Work

I know many of you have been asking about how Nathan's job (the actual reason we're here!) has been going.  I asked him to do a guest blog to fill everyone in on his work here. So here it is from the man in uniform himself.

My position in Sasebo is very different than the one I had at Walter Reed Bethesda. In Bethesda I was one of 50 psychologists. My role was to basically fill gaps and provide care where needed. But in Sasebo, I’m it. The mental health clinic here has a staff of one. I don’t have the luxury of being able to refer my patients elsewhere. I’m somewhat of a family doctor in that I see anything and everything under the sun.

Most of my day is spent providing outpatient care to sailors and their dependents. My caseload is extremely diverse, and in just two months I have seen patients with major depression, bipolar disorder, Aspergers, ADHD, cognitive disorder, alcohol abuse and dependence, drug abuse, schizoaffective disorder, brief psychotic disorder, panic disorder, PTSD, obsessive-compulsive disorder, generalized anxiety disorder, body dysmorphic disorder, dissociative amnesia, gender identity disorder, insomnia, narcolepsy, nightmare disorder, intermittent explosive disorder, gambling addiction, adjustment disorder, borderline personality disorder, antisocial personality disorder, histrionic personality disorder, and of course non-diagnosable problems like marital difficulties, infidelity, work-related stress, parenting problems, etc. Then there are people who come in to see me who don’t fall into any category. So it stays pretty interesting. Every day is different. I never know who will walk through the door.

Because Sasebo is a base consisting mostly of forward-deployed units, the vast majority of the patients I see are sailors assigned to sea duty. They spend as much as six months out of the year out at sea. You can imagine the stress this puts on them, their spouses, and their children. I’ve already learned that my workload increases exponentially the week before the ships go out to sea and the week the ships return. One might think that my workload decreases when the ships are out to sea, but so far that has not been the case. First of all, there are always some ships in port at any given time. But when the big ships leave, that’s when I tend to see more of the spouses. Also, I regularly do assessments on patients who get medevaced off the ships for psychiatric reasons. 

The base is small (Fleet Activities Sasebo holds roughly 5,000 sailors and dependents, although this number varies greatly depending on what ships are in port), and the services we offer are quite limited. Our facility is not a hospital but rather an outpatient clinic. There is no inpatient unit here, so when sailors show up with suicidal or homicidal thoughts or in the throes of a psychotic episode, I have to coordinate to get them flown to Okinawa for inpatient treatment. 

One big drawback of my job is that people know the psychologist is one of the few people who can get you OUT of the Navy. An unfortunate nickname for Navy psychologists is “wizards” because we supposedly make people “disappear.” The sailors know this. So just about every homesick kid who wants out of the Navy makes an appointment with me and tries to create a story about why he/she is mentally unfit to be in the Navy. Some of the stories are quite entertaining…and creative! The most common way people try to get out of the Navy is by telling someone in their command that they want to commit suicide. This of course incites panic because no commanding officer wants a suicide on HIS watch. So the immediate reaction is to send the sailor directly to me for a complete psychiatric evaluation. Nine times out of ten the person is not actually suicidal but just wants to go home. So I see a lot of people who just want out, and that gets old. Imagine the agony of being 20 years old and having to travel to Singapore, Malaysia, Hong Kong, The Philippines, Australia, Guam, Okinawa, Indonesia, and Thailand. Sheer torture!


But overall, I really love what I’m doing. I’m the psychological “expert” on base, and I have a lot of freedom to run my department (of one) how I see fit. I feel supported by my command and am really happy to be working on a true working naval base with real sailors. I’ve had chances to tour the ships and to learn a ton about how the fleet operates. I feel like I’ve learned more here about the Navy so far than I did in the 8 months I spent in Bethesda. The work here is more challenging; the hours are longer; but I wouldn’t want to be doing anything else right now. It really does feel like a once in a lifetime opportunity.