Healing Combat Trauma

When Is PTSD NOT PTSD? When Stubborn Pride Takes Control

Editor's note: We're not giving you medical or psychological advice here; consult with your own health care practitioner for that. What we are doing is sharing a longtime PTSD sufferer's opinion with you about his own situation, on the off-chance that it may instruct or enlighten. We have the feeling, now that he's outed himself, others may quite enjoy learning the distinctions he shares from his own life. And when we say "others," we mean spouses, significant others and family members...

From the subject of "Eyewitness to Combat," a Vietnam vet, Marine, with 40 years of "experience" on the subject:

"Post-Traumatic Stress Disorder has many faces and it sometimes masquerades as a behavioral problem; conversely, there are times when behavioral abnormalities masquerade as PTSD.  In other words, sometimes PTSD is mistaken for just stubborn Pride; and sometimes stubborn Pride is excused as PTSD.  There is also a third face, the one in which we appear completely “Normal.” So the “trick” becomes knowing which one is in control – the PTSD one; the PRIDEFUL one; or the NORMAL one. 

One of the most frustrating and difficult problems in sorting this out with traumatized MST or PTSD combat vets is that by their very nature, MST and PTSD sufferers are very complicated individuals, to say the least. It’s almost as if we are different people at different times.  And in fact we are.  My wife used to say she “never knew which one” of me “was coming home.” In other words: “PTSD really screws us up: mentally, emotionally, socially, personally, professionally and physically”.  However on many of the occasions that get blamed on PTSD, it is in fact our own personality “quirks” that have intervened, kidnapped and magnified the suffering from PTSD. And in the healing process, this habitual behavior must be sorted out before any true healing can “stick.” It’s true that we can be healed from our PTSD “disorder” but also allow our pride, habitual bad habits and negative attitude to completely mask any real improvement.

I do know that true healing from the destructiveness of PTSD is possible and real. I know this because I lived with all three faces of it for forty years and I have been healed.  Not “cured” but healed to a point that I now have a mostly “normal” a life rather than a mostly PTSD, prideful, bad habit and negative attitude life.  From this very long journey to healing I am able to speak from wisdom and experience on behavioral abnormalities disguised as PTSD.  I have been there; done that; and, for the most part, “have gotten away clean with it.” Now looking back, I am embarrassed and ashamed of myself for falling into the “pity party” that “works for me” trap.  I allowed myself to become “victimized,” believing that I was “entitled” to feel sorry for myself and that everyone else should feel sorry for me as well.  My PTSD actually made me feel “special” as everyone was made to “tiptoe” around me like a king walking among his subjects, so as not to “set me off”.  Trust me when I say that “this gets very old very quick” to those who love you, care for and about you; and it should be of no surprise when they begin to get a little bitter and non-empathetic toward our behavior.  It just gets tiring!  Upon entering the 90 day VA in-house PTSD treatment program years ago, I came face-to-face with a sign over the door of our billet, made by one of the previous vet therapists, that said: “How long would YOU put up with YOU?!  Well, not very damn long, I can tell you that – and that sign made the point for all of us.  So why should we expect others to do so?!  And if that’s true, why do we resist healing? Suffering from PTSD for most of my life made me very familiar with all of its symptoms and destructive consequences, along with what it does to our own physical body.  I am well aware of how devastating it is upon the family, friends and employers of those suffering from this disorder.  Today though, when I’m substantially healed, (see “before and after” story, linked here) I find that I can still act like a full blown PTSD’er.  The only difference is that now it’s my choice when to move into that arena, or not.  As my youngest grown son would say, “I’m going with NOT!”.  So in going there now it’s a premeditated decision to do so, not one dictated by PTSD. It’s premeditated because I first think about it, usually when my feelings get hurt, and then I stop taking my meds, as in “I’ll show them”, followed by then I stop doing what I know to do to keep me grounded and clear of stress such as EFT or Qi Gong.  Then I isolate myself in my all-too-familiar bunker, and “Away I go!” But this time it’s stubborn, God-damned pride that is pushing my behavior and keeping it in play, NOT PTSD. It might look like PTSD, sound like PTSD, feel like PTSD – and I am enjoying the effects. My world is now totally miserable, and I am glad – because I am back in control! The poet John Dryden put the sequence this way, “We first make our habits, and then our habits make us”.  Relinquishing control to our Prideful self is a habit we simply cannot afford if we suffer from PTSD.  It will destroy us and everyone around us. Again, if it is so miserable and so devastating, why stay in it? They “why” is PRIDE: Stubborn God-dammed, destructive PRIDE, a shitty attitude and very bad habits.  How does this fit into having PTSD?  It doesn’t fit into HAVING PTSD at all, but it DOES fit into KEEPING it!  And why would we want to KEEP Post-Traumatic Stress Disorder going, when we have the tools to get rid of it? Because it’s comfortable; it’s normal to us; it gives us control whenever we want; it gives us an excuse for bad behavior; it gives us an identity; it’s amusing to “shock” others; it draws attention to us; we don’t have to follow the rules and get a pass for doing so; it gets us “stuff”; it makes us somebody special and we can even be “paid” to have it.   And if you are getting “paid” to have it, it makes you a professional PTSD’er.  Sooooo why not act like one and let the spouse go to work; you get paid not to! You can sit on the couch and own the friggin’ remote and when you want to watch something cool you can clear the room and get a beer delivered to you in the process.  All the while someone can give you the beer, the TV and the couch.  I also know this to be true because I have spent up to a month terrorizing everyone in my life with my fucking PRIDE disguised as PTSD.  And I enjoyed the whole experience! But eventually even my pride got to a point that I couldn’t stand it anymore.  I allowed myself to be ashamed of this childish behavior and to apologize and ask for forgiveness so that I could come out of the corner.  NOW I really am ashamed of myself because I hurt those I loved and they didn’t deserve it at all.  But now I know what it is and will not go there again. (Publishing this handy little guide to PTSD vs. PRIDE of course will help!) I’ll use the tools I have been given in healing and use them gladly.  I do not want my loved ones to suffer the fool that I could become.  Scripture puts it this way in 1 Corinthians 13:11: “When I was a child, I talked like a child; I thought like a child; I reasoned like a child. When I became a man, I put childish ways behind me”.  In other words “it’s time we grow up!” Understand I am NOT talking about what “reaction” PTSD compels us to do that is destructive.  What I am talking about is what keeps us continuing the destructive behavior AFTER our PTSD moment has PASSED.  The fact that we suffer from a trauma-induced survival skill does not make us “crazy” or “insane” or incapable of being aware of our surrounding and how our actions affect others.  We still have the ability to know right from wrong and we know when we hurt others and we know when we hurt ourselves.  PTSD also doesn’t change our “moral code”.  If you were a nice person before; you are generally still a nice person and that becomes your “Normal” face.  If you were a courteous person before; you are generally still a courteous person and “Normal”.  If you were a grateful person before; you are generally still a “Normally” grateful person.  If we are truly remorseful for our actions which harm others, as we should be when we are “Normal”, then the abnormal behavior will stop until triggered again. And in our “Normal” state we are ashamed, embarrassed and truly sorry.  If we are not at least remorseful and/or our misbehavior is enjoyable, then we are either a narcissistic “asshole” or we are pretending to continually have PTSD behavior for control and that is our “Prideful” face.  If we are ashamed, embarrassed and sorry but continue in bad behavior, then we are stubborn “Prideful” fools using the ole, “That’s my story and I’m stickin to it” crap.  It will lead to your destruction and that of your family.  And PRIDE becomes the driving force, not PTSD, and the NORMAL face is destroyed.    That was PTSD.  But then I would get embarrassed and mad when “corrected” and take the Prideful mental position of: “Well I sure fucked that one up; so screw them all” and I would then “dig my heels in” and really make everyone miserable.  And I enjoyed it.  I was “showing them” for getting justifiably upset at me for my action.  That was PRIDE.  “They would learn to leave me alone whenever I would go into one of my “Marine Corps Moods”, as my kids would call it.  Yep, goddamn Marine Corps PRIDE!  (In truth, I have three kinds of pride: Texas pride! Irish pride! And Marine Corps pride! And that is a whole giant bucket of PRIDE…) Understand that I DID have severe PTSD and those triggering events happened a bunch but the moment I realized I had screwed up, PTSD ended and PRIDE took over to magnify the damage.  I was too proud to admit that I was wrong and then ask for forgiveness or even to say I was sorry.  For a Marine to apologize was a “sign of weakness”.  To take this action with those who love you only adds INSULT to INJURY.  However for a father, a husband, a son, a partner, to apologize is essential and your “Normal” self and is a great sign of love, appreciation, humility, strength, self-confidence and courage. When scripture states that “the meek shall inherit the earth,” it is not talking about the weak but the gracious, strong, self-confidently humble who attempt to right the wrongs they have done to others. Our families and loved ones know when that moment of awareness happens, and they appreciate it and respond to it, but conversely, with no remorse on our part they start to lose empathy for our plight, and rightfully so.  If our prideful attitude and bad behavior keeps up, they become aloof, distant, uncaring and bitter – and here’s the thing, we’ve helped to make them that way through our actions. PTSD is what causes the hyper-vigilance and other survival reactions triggered by events in our lives, but PRIDE is what causes us to stay in the now habitual act of PTSD.  True healing can only come when we understand that we will have the tendency to move into survival mode for the rest of our lives and that there are things we can do to effectuate a smooth, peaceful, happy life.  AND it is essential that we do those things consistently for the rest of our lives. (Examples would be taking our medication, and using the tools we can do at home for our own self-care, such as meditation, deep breathing, qi gong, EFT, music therapy, aromatherapy, etc. -- and knowing when it's PRIDE that's taken control!) We also must learn to be grateful to those around us who put up with our “moments” and have enough respect for them to swallow our pride and say we are sorry and mean it; then sincerely ask for forgiveness in love.  If you are unwilling to do this, then you are not ready to be healed because you are enjoying being miserable and making others miserable too much.  And I really feel sorry for you.  When we realize we have just had one of those “moments”; STOP, regain your composure, look around at what you have effectuated and apologize and mean it.  But if you do nothing else, just STOP and go to your corner.  When you have calmed down, then correct it before PRIDE takes control and kills everyone around you or before it forces you back into the “bunker”.  Your families know when you are faking PTSD and when it is real; so grow up and get your shit together."Pride goeth before destruction, and a haughty spirit before a fall.” Proverbs 16:18. Even with PTSD!"

© 2010 by Lily Casura / Healing Combat Trauma. All rights reserved. Use with attribution.

 

Military Spouses and Families -- Resource List of Books and Articles

In honor of today being "Military Spouse Appreciation Day" -- hey, shouldn't that be all year long, given what they do?! -- here's a really stupendously great bibliography of books and articles relating to military families, spouses and children and all the various issues they can encounter in the mental health/social work realm.

Unfortunately, I don't remember where I found it on the Web back in February of this year, so I can't credit it appropriately. (And I've Googled it a bunch of different ways to find it again, but with no luck.) Like every bibliography, there are possible additions, subtractions and revisions -- but "as is, where is," it's a tremendous resource of information for finding out more about these very important subjects.

REFERENCE LIST: Military Families 

Children

Barker, L. H. and K. D. Berry (2009). "Developmental Issues Impacting Military Families With Young Children During Single and Multiple Deployments." Military Medicine 174: 1033-1040.

Barnes, V. A., H. Davis, et al. (2007). "Perceived stress, heart rate, and blood pressure among adolescents with family members deployed in Operation Iraqi Freedom." Mil Med 172(1): 40-3.

Brom, D., R. Pat-Horenczyk, et al., Eds. (2009). Treating Traumatized Children: Risk, Resilience and Recovery Taylor & Francis, Inc.

Chandra, A., S. Lara-Cinisomo, et al. (2010). "Children on the Homefront: The Experience of Children           From Military Families." Pediatrics 125(1).

Chandra, A., L. T. Martin, et al. (2009). "The Impact of Parental Deployment on Child Social and      Emotional Functioning: Perspectives of School Staff." Journal of Adolescent Health In Press,         Corrected Proof.

Chandra, A., R. M. Burns, et al. (2008). Understanding the Impact of Deployment on Children and    Families: Findings from a Pilot Study of Operation Purple Camp Participants R. Corporation: 69.

Chartrand, M., D. A. Frank, et al. (2008). "Effect of parents' wartime deployment on the behavior of young children in military families." Arch Pediatr Adolesc Med. 162(11): 1009-1014.

Chartrand, M. and B. Siegel (2007). "At War in Iraq and Afghanistan: Children in US Military Families " Ambulatory Pediatrics 7(1): 1-2.

Cozza, S. and A. Lieberman (2007). "The young military child: Our modern telemachus " Zero to Three 27(July): 27-33.

Cozza, S. J., R. S. Chun, et al. (2005). "Military families and children during Operation Iraqi Freedom." Psychiatric Quarterly 76(4): 371-378.

Ender, M. G. (2006). Voices from the backseat: Demands of growing up in military families. Military Life: The Psychology of Serving in Peace and Combat, The Military Family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International. 3: (pp. 138-166). viii, 262.

Flake, E. M., B. E. Davis, et al. (2009). "The Psychosocial Effects of Deployment on Military Children." Journal of Developmental and Behavioral Pediatrics 30(4): 271-278.

Fallon, M. A. and T. J. Russo (2003). "Adaptation to stress: An investigation into the lives of United States military families with a child who is disabled." Early Childhood Education Journal 30(3): 193-198.

Goodman, R. F. (2002). Caring for Kids After Trauma and Death: A Guide for Parents and Professionals. A. Gurian, The Institute for Trauma and Stress at The NYU Child Study Center: 57.

Hardaway, T. (2004). Treatment of psychological trauma in children of military families. Mass Trauma and Violence: Helping families and children cope. N. B. Webb. New York, NY, Guilford Press: 259-282.

Horton, D. (2007). The impact of deployment on children in military families, Horton, Denise: Walden U , US.

Houston, J. B., B. Pfefferbaum, et al. (2009). "Children of Deployed National Guard Troops: Perceptions       of Parental Deployment to Operation Iraqi Freedom." Psychiatric Annals 39(8): 805-811.

Huebner, A. J. and J. A. Mancini (2005). Adjustments Among Adolescents in Military Families When A           Parent is Deployed, Military Family Research Institute at Purdue University: 50.

Huebner, A. J., J. A. Mancini, et al. (2007). "Parental deployment and youth in military families: Exploring uncertainty and ambiguous loss." Family Relations 56(2): 112-122.

Hutchinson, J. W. (2006). "Evaluating risk-taking behaviors of youth in military families." Journal of Adolescent Health 39(6): 927-928.

Jensen, P. S., S. N. Xenakis, et al. (1991). "The "military family syndrome" revisited: "By the numbers."." Journal of Nervous and Mental Disease 179(2): 102-107.

Kelley, M. L. (1994). "The effects of military-induced separation on family factors and child behavior." American Journal of Orthopsychiatry 64(1): 103-111.

Kelley, M. L., Hock, E., Smith, K.M., Jarvis, M.S., Bonney, J.F., and Gaffney, M.A. (2001 ). "Internalizing and externalizing behavior of children with enlisted navy mothers experiencing military-induced separation." Journal of the American Academy of Child & Adolescent Psychiatry: 40(4): 464-471.

Lamberg, L. (2004). "When military parents are sent to war children left behind need ample support." JAMA: Journal of the American Medical Association 292(13): 1541-1542.

Lemmon, M. and L. Chartrand (2009). "Caring for America's Children: Military Youth in Time of War."          Pediatrics in Review 30(6): E42-E48.

Lincoln, A., E. Swift, et al. (2008). "Psychological adjustment and treatment of children and families with parents deployed in military combat." Journal of Clinical Psychology 64(8): 984-992.

Mmari, K., K. M. Roche, et al. (2009). "When a Parent Goes Off to War  Exploring the Issues Faced by Adolescents and Their Families." Youth & Society 40(4): 455-475

Morris, A. S. and T. R. Age (2009). "Adjustment among youth in military families: The protective roles of effortful control and maternal social support." Journal of Applied Developmental Psychology 30(6): 695-707.

Paden, L. B. and L. J. Pezor (1993). Uniforms and youth: The military child and his or her family. The Military Family in Peace and War F. W. Kaslow. New York, NY, Springer Publishing Co: 3-24.

Ryan-Wenger, N. A. (2001). "Impact of the threat of war on children in military families." American Journal of Orthopsychiatry 71(2): 236-244.

Warren, Z. E. (2006). Cognitive and behavioral development of at risk infants and toddlers exposed to stressful life events: The effects of trauma in early childhood, Warren, Zachary E : U Miami, US.

Wethington, H. R., R. A. Hahn, et al. (2008). "The Effectiveness of Interventions to Reduce Psychological Harm from Traumatic Events Among Children and Adolescents: A Systematic Review." American Journal of Preventive Medicine 35: 287-313.

 

Communities of Support

 

Huebner, A. J., J. A. Mancini, et al. (2009). "Shadowed by War: Building Community Capacity to Support Military Families." Family Relations 58(2): 216-228

Kudler, H. and K. Straits-Tröster (2009). "Partnering in Support of War Zone Veterans and Their      Families." Psychiatric Annals online 39(2): 64-70.

Levin, A. (2009). "Military Hopes Civilian Clinicians Can Shrink Treatment Gap." Psychiatry News August       21, 2009 44(16): 16.

 

Culture

 

Danieli, Y. (2007). Assessing trauma across cultures from a multigenerational  perspective. Cross-Cultural Assessment of Psychological Trauma and PTSD. J. P. a. T. Wilson, Catherine So-kum. New York, NY, Springer Science + Business Media. Part 1: . (pp. 65-89). xxvi, 405.

Harris, J. J. and N. G. Jones (2007). African-American military service members and their families: A different environment. Human Behavior in the Social Environment from an African-American Perspective. L. See, A. New York, NY, Haworth Press: (2007).  (2nd ed.). (pp. 133-150). xliii, 782.

Lowe, T. B., J. G. Hopps, et al. (2007). Stressors experienced by African-American armed service personnel during the Iraq War. [References]. Human behavior in the social environment from an African-American perspective. L. A. See. New York, NY, Haworth Press: 519-542.

Osterman, J. E. and J. T. V. M. de Jong (2007). Cultural issues and trauma. Handbook of PTSD: Science and Practice. M. J. Friedman, Keene, Terence M. and Resick, Patricia A. New York, NY, Guilford Press: pp. 425-446.

 

Death

 

Bonanno, G. A. (2004). "Loss, Trauma, and human resilience, Have we underestimated the human capacity to thrive after extremely aversive events?" American Psychologist 59(1): 20-28.

Goodman, R. F. (2002). Caring for Kids After Trauma and Death: A Guide for Parents and Professionals. A. Gurian, The Institute for Trauma and Stress at The NYU Child Study Center: 57.

Lieberman, A., N. Compton, et al. (2003). Losing a Parent to Death in the Early Years Zero To Three Press.

Network, N. C. T. S. (2008). "Traumatic Grief in Military Children." Traumatic Grief in Military Children: Information for Medical Providers, from http://www.nctsnet.org/nctsn_assets/pdfs/military_grief_medical.pdf.

Network, N. C. T. S. (2008). "Traumatic Grief in Military Children." Traumatic Grief in Military Children: Information for Families, from http://www.nctsnet.org/nctsn_assets/pdfs/Military_Grief_Families_final3.pdf.

Pearson, G. (2007). "Review of Military Widow: A Survival Guide." Perspectives in Psychiatric Care 43(1): 65.

Pfefferbaum, B., S. J. Nixon, et al. (1999). "Posttraumatic stress responses in bereaved children       after     the Oklahoma City bombing." Journal of the American Academy of Child and Adolescent         Psychiatry 38(11): 1372-1379.

Ronel, N., U. Lebel, et al. (2006). "When parents lay their children to rest: Between anger and forgiveness." Journal of Social and Personal Relationships 23(4): 507-522.

Stoppelbein, L. and L. Greening (2000). "Posttraumatic stress symptoms in parentally bereaved children       and adolescents." Journal of the American Academy of Child and Adolescent Psychiatry 39(9):           1112-1119.

Wright, K. M., L. M. Burrell, et al. (2006). Military Spouses: Coping with the Fear and the Reality of Service Member Injury and Death. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 64-90.

 

 

 

Deployment

 

Basham, K. (2009). "Commentary on the Keynote Lecture Presented by Dr. Jonathan Shay, Friday, June      27, 2008 titled <i>The Trials of Homecoming: Odysseus Returns from Iraq/Afghanistan</i>, and additional reflections." Smith College Studies in Social Work 79(3): 299-309.

Basham, K. (2008). "Homecoming as safe haven or the new front: Attachment and detachment in military couples." Clinical Social Work Journal 36(1): 83-96.

Bowling, U. B. and M. D. Sherman (2008). "Welcoming them home: Supporting service members and their families in navigating the tasks of reintegration." Professional Psychology: Research and Practice 39(4): 451-458.

Burton, D. L. (2009). "Commentary on the Reaction Panel in Response to the Keynote Lecture presented      by Col. Carl Castro and Dr. Mark Chapin titled <i>The Deployment Cycle: Expectations and     Implications</i>." Smith College Studies in Social Work 79(3): 283 - 285.

Garran, A. M. (2009). "Commentary on the Reaction Panel in Response to the Keynote Lecture presented     by Dr. Jonathan Shay titled <i>The Trials of Homecoming: Odysseus Returns from         Iraq/Afghanistan</i>." Smith College Studies in Social Work 79(3): 310 - 313.

Haas, D. M. and L. A. Pazdernik (2006). "A Cross-Sectional Survey of Stressors for Postpartum Women during Wartime in a Military Medical Facility." Military Medicine 171(10): 1020-1023.

Herzog, J. R. and R. B. Everson (2007). The crisis of parental deployment in military service. Play Therapy with Children in Crisis: Individual, Group, and Family Treatment N. B. Webb. New York, NY, Guilford Press: 228-248.

McFarlane, A. C. (2009). "Military deployment: the impact on children and family adjustment and the need for care." Current Opinion in Psychiatry 22(4): 369-373

Packman, J., T. Paone, et al. (2006). When a Parent Gets Deployed: Helping Military Families Deal With Stress. Compelling Perspectives on Counseling G. Walz, Bleur, J. and Yep, R. Alexandria, VA, American Counseling Association: 67-69.

Pawlowski, L. M. (2005). Coping with military deployment: The C.A.R.E.S. resource for couples, Pawlowski, Lisa M : Regent U , US.

Peebles-Kleiger, M. J. and J. H. Kleiger (1994). "Re-integration stress for Desert Storm families: Wartime deployments and family trauma." Journal of Traumatic Stress 7(2): 173-194.

Rand, H. and R. N. S. R. Division (2008). Post -Deployment Stress: What Families Should Know, What Families Can Do, Rand Health and Rand National Security Research Division.

Russell, D. and D. Hamilton (2008). Reunion and re-integration with the family after deployment. Proceedings of the 6th Rocky Mountain Region Disaster Mental Health Conference. G. W. Doherty. Ann Arbor, MI, Rocky Mountain DMH Institute Press/Loving Healing Press: 95-98.

Scaturo, D. J. and P. M. Hayman (1992). "The impact of combat trauma across the family life cycle: Clinical considerations." Journal of Traumatic Stress 5(2): 273-288.

Shay, J. (2009). "The Trials of Homecoming: Odysseus Returns from Iraq/Afghanistan." Smith College          Studies in Social Work 79(3): 286 - 298.

Slosky, L. H. (2008). The use of rituals and routines in military families experiencing deployment, Capella U , US.

Taft, C. T., J. A. Schumm, et al. (2008). "An examination of family adjustment among Operation Desert Storm veterans." Journal of Consulting and Clinical Psychology 76(4): 648-656.

Warner, C. H., G. N. Appenzeller, et al. (2009). "Psychological Effects of Deployments of Military      Families." Psychiatric Annals 39(2): 56-63.

           

 

 

Grandparents

 

Bunch, S. G., B. J. Eastman, et al. (2007). "A profile of grandparents raising grandchildren as a result of parental military deployment." Journal of Human Behavior in the Social Environment 15(4): 1-12.

 

 

Intergenerational Transmission of Trauma

 

Brom, D., R. Pat-Horenczyk, et al., Eds. (2009). Treating Traumatized Children: Risk, Resilience and Recovery Taylor & Francis, Inc.

Dekel, R. and H. Goldblatt (2008). "Is there intergenerational transmission of trauma? The case of combat veterans' children." American Journal of Orthopsychiatry 78(3): 281-289.

Egolf, J. (2008). Flyboy's daughter. [References]. Proceedings of the 6th Rocky Mountain Region Disaster Mental Health Conference. G. W. Doherty. Ann Arbor, MI, Rocky Mountain DMH Institute Press/Loving Healing Press: 67-78.

Leiner, B. (2009). "The Legacy of War: An Intergenerational Perspective." Smith College Studies in Social     Work 79(3): 375 - 391.

Scharf, M. (2007). "Long-term effects of trauma: Psychosocial functioning of the second and third generation of Holocaust survivors." Development and Psychopathology 19(2): 603-622.

           

 

 

Interventions 

 

Brom, D., R. Pat-Horenczyk, et al., Eds. (2009). Treating Traumatized Children: Risk, Resilience and Recovery Taylor & Francis, Inc.

Budzik, C. L. (2008). "Providing well child care for military families: what every provider needs to consider." Pediatr Ann 37(3): 185-8.

Collins, R. C. and M. C. Kennedy (2008). "Serving families who have served: Providing family therapy and support in interdisciplinary polytrauma rehabilitation." Journal of Clinical Psychology 64(8): 993-1003.

Erbes, C., R., M. A. Polusny, et al. (2008). "Couples therapy with combat veterans and their partners." Journal of Clinical Psychology: In Session 64(8): 972-983.

 

Gambardella, L. C. (2008). "Role-exit theory and marital discord following extended military deployment." Perspectives in Psychiatric Care 44(3): 169-174.

Faran, M. E., M. D. Weist, et al. (2005). Promoting resilience in military children and adolescents.     Community Planning to Promote Resilience on Children. C. Clauss-Ehlers and M. Wiest. New York,             Kluwer Academic/Plenum Publishers: 233-248.

Goodman, R. F. (2002). Caring for Kids After Trauma and Death: A Guide for Parents and Professionals. A. Gurian, The Institute for Trauma and Stress at The NYU Child Study Center: 57.

Guha, V. (2005). Stress, coping and adaptation to wartime separation by families of National Guard personnel, Guha, Vatsala: U Hartford, US.

Hall, L. K. (2008). Counseling military families: What mental health professionals need to know. New York, NY, Routledge/Taylor & Francis Group.

Herzog, J. R. and R. B. Everson (2007). The crisis of parental deployment in military service. Play Therapy with Children in Crisis: Individual, Group, and Family Treatment N. B. Webb. New York, NY, Guilford Press: 228-248.

Hutchinson, J. and L. Banks-Williams (2006). "Clinical issues and treatment considerations for new veterans: Soldiers of the wars in Iraq and Afghanistan." Primary Psychiatry 13(3): 66-71.

Jenkins, D. M. and M. J. Barry (2007). "Relationship 101: Couples therapy in theater." Military Medicine 172(6): iii-iv.

Lemmon, K. M. and E. M. Stafford (2007). "Recognizing and responding to child and adolescent stress:         The critical role of the Pediatrician." Psychiatric Annals 37(6): 431438.

Moon, P. K. (2006). Sand Play Therapy With U.S. Soldiers Diagnosed With PTSD and Their Families. [References]. Vistas: Compelling perspectives on counseling 2006. G. R. Walz, J. C. Bleuer and R. K. Yep. Alexandria, VA, American Counseling Association: 63-66.

Saldanha, D. (2002). "Family intervention in the treatment of post-traumatic stress disorders." Journal of Projective Psychology & Mental Health 9(1): 57-61.

Schumm, W. R., R. J. Crock, et al. (2008). "Reliability and validity of the Kansas Marital Satisfaction Scale with different response formats in a recent sample of U.S. Army personnel." Individual Differences Research 6(1): 26-37.

Storey, C. L. (2009). "The Psychotherapeutic Dimensions of Clinical Case Management with a Combat          Veteran." Smith College Studies in Social Work 79(3): 443 - 452.

Webb, N. B., Ed. (2007). Play therapy with children in crisis: Individual, group, and family treatment (3rd Ed.). New York, NY, Guilford Press.

Wilson, R. M., S. Leary, et al. (2009). "Military Veterans Sharing First-Person Stories of War and      Homecoming: A Pathway to Social Engagement, Personal Healing, and Public Understanding of             Veterans' Issues." Smith College Studies in Social Work 79(3): 392 - 432.

 

           

Maltreatment 

 

Bradley, C. (2007). "Veteran status and marital aggression: Does military service make a difference?" Journal of Family Violence 22(4): 197-209.

Clark, S., B., K. Koenen, C., et al. (2007). "Intimate Partner Psychological Aggression and Child Behavior      Problems." Journal of Traumatic Stress 20(1): 97-101.

Gibbs, D. A., S. L. Martin, et al. (2008). "Child maltreatment and substance abuse among U.S. Army soldiers." Child Maltreat 13(3): 259-68.

Gibbs, D. A., S. L. Martin, et al. (2007). "Child maltreatment in enlisted soldiers' families during combat-related deployments." JAMA: Journal of the American Medical Association 298(5): 528-535.

McCarroll, J. E., Z. Fan, et al. (2009). "Alcohol Use in Nonmutual and Mutual Domestic Violence in the U.S. Army: 1998-2004." Violence and Victims 24(3): 364-379

McCarroll, J. E., J. H. Newby, et al. (2008). "Responding to domestic violence in the U.S.Army-The Family    Advocacy Program." Family and Intimate Partner Violence Quarterly 1(1): 5-23.

McCarroll., J. E., R. J. Ursano, et al. (2004). "Classification of the severity of US Army and civilian reports           of child abuse." Military Medicine 169(6): 461-464.

McCarroll, J. E., F. Zizhong, et al. (2008). "Trends in US army child maltreatment reports: 1990-2004."         Child Abuse Review 17(2): 108-118.

Newby, J. H., R. J. Ursano, et al. (2003). "Spousal aggression by U.S Army female soldiers toward employed and unemployed civilian husbands." American Journal of Orthopsychiatry 73(3): 288-293.

Rentz, E., S.W. Marshall, et al. (2007). "Effect of deployment on the occurrence of child maltreatment in military and nonmilitary families." American Journal of Epidemiology 165(10): 1199-1206.

Rentz, E., S. L. Martin, et al. (2006). "Family violence in the military: A review of the literature." Trauma, Violence, & Abuse 7(2): 93-108.

           

 

Marriage        

 

Adler-Baeder, F., J. F. Pittman, et al. (2005). "The Prevalence of marital transitions in military families." Journal of Divorce & Remarriage 44(1-2): 91-106.

Goff, B. S. N., J. R. Crow, et al. (2007). "The Impact of Individual Trauma Symptoms of Deployed    Soldiers on Relationship Satisfaction." Journal of Family Psychology 21(3): 344-353.

Huffman, A. H. and S. C. Payne (2006). The Challenges and Benefits of Dual-Military Marriages. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 115-137.

 

 

Military Families        

 

Adams, G. A., D. B. Durand, et al. (2005). "Direct and Indirect Effects of Operations Tempo on Outcomes for Soldiers and Spouses." Military Psychology 17(3): 229-246.

Adams, G. A., S. M. Jex, et al. (2006). Work-Family Conflict among Military Personnel. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 169-192.

Bowen, G. L., J. A. Mancini, et al. (2003). "Promoting the adaptation of military families: An empirical test of a community practice model." Family Relations 52(1): 33-44.

Castro, C. A., A. B. Adler, et al., Eds. (2006). Military life: The Psychology of Serving in Peace and Combat The Military Family. Westport, CT, Praeger Security International.

Chapin, M. (2009). "Deployment and Families: Hero Stories and Horror Stories." Smith College Studies in      Social Work 79(3): 263 - 282.

Clark, D. (2006). "Review of Courage After Fire: Coping Strategies for Troops Returning From Iraq and Afghanistan and Their Families." International Journal of Emergency Mental Health 8(3): 218-219.

Durand, D. B. (2006). Army Wife, Army Mother. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 3-10.

Harmon, A. L. (2008). A descriptive study of military family needs following a polytraumatic injury, Harmon, A Lisa: Virginia Commonwealth U, US.

Henderson, K. (2006). While They're at War: The True Story of American Families on the Homefront, Houghton Mifflin Harcourt

Hoshmand, L. T. H. a. A. L. H. (2007). "Support for military families and communities." Journal of Community Psychology 35(2): 171-180.

Huitink, J., M. Rajnik, et al. (2006). "International Adoptions by Military Families: A Reexamination." Military Medicine 171(12): 1201-1205.

Kelley, M. L., M. J. Schwerin, et al. (2007). "A participant evaluation of the U.S. Navy parent support program." Journal of Family Violence 22(3): 131-139.

MacDermid, S. (2006). Multiple Transitions of Deployment And Reunion For Military Families The Military Families Research Institute at Purdue University.

MacDermid, S., R. Samper, et al. (2008). Understanding and Promoting Resilience in Military Families.          Military Family Research. M. F. R. I. a. P. University. West Lafayette, Purdue University: 1-28.

Martin, J. and M. D. Sherman (2009). The Impact of Military Duty and Military Life on Individuals and           Families: Resources and Intervention. Families and Change: Coping With Stressful Events and   Transitions. S. J. Price, C. A. Price and P. C. McKenry. Thousand Oaks, CA Sage Publications.

Matsakis, A. (2007). Back from the front: Combat trauma, love, and the family. Baltimore, MD, The Sidran Press.

Palmer, C. (2008). "A theory of risk and resilience factors in military families." Military Psychology 20(3): 205-217.

Pavlicin, K. M. (2005). Surviving Deployment: A guide for military families Elva Resa Publishing LLC.

Pinder, R. J., D. Murphy, et al. (2009). "A Mixed Methods Analysis of the Perceptions of the Media by            Members of the British Forces during the Iraq War." Armed Forces & Society 36: 131-152.

Richard, E. M. (2008). Constructing and contesting the public and private lives of military families, Richard, Elizabeth M : Arizona State U , US.

Rieth, L. S. (2007). Changes in the air force couple's ability to pay debts: Evidence from the 1997 and 1999--2000 air force community needs assessments, Rieth, Linda S: Capella U , US.

Robbins, L. S. (2005). Disorganized attachment in a military sample: Contributions from maternal trauma history, expressed sadness and narrative errors, Robbins, Leah Susan: Alliant International U, San Diego, US.

Sayers, S. L., V. A. Farrow, et al. (2009). "Family Problems Among Recently Returned Military Veterans       Referred for a Mental Health Evaluation." Journal of Clinical Psychiatry 70(2): 163-170

Schachman, K. A. (2010). "Online fathering: the experience of first-time fatherhood in combat-deployed        troops." Nursing Research 59(1): 11-17.

Taylor, N. E., S. M. Wall, et al. (2005). "Mother and Soldier: Raising a Child With a Disability in a Low-Income Military Family." Exceptional Children 72(1): 83-99.

Ursano, R. J., H. C. Holloway, et al. (1989). "Psychiatric care in the military community: Family and military stressors." Hospital & Community Psychiatry 40(12): 1284-1289.

Wiens, T. W. and P. Boss (2006). Maintaining family resiliency before, during, and after military separation. Military life: The Psychology of Serving in Peace and Combat: The Military Family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International. 3: 13-38.

           

 

 

Military Service Members

 

Castro, C. C. (2009). "Impact of Combat on the Mental Health and Well-Being of Soldiers and Marines."        Smith College Studies in Social Work 79(3): 247 - 262.

Cohen, S. P., C. Brown, et al. "Diagnoses and factors associated with medical evacuation and return to                     Freedom: a prospective cohort study." The Lancet 375(9711): 301-309.

 

Hoge, C. W., C. A. Castro, et al. (2004). "Combat duty in Iraq and Afghanistan, mental health problems,       and barriers to care." N Engl J Med 351(1): 13-22.

            Kennedy, C. H. (2006). Understanding one of our nation's greatest assets: Military personnel, PsycCRITIQUES Vol 51 (38), 2006.

Litz, B. T. (2007). "Research on the impact of military trauma: Current status and future directions." Military Psychology 19(3): 218-238.

Pierce, P. (1998). "Retention of Air Force Women Serving During Desert Shield and Desert Storm." Military Psychology 10(3): 195-213.

           

 

Moving Relocation     

 

Burrell, L. M. (2006). Moving military families: The impact of relocation on family well-being, employment, and commitment to the military. Military Life: The Psychology of Serving in Peace and Combat, The Military Family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International. 3: 39-63

Weber, E. G. and D. K. Weber (2005). "Geographic Relocation Frequency, Resilience, and Military Adolescent Behavior." Military Medicine 170(7): 638-642.

           

 

National Guard Reserves

 

Chisolm, J. S. (2007). The emotional impact and pastoral care implications of mobilization and deployment on national guard and reserve military members and their families, Chisolm, Joseph Steven: Texas Christian U , US.

Darwin, J. (2009). "Families: They Also Serve Who Only Stand and Wait." Smith College Studies in Social      Work 79(3): 433-442.

Edwin, J. A. (2008). An evaluation of a military family support program: The case of operation: Military Kids in Indiana, Edwin, James Augustine: Purdue U , US.

Faber, A. J., E. Willerton, et al. (2008). "Ambiguous absence, ambiguous presence: A qualitative study of military reserve families in wartime." Journal of Family Psychology 22(2): 222-230.

Guha, V. (2005). Stress, coping and adaptation to wartime separation by families of National Guard personnel, Guha, Vatsala: U Hartford, US.

Renshaw, K. D., C. S. Rodrigues, et al. (2008). "Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: Relationships with spouses' perceptions of veterans' experiences and symptoms." Journal of Family Psychology 22(4): 586-594.

Renshaw, K. D., C. S. Rodrigues, et al. (2009). "Combat exposure, psychological symptoms, and marital       satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to         2006." Anxiety Stress and Coping 22(1): 101-115.

Sahni, N. (2005). Perceptions of those left behind: An exploration of family dynamics within military reservist families during the 2003 Iraq wartime deployment, Sahni, Nameeta: Alliant International U, San Diego, US.

Tollefson, T. T. (2008). "Supporting spouses during a military deployment." Family & Community Health 31(4): 281-286.

 

Policy

 

Jackonis, M. J., L. Deyton, et al. (2008). "War, Its Aftermath, and US Health Policy: Toward a          Comprehensive Health Program for America's Military Personnel, Veterans, and Their Families."    Journal of Law Medicine & Ethics 36(4): 677-689.

 

 

Posttraumatic Stress Disorder/Mental Disorder

 

Browne, T., L. Hull, et al. (2007). "Explanations for the increase in mental health problems in UK reserve      forces who have served in Iraq." British Journal of Psychiatry 190: 484-489.

Evans, L., T. McHugh, et al. (2003). "Chronic posttraumatic stress disorder and family functioning of             Vietnam veterans and their partners." Australian and New Zealand Journal of Psychiatry 37(6):          765-772.

Frenz, M. (2007). Combat Veterans Diagnosed with Post Traumatic Stress Disorder: The Effects on Their Children: A Phenomological Study, University of Phoenix. Doctor of Management in Organizational Leadership: 187

Galovski, T. and J. A. Lyons (2004). "Psychological sequelae of combat violence: A review of the impact       of PTSD on the veteran's family and possible interventions." Aggression and Violent Behavior         9(5): 477-501.

Grieger, T. A., S. J. Cozza, et al. (2006). "Posttraumatic stress disorder and depression in battle-injured        soldiers." American Journal of Psychiatry 163(10): 1777-1783.

Litz, B. T. (2007). "Research on the impact of military trauma: Current status and future directions." Military Psychology 19(3): 218-238.

Manguno-Mire, G., F. Sautter, et al. (2007). "Psychological Distress and Burden Among Female Partners of Combat Veterans With PTSD." Journal of Nervous and Mental Disease 195(2): 144-151.

Nemeroff, C. B., J. D. Bremner, et al. (2006). "Posttraumatic Stress Disorder: A State-of-the-Science            Review." Journal of Psychiatric Research 40: 1-21.

Outram, S., V. Hansen, et al. (2009). "Still living in a war zone: Perceived health and wellbeing of    partners of Vietnam veterans attending partners' support groups in New South Wales, Australia."            Australian Psychologist 44(2): 128-135.

Rand, H. and R. N. S. R. Division (2008). Post -Deployment Stress: What Families Should Know, What Families Can Do, Rand Health and Rand National Security Research Division.

Ray, S. L. and M. Vanstone (2009). "The impact of PTSD on veterans' family relationships: An         interpretative phenomenological inquiry." International Journal of Nursing Studies 46(6): 838-      847.

Riddle, J. R., T. C. Smith, et al. (2007). "Millennium Cohort: The 2001-2003 baseline prevalence of mental    disorders in the U.S. military " Journal of Clinical Epidemiology 60: 192-201

Samper, R. E., C. T. Taft, et al. (2004). "Posttraumatic stress disorder symptoms and parenting satisfaction among a national sample of male Vietnam veterans." Journal of Traumatic Stress 17(4): 311-315.

Stein, M. B. and T. W. McAllister (2009). "Exploring the Convergence of Posttraumatic Stress and Mild           Traumatic Brain Injury." American Journal of Psychiatry 166(7): 768-776.

            

Psychological Toll      

 

Karney, B. R., R. Ramchand, et al. (2008). Invisible wounds, a working paper, Rand Health and the Rand National Security Research Division: 182.

Richardson, J. D., J. Sareen, et al. "Psychiatric problems in medically evacuated service members." The       Lancet 375(9711): 257-259.

           

 

Reference Handbook 

 

Ainspan, N. D. a. W. E. P. (2008). Returning Wars', Wounded, Injured, and Ill, Praeger Securit International

 

 

Schools

 

Aydlett, A. E. (2006). Dealing with Deployment: a Small-Group Curriculum for Elementary and Middle     School Students. Alexandria, VA: American School Counselor Association

Fitzsimons, V. M. and C. A. Krause-Parello (2009). "Military children: when parents are deployed              overseas." J Sch Nurs 25(1): 40-7.

Horton, D. (2005). "Consultation with military children and schools: A proposed model." Consulting          Psychology Journal: Practice and Research 57(4): 259-265.

Network, N. C. T. S. (2008). "Traumatic Grief in Military Children." Traumatic Grief in Military Children:    Information for Educators. from                http://www.nctsnet.org/nctsn_assets/pdfs/military_grief_educators.pdf.

Secondary Traumatization

Bride, B. E. and C. R. Figley (2009). "Secondary Trauma and Military Veteran Caregivers." Smith College      Studies in Social Work 79(3): 314 - 329.

Burton, D. L. (2009). "Commentary to Reaction Panel in Response to the Keynote Lecture presented by        Drs. Brian E. Bride and Charles R. Figley titled <i>Secondary Trauma and Military Veteran      Caregivers</i>." Smith College Studies in Social Work 79(3): 330 - 334.

Chara, K. A. (2008). Secondary PTSD transmission among survivor families of World War II sailors of the United States ship Emmons: A descriptive and correlational analysis of reported and perceived long-term symptoms among veterans, their wives, and adult offspring, Chara, Kathleen A : Capella U , US.

Dekel, R. and Z. Solomon (2007). Secondary traumatization among wives of war veterans with PTSD. [References]. Combat stress injury: Theory, research, and management. C. R. Figley and W. P. Nash. New York, NY, Routledge/Taylor & Francis Group: 137-157.

Dekel, R. and H. Goldblatt (2008). "Is There Intergenerational Transmission of Trauma? The Case of Combat Veterans’ Children." American Journal of Orthopsychiatry Vol. 78(3): 281-289

Fals-Stewart, W. and M. Kelley (2005). "When Family Members Go To War--A Systemic Perspective on Harm and Healing: Comment on Dirkzwager, Bramsen, Ader, and van der Ploeg (2005)." Journal of Family Psychology 19(2): 233-236.

Figley, C. R. (2005). "Strangers at Home: Comment on Dirkzwager, Bramsen, Ader, and van der Ploeg (2005)." Journal of Family Psychology 19(2): 227-229.

           

Single Military Parents

 

Kelley, M. L. (2006). Single military parents in the new millennium. Military life: The psychology of serving in peace and combat C. A. E. A. Castro, Amy B (Ed); Britt, Thomas W (Ed). ,Praeger Security International. 3: 93-114.

Roper, L. L. (2007). Air force single parent mothers and maternal separation anxiety, Roper, Lawanda L : Capella U , US.

 

Spouses          

 

Dana, K. L. (2006). Careers of their own: Role-identity negotiation among air force officers' wives, Dana, Krista Lorrell: U Oklahoma, US.

Dekel, R., H. Goldblatt, et al. (2005). "Being a Wife of a Veteran with Posttraumatic Stress Disorder." Family Relations 54(1): 24-36.

Gorbaty, L. R. (2009). "Family reintegration of reserve service members following a wartime deployment:    `A qualitative exploration of wives' experience." Dissertation Abstracts International: Section B:    The Sciences and Engineering 69(7-B): 4421.

Hobson, T. A. (2006). The impact of deployment on the stay-behind spouse of active duty navy women, Walden University.

Jebo, J. L. (2008). An untraditional life: Male spouses of female military personnel, Jebo, Jennifer L : Virginia Polytechnic Inst And State U , US.

Keener, M. (2007). Shared Courage: A Marine Wife's Story of Strength and Service Minneapolis, MBI            Publishing Company.

Mansfield, A. J., J. S. Kaufman, et al. "Deployment and the Use of Mental Health Services among U.S.          Army Wives." N Engl J Med 362(2): 101-109

Matsakis, A. (2005). In harm's way: Help for the wives of military men, police, EMTs & firefighters. Oakland, CA, New Harbinger Publications.

Orthner, D. K. and R. Rose (2009). "Work Separation Demands and Spouse Psychological Well-Being." Family Relations 58(October): 392-403.

Sahlstein, E., K. C. Maguire, et al. (2009). "Contradictions and Praxis Contextualized by Wartime       Deployment: Wives' Perspectives Revealed through Relational Dialectics." Communication         Monographs 76(4): 421-442.

Spera, C. (2008). "Spouses's ability to cope with deployment and adjust to Air Force Family demands." Armed Forces & Society 35(2): 286-306.

Westman, M. and D. L. Etzion (2005). "The Crossover of Work-Family Conflict From One Spouse to the Other." Journal of Applied Social Psychology 35(9): 1936-1957.

Wright, K. M., L. M. Burrell, et al. (2006). Military Spouses: Coping with the Fear and the Reality of Service Member Injury and Death. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 64-90.

           

Traumatic Brain Injury          

Anderson, M. I., T. R. Parmenter, et al. (2002). "The relationship between neurobehavioural problems of      severe traumatic brain injury (TBI), family functioning and the psychological wellbeing of the            spouse/caregiver: path model analysis." Brain Injury 16(9): 743-757.

Cernak, I. and L. J. Noble-Haeusslein (2009). "Traumatic brain injury: an overview of pathobiology with       emphasis on military populations." J Cereb Blood Flow Metab.

Collins, R. C. and M. C. Kennedy (2008). "Serving families who have served: Providing family therapy and    support in interdisciplinary polytrauma rehabilitation." Journal of Clinical Psychology 64(8):     993-1003.

Committee on Gulf War and Health: Brain Injury in Veterans and Long-Term Health Outcome, Board on       Population Health and Public Health Practice, et al. (2008). Gulf War and Health: Volume 7: Long       Term Consequences of Traumatic Brain Injury.

French, L. M. and G. W. Parkinson (2008). "Assessing and treating veterans with traumatic brain injury." J Clin Psychol 64(8): 1004-13.

Friedemann-Sanchez, G., J. M. Griffin, et al. (2008). "Communicating Information to Families of       Polytrauma Patients: A Narrative Literature Review

            " Rehabilitation Nursing 33(5): 206-213.

Groom, K. N., T. G. Shaw, et al. (1998). "Neurobehavioral symptoms and family functioning in         traumatically brain-injured adults." Archives of Clinical Neuropsychology 13(8): 695-711.

Griffin, J., G. Friedemann-Sánchez, et al. (2009). "Families of patients with polytrauma: Understanding         the evidence and charting a new research agenda." Journal of Rehabilitation Research &       Development 46(6): 879-892.

Hoge, C. W., D. McGurk, et al. (2008). "Mild traumatic brain injury in US Soldiers returning from Iraq."         New England Journal of Medicine 358(5): 453-463.

Jaffee, M. S., K. M. Helmick, et al. (2009). "Acute clinical care and care coordination for traumatic brain   injury within Department of Defense." Journal of Rehabilitation Research & Development 46(6):          655-666.

Kreutzer, J. S., T. M. Stejskal, et al. (2009). "A preliminary investigation of the brain injury family    intervention: Impact on family members." Brain Injury 23(6): 535-547.

Lezak, M. D. (1978). "Living with the Characterlogically Altered Brain Injured Patient." Journal of Clinical      Psychiatry 39: 593-598.

Lefebvre, H., D. Pelchat, et al. (2005). "The experiences of individuals with a traumatic brain injury,             families, physicians and health professionals regarding care provided throughout the continuum."          Brain Injury 19(8): 585-597.

Lew, H. L., J. H. Poole, et al. (2007). "Program development and defining characteristics of returning           military in a VA Polytrauma Network Site." Journal of Rehabilitation Research & Development     44(7): 1027-1034.

Perlesz, A., G. Kinsella, et al. (1999). "Impact of Traumatic Brain Injury on the Family: A Critical Review."    Rehabilitation Psychology 44(1): 6-35.

Pessar, L. F., M. L. Coad, et al. (1993). "The Effects of Parental Traumatic Brain Injury on the Behavior of             Parents and Children." Brain Injury 7(3): 231-240.

            Ponsford, J., J. Olver, et al. (2003). "Long-term adjustment of families following traumatic brain injury          where comprehensive rehabilitation has been provided." Brain Injury 17(6): 453-468.

Rand, H. and R. N. S. R. Division (2008). Post -Deployment Stress: What Families Should Know, What Families Can Do, Rand Health and Rand National Security Research Division.

Sahlstein, E., K. C. Maguire, et al. (2009). "Contradictions and Praxis Contextualized by Wartime       Deployment: Wives' Perspectives Revealed through Relational Dialectics." Communication         Monographs 76(4): 421 - 442.

Sinnakaruppan, I. and D. M. Williams (2001). "Family carers and the adult head-injured: a critical review     of carers' needs." Brain Injury 15(8): 653-672.

Uysal, S., M. R. Hibbard, et al. (1998). "The effect of parental traumatic brain injury on parenting and          child behavior." Journal of Head Trauma Rehabilitation 13(6): 57-71.

Verhaeghe, S., T. Defloor, et al. (2005). "Stress and coping among families of patients with traumatic           brain injury: a review of the literature." Journal of Clinical Nursing 14: 1004-1012.

Wells, R., J. Dywan, et al. (2005). "Life satisfaction and distress in family caregivers as related to specific     behavioural changes after traumatic brain injury." Brain Injury 19(13): 1105-1115.

Pulling the Pin: Combat Vets, PTSD and Troubled Personal Relationships

Combat veterans with PTSD often have tremendous difficulty with their closest personal relationships: marriages and families.  Divorces, multiple marriages, and short-term relationships that end unhappily are very common: All situations that compound the pain and suffering that already exists with PTSD.

While there are a few books out there that provide some helpful advice about the difficulty of combat vets with PTSD sustaining good relationships, some insight is also in order.  While many obstacles could be mentioned, we'll stick to just a few important ones.

1.    Needing to have a constant enemy. Combat veterans will tell you that their training requires a constant enemy for alertness, vigilance, what amounts to staying alive. Once combat ends -- or between episodes of combat -- that "role" needs to be filled by somebody.  The most obvious candidate to fill that role?  The combat veteran's usually unwitting, and unwilling, partner. If the spouse or partner isn't available, the next best candidate is a child. The combat veteran is often unaware that he or she is using this tactic at all, and the one victimized by it can often tell "something is wrong," but isn't always clear on exactly what that is.

2.    Pestering and teasing doesn't feel like love, but it does feel like irritation. Let's say the coast is clear.  It's a sunny day, everything seems (temporarily) all right in the combat veteran's world. But he or she teases and pesters a spouse, partner or family member (e.g., a child) incessantly, until that person gets fed up and walks away.  "But I was just teasing!" says the combat veteran.  Yes, but the frictional nature of the allegedly good-natured teasing has a predictable effect: it drives close others away, much like bad behavior also does. Now the combat veteran can be left alone: But is that what he or she really wanted?  Perhaps.  Perhaps not.  The main thing, combat vets say informally, that inspires this strategy, even on an unconscious level, is that too much peace and calm is off-putting, and creating (or re-creating) a little "chaos" in interpersonal relationships puts the combat vet with PTSD back where he or she is more likely to be comfortable.

Now factor either (or both) of these two behavioral patterns (among several others that could have been discussed) with the combat veteran's periodic desire for intimacy -- and imagine the realistic toll that such behavior, even if unintentional, takes on the spouse or partner's desire for intimacy.  More likely, either one or both of these behaviors is more likely to shut down or numb the spouse or partner, who then is more tempted to resist attempts at intimacy.  Is turning down intimacy the problem?  Is it the only problem, or even the central problem?  Probably not, if either of these fairly typical behaviors are an issue.

Sometimes a Photo Just Says It All...

The Other Purple Heart: For Wives, Husbands and Partners of Those with PTSD

The Bible, in the section known as Proverbs (from the Wisdom Literature tradition), has a stunning description of a woman known as the "Proverbs 31 Woman," or the "wife of noble character."  Here's just one sampling of what she's said to be like: "A wife of noble character who can find? She is worth far more than rubies. Her husband has full confidence in her and lacks nothing of value. She brings him good, not harm, all the days of her life."

From the spiritual to the secular, we have another example of the same in the praise that well-known philanderer Ben Franklin (and yes, that's a man who collects paramours, not stamps -- in his case, on two sides of the Atlantic) heaped on his wife, Deborah, for being the highly-cliched but apparently in their case, true, "wind beneath his wings."  While Franklin became famous for, among other things, his witticisms about wealth in "Poor Richard's Almanac," he often credited his wife and her good habits with being the reason they saved any money at all. (I'll find the reference later, but it's true.)

Well, if you scratch the surface of PTSD and veterans, you quickly find how many of the perhaps less famous (guys get famous) , nonetheless vitally key players, heroes and and true angels, are women.  There's Sarah Haley, who we read about the other day; Kathie Costos; Patience Mason; Aphrodite Matsakis; the list goes on and on.  (We fully expect that Kellee Twiggs was that kind of woman, too; as is Bet Ison; as is the highly-impressive Jennifer Briest, though that's TBI not PTSD.) And now, there's Pat Kemm Mann who we can add to the list.  (Not the same "Pat," whose wonderful insights and recollections into his time at war we've been reading about in the "Eyewitness to Combat" series.)  This lady is one impressive person, in her tremendous caring for her husband who she met and married when he had PTSD, as well as her remarkable smarts and strength of character in being the support he and their subsequent family needed.  Just an amazing woman. 

Not saying she's likely to be the only one out there -- actually, she reminds me very much of Kathie Costos, through whose blog I learned about her story, and secured permission to reprint it here -- but she IS very much worthy of our admiration, and she is also articulate and organized enough to tell her story in a compelling way: a story she's willing to share in the hopes that it helps younger wives and women learn what it takes to "love someone with PTSD" and be a real support to them in the life they build together.  As we read about yesterday in the Tao of Caring for Others, sometimes caring for someone else can be just an expression of who you are.  In Pat's case, that's the story.  Here it is, in her own words, about "loving someone with PTSD":

"At the age of 32, I met a man who wasn’t intimidated by my independence or education. A man who made me laugh, introduced spontaneity into my life and who cherished me. He was a 30 year old Nam vet...and twice divorced. But we shared the same family values and dreams for the future. When he proposed, I told him that I was not going to be his third wife; I would be his LAST wife. I only intended to get married once.

He told me that he had a dark side. I had no idea what he meant. I was to find out within months of our marriage. He was driven at work. Always put in more than was required. Naively, I just assumed he had a strong work ethic. I didn’t realize he was trying to escape demons. He had warned me about nightmares; told me how to wake him so he wouldn’t inadvertently hurt me. As a GI Brat growing up in a family with a strong, military tradition, I didn’t think it that unusual since I had several uncles with the same problem.

3 months after we married, however, his behavior began to change noticeably. He began “self-medicating” with alcohol. And he began seeing things that weren’t there. Hearing people calling him for help. Sometimes hearing a child cry would make him jumpy. The smell of urine would bring flashbacks. He had to sit with his back to the walls in restaurants. Anxiety attacks in crowded places. Sudden noises, like party balloons popping or a car back-firing would make him jump or even “hit the deck”. He would be embarassed and apologetic, telling me it sounded like small arms fire.

I was to learn that he had entered a 6 month period of “anniversary dates”. Not pleasant anniversaries. Anniversaries of the Tet Offensive, of being left for dead under a pile of bodies, of being a VC POW (until he managed to escape), of ambushes, being overrun, of being shot down, wounded and crawling and hiding for 7 days until he reached a friendly LZ. All of them crashing down on him like an avalanche of horror.

One day he came home from work and instead of coming into the kitchen where I was washing baby bottles, he went downstairs to the basement. That was unusual but I didn’t think too much about it. Then suddenly I felt an overwhelming sense of panic. I dropped the baby bottle and ran down the stairs. He was standing under them, in the dark, with a pistol in his hand. He was exhausted and terrified of going to sleep because at least when he was awake, he could see what was happening around him as well as the “film” his mind was playing. But he couldn’t make himself blow his brains out because he didn’t want me to have to live with that image forever burned in my brain.

The term PTSD wasn’t known then, or at least not known by many. But I knew my husband was suffering from “Combat Fatigue”. He didn’t want to believe that. Hell, he was a Hillbilly. A rough, tough coal miner. A combat hardened Marine. A third generation Marine... But one who’d been on Valium (through a civilian doctor) since he finished his second tour of duty.

He ended up starting therapy before our first anniversary. The man I had fallen in love with was slowly disappearing, being overshadowed by an often cold, uncommunicative loner. Sometimes I felt like a Life Guard, hanging on to a drowning man, refusing to let him go under.

But I had an advantage that many of the younger wives of combat vets didn’t have. Growing up on military bases. A brother and friends who’d gone to Vietnam while I was in college. I was 33 years old. And I had enough psych courses under my belt that I was able to "deal" with the nightmares, hallucinations, rages, and suicidal ideations as well as monitor and administer the massive quantities of anti-psychotic medications the VA was doling out... (and to eventually question the efficacy of most). Even so, the pain of seeing him look at me, with total confusion in his eyes - knowing he doesn’t know who I am but thinks he should... the pain and sorrow was indescribable.

His cup of stress was full to the brim from memories alone. Anything at all, no matter how minor, was like that one extra drop that causes the cup to overflow. Every car “accident” - always single car accidents, one near fatal - happened immediately following his 6 months of anniversary dates, when he had reached the limits of his endurance.

At one point, we lived on the Texas coast. Driving to the Houston VA was a challenge. It’s a nice, straight highway but for long stretches, it has rice paddies on both sides. He drove hunched over the steering wheel , knuckles white. Eyes darting constantly left and right. Muttering about damn rice paddies. I knew what he was doing and finally told him “I’ll drive. You watch for Gooks.” After that, I always drove that stretch.

I found myself “interpreting” other people’s actions and comments to my husband so he wouldn’t deck someone who had merely glanced our way but whom he thought was challenging him. He was quick to anger and quick to fight. But he was mostly able to keep his promise not to get in fights after I told him I knew he could take care of himself but no matter how the other guy looked, it hurt me to see him with scraped and swollen knuckles.

It wasn’t easy. And it wasn’t fun. But the man I loved was still in there and I was determined to beat back the demons that were dragging him down. We lost some friends who just saw him as crazy or irrational or scary. I remember once asking “Who are we not friends with this week?” His head kind of jerked, he looked at me for a moment and then he laughed. It stopped another rampage over an imagined insult or slight.

He had no patience at all. If we decided to go somewhere, the girls and I had to be ready to go the second he was. I’d remind him that no one’s life was in jeopardy if we were slower than he wanted. The thing that did the trick, though, was the time I finally took the car keys from him, handed over our two small daughters and told him that this time, HE could get them ready to go. I’D sit in the car and honk the horn.

He started group therapy and we found friends who understood because they were going through the same thing with minor variations. Almost all had done the “geographical tour”, moving from job to job or state to state as they tried to escape what was inside them. Some had used alcohol, prescription drugs or even street drugs to escape the psychological pain. And, like so many of the guys, his previous marriages didn't last simply because he couldn't let himself care that much and did everything he could to protect his fragile emotions from being fully engaged. A lesson he learned too well from losses in combat.

For some reason, he trusted me enough to open up about a few things that happened in Nam - things that clawed and burned in his mind. Which was both a good and a bad thing for him. He knew he had a safety net but letting those painful memories out (those he hadn't completely blocked, anyway) ripped the scabs off some horrendous memories.

Our two daughters were old enough to know that their Daddy was different from most of their friends’ daddies. But our daughters maintain that the thing that helped them understand their dad the most was that I always explained his behavior to them in terms that were age appropriate. One thing I'm especially proud of was when a VA Therapist asked me how I'd managed to raise such normal kids. While they didn't always LIKE him or what he was doing, they always loved him and knew that he loved them in return, even when he would "go bush", miss out on important events in their lives, or self medicate to excess.

And yes... he went to counseling and group therapies. We went through marital counseling and family counseling as well after one particularly rough patch. All of which were extremely helpful only because he was able to get outside his comfort zone, accept the validity of our feelings and make the effort to change certain behaviors.

When his PTSD, appointments and hospitalizations began to interfere with his ability to support his family, we began the torturous process of applying for disability. And we had to do it all over again for Social Security. Writing to every doctor he’d ever seen, every hospital he’d ever been in and trying to locate witnesses who had made it home, up to ten years after the fact.

I had to help him with the VA claim statement. I remember sitting, after the girls were in bed, writing down what he said as he spilled his guts and his pain all over the dining room table. Crying inside because of the horrors he went through and yet not daring to show any emotion on my face because it would have made him stop talking - for fear of upsetting me, disgusting me, or making me think less of him. And then having to sort through the jumble and make complete, intelligible sentences out of it.

I am eternally grateful to the PVA (Paralyzed Veterans of America) service rep who took the 13” thick stack of documents covering 10 years and went to bat for my husband.

In spite of one VA doctor who attempted to keep me out, I sat in on every appointment with my husband after I realized that the doctor didn’t know half of what was going on. This was something I felt very strongly about. I had to play an active role in his treatment. No one knew him better than I did.

The doctor would ask “How have you been since I last saw you?” And my husband would reply “Fine.” Then I’d jump in and tell the doctor what I’d observed. He WASN’T “fine”. And the fact that he couldn’t recognize his actions as irrational proved my point! Reactions that can keep you alive in combat are not always appropriate Stateside. Asking some of these guys how they are is like trying to get a blind person to describe the color yellow.

And I remember the anger I would feel each time a new doctor was assigned to my husband. The dreaded First Three Questions: Have you ever seen anyone killed? Have you ever been in fear of your life? Have you ever killed anyone? Check his records! 3 Purple Hearts. Siver Star. Bronze Star. Presidential Unit Citation. Combat Air Crew Wings with 3 or 4 devices. You don’t get those sitting behind a desk!

We've had our share of difficulties and I've often been asked why or how I stuck it out with him. My answer was always very simple: He's a good, kind, and decent man with serious problems. I wouldn't leave him if he had Cancer; I won't leave him because he's got emotional or mental problems. With close friends, I laugh and say "Because I'm strong, stupid or stubborn. Haven't figured out which yet!"

After almost 30 years, we're still married. Our family is stronger and closer than ever. The grandchildren all love their Pa-Pa and he adores them. Both daughters have chosen careers in medical fields where they can help others and are totally comfortable dealing with what some of their co - workers call "crazy Nam vets". And they're quite vocal in the defense of these guys. I'm proud of them. But then, almost all of our best friends are men (and their families) that we met while they were in the “Nuts and Flakes” wards at various VA Hospitals.

And I'm proud of my Marine, a crew chief and door gunner on med-evac choppers who served two tours (during which he endured being shot down 13 times, left for dead 3 times and 58 days as a POW of the VC). Once, he apologized to me for "being so weak". I told him he was the strongest man I'd ever met and that I would never want to be with a man who saw and went through what he did... without it bothering him.

My husband is worth the effort it’s taken and the rewards are immeasurable. He’s not “well” by any means, and he may never be because serious help came too late. But we have a good marriage filled with humor, love, respect and trust that goes both ways. Even with the problems, that’s still more than many have.

I have hope for our new Walking Wounded. No one questions the reality of PTSD anymore. More help is out there. I just hope that those who need it are informed that it is available... without the stigma my generation had to fight and without the delays that make it less successful.

Pat Kemm Mann
Fruitland Mesa
Crawford, CO 81415

Helping Military Families Cope and Heal from Stressors of Deployment and Combat

(From a press release)

Helping Military Families Help Themselves

For a civilian, it’s hard to fathom the stress a military family faces when a parent or spouse is sent to combat zones. Long and often multiple wartime deployments take a toll not only on the service member on the front lines but on family members back at home. According to recent figures released by the RAND Corporation, one in five veterans of the Iraq and Afghanistan wars may suffer from psychological health problems, which can add the strain on military family members.

Now, a program initiated at the University of California, Los Angeles (UCLA) and supported by the U.S. Navy’s Bureau of Medicine and Surgery is reaching out to military families to help prevent the personal and family problems such stress can bring. Project FOCUS (Families OverComing Under Stress) is now being rolled out to nine military bases across the nation and in Okinawa, Japan.

“There is increasing awareness that military families, especially the children, can be significantly affected when a parent is deployed, and there is even greater psychological wear and tear when there are multiple deployments,” says Patricia Lester, MD, an assistant professor of child and adolescent psychiatry at UCLA and the director of the FOCUS program. “The spouse left behind is suddenly thrust into the role of being a single parent; routines are interrupted; the children may not understand where their mom or dad has gone; and the service member on the front lines is constantly worried about how their family is doing back home.”

The FOCUS program provides parents and children with customized training that will address the impact of wartime deployment on families and helps them learn very specific communication and problem-solving skills to address these challenges. In addition, FOCUS trainers will provide outreach to groups within military communities to raise awareness about the kinds of pressures families face and to let them know help is available to cope with deployment.

“We build resiliency,” Lester says. “It’s a three-pronged approach to restore a psychological balance to the family, promote future resiliency, and increase knowledge and understanding among the military family culture.”

Families meet with counselors in multiple sessions. Some of the sessions are only with the parents, some are only with the children, and the rest are family sessions. Each session focuses on helping family members identify and share their concerns and fears about a spouse or parent being deployed to a war zone. In separate sessions with parents and children, FOCUS trainers teach them skills to help manage their emotions, solve problems within the family, set goals, and communicate with one another.

“If there are five family members, there’s a good chance that there are five different stories of what that most recent deployment experience was like,” Lester says. “Family members often don’t want to ‘burden’ each other with their personal problems, but in these exceptional circumstances of long-term separations, building a shared family narrative can be very helpful in reestablishing a close family identity and building its strength.”

— Source: University of California, Los Angeles, Health Sciences

Study Shows Mind-Body Medicine Works on PTSD

(Just what we've been talking about, and who we've just been talking about as well.  Heh.  Love that.  So confirming...)

Read down and see how therapeutic this would be for people in rural communities, with little or no access to the VA, who are in therapy or not, for DIY types and those who prefer to access healthcare through a practitioner of one kind or another.  Just wonderful... and we knew it all along :-)

---

The Washington, DC based Center for Mind-Body Medicine (CMBM) announced today the publication of a landmark study on the use of its comprehensive, non-drug model to treat posttraumatic stress disorder (PTSD) in war traumatized children. The study, “Treatment of Posttraumatic Stress Disorder in Post-War Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial,” which was published today online in the Journal of Clinical Psychiatry is the first randomized controlled trial (RCT) ever of any intervention with war traumatized children. It is also the first RCT of a successful, comprehensive mind-body approach with any traumatized population.

The study demonstrates that the Center’s groundbreaking model can be used to produce highly significant and lasting changes in levels of stress, flashbacks, nightmares, and symptoms of withdrawal and numbing in highly traumatized children – those who lived in an area of Kosovo where in 1999 90% of the homes were burned and bombed and 20% of the children lost one or both parents.

 The CMBM approach includes self-expression and mind-body techniques and was offered to these children over 12 sessions in an educational, supportive small group setting. Eighty-two high school students in Kosovo participated in the study. The program was conducted by teachers and included meditation, guided imagery, breathing techniques, and biofeedback as well as self-expression through words, drawings, and movement. All the students met the criteria for posttraumatic stress disorder (PTSD) which was measured using the Harvard Trauma Questionnaire. Following the program, the number of students having symptoms indicating PTSD was significantly reduced from 100% to 18%. The reduction in symptoms was maintained at a 3 month follow-up. The improvement in PTSD symptoms was significantly greater compared to a similar group of students who did not participate in the mind-body skills program. This is the same model that CMBM’s founder and director, James S. Gordon, M.D., describes in detail in his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression.

“This RCT,” Dr. Gordon, the lead author, says, “is important because it provides scientific evidence for the efficacy of a model that has been taught to almost 3,000 health and mental health professionals and educators worldwide. We’ve used this small group model to give tens of thousands of children and adults practical tools that help them to feel better quickly, and we’ve taught them to use their intuition and imagination to solve problems that had seemed overwhelming. We help traumatized people around the world to draw on strengths they may have forgotten they have, and we offer them a ‘safe place’ in which they can share their pain with others who have suffered as they have.”

“This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “It’s highly acceptable to populations which do not want to be given medication, those with no access to a doctor or therapist, and those who are in psychotherapy.”

This model, which Dr. Gordon presents in a step-by-step self-help format in Unstuck, is currently being used by CMBM with war traumatized populations in Israel and Gaza as well as in post-Katrina southern Louisiana. It is widely used with anxious and depressed people and those with chronic illness in the US, and has already been incorporated as a stress reduction program for students in a dozen US medical schools.

The CMBM model is also of increasing interest to the US Department of Defense and the Veterans Administration. “The military,” Dr. Gordon says, “understands the breadth and depth of the psychological crisis (as many as 300,000 returning veterans are expected to have posttraumatic stress disorder or major depressive disorder, and another 320,000 will have been made vulnerable to these conditions by traumatic brain injury). The military’s leadership is committed to finding evidence-based approaches, like the one taught by The Center for Mind-Body Medicine, that can make a difference for the individual veteran and his/her family, an approach that can be taught to the large numbers of professionals and peer counselors who serve them.” More than 100 health and mental health professionals who work with the military are expected at the next CMBM training in mind-body medicine on October 25-29 in Minneapolis, and many more are expressing interest in learning and using the CMBM model.

For more information about the upcoming training, click here,  or to order Unstuck: Your Guide to the Seven-Stage Journey Out of Depression", please email The Center for Mind-Body Medicine (CMBM) at [email protected] or visit www.cmbm.org.

Home Sweet Home -- After Deployment, What? Support for Returning Veterans and Families

Some words of wisdom from Vietnam veteran, professor of social work, and author, Raymond Monsour Scurfield, D.S.W., for returning veterans and their families.  For everyone who searches this blog looking for "ways to support returning veterans," I hope these words will provide some constructive help and solutions:

The partner back home, the children, significant extended family members all also have their unique combinations of pre-war characteristics, strengths and problems. These inevitably become intermingled with their life experiences while the veteran has been deployed. And, similar to the veteran, their combination of pre-deployment and life experiences and characteristics and patterns during the partner’s absence while on deployment now come face-to-face with the returned veteran who has been extraordinarily impacted by war.

And so, just what is the family to say and do in regard to a veteran who has recently returned from deployment and who appears to be quite different, appears to have been significantly impacted by the war? Should the partner and family remain silent and just avoid talking with the returned active duty about these noticeable changes (that are negative) in the hope that he/she eventually will revert back to how he/she was before being deployed? Also, there could be positive changes (discussed later).

But the rest of the family has needs and wants right now. And the family has just as much right and needs as does the returning veteran to be reached out to, listened to and understood, and their issues and feelings respected and addressed. To be of optimal help to your veteran partner, you first must understand what your primary needs and wants are right now, as you and the family are readjusting to the veteran being back and adjusting to someone who has been profoundly touched by war.

Are you resentful, relieved, entrenched in daily habits developed while your veteran partner was deployed, resistant or very ambivalent that your veteran partner has disturbed whatever homeostasis you had achieved in his/her absence? Do you want to just drop all the responsibilities onto your veteran partner, because you are exhausted and angry and needy and want your own space that was impossible to have while your partner was deployed? Are you so happy to have him/her back that you choose to bury or deflect all or most of your or the family’s pent-up feelings and issues and defer to your veteran partner’s needs and wants?

Do you have really mixed feelings about your military spouse being back now? Perhaps you are missing the freedom, that life was perhaps actually simpler in some or many ways, with fewer hassles and explaining to do, when your spouse was not around. (Sometimes my wife tells me, when I might hover around her too closely in the kitchen or in the bedroom when she wants her personal time, that “I am taking her oxygen.” :-) And, you are very glad that he or she is back. Yes, for some, absence does make the heart grow fonder.

On the other hand, there are military personnel and their spouses who realize they at least partly actually prefer that they are separated by periodic deployment. And indeed, for some, their relationship and their lives work as well as they do precisely because there are periodic deployments—and both partners (or only one) prefers it this way.

Of course, you also must pay close attention to what is going on with your veteran partner recently returned from deployment overseas. The vast majority of veterans who are recently returned from war appear to be all right, do not want to dwell on what has happened to them while they were in the war, don’t want to spend much time talking about it, thinking about it, or feeling about it. Rather, they want to put it aside, deflect it or bury it and get their lives back. This is normal and expectable.

There is a substantial sub-group of returned veterans who remain totally or partially preoccupied with the war and what happened, are obviously impacted about what they have experienced, are either sorely troubled and/or become quite isolated. Ironically, most of this group, similar to the first group, also does not want to dwell on it, don’t want to talk about it, think about it, or feel about it. They too want to put it aside, deflect it, bury it, as a way to get their lives back to normal.

There is a third sub-group who revel in/savor the war, miss it, yearn for it, talk or think about it a lot—to the point that it interferes with living in the here-and-now with you. This group is probably very resistant to changing anything about themselves, may not really like much about normal civilian life, and make it very difficult for you to connect with them in a meaningful way. Or, they feel stuck and don’t know how to ask for help.

A smooth and successful readjustment may require a remarkable balancing act by both the returned service member and the family. The veteran is responsible to be aware of when he or she is struggling with deployment-related issues and problems, and doing something about it. However, the service member may be in denial about this.

And so, the family may have to decide if it is necessary to confront the service member about his/her denial and/or do a balancing or juggling act to some degree between and amongst the array of competing needs and wants of the veteran, partner, any children and any involved extended family members. If and when do you need to become more assertive with your concerns to your veteran partner and not just allow a bad situation that is not showing much sign of improving to stagnate or become entrenched and chronic. Did anyone say that life was fair?

The vast majority of vets who are trying to deflect, deny, minimize or bury what has happened in the war and what may be going on inside themselves about the war, may need a wake-up call about their denial and avoidance. This might be from a close friend, religious confidant, and/or perhaps from the partner. The family may have to decide if you are willing to do what you have to do to stay – or get – skilled at balancing patience and persistence, diplomacy and assertiveness, and giving to your veteran partner while also being vigilant to taking care of your and your family’s needs and wants. This is not an easy row to hoe, and why getting assistance and support for you may be very advisable.

--Used with permission.

Mind Body Medicine: Healing the Wounds of War

When I started this blog over two years ago now, I was hoping that somehow James S. Gordon, M.D., and the Center for Mind-Body Medicine which he founded in Washington, DC, would somehow get involved in the prospect of bringing mind-body medicine to the troops.  Gordon is a Harvard-trained psychiatrist, with impeccable credentials, who has a lifetime interest in expanding patient care into new areas, particularly Complementary and Alternative Medicine (CAM), and mind-body medicine in particular.  (Mind-body medicine is a shorthand way of re-combining the two "halves" of medicine perhaps unjustly sundered in an arbitrary Cartesian mind-body split.  Much of Eastern thought, rather than Western, never saw them divided at all.)  In a previous lifetime, where I interviewed luminaries in the natural medicine field, Gordon was a favorite interviewee - smart, genial and with a very forward-thinking grasp of what mind-body medicine could accomplish.  Gordon, who was featured in the Bill Moyers series on PBS, Healing and the Mind, was a frequent lecturer at the Smithsonian Institution in Washington, DC, and for years had served as the head of the White House Commission on Complementary and Alternative Medicine.  He is also a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown University Medical School.

But more to our purposes, when war broke out in Kosovo, he and the Center for Mind-Body Medicine (CMBM) took their methods into the region, creating a program called "Healing the Wounds of War," to help war-torn schoolchildren and their caregivers manage the trauma they had undergone, through a sustained, devastating conflict.  What I was hoping -- and I kept checking the CMBM website periodically to find out -- was that they would leapfrog off their successes with PTSD in Bosnia and Kosovo, and Israel and the Middle East, and develop something geared to PTSD in servicemembers, and the conflicts in Afghanistan and Iraq.  For years, nothing was obvious (yet), but here's some of their success with children in Kosovo.  Notice what symptoms the program helped with, how impressive the statistics are, and make the conceptual leap to how this might help with combat veterans and/or their families:

The clinical efficacy of the CMBM program with traumatized children has been repeatedly demonstrated. In a pilot study in which high school teachers in the Suhareka region of Kosovo used the CMBM model, levels of posttraumatic stress disorder in high school students were reduced from an average of 88% to 38% in only six weeks (read the research, published in Journal of Traumatic Stress, April 2004, linked here). Participants have also reported the following documented effects of CMBM trainings, including: the alleviation of their own stress and trauma; decreases in anxiety and depression; increased optimism; decreased anger; and increased capacity to help others.

You can read more about the program's specific successes, here.  Or, you can read a general overview of the program and what's involved, here.  You can also read Dr. Gordon's bio, here.

PTSD Trauma for Veterans and Their Families is Predictable - "The Generic Effects of Combat"

In an article from Australia, there's a great quote about combat trauma/PTSD, and its very ordinariness.

(The article's topic is how "mental health problems caused by war service afflict veterans' families and children too.)  One of the premises of the article is that, based on a study, "Sons and daughters of Vietnam veterans are three times more likely to commit suicide than those of similar age in the general population (Australian Institute of Health and Welfare 2000, Suicide in Vietnam veterans' children: Supplementary report no.1).  According to the same report, "They are also more likely to die of accidental death, experience depression and abuse alcohol or other drugs."

That's the overall pretext for the article.  However, now comes the excellent quote, with a bit of preamble from the article itself, linked here:

According to Professor Hedley Peach, conducting research into veterans' sons and daughters is vital, not only to examine in detail the reasons behind their poor health but to set up support services that work for them.  He is also eager for doctors to consider war service when treating patients, as in many cases it could help diagnosis ....  Peach, a member of the scientific committee advising the Government on the feasibility study and professorial fellow at the University of Melbourne, says the Government should also consider studying grandchildren of Vietnam veterans to avoid more problems spiralling down through the generations.

''If the sons and daughters have got mental health problems and have young children themselves, what effect will that have on the grandchildren? We have to break the cycle.''

He suggests stressful familial environments could be behind the children's mental health problems, already highlighted by existing research. While many people with mental illness have a genetic predisposition to their condition, veterans were screened for mental illness before they went into the service, making stress a more likely factor in the children's ill health.

''In studies done by clinical psychologists running PTSD clinics for Vietnam veterans, children have reported a high level of dysfunction in families,'' he says. ''When we focused on Agent Orange so much in the past we missed the bigger picture. We are seeing the same sorts of problems in veterans of the Iraq and Gulf Wars, and fighters in World War II are now saying they suffered from the same problems. It is not due to any specific war, it is the generic effect of combat.''

Thanks to Kathie Costos for this reference...