A doctor speaks about basic training for marine recruits. Notice the similarities to Wilderness programs.
http://content.nejm.org/cgi/content/full/351/1/3Excerpts:
Within a few weeks, I started to get a sense of what I would see clinically. The first thing to ask a recruit is "What training day are you?" You can usually guess the final diagnosis on the basis of this information. Basic training includes 2 "intake days," 5 "forming days," and 70 "training days." The kids who come into the emergency room on an intake day are usually there with slapstick stuff: someone breaks his arm stepping off the bus, another knocks himself out by running into a wall. Not a good beginning.
During the forming days (also known as "disorientation"), the drill instructors (DIs) introduce themselves and make the first real demands on recruits. This is when the weeding-out process begins. The earliest to go are the kids who've hidden a significant medical history, anything from asthma to bad knees. These are "fraudulent enlistments." When they get into trouble, the DIs send them to us to sort out. One kid sent in for "weakness" told me he would be fine if he could just restart his medications.
"What medications?"
"Zyprexa, Prozac, Buspar, and Ambien for sleep."
"And they let you in here? Did your recruiter know about this?"
"My dad told me not to tell him."
I looked at him. "What does your father do?"
"He's career Navy."
"And he told you not to say anything?"
The kid looked sheepish. "He thought this might make a man of me."
That first week, the kids meet the Third Hat ? usually the most junior of the DIs, who has been described as "a maniacal, sadistic, extremist psychopath whose name you, the recruit, will never forget." His job is to ensure that once a recruit becomes a Marine, he will not crack up, become insubordinate, or "go postal" at a critical moment. Obviously, the Third Hat doesn't accomplish this feat by being soft-spoken. And it's because of him, I presume, that I see the other common complaints of early training ? chest pain, shortness of breath, dizziness, weakness. The diagnosis invariably is "panic attack," but these are ferocious panic attacks: heart rates of 180, respiratory rates of 50, carpopedal spasm, and ? worst of all ? tears. Seeing a 6-ft 4-in., 250-lb former high school football star hyperventilating, sobbing, and begging to be sent home is an unsettling experience. And what exactly should I do for him?
I have two roles here: doctor and member of the Marine training team. My usual remedies, benzodiazepines and reassurance, aren't really adequate for this situation.
The final stage of boot camp, the Crucible, is a 54-hour mental and physical gauntlet. It consists of combat exercises, forced marches, and "warrior stations."
Oddly enough, we don't get too many injuries at this stage; most of the kids are smarter about dodging blows. What we do see are kids who are end-stage sick, with double pneumonia, grapefruit-size abscesses, appendicitis. These guys will do anything now to see this thing through. By this time, a recruit has become invested ? invested in making it with his fellow recruits, invested in proving the Third Hat wrong, invested in just getting the whole damn thing over with. One kid came in with fulminating Guillain?Barré and dropped out only when he became apneic.
The final stage of the Crucible, a nine-mile hike, is dedicated to the men of Easy Company who in 1944 fought their way to the top of Mount Suribachi on Iwo Jima and planted an American flag.
