Practice Profile

On Oct. 25, a pair of suicide bombers detonated massive vehicle bombs outside Iraqi government ministries in the heart of Baghdad, killing at least 153 people and wounding hundreds more, among them a team of U.S. security contractors. All of the men had cuts, scrapes, bruises and burst eardrums. One had a badly injured eye and several had been knocked unconscious.

Within a half hour, U.S. Embassy medical staff were treating them. Central to the team’s efforts was James Angelos, PhD, the embassy’s only psychologist. Angelos talked to the dazed and bloody contractors as they streamed into the embassy’s small clinic, staffed by a physician, a physician’s assistant and two nurses. He checked each man for concussion to determine who might need follow-up testing and treatment for a traumatic brain injury.

After the immediate crisis passed, Angelos conducted follow-up neuropsychological evaluations and provided counseling to the injured.

“They’re going to recover physically, but psychologically, [their lives are] changed,” he says.

Such intense trauma is still new for Angelos, 62, whose job back home in Santa Barbara, Calif., is to help people who’ve suffered traumatic brain injuries and spinal cord injuries, often from vehicle accidents. But that changed in August 2008, when he came to Iraq to work with State Department and federal government. He had been looking for a way to contribute his professional skills to the U.S. effort in Iraq, and found the opportunity in a 2007 job announcement.

“I really did see this as a unique call for a citizen, to step out of my comfort zone and the security of home and family, and serve my country,” he says. “I’d always been taught that privilege goes hand in hand with responsibility.”

Several months after he was offered the job, Angelos went through a seven-week State Department training course. In addition to learning about the State Department’s structure and mission and going through cultural sensitivity exercises, Angelos received training most psychologists don’t get, such as how to maneuver a car to break through a roadblock and how to fire weapons.

Before he arrived, State Department Diplomatic Security specialists had emphasized that he’d be living and working in a war zone. But even the most intense training couldn’t completely prepare him for the moment he landed in Iraq, and he started to see firsthand the pervasiveness of security efforts.

Every movement takes place in a vehicle armored with steel plates, accompanied by military vehicles and people with weapons, Angelos says. Buildings are protected with sandbags and concertina wire.

“You’re in a very confined and restricted environment every place you go,” he says.

That sense of danger creates an undercurrent of stress for employees, Angelos says.

“We don’t have rockets raining down on us anymore, but there’s an underlying low level of tension that progressively and incrementally eats away at people and the next thing you know, they’re in here asking for Valium or sleeping tablets.”

Despite the danger, Angelos says he’s committed to traveling to wherever he’s needed in Iraq. “I’m not going to restrict my movements, or my responsibilities, for that kind of reason. If you do that, you might as well go home,” he says.

Riding a psychology circuit

As the embassy’s psychologist, Angelos spends a quarter of his time visiting provincial reconstruction teams, the State Department-run groups that help local Iraqi officials rebuild Iraq’s civic, economic and agricultural infrastructure. Housed at U.S. military bases throughout Iraq, the teams live and work in austere conditions, often sleeping in converted trailers with little privacy. During a typical visit, Angelos meets with each team and gives a briefing about stress.

Often, each team member is required to meet with Angelos privately so that someone who needs help doesn’t feel the stigma of seeking him out. Countering stigma is important because Foreign Service Officers can be reluctant to open up about their distress for fear of jeopardizing their careers, Angelos says. He reassures them that being counseled for adjustment issues is “no fault” — meaning they have no repercussions for security clearances and future promotions.

Angelos also keeps office hours at the embassy. He sees 10 to 12 clients in a typical week.

Many of these clients are experiencing adjustment problems — they’re worried about how they’re doing at their jobs, they’re having trouble sleeping or they are suffering gastrointestinal upsets. Such symptoms are similar to his California clients who are judges, lawyers and physicians: They are accomplished people with hectic careers.

“They’re the kind of mild indicators that’d be normal and expected in a stressful kind of environment,” he says.

Often his biggest challenge is helping Foreign Service officers, who tend to be high achieving, diligent, Type-A personalities who don’t make enough time to sleep, eat nutritious meals or exercise. “It’s a marathon, it’s not a sprint,” he tells them, emphasizing that if they want to stay effective, they need downtime.

Angelos is also on call for emergencies 24 hours a day, seven days a week. A few times, he has conducted a crisis intervention for a service member or civilian overwhelmed by stress and possibly suicidal. In those situations, he’s helped to arrange their evacuation out of the country and follow-up treatment.

In addition to offering individual therapy, Angelos teaches a course in biofeedback techniques to embassy staffers. As needed, he runs support groups on a variety of topics, such as coping with the stress of separation from their families.

His work at the embassy earned praise from a high-ranking State Department officer familiar with his contributions, who described him as a tremendous asset. “Jim kept me informed of trends, what people were worried about, what was on their minds and what I could do about it, if anything,” said the officer, who did not want to be identified.

Sometime before July, Angelos hopes to return to his wife, their three grown children and two grandchildren in Santa Barbara.

“I could probably leave here in the spring with good conscience, having done a good job and not walked away when things were difficult,” he says.