Running Amok: Mental Health in the U.S. Foreign Service



Yet Another Effete Diplomat on the Cocktail Circuit

Ship me somewhere's east of Suez, where the best is like the worst.
Where there aren't no ten commandments, an' a man can raise a thirst.
           ~ Rudyard Kipling, Mandalay

Amok
In the second year of my Foreign Service career, I was assigned to Vientiane, Laos.  My deployment was accelerated by my predecessor's seeking and being granted a one-year curtailment of his tour of duty because he was going bonkers.  Moreover, an admin officer had to be removed in a straitjacket after holing himself up in his house and smearing the walls with his own feces, another victim of mental and emotional stress.  I, on the other hand, thrived at this isolated outpost, our only one in Indochina five years following the fall of Saigon.  The setting was a cross between "Heart of Darkness" and "Casablanca."  My seizure at gunpoint and brief incarceration by the authorities, which prompted a diplomatic row, was just one of the pressures at this surreal place.  Years later, in civil war-torn Cambodia, the State Dept. regularly sent a psychiatrist to post to measure our stress levels amid coup attempts, assassinations, 12-14-hour work days seven days a week and an unhinged ambassador.  At another embassy, one of our largest, the Secretary of State discreetly sent out two senior officials to gently pry our prominent career ambassador out of his job in the wake of his increasingly bizarre behavior, including public denunciations of an American ally.

PTSD on the Rise
There is a popular perception of diplomats as wan angora-stroking effetes whose greatest challenge of the day is cocktails at the tennis club.  This couldn't be farther from the truth.  The stress of serving in isolated poverty-ridden countries and war zones can be tremendous.  Family members are not allowed at many of these posts, resulting in so-called unaccompanied tours.  Children are sometimes required to be separated from parents and placed in overseas boarding schools.

In recent years, the number of Foreign Service personnel medevacced for mental health reasons has doubled.  One study revealed 15 percent of FS members suffered from PTSD.  A similar study done by the Defense Dept. found that 17 percent of soldiers returned from Iraq and Afghanistan suffered from the same condition.  As the U.S. has gotten involved in more overseas conflicts, the pressures on our diplomats have compounded.

A particularly sad case was documented in the September 2010 issue of the Foreign Service Journal.  A former military officer and tsunami survivor, this FSO was assigned to one of the most dangerous war zones six years into his State Dept. career.  He worked 12-14-hour days amid gun and mortar fire.  After being injured in a roadside bomb attack, a State Dept. psychiatrist prescribed an antidepressant for his PTSD.  But the medication caused lack of sleep, loss of appetite and high blood pressure.  When he complained about the side effects, he was prescribed a different antidepressant.  But the side effects continued and he was evacuated from post and placed in psychiatric hospitalization in Washington.  State Dept's MED office failed to provide him with a doctor proficient in treating PTSD, so he found one on his own.  He was told he could not return to post.  Further treatment did not resolve his problem and he was medevacced again from another post.  He lives in Washington, separated from his wife, and essentially grounded for medical reasons.  His career prospects don't look good.  This officer is convinced that, had he received better treatment, his current situation could have been avoided.

Mental Health Treatment Can Be Bad for Your Career
The growing concern in the Foreign Service ranks over mental health problems prompted Secretary Clinton to assure employees that they can and should seek treatment by State Dept. medical professionals with no worry that it would impact negatively on their careers.  But a loose grouping of FS professionals calling themselves Concerned Foreign Service Officers has strongly urged U.S. diplomats to seek needed psychiatric help from private practitioners rather than from State Dept. doctors.  "CFSO has seen numerous cases where even allegations of mental health issues, ranging from PTSD to depression to marital discord to stress-related substance abuse have been referred by M/MED to Diplomatic Security (DS), usually resulting in recommendations to revoke a clearance."  In other words, if you seek treatment for a mental health issue, you risk losing your security clearances, which is definitely a career-killer.  The upshot?  Those with PTSD, substance abuse issues, depression, etc. refusing to seek treatment for fear it would stifle their career. 

The Best is Like the Worst
A Foreign Service career is not for the faint of heart.  The threat of terrorism, disease, isolation and sheer mental exhaustion is prevalent.  And as we shift more human resources to places like Afghanistan and Iraq, as well as Africa, the Middle East and other troubled areas, the greater the stress on American envoys.  Cocktails at the tennis club?  Sorry, I've got a war to cover.