The Foreign Service Journal, January-February 2016

36 JANUARY-FEBRUARY 2016 | THE FOREIGN SERVICE JOURNAL a Unusual Stresses and Dangers O ur work in the FS is unique and not well understood outside of our community. We face stresses and dangers most friends and family will never understand back home. That said, it is hard for FSOs to express themselves to colleagues they are living and working with without feeling they are revealing a vulnerabil- ity. Only after serving in Afghanistan did several colleagues share howmuch mental hardship they endured during their tour. I am not sure the [foreign affairs] agencies truly appreciate the mental health burden some of our colleagues deal with; nor do they extrapolate that back to its impact in the workplace. A safe environment needs to be formed for people to seek help without fear of recrimination. We are in the relationship busi- ness... healthy colleagues = healthy workplace. a PTSD: Pretending to be All Right T he mental health support offered is generally good, though there is room for improvement in helping members respond and recover after trauma and crisis. As a supervisor, I have been impressed with the skill, compassion and discretion of RMO/Ps in dealing with substance abuse and mental health problems. I am concerned that the effectiveness is undermined by the predisposition of MED or RMO/Ps to recommend curtailment when treatment at post might be a good first step; this predispo- sition acts as a disincentive to report problems. I myself was evacuated from post for PTSD and enrolled in the State Department’s treatment program. The treatment was in the form of counseling sessions with a contracted provider. I have since reviewed the literature on PTSD treatment and recognize what the counselor was trying to do; but the coun- selor was not effective and the treatment, for me, was useless. Nonetheless, it became clear to me that my ability to secure a new medical clearance to go on to my next assignment was dependent on satisfying my counselor that I was “cured,” thus validating his treatment. I swore up and down that I was all better (when in fact I was not at all improved) and thanked everyone concerned for hav- ing helped me so much, and in this way I earned back my medi- cal clearance and was able to head to my next post. Some years later, I consider myself recovered from PTSD, but I attribute that to time and the opportunity to rebuild my life and relationships, not to the counseling that I had to pretend was effective. a PTSD: Treatment Traumas I was injured in a terrorist attack overseas. This was in 2004, before the State Department began to take seriously PTSD and mental health issues that develop as a result of high-stress, high-threat assignments. Compared to 2004, a lot has changed for better and for worse. I was injured, medevac’d from Iraq, treated for my physi- cal injuries and received counseling from someone the depart- ment recommended. Then, at my request, I returned overseas just a few months later to a hardship (though not “dangerous”) post. I was glad they allowed me to return to work abroad so quickly—I think it was helpful to my recovery. I struggled with PTSD in my onward assignment, but did not seek treatment. I should have. I resisted because I was concerned that seeking treatment would result in bureaucratic hassles and threats to my medical clearance. Also, my illness caused me to resist doing anything that brought additional attention to me, which seeking help would have done. Privacy concerns have had a huge effect on whether or not I seek men- tal health treatment (or any other kind of medical help) at post. Gossipy family members should not be given positions in medical units where confidential medical information on embassy staff is handled. I don’t have this concern with our direct-hire medical staff, but they need to be careful who they hire and what kind of access they give to uncleared family members with no experience in the medical field or in handling medical information. My continued use of medication (left over frommy PTSD diagnosis) has had no impact on any clearances. Although my experience was not bad, I hated having to answer questions about my PTSD more than five years after I had recovered. Don’t let it be a red flag every time clearances are renewed if it doesn’t need to be. Dealing with the bureaucracy after having sought mental health treatment is itself enough to cause PTSD.