Michael Perlman

Michael is a psychiatrist in full-time practice in Northampton, MA.  His focus is on adults and he specializes in manic-depressive illness, which he treats through psychotherapy and medication.  He is 71 and has been in private practice for 30 years.  He is married and has two children and seven grandchildren.

I was doing my psychiatric residency in the Massachusetts Mental Health Center in Boston, Massachusetts from July 1966 to June of 1969. During that time period I was subject to a military draft and there was something called the Berry Plan, which said that if you agreed to go into the military in your specialty you wouldn’t be drafted and they would wait until you finished your specialty training before you would go in. I didn’t want to go to Vietnam. I enlisted because I would have been drafted and if I had been drafted I wouldn’t have been allowed to practice my specialty.  What I wanted to do was to practice the specialty of psychiatry which I did.

I thought about going into public health service, but because I didn’t want to work in a federal prison and I figured they’d put me in a federal prison, I decided to go into the Navy.  The Navy, in their wisdom, put me in the maximum security Marine prison in New Hampshire – the U.S. Naval disciplinary command post in Portsmouth, New Hampshire where I served from July of 1969 until February of 1971.

I was married and we had one child, Adam, who was born in January of 1968 in Boston. I was very much against the war and my wife, Gail, was even more against the war than I was and was not happy about me going into the military. We rented a house in Kittery Point, Maine and my wife became pregnant in the course of the time I served there.  Our daughter, Becky Perlman, was born in the Naval hospital in New Hampshire.  Gail had her position and I had my position about the draft and the war, but I was the one who had to make a choice as to what I was going to do that I thought was sensible. I didn’t see any very good alternative and I thought I should serve in some capacity and so I went in.  The first thing I did was I took a course in the Uniform Code of Military Justice, a correspondence course, so I knew who was who and I knew exactly what I could and could not do in the military.

One of the things I did was I submitted a challenge about the lack of privileged communication for psychiatrists in the military.  We were told that we were supposed to do psychotherapy, but we were also told that there was no privileged communication for psychiatrists.  I sent a letter through the chain of command, through my commanding officer who was a Marine colonel, and the legal officer of our prison, saying that I was being given conflicting orders and I was respectfully requesting clarification of those orders. On the one hand, I was told that I had to do psychotherapy – I gave them reasons why you need privileged communication in order to do psychotherapy – and on the other hand I wrote, there’s no privileged communication, so I’m being given conflicting orders. Also, I told them, you have privileged communication for priests and ministers who are chaplains here, and you don’t have it for me and therefore you’re favoring religious versus secular counseling and that’s a violation of the Bill of Rights.  It’s an establishment of religion!  I never heard from them. That was one of my ways of dealing with the situation I was in – to seek this clarification.  When it was not forthcoming, I just went ahead and acted as if the patient had.  I just had privileged communication and that was never challenged in any way. I never had any kind of problems with that. I took it as a given that I wouldn’t reveal what people were telling me.

I decided early on that I would make the best of the situation – that is to try to not avoid things, but to do what I believed in.  So one of the first things I did was, since we had to do a psychiatric evaluation on every prisoner who came in, I decided to ask each of them why they were there. If I had any sense that they were there unjustly, I asked them to give me a copy of their record of trial.  I read this over and made a determination in my own mind as to whether they were there unjustly.  If I still felt they were there unjustly, I found lawyers for them. I made contact with civil rights lawyers outside the prison and I would act as a liaison between them.

One example comes to mind.  This particular man was a Southerner, a young kid really, who clearly shouldn’t have been there.  I said to him, “You know, you’re here unjustly.  I think you should get a lawyer.”  He said, “I don’t know how to get a lawyer,” and I said, “How about the American Civil Liberties Union (ACLU)?”  His response was, “I don’t know how to contact them,” so I took out my wallet and showed him my ACLU card.  I was a member.  I said to him, “Here’s the address, but don’t tell anybody that I gave you this.” This was early in my career at the prison and I was wary of it being known that I was doing this type of “counseling”.  He said, “Of course I wouldn’t tell anybody,” and I said, “Why ‘of course’?” and he responded with, “Everybody knows there’s confidentiality between doctor and patient.” True story.

So the role was to do these kinds of evaluations. The civilian head of the prison at that point said that we were window dressing for Congress.  I figured if I’m ‘window dressing’, I’m going to do the best I can, so I did a thorough psychiatric evaluation on every man I saw.   Clearly no one had performed such an evaluation prior to his conviction.  That happened frequently and still does.  If you look at the criminal justice system right now, a significant percentage of people have mental disorders and have never been diagnosed.

The other responsibility we had was to do treatment and so anybody who came to me, and that includes prisoners, that includes guards who were Marine guards or officers either Naval or Marine officers, we would treat for any kind of psychiatric condition they came in with. Some of them had PTSD (post-traumatic stress disorder), absolutely. (Prior to this interview, Michael and I had attended a workshop at our Trinity College reunion during which a Vietnam veteran who had flown numerous missions dropping napalm and Agent Orange attempted to convince the audience that PTSD was greatly exaggerated and afflicted hardy anyone who served in Vietnam).  This was, for me, even though it was I felt it was a foolish war, a way I could at least do something constructive in the midst of the insanity of the war effort.  Other people with whom I served spent their time studying for their medical boards and they avoided the whole issue of the war, but I wasn’t comfortable with that so I decided to do what made sense to me.

The experience of evaluating the soldiers who were guilty of felonies during the war gave me a willingness to challenge the assumptions of certain conventional wisdom within the military or what certain people felt about the war. I was actively looking for evidence of post-traumatic stress disorder and especially post-traumatic stress disorder as it related to the crimes against civilians, massacres against civilians. In the course of that, even though I was actively looking and I was prepared to recognize that it could be there, I was very careful not to plant that into people’s minds and I didn’t want to in any way suggest that that’s what I was looking for or give people clues as to what I was looking for. I would encourage people to free associate. That’s what I was doing in psychotherapy anyway.  I didn’t ask them leading questions that were designed to elicit certain kinds of information.  What I tried to do was to structure the situation in such a way that if there was problematic traumatic material, problematic conflict would emerge. I definitely did not want to do anything that was going to lead my client in any way. I would say to them; “Sit back.  Close your eyes.  Try to give up control and tell me what feeling or picture or thought comes to your mind.” I did not find that in the majority of people there was this post-traumatic stress disorder, by no means. But there were a few. There definitely were some.

There was one man I remember who talked about killing people and then talked about having recurring dreams, but the truth is I am still concerned about confidentiality, though, so I am reluctant to give details.  Let it suffice to say that I definitely saw some people who I felt became actually psychotic as a result of feelings associated with killing civilians.

The vast majority of people were in the prison for desertion, which meant that they had left their unit for more than 30 days.  This didn’t automatically mean opposition to the war. Most of them were rural whites and urban blacks who had difficulty with the discipline in the military and I don’t think it was a political decision at all that led them to desert.  Most of them were Marines, so most had enlisted.  Almost all of them had originally gone into the Marines for positive reasons. They thought it’d be a good thing for them and that they could really be proud of their country and their service. When they deserted, they ran away from the structure and having to do such and such.  They just couldn’t tolerate having somebody watch them as much as they were being watched. There were also people who did things like murder and rape and killing officers, but those were usually a small minority of the people in the prison.

I’m reminded that there was a clemency and parole board.  The board consisted of a Marine major, a civilian, a Navy warrant officer and me.  We were presented with cases of Navy and Marine people who were asking for clemency and parole and we had to make recommendations to the clemency and parole board in Washington.  I remember one case in which these two black men, who were serving 15-year sentences, had complained to their CO (Commanding Officer) that the Vietnam War was a white man’s war.  One of these guys came before the board and said that he wanted to be released.  He wanted to become a social worker and go to Harlem to help his people. I voted for immediate release. We had secret ballots, but we could actually see one another’s ballots.  The major right next to me looked at my ballot and said, “The CO will be furious,” and I said, “I don’t care.” And so he wrote immediate release on his. Did any good come out of this? Probably not. Maybe this was sent to the clemency and parole board in Washington, but who knows what happened. It’s really impressive to me that this Marine major, who came across as a very tough guy, could be influenced in this way, that he was receptive. I was quite struck by that.

I had a great deal of respect for many of the Marines. I used to play basketball with them.  Every lunchtime we would play and I got to know them pretty well and I liked a lot of them.   Many of them had been in Vietnam.  Often they were very decent, reasonable people.

Another key component of my role was to tell the truth about things that were going on in the prison – what was going on with other prisoners and what was going on with the guards. Just telling the truth about all kinds of things is very helpful. Not infrequently, some of the men were upset about different kinds of things.  Giving them a chance to talk about those things helped them deal with them. I had a model in my mind that the mind is an autonomous instrument that if its given the fodder – the feelings and the details of problematic events – it will tend to work those through and process things.  My job was to help them do that.  I used medication to assist in this process.  We were allowed to use medication totally at our judgment and we were not interfered with at all by the authorities. We had to be very careful though, since we were dealing with a population that would often use drugs to self-medicate and become addicted. You had to be enormously careful about prescribing anything that could be abused.  Those who had major drug problems had already been de-toxed by the time they arrived in the prison so that was already settled.  We never had to deal with acute, or sub-acute withdrawal of drug or alcohol problems.

I saw my job as helping the people with their feelings. I would even talk about the war and my view of the war.  I would talk about America and my view of America. I remember I was doing group therapy with six prisoners, three of them white and three of them black and they didn’t understand anything about Israel so I spent 2 hours giving them the history of Israel from 3000 years ago. The goal was I would help them understand the truth. They asked me a question that got us started.  It wasn’t as if I was imposing anything on them. They said, “Look, we want to know about what’s happening over there…”  I think it’s therapeutic for them to have me tell the truth or give my perspective on something when they’re asking about it. It has to do with trust.  One of the things that I’d always felt about psychotherapy is that the most important thing is to do everything you can to maximize the sense of trust that the patient has in you and so everything I did in the psychotherapy with them, even given the constraints, was to maximize the trust they would have.

I was very wary about the misuse of medications and at the same time, I knew I had to be very careful about violence.  There was always a sense that violence could occur at any time.  You had to make sure that you wouldn’t allow yourself to be threatened in any way by some of the prisoners, some of whom were really vicious people.  In some instances, before their military service, a sentencing judge had told them that they could choose between jail time or the military These were people who had had problematic lives before they went into the military.  It was actually quite terrifying.  For instance, you would walk into the prison in the morning and you would hear an iron gate clang behind you and you were told very early in the course of the prison experience that if we were taken hostage there would be no negotiations for us.  I had nightmares for weeks about that. I don’t think I had PTSD from the experience of working there, but at the time I had nightmares and for weeks or months afterwards I had nightmares about being a hostage. The dreams were about being trapped and not being able to get out, being in some enclosed space and not being able to get out of it.

There was also violence among the inmates.  Prisoners would rape other prisoners; there was constantly a risk of that. There were also times when we had to go down to the hole (solitary confinement) to examine people and make sure they were O.K., make sure they weren’t going crazy.  It was very cold in solitary and the wind on the coast of New Hampshire in the winter would be freezing. We also had general medical people who examined the inmates as well. If anyone suspected that one of the prisoners in solitary was actually going crazy, it was my job to figure out whether they were faking or not.  What comes to mind is that I was an emergency room doctor for 60 days during my medical training as an intern.  I had to do all kinds of things like examining an 18 year-old kid’s body who had just died from a heroin overdose. It’s not pleasant. You just have to do it.  Maybe such a stint prepared me for the prison experience.

Back to the drugs, my hunch is that at least some of the inmates were abusing the meds we were dispensing.  When they were given a dose, they could cheek it and then put it under their tongue, take it away and sell it.  Now you have to be mindful of that in any hospital or prison patient, but especially in that setting with that population you had to be mindful of it all the time.

I couldn’t wait to get out.  One day I was there and the next day I wasn’t.  Near the end of my time they had a farewell meal and when we were about to eat, someone in charge said, “We should say a blessing,” and I said, “Can I say the blessing?”  I said the blessing in Hebrew. It was an opportunity for me to be self-revealing, showing something of my core personal identity, beyond my professional identity, which I had had such a hard time being while working there.   It wasn’t that I didn’t have the freedom to do what I wanted in my time with the inmates.  I felt an enormous amount of respect from the various Marine officers and I could do whatever I wanted.  As long as you were respected, as long as you were known as somebody they could trust, you could do anything that was appropriate professionally.

There was a barber shop there and I used to have my hair cut at the same times that members of the O.N.I – Office of Naval Intelligence – were there and I would talk to them. I don’t remember that we would talk about political stuff.  We would just talk. I felt very comfortable with them and if they sensed that you were a solid person they could trust, they didn’t give you a hard time at all.  Coincidentally, just two weeks ago in Toronto I went to the American Psychiatric Association meeting and I ran into Dennis Jurczak who was a career psychiatrist in the navy.  He was also my boss and he and I, even though we had very different political orientations, got along very well. Back then we used to talk about our different backgrounds and he once gave me a book about the history of Poland. I liked him. There’s definitely a way in which the military puts you in contact with some people you wouldn’t normally get in contact with and that can be a very exciting adventure.

Looking back my time in the military definitely brought the reality of war, the reality of prison and the reality of the military closer to my consciousness. I think that’s the major way in which it affected me, but it also at least for a while, affected my career.  A lot of the work we did required that we analyze things and spell out why we made our conclusion.  I liked doing this type of forensic work.  The next job I got was as the director of legal medicine with the department of mental health in the four western counties of Massachusetts.  I spent 3 ½ years doing that and working with prisons.  I was involved in a lot of work with some people in Boston who were in the forefront of the treatment of prisoners and forensic psychiatry.  I also did a private practice and after the 3 ½ years I found that my private practice of psychiatry was more gratifying than the forensic stuff so I let that go.

While I was working in the prison, I was struck by the fact that the vast majority of the prisoners were poor, rural whites and  poor urban blacks and it seemed to me to be totally unjust that they were the ones we found to fight the war.  So many people escaped serving during the war for all kinds of reasons and it just seemed to be totally unjust that these men bore the brunt of the war and then the prison experience.  It was this sense of outrage that has caused me to feel that there should be a universal military draft.  When I read in New York Times editorials that such a position is unrealistic, I’m enraged at the lack of willingness of those editorialists to stand up for what I think is justice.   I’ve always had awareness that people in my family served in the military. I have a first cousin who was killed in Vietnam.  He was an officer whose plane was shot down. My wife’s uncle was killed in World War II.  He was a lieutenant in a tank in the intelligence corps and was killed soon after D-Day on January 7,  1945 in France.  My father was in the Coast Guard.  I always had a sense that you should serve. There are options.

What do I feel now about what I did and what I saw?   It’s a little upsetting. The whole experience feels painful.  There’s a lot of pain.  There’s also a sense, maybe more than anything else, of injustice about the people who had to fight and the people who were allowed to not fight.  That more than anything is I think what strikes me – the fact that those I treated were the victims. They were the ones who were exposed to the terrible conditions they were in where people could rape them and people could be physically violent with them, but just now I was thinking more about the fact that they had to be in that awful position and other people escaped that.

The other thing I should tell you is that, as we’ve talked about this and I’ve talked about what it was like to be in the prison, it’s painful and scary.  Just remembering that kind of experience is also very painful.  As for sharing people’s pain and their personal stories, I’ve never published a paper on psychotherapy and manic depressive patients, my specialty, because I am too concerned that I couldn’t successfully disguise the material and at the same time convey the reality of their lives.  For me, if I have to make that choice, the decision is you protect rather than publish.