Personal View: A way out for the conscientious objector: “become” a mental patient
Authors: Daniel Moldavsky
Journal: BMJ (2006)

Military service for a period of two to three years is compulsory for everyone in Israel. Male doctors, in common with other male citizens, have to serve in the army reserves for periods of up to two months each year until the age of 51. They therefore face situations during their professional lives that colleagues in countries without compulsory military service do not, fortunately, encounter.

In a country such as Israel, military service is seen as a reflection of a person's involvement with their community. Being unwilling to serve can have major implications on someone's future, including their job prospects and practical issues such as obtaining a driving license.

Psychiatrists are regularly required to assess people whose chief complaint is reluctance to serve in the army. Some of these people justify their position on personal grounds, such as job or family commitments, or tiredness resulting from the harsh realities of policing the Israeli occupation of the Palestinian territories and population.


Refusing to serve in the army on ideological grounds is difficult


Refusing to serve in the army simply on ideological grounds is difficult. Those who try this route have to endure long periods in prison before being recognised as conscientious objectors, according to cases documented by human rights organisations.

One way out for conscientious objectors is to be diagnosed with a psychiatric illness. In my experience as a psychiatrist doing reserve military service, many soldiers choose this path to apply for discharge. The almost daily scenario facing a psychiatrist is a soldier who is left with no other choice than “becoming” a mental patient. This means that, as long as the psychiatrist understands the soldier's predicament, what follows is an effort to medicalise the problem. Reluctance to serve in the army is subsequently re-categorised as an outcome of anxiety, mood disorder, personality disorder, or impulse control disorder, or given some other mental illness diagnosis.

Am I casting doubt on the professional competence or integrity of my colleagues in Israel? No. There are some clear cases of psychopathology where the obvious outcome is discharge from the army. However, the issue becomes more complex during periods of increased conscription, when the divisions between active avoidance, passive refusal, and silent protest become blurred.

This problem occurs, in my opinion, when there is a lack of complete consensus in a society about the perceived righteousness of a war in which it is fighting. The consensus in Israel has been incomplete since the highly unpopular war against Lebanon.

In 2002 when Jenin and other cities on the West Bank were destroyed, it was impossible not to empathise with the plight of soldiers requesting psychiatric assessment, who claimed they had strong grounds on the basis of personal or family problems for not serving. Although most of them would have disagreed that they were conscientious objectors, I asked myself repeatedly about the extent to which these soldiers were reflecting the profound distress pervading Israeli society more generally. I also questioned why psychiatrists ended up with the task of medicalising human suffering and diagnosing people as being mentally ill when their main symptom was that they wanted to live and let live.

This situation poses a moral and ethical dilemma. But it could easily be dealt with by disentangling the “social” from the “medical.” The problem is that refusal to serve is seen as a problem with “motivation,” which is neither ideological nor mental. Because the Israeli army—along with armies in most Western countries—is reluctant to recognise refusal to serve because of pacifist views or objection on the grounds of conscience, no one takes responsibility for dealing with the issue.

Some Western countries, including France and Germany, have long recognised conscientious objection as a reason for refusing to enlist. And some of the countries in the former Soviet bloc, notably Poland, followed this path during the 1990s. But in countries where conscientious objection is not seen as a valid reason for reluctance to serve in the army, soldiers continue to suffer. The psychiatrist, in turn, is pressed between his loyalty to the soldier-patient's welfare and pressure from the army.

The soldier's fate will depend on the individual psychiatrist's views on values and human rights. On many occasions, empathising with a fellow human being in distress, I simply tried to do everything possible to negotiate their discharge.

Psychiatrists constantly face moral and ethical dilemmas rooted in social suffering. We need to understand the social and political context of situations if we want to give effective help. We all have a duty to protect and preserve life. Ultimately, both soldiers and civilians are victims.