Mental Health Matters: Leaving the uniform behind: Loss, identity and transitions after the military

Having grown up in the rolling prairie state of Iowa, I was naïve to the deeply held ideas, values and history of the military in the south. Truthfully, the two areas of the United States could just as well be different countries. The cultures are just that different from each other. Now having lived in South Carolina since 2001, I have learned a great deal. As I write this today, I want to be clear that I am writing about and for all veterans from all our country’s conflicts, including those on both sides of the Civil War, or the War of Northern Aggression, depending on which side we are referring to.

I start with this because it doesn’t really matter which conflict we focus on. Or for that matter, what side of the conflict we are talking about. Armed conflict inevitably leads to trauma. Trauma impacts all of us. If one member of our community carries the weight and scars of war, entire communities are also impacted by the same. At the same time, I acknowledge that there is something particularly haunting about civil conflict that stands alone as its own special kind of injury.

While I do not have a military history, I do have two significant memories. One is of one of my cousin’s, one of my dad’s nephews coming home from Vietnam carrying significant and damaging wounds that impacted his own as well as his family’s lives in very painful ways. Overseas, he had learned to cope with the stress of his situation by using alcohol and drugs to numb the pain and fear. Upon his return to the U.S., he continued to cope in these same ways. The rest of his life was a series of heartache, self-destruction and ongoing trauma on top of what he was carrying from his experience in the service. I watched as his mother, already a widow, wept her way through the remainder of her life. Watching her son implode had to be one of the heaviest wounds a mother can possibly experience.

A second significant memory involves watching the draft being conducted on TV. My family sat in pretty much complete silence, wondering where my only brother would fall in the that draft process. It was called the draft lottery. It was somber, full of dread and fear. In the end, he was not drafted. But for all families with draft-eligible family members, these experiences are etched into our mental and emotional landscape.

It is May, a month when Memorial Day observations occur. Throughout my career as a mental health therapist and social worker, I have heard countless stories and have seen up front the evidence that war leads to generations of mental pain and wounds.

As far back as we have written records, we have evidence that one of the results of war is psychological and emotional pain. Over the centuries, we have had different names for this phenomenon. During the Civil War (or the War of Northern Aggression), the psychological fallout from the conflict was referred to as “nostalgia” (which referred to extreme homesickness,) or “soldier’s heart” (describing a racing pulse and physical exhaustion).

By World War I these symptoms were known as “shell shock.” At that time, the prevailing medical belief was that invisible wounds were caused by the physical impact of concussive blasts. Not that far off given what we now know today about closed head injuries. By World War II and the Korean War, the language had again changed to “combat exhaustion” or “battle fatigue.” By this time, there was acknowledgement that prolonged deployment stretched soldiers to their physical and mental limits.

Of course, the next major conflict was the Vietnam War. By this time, our growing knowledge and observations had helped move the science of trauma along far enough that we recognized the prolonged systemic psychological aftermath with some more depth. We recognized at that point that many of those who survived the conflict suffered from what was then called Post-Vietnam Syndrome. This was also complicated by the highly fraught reception many veterans faced from their own country and fellow Americans upon their return home. It was a very different war than those previous, with the culture holding very polarized views of our involvement in East Asia.

By the 1980s, the American Psychiatric Association officially recognized the condition as PTSD (Post-Traumatic Stress Disorder). It was also during this time that we began to recognize that many people are impacted by trauma, extending far beyond military service. Anyone can suffer from PTSD.

So, what exactly do veterans experience in their adjustment back to civilian life? What puts them at such high risk of experiencing a range of mental health conditions including not just PTSD, but also anxiety, depression and substance use/abuse? What puts our veterans at such risk for suicide that they experience this at a significantly higher rate than their non-veteran peers?

So, what does the research tell us about the state of veterans’ mental health at this time in our history? We have learned that PTSD is one of the core mental health issues our returning military members face upon their return to life post-conflict. One in five veterans of the Iraq and Afghanistan wars experience PTSD, a significantly higher rate than the general population. In addition, the condition is made even more complex because alongside PTSD, many experience significant anxiety and depression as well. How does substance use play a role here? Humans try to treat pain in any way we can. Substances and alcohol are very effective remedies, at least in the short term. This is compounded by the fact that more mainstream treatments are often hard for veterans to access when they need it.

To understand the weight of these coping skills, it is helpful to recognize some of the particular struggles our military members face both in the military, as well as upon their retirement or discharge from the military.

Identity: One of those struggles includes the loss of identity and the transition these events imply in their lives. The military provides a great deal of structure and identity for its members. The military has very clear lines of authority, rules of communication and expectations for behavior. Upon discharge or retirement, all these boundaries fall away. Everything that helps define military identity, purpose and role no longer exist in the civilian world. Leaving the uniform behind holds significant loss and grief.

Relationships: Returning to civilian life is also complicated by the struggle to integrate back into the lives of family and relationships with loved ones. This is not unique to military life. Any time a family member or loved one has a unique and defining experience, integrating back into “normal” relationships presents significant challenges. Astronauts returning from their missions often find it very difficult to integrate into previous relationships once they have had the life changing experience of space travel. The event has not been a shared one. There is a gap of understanding and experience. For the military member, this isolates them from one of their most important support systems. This can cause intense loneliness and isolation.

Spouses: These in turn translate into significant hurdles with spouses. What the traumatized person often needs is akin to emotional intensive care. Except their spouse/significant other is their only caretaker, and is often ill-equipped for the task they now face. Spouses burn out, experiencing caregiver stress and distress. It is rare that any respite services show up to give the spouse relief.

Children: Relationships with their children also represent unique challenges. How does a parent explain PTSD to their child(ren)in a way that makes sense? The nature of their afflicted parent’s behavior is often erratic, unpredictable and frightening to witness. When children are the target of those unpredictable behaviors, home can cease to be a safe place for them. Spouses often do not have the language to describe their spouse’s behaviors to their children. Spouses can become traumatized themselves from trying to care for their returning military family members.

Translation of skills: How does one start to translate the skills and strategies used in the military into civilian life? Equally as important, how does one cope with the trauma while trying to integrate back into civilian life? The military relies on its members’ commitment to the military community, to the unit. Civilian life by comparison is very individually focused. Everyone is out for themselves. The type of loyalty required by the military is hard to replicate on the civilian side of life.

This last point leads us to an important need for many retired/discharged military members. That need is to have a tribe to belong to. Tribes provide us with a sense of safety, belonging and identity. Tribes are in fact so important that when children grow up without a natural tribe, they instinctively seek to develop one. It is often called a gang.

In a future article, I will spend time exploring specific strategies and approaches we can take to support our military members. For this article, I want to conclude with several resources that have been developed specifically to support veterans and their families.

Of course, Veterans Affairs has numerous programs and supports for returning military members. Of note, there is the Veterans Crisis Line. This can be accessed by dialing 9-8-8, then press 1. You can also access support by way of text by texting to 8-3-8-2-5-5. Through these pathways, you can access qualified and caring support on the other end.

Coaching into Care is a free telephone service for family members and friends looking for support and strategies on how to encourage a veteran to seek professional mental health care.

There are also vet centers, small non-medical counseling centers located in local communities. These services provide private, confidential individual and group counseling, family and couples counseling, bereavement counseling, and help for trauma or military sexual trauma (MTS). Many of these services are also available remotely as well as in person.

There are also specialty clinics in various locations across the country which provide specific care and intervention for conditions such as PTSD, depression, anxiety and/or substance abuse.

Outside of the VA, there are supports such as The Wounded Warrior Project. WWP is the nation’s leading veterans service organization dedicated to the total wellbeing of the post-9/11 wounded, ill or injured veterans and their families.

Finally, NAMI, the National Alliance on Mental Illness, has developed specialized programing for our military members and their families. NAMI Homefront is a six-session educational program designed for families, caregivers and friends, of military service members. It equips family members and friends with the practical skills, resources and a supportive community to help service members and their loved ones navigate the mental health system we have, to enable them to transition to civilian life. It is one of NAMI’s signature programs and like all NAMI programing, it is completely free.

You can access your local NAMI affiliate through the interactive NAMI Find Your Local Affiliate locator. Through this locator resources, you can enter your location by zip code or through their state drop down menu.

I close with words of thanks to all our veterans. Your sacrifices and actions impact all of us every day. All of us enjoy the results of your work now and long into the future.

With much gratitude, I wish you all a peaceful and safe Memorial Day. Whether you observe on May 10, or the last Monday in May, peace and safety to each of you.

Have questions you’d like to ask Shirley? Message her at oasistherapyservices@gmail.com.