Because that’s where the money is

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“Because that’s where the money is.” William “Willie” Sutton (1901-1980)

William “Willie” Sutton (1901-1980) was an infamous bank robber who stole an estimated $2 million dollars during a 40-year crime career. When asked by a reporter why he robbed banks, Willie was purported to have responded, “Because that’s where the money is.” Years later, Willie would deny ever making this comment, though one cannot help but smile at the clarity of logic the statement makes, regardless of the truth of the story.

I believe most providers at some point in their training have likely been exposed to the story of Willie’s famous response. It reminds young physicians to pursue first the obvious diagnosis suggested by the patient’s history and physical exam, “Because that’s where the money is.”

This past June, top military leaders from the services were lined up in front of a congressional panel to answer questions concerning the overwhelmingly high rate of sexual assault plaguing the ranks. Army Gen. Ray Odierno stated, “Sexual assault and harassment are like a cancer within the force — a cancer that left untreated will destroy the fabric of our force.”

A recent Pentagon report estimated that 26,000 military members were victimized by sexual assault last year. Many have suggested this number is low, due to the reticence of victims to report assaults over concerns of career and reputation. What could Willie Sutton possibly have to do with this painful issue that blights our military? Bear with me and allow me to write myself out of this editorial “corner.”

Close on the heels of this news event, requirements for retraining in sexual assault within the military filtered through the ranks. Everyone in the Army was required to watch certain video presentations about this issue and participate in discussions with immediate supervisors. One of the videos detailed the experience of a young female enlisted soldier who was assaulted by a senior noncommissioned officer (NCO) and then had difficulty in reporting the issue through her chain of command. Apparently the NCO was popular within the command and immediate leaders within this soldier’s command initially chose to protect the NCO from her accusations. Fortunately, this soldier stuck to her convictions and, eventually, her accusations were confirmed by other female soldiers within the same unit who were bolstered by her courage as she refused to remain silent in the face of considerable peer pressure.

Throughout this short video, I could not help but wonder why she did not seek medical help early in her ordeal. I am certainly not being critical of this victim of sexual assault; rather I was saddened that she did not see the federal medical community as a place to go following her personal tragedy. Seeking medical attention would not have put right the assault or the terrible abuse of authority perpetrated by the NCO, but I believe she would have received much sooner the understanding, care and leadership this situation demanded.

Among the many materials I was required to view, I was particularly struck by this soldier’s story. My eldest daughter has taken a four-year Army ROTC scholarship, and I as a father cannot help but feel concerned  about the risk of this type of assault in the current military climate. As part of this retraining requirement, a personal communication was mandated between individuals and their immediate supervisors about the sexual assault materials we had reviewed. My supervisor and I both have teenage daughters, and I had mentioned that my eldest daughter recently had joined the Army ranks. This officer stated she was not sure she could recommend military service to young women because of this issue.

In light of the current pestilence concerning this subject, I did not have a clear response. I have tried to arm all three of my daughters against this threat by being brutally clear about the issue and the importance of situational awareness regarding this potential danger. Obviously, that is not the complete answer to the threat of sexual assault.

In the end, this is a leadership issue that will require retraining of the force at all levels. Sexual assault, like any assault, is the forced physical and psychological dominance of one individual over another. It certainly is not limited to males assaulting females, and it is not limited to our military team. The stories my eldest tells about the risks of date rape in college are no less unnerving. This is a social evil that is rooted deep in our collective biological and cultural history.

For the military, historically the domain of men hacking at each other face-to-face on the battlefield, the adjustment to women in ever more prominent roles has been challenging. Today’s war is less a game of brute strength and far more focused on the intelligent mastery of the machines of war. As a modern force, we cannot afford to limit the defense of the country to only the male half of our population willing to defend our freedom. Women are vital to our defense and here to stay.

I suggest we stop having the discussion about whether women should be in the military and start dealing with how we are going to provide conditions on our military teams to maximize the potential women bring to the fight. Part of this effort requires creating a safe environment for all servicemembers (like my daughter) to function on a military team that is free of sexual predation and dominance. When assault of any type occurs, servicemembers must be armed with clear paths of action to respond.

Much of this solution rests with line commanders, but federal medicine can and must play a key support role in the process. Federal medicine has demonstrated we can adapt to the challenges of post-traumatic stress and traumatic brain injury by providing healthcare that limits the impact of these diseases to the individual and the force. We have made great strides in destigmatizing these health issues, allowing those burdened with these ailments to come forward and begin the process of recovery. We must play the same caring role on this issue as our military works to drive the scourge of sexual assault from its ranks. Federal medicine must begin now developing programs within our system to be part of this solution.

Servicemembers should be trained to see federal medicine as the obvious resource and solution for dealing with the trauma of sexual assault. Victims of assault should come to us because “that’s where the money is” in terms of dealing with this terrible trauma and working towards physical and emotional recovery.

As far as my daughter is concerned, I remain proud that she has decided to become part of the Army team. Like any team, we have challenges, but we have demonstrated in the past that the military can overcome social ills and implement positive change within the ranks in deference to building a stronger team. I am confident this issue will be no different.

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