demands unique to a combat environment.
• The goal is to return the services members to normal operations.
• High risk military personnel go through rigorous assessments.

A day in the life of a Military Clinical Psychologist

0800- begin work

0900- team meeting

1000- neuropsychological assessment

1200- run

1300- read

1400- therapy session

1500- supervise psychologists in the clinical leadership of teams

1600- research

1700- notes and go home

https://www.online.psychol.ucl.ac.uk/assets/Clinical%20Psychologist.pdf

Benefits

• Space-available free travel to destinations worldwide
• Access to base facilities such as supermarkets, retail stores, officer's clubs, free or discounted movie theaters, fitness centers, and libraries
• Annually funded continuing education
• Full health coverage (including pharmacy and dental) for service member and family
• 30 days paid vacation each year
• Retirement option at 20 years of service with life-long health coverage

Financial Compensation and Benefits

Financial Compensation

• A typical military predoctoral intern and a commissioned officer at the 3rd-level pay grade and less than 2 years of service, earn just over $62,000 annually
• Military psychologists with 10 years of service earn about $94,000 annually
• Toward the end of a 20-year career,a military psychologist can earn as much as $115,000 per year if promoted to the 5th-level pay grade or $127,000 if promoted to the 6th-level pay grade

Resources

• Dunivin, D. L., & Ingram, M. V. (2007). Military psychology: a dynamic and practical application of psychological expertise. Career paths in psychology: where your degree can take you (2nd ed., pp. 281-306). Washington, DC: American Psychological Association.
• Johnson, B. (1995). Perennial ethical quandries in military psychology: Toward American psychological association-department of defense collaboration. Professional Psychology: Research and Practice, 26(3).
• https://www.online.psychol.ucl.ac.uk/assets/Clinical%20Psychologist.pdf
• http://www.navy.com/careers/healthcare/clinical-care/clinical-psych.html