Content Disclosure: War or Battle Scenes; Strong Language; Trauma and PTSD
My Acute Care Unit patients are locked behind three doors to prevent their escape. Individual rooms are molded plastic and rubber. Beds, desks, bookshelves, every sharp edge, and everything that can hold a rope is rounded and flattened. Both measures worked. We at Miami’s Behavioral Health Hospital had never lost a patient to elopement or self-slaughter.
That summer morning, I buzzed into my first ACU patient’s room. Waiting there was Philo Outis, twenty-eight, a descendant of Greek sponge divers from Tarpon Springs and a combat medic with three Iraq deployments. Philo acknowledged previous alcohol abuse and adverse childhood experiences. No surprise. What shocked me was what landed him in ACU.
According to the Army, Sergeant First Class Philo Outis refused to deploy to Afghanistan, then refused an administrative discharge that would have spared him punishment. After two weeks’ cajoling and threatening, the Army branded Philo a deserter, convened a court-martial, and appointed me to a three-member Sanity Board to determine whether he was sane or not. The Army’s psychiatrists, chaplains, and brass said Philo suffered only from a personality disorder and, worse, bad character. But Philo’s own defense lawyer said he was nuts.
Desertion, the most serious military crime, carried a possible death sentence, and Sanity Boards find fewer than one defendant in two hundred not responsible due to mental illness. While the Board’s neuropsychologist and neurologist reviewed witness statements and tested him to decide if Philo was lying about his psychiatric symptoms to “earn” an insanity determination, I, as Board psychiatrist, would decide whether, when he refused to deploy, Philo suffered from a serious mental illness that kept him from understanding the wrongfulness of his conduct. If I found Philo “insane” when he went AWOL, the charge would be dismissed. Whereas if I found him “sane,” Philo would go to trial for his life. As a firm opponent of the death penalty, I was determined, if ethically possible, to find him insane. By court-martial rules, I had six weeks. I took a deep breath and buzzed into Philo’s room.
On my entry, he stood at attention like a Homeric hero. Tall, athletic, alert, determined. Philo had gravitas.
“I’m Dr. James Panther,” I told him. “At ease, Sergeant Outis.”
We shook hands.
I pulled up a chair and asked him to sit. “Your secrets are safe with me, Philo. Psychiatrist-patient privilege attaches. Anything you tell me will not be used against you in court-martial.”
His gray eyes slitted with suspicion.
“No trick, Philo. My only purpose is to facilitate a diagnosis and treat you.”
“I don’t care if you tell the world everything I share.” He was warm and sincere, with none of the glib superficial charm, shallow affect, and remorselessness of psychopaths I’d treated. But we’d barely begun. “That’s if I tell you anything. You know I’m sane, right?”
“What sane person isn’t a conscientious objector?”
Philo chuckled. “Problem is, if everyone’s a CO we can’t have a war. Doc, I’m not willing to kill, but I’m willing to die.”
“Tell me about that.”
“Nah. I’ll stay mum.”
“The status quo