To Squander the Fighting Strength? Personal Experiences with Preventive Psychiatry and the Dilemma of Wartime Public Mental Health
My colleagues who have known me throughout my controversial military career and beyond, and who know in particular of my work on the antimalarial drug mefloquine (marketed in the US previously as Lariam), could be excused for assuming this was an early interest of mine. In fact, my work on the mental health effects of antimalarials began relatively late, and then initially only as an aspect of a much broader and newfound interest in public mental health that matured only during my first wartime deployment. I am frequently asked if there was a specific patient or patient experience during this deployment that led me to my work in these areas. I reply that to assume as much is to misunderstand the public mental health perspective. The practice of public mental health deemphasizes the significance of individual clinical anecdote for the subtler but vital truths found in the dry statistics describing the health of populations. To practice public mental health is to not miss the forest for the trees.
KeywordsWartime public mental health Mental health in wartime Public mental health in wartime Preventive medicine in wartime Mefloquine and mental health
Disclosures: Dr. Nevin receives consulting fees from attorneys representing clients alleging harm from their exposure to antimalarial drugs, including mefloquine, and has been retained as an expert witness in criminal and civil cases involving exposed civilians and military personnel.
- 1.Johns Hopkins Bloomberg School of Public Health. Alumni profile: Remington L Nevin, MD, MPH’04. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health; 2014. http://www.jhsph.edu/alumni/alumni-profiles/remington-nevin.html.
- 2.Nevin RL, Niebuhr D, Frick K, Grabenstein J. Improving soldier care through outcomes research: the accession screening & immunization program. US Army Med Dep J. 2006;2006:(July–September):30–38.Google Scholar
- 4.Llewellyn CH. Preventive medicine and command authority – Leviticus to Schwarzkopf. In: Kelley PW, editor. Military preventive medicine: mobilization and deployment, vol. 1. Washington, DC: Borden Institute; 2003. p. 3–19.Google Scholar
- 7.Department of Defense, Office of the Deputy Secretary of Defense. Memorandum dated February 26, 2008 Subject: establishing an armed forces health surveillance center. Pentagon, VA: Department of Defense, Office of the Deputy Secretary of Defense; 2008.Google Scholar
- 8.U.S. Armed Forces. Army medical surveillance activity. Ambulatory visits among members of active components, U.S. Armed Forces, 2005. Med Surveill Month Rep. 2006;12(3):10–5.Google Scholar
- 9.Pavlin JA, Murdock P, Elbert E, et al. Conducting population behavioral health surveillance by using automated diagnostic and pharmacy data systems. Morb Mortal Wkly Rep. 2004;53(Suppl):166–72.Google Scholar
- 11.Wooltorton E. Mefloquine: contraindicated in patients with mood, psychotic or seizure disorders. Can Med Assoc J. 2002;167(10):1147.Google Scholar
- 14.Armed Forces Health Surveillance Center. Prescriptions for psychotropic medications within one year before deployment: the experience of a U.S. Army combat unit, 2007. Med Surveill Month Rep. 2008;15(4):11–4.Google Scholar
- 15.Kauffman M. Before deployment. The Hartford Courant: Many Soldiers Leave Mental Problems Off Health Assessment; 2009. http://articles.courant.com/2009-10-11/news/hc-predeploy1011.artoct11_1_mental-health-deployment-screening-tool.Google Scholar
- 16.Nevin RL. Low validity of self-report in identifying recent mental health diagnosis among U.S. service members completing pre-deployment health assessment (PreDHA) and deployed to Afghanistan, 2007: a retrospective cohort study. BMC Public Health. 2009;9:376.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Department of Defense Task Force on Mental Health. An achievable vision: report of the Department of Defense Task Force on Mental Health. Falls Church, VA: Department of Defense Task Force on Mental Health; 2007.Google Scholar
- 18.Department of Defense, Office of the Assistant Secretary of Defense (Health Affairs). Memorandum dated November 7, 2006. Subject: Policy Guidance for Deployment-Limiting Psychiatric Conditions and Medications. Aurora, CO: Department of Defense, Office of the Assistant Secretary of Defense (Health Affairs); 2006.Google Scholar
- 19.Cave D. Army’s top recruiter says 2006 may be biggest test. New York Times; 2005. http://www.nytimes.com/2005/05/13/nyregion/armys-top-recruiter-says-2006-may-be-biggest-test.html.
- 23.Brusher EA. Combat and operational stress control. In: Ritchie EC, editor. Combat and operational behavioral health. Washington, DC: Borden Institute; 2011. p. 59–74.Google Scholar
- 24.U.S. Army, Office of the Surgeon General. Memorandum dated February 2, 2009.. Subject: updated guidance on the use of mefloquine for malaria prophylaxis. Washington, DC: Office of the Surgeon General; 2009.Google Scholar
- 25.Department of Defense, Office of the Assistant Secretary of Defense (Health Affairs). HA policy memorandum 13-02: guidance on medications for prophylaxis of malaria. Aurora, CO: Department of Defense, Office of the Assistant Secretary of Defense (Health Affairs); 2013.Google Scholar
- 29.Wicken C, Nevin RL. US Military surveillance of mental health disorders, 1998–2013. Psychiatr Serv. 2016;67(2):248–51.Google Scholar
- 30.Armed Forces Health Surveillance Center. Signature scars of the long war. Med Surveill Month Rep. 2013;20(4):2–4.Google Scholar
- 31.Armed Forces Health Surveillance Center. Ambulatory visits among members of the active component, U.S. Armed Forces, 2012. Med Surveill Month Rep. 2013;20(4):18–23.Google Scholar
- 32.Hurt L, Zhong X. Rate of prescriptions by therapeutic classification, active component, U.S. Armed Forces, 2014. Med Surveill Month Rep. 2015;22(9):12–5.Google Scholar
- 33.Armed Forces Health Surveillance Center. Hospitalizations among members of the active component, U.S. Armed Forces, 2012. Med Surveill Month Rep. 2013;20(4):11–7.Google Scholar
- 34.Armed Forces Health Surveillance Center. Deaths while on active duty in the US Armed Forces, 1990–2011. Med Surveill Month Rep. 2012;19(5):2–5.Google Scholar
- 36.Miller TC, Zwerdling D. Military still failing to diagnose. Treat Brain Injuries: National Public Radio; 2010. http://www.npr.org/2010/06/08/127402993/military-still-failing-to-diagnose-treat-brain-injuries.
- 38.Power J. Invisible wounds. Johns Hopkins Public Health. 2015;2015(Spring):28–35.Google Scholar
- 39.Nevin RL. Mefloquine and posttraumatic stress disorder. In: Ritchie EC, editor. Textbook of military medicine: forensic and ethical issues in military behavioral health. Washington, DC: Borden Institute; 2015. p. 277–96.Google Scholar
- 40.Johns Hopkins Bloomberg School of Public Health. Keeping soldiers safe: Bloomberg School student’s research instigates military ban on malaria drug. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health; 2013. http://www.jhsph.edu/news/stories/2013/student-remington-nevin-antimalarial-drug-research.html.
- 41.United Press International. Report: U.S. military still using dangerous malaria drug. UPI.com 2013. Washington, DC: United Press International; 2013. http://www.upi.com/Health_News/2013/12/24/Report-US-military-still-using-dangerous-malaria-drug/UPI-27391387931392/.
- 43.American College of Preventive Medicine. Code of ethics. Washington, DC: American College of Preventive Medicine; 2009.Google Scholar