"Very much in the middle"
How a military psychiatrist balanced treating Afghan detainees and U.S. troops
Thomas Fluent, M.D., clinical assistant professor of psychiatry at the Univeraity of Michigan Medical School and medical director of ambulatory psychiatric services at
"There are certain situations that don't naturally appeal to what Lincoln called the "better angels of our nature," reflects Thomas Fluent, M.D., clinical assistant professor of psychiatry at the University of Michigan Medical School and medical director of ambulatory psychiatric services at U-M.
High on the list for him: the nine months he spent as chief of mental health services for more than 1,000 detainees at Bagram
On a recent morning, Fluent, a captain in the U.S. Navy Medical Corps with more than 20 years of active duty and reserve service,
On a recent morning, Fluent, a captain in the U.S. Navy Medical Corps with more than 20 years of active duty and reserve service, reflected on being "very much in the middle" of such a challenging dynamic.
Fluent - a warm, energetic and self-effacing man who prefaces many of his insights with phases like, "Now this is going to sound corny, but..."-- explains in a dozen different ways over the course of an interview that for him the key was to never lose sight of the humanity of the people he was dealing with, nor of his own humanity. Fluent's job was to help detainees as they struggled with exactly the types of emotions you'd expect: homesickness, loneliness, sadness, trouble sleeping, worry about the safety of their families and uncertainty about what the future might hold.
"My approach was to model that ambivalence, to respect the tension inherent in the situation," he says.
While doing his best to help the detainees in his capacity as a psychiatrist, Fluent also worked to maintain the respect of the guard force and not seem overly accommodating of the prisoners.
"It's definitely a fine line," he acknowledges.
"It helped just to acknowledge the reality of the situation," he says.
"I found I focused a lot on my non-verbal communication, my eye contact and facial expressions," Fluent says. "I wanted my eyes to communicate warmth and humanity, but not 'I'm a fool.' "
Many of the detainees had very little experience with Western medicine, much less talk therapy. Their attitude seemed to be, the more medication you got, the better the doctor, he notes. Still, Fluent looks back at the mission with a sense of accomplishment.
"We did good things there," he says. "I know I made a difference, although it was the kind of mission where that sense was a little harder to wrap your arms around compared to my experience at Landstuhl," an earlier deployment to Landstuhl Regional Medical Center in Germany. There, Fluent mainly treated physically and psychologically injured Coalition troops fresh from the battlefield.
Fluent says he's grateful for the support he received while deployed. In July, U-M's Psychiatry Department received a Patriot Award from the Michigan Committee for Employer Support of the Guard and Reserve in recognition of its support for National Guard and Reserve forces.
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