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Tuesday, January 17, 2017

EXCLUSIVE: What Chelsea Manning teaches us about the U.S. military's mental health crisis

Chelsea Manning

Outside the newly christened Stewart Lee Udall Federal building in Washington, D.C., the air was crisp, but inside, President Barack Obama was glowing. Surrounded by top staff and military leaders, the president signed into law a bill that would eventually repeal the U.S. military’s “Don’t Ask, Don’t Tell” policy (DADT), which had for 18 years banned gays and lesbians from serving openly in the military.
Evoking the memory of a heroic gay soldier who narrowly escaped death at the famous Battle of the Bulge—one of the largest and bloodiest for the Americans of World War II—Obama recalled the many sacrifices of American troops, including those who had given their lives. “None of them,” he said, “should have to sacrifice their integrity as well.”
Less than 50 miles away, at a Marine Corps brig in Quantico, Virginia, Private First Class Chelsea Manning stood in her cell, unable to lay down.
For 23 hours that day, just as she had for the approximately 140 days that preceded it, Manning sat alone under a fluorescent light in a six-by-eight-foot cell marked “192.” An “anti-suicide” blanket, quilted from a coarse, tear-resistant material, covered her rack (what Marines call a bed), neighboring a cold steel sink with a toilet bowl below. To use it, she would stand at parade rest in front of her cell door—feet 10 inches apart, her hands interlocked behind her—and wait for a guard to notice her. Then she could ask for some toilet paper.
From 5am until after 5pm, Manning was prohibited from lying down in her rack. She wasn’t allowed to exercise so instead she would dance; unlike pushups, dancing wasn’t prohibited in the brig’s rule book. Sometimes she was allowed to read books that were sent by her family, all of which were stored in the adjacent cell. As long as she was reading, or appeared to be reading, she could hold on to the book. But if she paused, to rest her eyes, for instance, a guard would quickly approach her cell and ask to retrieve the book.The most “entertaining” object in her cell during those 11 months at Quantico was a metallic mirror bolted to the wall. Starved of real human contact, she spent untold hours standing in front of the mirror, interacting with herself as her overseers observed from a room across the hall. Only if she had heard the guards talking that day—perhaps while being led to or from her cell in chains during her allotted one hour of “rec call”—would she have known that Dec. 22 was a special day. After all, she was never allowed to watch the news, and the guards took special care to keep her in the dark about current events.
Nearly 10 months passed before DADT was formally repealed on Sept. 20, 2011. In a statement marking the occasion, the president wrote: “As of today, patriotic Americans in uniform will no longer have to lie about who they are in order to serve the country they love.”
He was almost right.
Another five years would pass before transgender Americans like Manning were granted the same right to serve their country without being forced to lie.

Intensifying over time

Obama’s remaining time in the White House is no longer counted in days, but in hours. One week ago, news spread that the president is considering a commutation for Manning, who has more than 28 years of prison time remaining on her sentence. Her fate, at least for the next few years, will be imminently known. (Soon after publication, Obama commuted Manning's sentence.)
What is known now, however, is that Manning is unlikely to see any mercy during the presidency of Donald Trump, who, when asked about transgender soldiers on the campaign trail, berated the U.S. military for becoming “more and more politically correct every day.”
First detained in May 2010, Manning was accused of leaking more than 725,000 secret U.S. government documents to WikiLeaks. She was charged and convicted under the Espionage act for willfully disclosing national defense information; but acquitted of aiding the enemy. After pleading guilty without the protection of a plea agreement, Manning apologized in court for her actions. “I'm sorry that my actions hurt people. I'm sorry that they hurt the United States,” she said. “I understand that I must pay the price for my decisions and actions.”
Despite the large cache of files she released, Manning was charged with leaking portions of only 227 documents. Portions of at least 44 of the 116 U.S. diplomatic cables included were subsequently declassified by the U.S. State Department. According to a classified review by Defense Intelligence Agency, the overall risk to U.S. national security resulting from Manning’s leak was reportedly moderate to low.

While only a small percentage of transgender men and women experience gender dysphoria, those who do may experience a wide variety of symptoms, including, but not limited to, anxiety, severe depression, and the desire to self-harm, ranging from suicidality to self-surgery. (In the case of trans women, this means attempts at self-castration.) Widely recognized as the world’s authority on gender dysphoria, the physician-led World Professional Association for Transgender Health (WPATH) recommends a broad range of treatment: psychotherapy, which is not alone sufficient; changes in the patient’s gender role, e.g., dressing, grooming, and expressing oneself as consistent with one’s gender; in addition to hormone therapy, which Manning began while custody in February 2015.
In more severe cases, gender-affirming surgery is deemed necessary in order to relieve the mental distress experienced by a person whose brain is constantly reminding them they are trapped in a body in which they do not belong. Such is the case with Manning. “Gender dysphoria intensifies over time,” her lawyers wrote in a 2015 complaint. “The longer an individual goes without treatment, the greater the risk of severe harms to the individual’s physical and psychological health.”
“I just remember thinking, I’m going to die.”
“Manning’s providers have recommended that she be permitted to grow her hair consistent with the female grooming standards and that she be treated with genital surgery,” says Chase Strangio, Manning’s attorney at the American Civil Liberties Union. “Despite these recommendations, these treatments have been withheld causing Chelsea to experience significant and at times deadly distress. Courts have also routinely held that it violates the Constitution to deny prisoners recommended health care for non-medical reasons.”
“Since her sentencing, Chelsea has had to fight to receive the basic care recommended by the military’s own doctors and the continual resistance to providing this care not only runs afoul of the Constitution but jeopardizes her health and well-being,” Strangio says.
With the advent of the Pentagon’s new policy welcoming transgender service members, formally announced in September 2016, Manning’s forecast for treatment greatly improved. After years of being denied treatment—which her lawyers contend led to two suicide attempts last year—she was slated to become the first U.S. prisoner to undergo surgery for gender dysphoria. But with Trump entering the White House this week, Manning’s hope of achieving mental health and wellbeing may be shattered for the foreseeable future.

‘Tell them they are weak’

To understand Manning’s experience is to understand that the military she served in was rife with regulations and a culture hostile to her very existence.
In 2007, when Manning enlisted in the Army, transgender Americans were defined by Department of Defense as mentally diseased and unfit for service. (A plurality of transgender service members, like Manning, were enlisted in the Army, according to a 2008 survey.) It remained that way for more than half a decade after Manning’s arrest.
Partly stemming from her dysphoria, Manning’s behavior, even prior to her crimes, was frequently disruptive and caused alarm among her colleagues in Iraq. Mental illness is an issue that service members are often reluctant to talk about, and for good reason. Even the widely discussed post-traumatic stress disorder (PTSD) carries with it the stigma of weakness among the warrior class.
Army Specialist Brandon Neely, a former guard at the Guantanamo Bay detention camp in Cuba, witnessed this stigma firsthand while serving a year in Iraq. “I’ve known more guys that I served with in Iraq that committed suicide than I know who got killed when I was in Iraq,” he says. (Neely is notable for speaking out against human rights abuses he says he witnessed and participated in, regretfully, at Guantanamo Bay. He is also the former president of the Houston chapter of Iraq Veterans Against the War.)
The practice of shaming soldiers who seek mental health care lies on a continuum that begins on the battlefield and continues stateside. In Iraq, Neely says, soldiers of higher rank would often publicly humiliate subordinates who asked to speak to a psychologist. “They would berate them, call them names, tell them they are weak, tell them they couldn’t handle it,” he says. “Why would you wanna come forward and go through all that?”
“There’s no real outlet,” adds Neely, except for talking with other vets. “I couldn’t imagine what it’s like for Chelsea Manning being in prison. She has nobody to talk to. No friends or anything like that. At least here, if a friend of mine is having problems, they can call me.”
Outside of the harassment and personal and sexual violence experienced by transgender soldiers on active duty, their experiences while attempting to receive care from the Veterans Health Administration (VHA) speaks volumes about the system’s overall dysfunction and the extreme neglect of those under its care. Indeed, if the Department of Veterans Affairs (VA) viewed transgenderism as a psychopathological issue, as its regulations stated, its treatment of soldiers manifesting this perceived mental illness may be defined as callous, if not acutely hostile.
Research in 2008 into the experiences of transgender service personnel revealed numerous instances of “organization and interpersonal discrimination” on the part of VA doctors, nurses, and non-medical staff. (Of transgender veterans attending VA facilities, up to 82 percent were, like Manning, trans women.) Ten percent of veterans reported being turned away from VA facilities specifically because they were transgender; only a third of those had raised the issue of transition with the medical staff. In extreme cases, military doctors refused to see transgender veterans, denying them access to general medical care.
“I was told by a religious clerk that I should just go away because I was an insult to the brave real men who were there for treatment,” a trans woman told researchers. After another inquired about the possibility of treatment, a doctor told her: “The VA does not turn men into women.”
“The VA does not turn men into women.” 
Manning was hoping to achieve the exact opposite when she enlisted: “I thought a career in the military would get rid of it,” she wrote of being transgender in 2010 email to a supervisor in Iraq. She is not alone. Facing a societal stigma, the phenomenon of trans women joining the military to purge “the feminine self” was defined by former military psychologist George R. Brown, whose 1988 scholarly work on the topic bore the title, “Transexuals in the Military: Flight Into Hypermasculinity.” A copy of Brown’s article was discovered among Manning’s possessions subsequent to her arrest in Iraq.
A more recent study by Brown demonstrates the prevalence of biologically male service members who identify as transgender is more than double that of the civilian population. This research shows that—at least as of 2012—trans women were flocking to military service, wittingly committing themselves to a climate of heightened hostility toward their gender identity or self-perceived mental illness.
According to the National Center for Transgender Equality, there are more than 134,000 transgender veterans in the United States; but as Trump’s crusade against “political correctness” becomes the stuff of White House policy, their future, and the future of the nation’s transgender service members on active duty, appears as unknown as Manning’s own fate.

‘Always planning, but never acting’

Manning was first diagnosed with gender dysphoria weeks before her arrest by Cpt. Michael Worsley, an Army psychologist. Her condition, which manifested itself in the form of psychological distress, anxiety, and occasional emotional outbursts, was exacerbated by her Army life, Worsley stated at trial. Asked what mechanisms the military had in place to treat with gender dysphoria, he responded, “Really, none. There was nothing available other than somebody like me and, again, [she] was taking a chance with that.” 
Indeed, Worsley’s diagnosis left Manning in a rather precarious situation. “You could be court-martialed and put out of the military,” said in court. “So to share that with anybody was an extremely difficult thing.”

After a violent episode in which Manning struck a fellow soldier, Worsley and Manning began discussing a plan to get her out of the Army—one that would allow her to retain her benefits and “go on and have a productive life.” Due to its discriminatory policies, Worsley asserted, Manning had little or no hope of receiving the treatment she required from the Army. Her work environment, he said, was “openly hostile.”
In Iraq, a sign hung above the desks of the targeting analysts in the intelligence shop where Manning worked: “If you think for one second you can come in here and bug us with sissy shit you might want to rethink your pathetic life.”
Immediately after her arrest in late-May 2010, Manning was transferred from Iraq to Camp Arifjan, Kuwait. There, following a brief indoctrination period, she was detained in a 20-man tent along with several other prisoners. It was soon after that that Manning overheard the other prisoners gay bashing. Apparently agitated, she responded by telling the other prisoners that she was gay. While being interviewed about the incident by Army personnel, she experienced an anxiety attack and was segregated into a cell by herself.
Manning’s behavior became increasingly peculiar after arriving at Camp Arifjan, but the doctors observing her saw no immediate signs that she intended to harm herself. That quickly changed, however, after she was placed in isolated confinement, whereupon she was forced into a reverse sleep cycle. “My days were my nights and my nights were my days, and after a while, it all blended together and I was living inside my head,” she later said in court. “I just remember thinking, I’m going to die. I’m stuck here in this animal cage, and I’m going to die.”
The mounting isolation, in which Manning only interacted briefly with the guards who brought her food, led to a mental breakdown.
After a month in confinement, Manning became unresponsive to commands and would sometimes yell uncontrollably in a manic state. She babbled incoherently, shaking and bashing her head into a wall. She was once observed knotting her sheets and turning them into a noose. During an interview with mental health physicians in Kuwait, Manning stared off into space blankly, hugging herself, with her knees pressed fully against her chest. She didn’t intend to use the noose, she told the doctors, but she at least wanted the option.
Visited by a physician the next day, Manning reported feeling helpless and scared. She continued to consider ending her own life, though she said she had no immediate plans to do so. The following day, she was accused of collecting various items that might be useful for hurting herself; she later admitted trying to remove a pin from her cell door for this reason. She repeatedly said she would not notify anyone if she planned to die.
Upon arriving at the Quantico brig the following month, Manning was asked if she was contemplating suicide on an intake questionnaire. “Always planning, but never acting,” she wrote.
Manning’s one suicide attempt at Arifjan was later used to hold her at Quantico under extreme “prevention of injury” procedures, even though the brig's own mental health professionals advised against it. The presiding military judge later granted her 112 days of sentencing credit for a portion of her confinement at Quantico, where she was stripped of her underwear and forced to stand naked at attention.
Update 4pm CT, Jan. 17: Two hours after publication of this piece, news broke that Obama has commuted Manning's sentence. She will be released on May 17.
For more information about suicide prevention or to speak with someone confidentially, contact the National Suicide Prevention Lifeline (U.S.) or Samaritans(U.K.). If you need to speak to counselors with experience dealing with transgender issues, contact Trans Lifeline at (877) 565-8860 (U.S.) or (877) 330-6366 (Canada).

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