Saturday, February 18, 2006

Healthcare Concerns for LGB United States Military Personnel

A recent article in Professional Psychology: Research and Practice discusses the difficulties faced by military psychologists serving lesbian, gay and bisexual (LGB) military personnel. It provides a very interesting discussion of medical practice in circumstances where standards of medical ethics conflict with institutional requirements (e.g. military rules).

Official military rules allow for confidentiality (within certain limits) for military psychologists. However, these rules lack teeth in a military system that values military oversight of service-members’ lives. For example, military psychologists’ records may be viewed by non-medical staff members of the military, particularly when staff members suspect that an individual’s performance may be linked to a psychological state. Thus, although psychologists needn’t openly disclose information, the military has devised a mechanism of bypassing the psychologist altogether.

As a result, some scholars advise psychologists to avoid documenting references to homosexual activities during therapy sessions. This recommendation, if followed, may lead to records being left dangerously incomplete. If a service member’s suicidal tendencies are linked to homosexual feelings, a medical record that omits references to the patient’s homosexual feelings may harm a patient more than help him. If the service member changes psychologists, for example, the new psychologist may be left unaware of the causes of the patient’s suicidal tendencies. As a result, the quality of therapy may be decreased. When choosing how to document a patient's condition, a psychologist may be forced choose between the lesser of two evils.

Furthermore, the regular rotation of individuals through military posts means that a service-member who is a psychologist today may be asked to abruptly change positions tomorrow. It is unclear how a military psychologist who counsels an openly gay service-member will handle information of the member’s homosexuality when he becomes a military administrator who is charged with imposing “Don’t Ask; Don’t tell.” Should he simply pretend that he was not told?

We have no reason to believe that only academics ponder these questions. Service members considering whether to seek counseling for feelings of depression or anger associated with their sexuality may be hesitant to trust psychologists enmeshed in the military machine. As a result, these individuals may turn to the only “counselors” in military settings for whom confidentiality is guaranteed: chaplains. Chaplains are often individuals who lack medical training and who have been known, in the past, to suggest “reparative treatment” for homosexuality. Needless to say, reparative remedies lack scientific support just as chaplains lack the medical credentials needed to counsel individuals coping with homosexual feelings.

Our first priority ought to be repairing a military environment that exacerbates the already difficult task of coping with homosexual feelings. The very fact that service-members avoid counseling for fear of being removed from the military is startling to say the least. However, changes in the ‘Don’t Ask; Don’t Tell” policy must await a more rational period in American politics. In the meantime, the military ought to seriously consider importing civilian psychologists onto military bases and making these experts available for service-members. These civilians ought to be guaranteed uncompromised client-patient confidentiality.


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