Fall 2008

Mind over mortar

Psychiatrist helps soldiers cope with life in the combat zone

Classes represented in this story: ’92, '10, '11

An Iraq dust storm will not deter Michael F. McBride, MD ’92, GME ’97, from displaying the banner that several Medical College of Wisconsin students sent him during his tour of duty.   Dr. McBride (right), a Medical College alumnus, faculty psychiatrist and U.S. Army Reservist, even took his banner to the palace in Baghdad while he was stationed in Iraq this year.

Death is a daily risk for combat soldiers. One moment they may be defusing a bomb. The next, they may be kicking in the door of an urban apartment looking for insurgents. Mortar attacks. Ambushes. When maintaining composure and having a clear head can mean the difference between living and dying, the value of good mental health cannot be overstated. Many soldiers in the Middle East have learned they can count on Michael F. McBride, MD ’92, GME ’97, to help.

A psychiatrist and a major in the U.S Army Reserves, Dr. McBride returned in June from a six-month tour in Iraq. He was attached to the 785th Combat Stress Control Company out of Fort Snelling, providing mental health care to troops and civilian contractors in and around Baghdad. Though they treated a large variety of problems spanning the psychiatric spectrum, they often treated problems related to adjustment to a soldier’s lifestyle, including insomnia, anxiety, depression and other issues that could interfere with their function.

“The 15-month deployments, with many soldiers doing their second, third or fourth tours, combined with the ‘stop-loss’ policy, contributed to severe strain on families back home,” Dr. McBride said. “The grief over missing key life events in children or having marriages dissolve were devastating. Many soldiers were just beginning to deal with their combat trauma from the earlier deployments.”

Each soldier deals with stress differently, he said, and as a mental health provider, he was trained to both understand the soldiers’ feelings and to build their resilience. Often, they would come to the clinic with a USB drive filled with photos or video of combat experiences. One, he said, kept a file of dead bodies, even though he knew it was not healthy and against the rules. Dr. McBride recognized this as the soldier’s need to master the trauma through exposure.

Helping the soldiers find healthy ways to cope was an important part of his job in Iraq. Useful techniques include turning the passive into active, exercise, having a moral compass, cognitive flexibility and humor. Even denial can be effective when it doesn’t endanger their safety. Each serviceman needed to find a way to deal with the lethal threat of random mortar and rocket attacks. Many soldiers adopted a fatalistic defense, stating “if it’s going to happen, it will happen,” he said. From a mission perspective, these varied techniques enabled Dr. McBride’s unit to return 90 percent of the soldiers they saw to active duty, fulfilling their goal and motto of conserving the fighting strength.

Dr. McBride had never considered joining the military due to a childhood illness that left him deaf in one ear. The Sept. 11 terrorist attacks gave him reason to seek an exception to the Army’s rules, and after months of making his case to the recruiter, he was finally granted a medical waiver. His first deployment was in 2003, followed by a second tour in 2006. He served both at Landstuhl Regional Medical Center in Germany treating blast-injured soldiers who had been evacuated from Iraq and Afghanistan, which he describes as “the most emotionally draining medical work I have ever encountered.”

Regardless of his training and experience, Dr. McBride was not immune to the stresses of active duty in Iraq, even though his responsibilities differed from those of the combat soldiers.

“My own experience is still hard to discuss,” he said. “I recognize my own need to deal with the effects of the combat zone through the subtle changes I witness in my emotional state and cognitions.”

The feeling of separation from home is something Dr. McBride certainly shared with the soldiers he treated, but also something for which he received some unexpected support.

When Dr. McBride revealed that he would not be available for M1 shadowing opportunities last semester because he was being deployed, many students at the Medical College of Wisconsin were stunned, including M3 Anna Berg, Class of 2010, who was president of the newly founded Psychiatry Student Interest Group at the time.

“Dr. McBride is a huge part of the MCW M1 experience, not just for me but for everyone who takes his class,” she said. “I had shadowed him many times during my first year and found his attitude toward patient care refreshing and hopeful. He takes the opportunity to reach out to every person in each new M1 class and remind them that though the pursuit of a medical education is harrowing, they are not alone.”

To help students sort through their feelings about Dr. McBride’s deployment and to bring him comfort while overseas, Berg spearheaded a letter-writing campaign. Students from all four medical school classes joined the “Dr. McBride Project” because of the positive influence he has had on them. Each week, a few students would write him a letter by e-mail with news from home. Somehow, he managed to respond to every one.

“To me, setting up the letter-writing campaign was a way to confront and deal with my own fears that something bad could happen to Dr. McBride and that the Medical College community wouldn’t be able to be there for him if it did,” Berg said. “All of us who wrote to him wanted him to know that he had our support and that we were thinking of him and marveling at the work he was doing over there.”

Berg, along with Abby Maciolek and Nick Teneuque, Class of 2010, and Karina Sater, Class of 2011, also created a banner to enliven Dr. McBride’s office in the field, which many of the M1 and M2 students signed. It, plus the letters, kept Dr. McBride’s spirits up.

“Each week, I received news from students about the snowy weather in Wisconsin, the challenges with physiology, the nuances of their personal lives and relationships with others,” he said. “It was a small but bright spot in my schedule, and I deeply appreciated it. In many ways, having that little contact with home helped to stave off the depression of being in the stark world of the combat zone. I am forever in their debt.”

Since returning home, Dr. McBride has joined a multidisciplinary team of mental health providers at the Clement J. Zablocki VA Medical Center in Milwaukee, tasked with creating a new treatment program for the younger veterans of Operation Iraqi Freedom and Operation Enduring Freedom. Now a Medical College faculty member, Dr. Mc Bride is Assistant Professor of Psychiatry and Behavioral Medicine.

Returning veterans face a number of challenges, and Dr. McBride said he is now seeing the aftermath of what combat trauma does to the body and mind. Among the parts of the brain affected by trauma is the amygdala. In acute trauma, these two clumps of densely packed nerves trigger a cascade of neurochemicals to prepare the body for fighting or fleeing. When the body is subjected to chronic stress and trauma, the amygdala change permanently.

“Returning veterans display this by their hypervigilance, heightened startle response, high anxiety states, emotional numbing and avoidance of all things relating to a possible threat,” he said. “Vets can have trouble with crowds, driving on our freeways and loud noises. I find it ironic how we celebrate our independence as a nation with fireworks, which many veterans find re-traumatizing.”

The goal of Dr. McBride’s current work is to provide a comprehensive and individualized treatment plan that returns young veterans to the developmental path of their choice. Since the VA system is designed more to address the needs of older veterans, the work is exciting but vexing, and he has needed to find creative solutions, such as the mentoring program he is developing that pairs returning veterans with a mentor from the Vietnam generation.

“There is tremendous support from our administration and society at large, perhaps because of the recognition of failure to reach out and assist the veterans of the Vietnam era,” he said. “We want to do this job the right way, which will hopefully avoid the tragedy of another chronically sick generation of veterans.”