A Way to Leadership Success
March 2010 Navy
by CDR Joan M. Smith, NC, USN
In an August 2009 article in Military Officer magazine, when asked about his role in organizing, training, and equipping the Air and Army National Guard, General Craig McKinley, USAF, National Guard Bureau Chief stated, “I enable them to be prepared to perform and to be fully integrated into the service.” In regard to the leadership role and contribution of the Navy’s Full-Time Support (FTS) staff, RADM Carol M. Pottenger, USN, Commander, Naval Expeditionary Combat Command was quoted in the August 2009 official publication of the Association of the U.S. Navy, Navy magazine as saying, “Everyone within the FTS community should be willing to help others and find ways to pass on keys to success to their shipmates.” In the June 2009 edition of the Reserve Officer Association magazine, The Officer, Lieutenant General Dennis M. McCarthy, USMC (Ret), Executive Director of the Association stated that education and advocacy training for the Reserve Component is vital to a military policy that will provide adequate national security.
Education and training prepare the leader to prevent and manage actual, possible, and potential problems that might hinder mission accomplishment and national security initiatives. Lack of knowing is a hindrance to good leadership. For the novice leader, lack of knowledge, and lack of education and training, can be anxiety provoking. Learning about the fundamentals of anxiety disorders can be personally rewarding and instrumental in mission accomplishments.
According to the first stage of the Four Stages of Learning Model, some inexperienced leaders can be classified as “unconscious incompetent.” As new leaders, Junior Officers (JOs) are not fully integrated into their leadership role and need ongoing education and training to ensure competency. For some, they do not know what they do not know when it comes to human resource management, health promotion, mental health and wellness (Wheeler, 2006). By making superior performance, willingness to help others, and education and training leadership priorities, Generals and Admirals are orchestrating a plan to ensure military policy will provide adequate national security.
Support for education and training builds morale, influences behaviors, and enables mission success. According to the U.S. Coast Guard, leadership competencies fall within four broad categories: leading self, leading others, leading performance and change, and leading the Coast Guard. An essential aspect of leading others is a strong understanding of human behavior, the stress response, and mental health. Making tough decisions with imperfect information is the stuff of a good story. However, when information is available, it should be put to use to manage the complexity of human resources in the ongoing global war on terror.
As a member of the Navy Nurse Corps and a Post Master Graduate student in Psychiatric-Mental Health Nursing at The University of North Carolina at Chapel Hill School of Nursing, I contend that all JO leadership courses should include basic content in mental health disorders. In light of the high suicide rate among U.S. Army soldiers, and the recent murder of five service members at the Camp Liberty clinic in Baghdad, the purpose of the course would not be for the JO to learn to make clinical judgments about mental health disorders. Instead it would inform the non-medical leader about mental health symptoms that are present, persistent, and possibly serious.
A review of the Army War College and the Naval War College recommended reading list found no book that addresses psychiatricmental health concerns. The classic novel, Caine Mutiny (1951), addresses the emotional toll of war upon a ship’s crew; but on these lists, there is no supplemental material to help the reader understand the clinical significance of Captain Queeg’s mental instability. As of this writing, these lists do not reflect any titles that would enhance a medical officer’s recommendation to a line commander.
In 1945, Lord Moran, Winston Churchill’s physician, wrote that military leaders need to be able to recognize diminishing mental health among its members. In his book, The Anatomy of Courage, he references his accounts as a “record of changing moods. (p. xviii).” He writes about cowardice, the birth of fear, fatigue, festering thoughts and the importance of leaders who have forward thinking minds, leaders who embrace change and implement innovation. Moran’s text shares stories of individual soldiers who “...exhibited signs of anxious misery, apprehensive expectation, and obsessive thinking (p. 47).” He shared that at that time, the mantra was “get rid of the unstable soldier (p. 62),” those who chose flight over fight. These soldiers were ridiculed and labeled as being “scared pink.” Ultimately, the decision to deploy or mobilize an individual rests with the Line. Fundamental knowledge gleaned from a basic course addressing anxiety and depressive mood disorders might be beneficial in the decision-making process.
In some circles, as was the case during past wars, there is still a stigma tied to mental illness. The organizational culture of some military units continues to recognize those with psychiatric illness as “...crazy in the head...” as opposed to being ill and in need of treatment, compassionate care, and support up until and after recovery. Many lack understanding that just as a broken limb needs a plan of care, so too does a broken spirit; a spirit who, according to Moran’s observations, broke under “anxious misery.” “Take the emotion out of it” and “the military isn’t a social service agency” are two expressions that some in the military have expressed to mental health advocates championing post-deployment mental health counseling. Post-deployment health screenings are designed for the member to discuss or identify any problems that may have developed during the mission. It is common knowledge that most do not discuss issues related to mental health during their postdeployment screening for fear of career ending consequences. There continues to be a lack of trust among military personnel when it comes to mental health care.
In addition to a need to understand the mental health issues associated with deployments, new leaders need to be aware that some mental health issues affect the entire family and spill over into the workplace environment. Postpartum depression (PPD) is one mental health issue that affects approximately 12% of new mothers across the U. S. It can occur immediately after birth and intensify throughout the first six months of postpartum. Fatigue, added responsibility, financial strain, and career demands significantly impact the incidence of postpartum depression. It has been reported that women from low socioeconomic backgrounds and military women may experience postpartum depression at high rates (Rychnovsky & Beck, 2006, Doering, Runquist, Stetzer, 2009, Goodman, 2009).
Approximately 150,000 women serve in the U.S. military. A study by Appolonio & Fingerhut, 2008, found that among postpartum active duty women, 19.5% were identified as experiencing symptoms of PPD, a rate higher than that for the nation. Prenatal anxiety, prenatal depression, and life stress were three of several significant psychosocial factors identified as compounding factors for this particular population. Untreated postpartum depression can degrade into postpartum psychosis associated with hallucinations, delusions, illogical thoughts, feelings of anxiety and agitation, periods of delirium or mania, limited food consumption, suicidal or homicidal thoughts, and insomnia. Additionally, in his 2005 analysis of Biomedical Research on Health and Performance of Military Women, Dr. Karl Friedl reported that workplace issues and being a woman in a predominantly male workforce were identified as significant sources of stress. Recognition of anxiety, depression, and significant life stress among military women in the prenatal period, coupled with the use of medication and counseling, are keys to prevention of postpartum depression and postpartum psychosis. Understanding that postpartum depression can stem from prenatal anxiety is important for those JOs who are Division Officers and who lead pregnant and parenting servicewomen.
Today, we know that by replacing and/or supplementing neurotransmitters, chemical agents that signal brain activity, moods can be regulated, obsessions can be controlled, and anxiety eliminated. Along with psychotherapy, psychotropic drugs that boost these neurotransmitters are a safe and effective treatment to help individuals experiencing these mental health disorders. It is hypothesized that, if left untreated, these disorders can lead to irreversible neuronal loss. Unfortunately, too many lack the knowledge and understanding of anxiety, depression and routine treatment plans. Lack of knowing, no care, or delayed care can result in a negative spiral towards irreversible damage.
“Treating the Wounds of War” is the title of an article published in the June 2009 issue of Military Officer magazine. Throughout the article, the author, Don Vaughan, writes about the constant care and observation of those recovering from burns. He highlights the significance of “closely monitoring” all burns and references the importance of closely watching less severe burns “...because they can turn into full-thickness burns or become infected (p. 56).” The same goes for “closely monitoring” those who have experienced emotional injuries. They, too, will heal with the same degree of vigilance offered to burn victims whose wounds are physical and visible. Increasing knowledge and awareness of mental health issues by junior leadership will help many who are coping with the aftermath of a variety of anxiety-provoking experiences.
Military leaders who have a basic understanding of treatments for mental health disorders can be instrumental in helping a member adjust his/her thinking and behaviors and return to an optimal state of mental health. In turn, this increases operational readiness. Great significance must be placed on the fact that when it comes to treatment plans, one size does not fit all. The individual must always be the primary focus. Untreated mental illness can result in a state of inefficient information processing with further decomposition where anxiety, depression, worry, and obsession set the stage for sustained negativity and ongoing illness.
Ensuring readiness through education and training; building a healthy, well-informed military workforce; embracing and empowering leaders who have forward-thinking minds and who embrace change and implement innovation are the ways to pass on keys to success. Understanding that lack of knowledge about human behavior can be detrimental to a leader’s success is the first step away from “unconscious incompetent.” Lack of trust in post-deployment counseling is compounded by an organizational culture that recognizes individuals with mental health concerns as “crazy in the head.” Individuals experiencing symptoms of anxiety and depression should be encouraged by leaders to address their illness without fear of career ending consequences. By incorporating fundamental knowledge of the signs and symptoms, diagnostic criteria, and routine treatment plans of basic mental health issues to an intermediate non-medical leadership course for junior officers, a life could be saved; a family strengthened; and the career of a Soldier, Sailor, Airman, or Marine could be maintained while a spirit is mended.
References
Appolonia, K. K. & Fingerhut, H. (2008). Postpartum depression in a military sample. Military Medicine, 173(11), 1085-1091.
Bresnahan, A. (2009). Interview with RADM Carol Pottenger: Inspiring leadership for an integrated full-time support team. Navy 56(8), 18-20.
Doering, J. J., Runquist, K. M., and Stetzer, F. C. (2009). Urban postpartum women severe fatigue and depressive symptoms in lowerincome. Western Journal of Nursing Research, 31, 599-606
Friedl, K. E. (2005). Biomedical research on health and performance of military women: Accomplishments of the defense women’s health research program (DWHRP). Journal of Women’s Health 14(9), 764-802.
Goodman, J. H. (2009). Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 36(1), 60-69.
McCarthy, D. M. (2009). Our goal is advocacy; our tool is education. The Officer, June, 4
Moran, L. (1945). Anatomy of Courage. The Classic Study of the Soldier’s Struggle Against Fear. Garden City Park, NY: Avery Publishing Group, Inc.
Philpott, T. (2009). A seat at the table. Military Officer, August, 54-60.
Rychnovsky, J. & Beck C. T. (2006). Screening for postpartum depression in military women with the postpartum depression screening scale. Military Medicine, 171(11), 1100-1104.
Vaughn, D. (2009). Treating the wounds of war. Military Officer 56, 55-57.
Wheeler, K., (2008). Psychotherapy for the Advanced Practice Psychiatric Nurse. St. Louis, MO. Mosby.