Psychiatrist Prepares Americans For Stress of Iraq Assignment

Iraq is a difficult and dangerous place for U.S. military and government employees working with the U.S.-led Coalition Provisional Authority (CPA).

U.S. State Department employees are among the approximately 3,000 U.S. military, federal, and contract workers in Baghdad, according to Samuel Thielman, M.D., the State Department’s chief of crisis response in the Office of Medical Services’ Division of Mental Health Services.

This is a new position created last year to supplement the work of Foreign Service psychiatrists stationed in different regions of the world. When the State Department increased its presence in Iraq, the psychiatrist in Cairo responsible for the Eastern Mediterranean region, including Iraq, was unavailable to meet with federal employees there and develop a crisis mental health response.

Thielman stepped in to fill that need. In some countries such as Iraq, he is also responsible for employees of affiliated agencies, such as the FBI or Drug Enforcement Agency, and civilians working on contract.

Another part of his job is to plan mental health education for the State Department in Washington, D.C., said Thielman, who visited Iraq last December.

Federal employees who go to Iraq do so voluntarily, and many are unmarried, Thielman told Psychiatric News last month.

Before departing for Iraq, State Department staff are briefed on the living conditions there and shown photos of CPA temporary headquarters in a former palace of Saddam Hussein and other key buildings in Baghdad.

The departing staff must attend a State Department course on diplomatic security and antiterrorism that incorporates stress-management techniques, he noted.

State Department employees are screened for illness, including mental illnesses, prior to serving in any foreign country and upon their return.

“We screen for mental illnesses beforehand to avoid sending an employee to a post where psychiatric medications and support are very limited,” he explained.

Thielman said that U.S. military and civilians in Iraq are under constant threat of attack by pro-Saddam forces or other groups that oppose the new, U.S.-coalition-led government.

“When I was there in December, morale was high, but the staff complained a lot about living in cramped quarters with military personnel and civilian contractors. About 200 bunk beds were set up in Saddam’s bedroom and in portable trailers,” Thielman said.

He asked State Department employees about the impact on them of the October 26, 2003, rocket attack on the Al-Rashid Hotel in Baghdad, which killed several civilians. Thielman said that some employees reported in December acute or posttraumatic stress symptoms but noted that psychiatric disorders were rare among the staff.

If an employee had a psychiatric emergency in Iraq, the individual would be stabilized and then medevaced to a military post in Germany or to the United States for further treatment as soon as possible, Thielman said.

To date, no State Department staff member has had a psychiatric emergency that required medical evacuation, Thielman said.

Information about health careers with the Foreign Service is posted online at www.foreignservicecareers.com/specialist/self_evals/med_jobs.html. ▪