On August 3, a nineteen-year-old sailor went overboard from the aircraft carrier USS Abraham Lincoln. Rescuers pulled him from the water and took him for medical care. According to his wife, he was attempting to die by suicide. The Navy has not confirmed this, but news reports say charging documents accuse him of malingering under Article 83 of the Uniform Code of Military Justice and being absent without leave under Article 86. He may now face a captain’s mast, a nonjudicial disciplinary hearing rather than a court-martial.
No final punishment has been made public, and the sailor’s medical information remains private. The Navy says his medical care and the disciplinary process are separate matters. Yet even with those stipulations, this story raises a question medicine cannot ignore: Why do we see a medical crisis as something that happens to someone, but often treat a psychiatric crisis as something the person caused?
If a sailor has a seizure and falls overboard, no one sees the event as a sign of bad character. Psychiatric illness is different because many of its most serious symptoms appear as behavior. Depression can look like withdrawal or absence. Mania can seem reckless. Psychosis can appear threatening. A suicidal crisis can lead to actions that are frightening and dangerous. When illness shows up as behavior, people judge quickly.
As a psychiatrist, I find it troubling to see malingering alleged in this situation. Calling something malingering is not a neutral description of events. It is a judgment about motive. Article 83 requires that someone intend to avoid work, duty, or service. A suicide attempt may be intentional in the sense that a person acts deliberately, but that does not make it malingering. Wanting to die is not the same as wanting to avoid duty. Treating those motives as the same risks ignoring the psychiatric crisis at the heart of the act.
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The military’s own guidance recognizes the difference. In its discussion of Article 83, the current Manual for Courts-Martial states, “Bona fide suicide attempts should not be charged as criminal offenses.” It directs the convening authority to consider health conditions, personal stressors, and Department of Defense suicide-prevention policy. This language is guidance, so it does not decide this case. Still, its meaning is clear. A suicide attempt should not be treated as self-injury done to avoid responsibility.
Military appellate law has confronted the same distinction. In United States v. Caldwell, the Court of Appeals for the Armed Forces set aside a guilty plea involving a bona fide suicide attempt because the record did not establish the required harm to good order and discipline. The court did not grant blanket immunity for self-injury, but it rejected the idea that medical treatment and disruption to a unit automatically turn a suicide attempt into a crime.
Medicine should recognize this same mistake within its own institutions. We see it when a patient who self-harms is dismissed as “attention-seeking,” when addiction is blamed on weak character, or when depression is seen only as unreliability. We also see it when a suicidal patient is called manipulative because staff finds the crisis hard to manage. These labels may sound clinical, but they often mask moral judgments disguised as medical terms.
None of this ignores the danger of someone going overboard. Responding to a man-overboard call can put rescuers at risk and disrupt important operations. Commanders have to protect the crew, just as hospitals must protect patients and staff. Temporary removal from duty, psychiatric evaluation, hospitalization, monitoring, and limits on access to weapons may all be necessary. But safety measures are not the same as punishment.
Before punishing behavior that may stem from psychiatric illness, the clinical facts should be established. The person should be stabilized, evaluated, treated, and given appropriate follow-up. Only then can anyone fairly decide whether separate misconduct remains.
Suicide prevention relies on people sharing their suicidal thoughts before they act on them. Every response to a crisis sends a message to those whose struggles are still hidden. If a sailor sees that surviving a suicide attempt could lead to a captain’s mast, promises about getting help will seem less believable. The message may become: Do not let anyone know how bad things are.
Medicine has seen this pattern before. Patients hide symptoms when they expect disbelief, pressure, or shame. Institutions may have supportive policies on paper, but people decide whether to trust them by seeing what actually happens when someone becomes ill.
We do not know all the details of what happened aboard the Abraham Lincoln. The Navy may have evidence that has not been made public, and it should be able to explain its actions while protecting the sailor’s privacy. But the principle should be clear. A suicide attempt is a medical emergency. If that is what happened here, the first response should be care, not discipline.
This essay is cited in the KevinMD record on physician suicide.
Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient–clinician relationships in modern health care. Additional information about his clinical practice and professional work is available on his website, timothylesacamd.com. His professional profile also appears on his ResearchGate profile, where further publications and details may be found.
