Monday, February 20, 2017

Understanding Military Veterans

     Working with military veterans over the last three years has been a rewarding learning experience.  I have worked with more than 50 veterans, both men and women, from 23 to 90 years old, who have served in the Army, Navy, and Marines in conflicts ranging from the Korean War and Desert Storm to Operation Iraqi Freedom and on bases throughout the world during peace time.  Some have served for between three and five years.  Others have served careers of 10 or 20 years or more.  Certainly all of those veterans have experienced traumatic events but it would be incorrect to assume that all of them have post traumatic stress disorder.  In fact, they have experienced everything from depression and social phobia to relationship conflict and parenting concerns.  As we have worked on those challenges I have discovered three factors that influence a veteran's experience of their active duty as well as their readjustment to civilian life after service. Those factors are childhood and family experiences, meaning and motivation for service, and conditions and reasons for discharge or retirement.
     If a service member has grown up in a nurturing, responsive family with adequate resources and support, it contributes to their emotional regulation and positive sense of self.  This establishes a foundation or safe base from which to explore the world.  Positive family relationships provide a source of resilience for service members.  They are patterns for successful relationships developed with other soldiers and sailors that contribute to unit cohesion and teamwork.  They also provide a sense of safety and coping when service members face conflict and traumatic experiences on deployment and in combat.  These early childhood and family experiences cannot prevent post traumatic stress or even injury but may prevent it from becoming a disorder and contribute to healing and recovery.  On the other hand, if a service member grows up in a chaotic or abusive environment marked by parental conflict, lack of resources, violence and separation, they are predisposed to post traumatic stress disorder if they do not already suffer from it.  Their lives are marked by high stress and emotional dysregulation, negative core beliefs and low self esteem.  This makes them particularly vulnerable to the inevitable new stressors of military service.  Rather than inoculating the member against the impact of sleep deprivation, high alert duty, and battle, childhood trauma leads the member to be overwhelmed by military service to the point of developing disorders and disabilities.
     Ironically, so much about military service makes it attractive to people who have experienced childhood trauma.  It offers consistency and structure, a sense of belonging and importance, and the basic needs of food, clothes, shelter, and medical care, just like a functioning family.  Foster and adoptive youth, juvenile delinquents, their parents and advocates often see military service as an attractive option because they perceive it will teach the youth responsibility, lead to a successful career, or reverse a downward spiral. However, these traumatized youth take their underlying hypervigilance and negative core beliefs into a high pressure environment and challenging culture in which individuals are tested to form a fighting force.  Some succeed and achieve while others fail and suffer.  Those who survive basic training and go on to successful service develop relationships with officers and unit members who care for them and watch out for them much like a parent, brother, or sister.  They find the support to develop the resilience to survive isolated deployments and dangerous and deadly events.  They often continue these bonds into post service life.  Those who are not able to develop those relationships often find themselves cut off, targeted, and mistreated, some to the point of harassment, physical and sexual abuse.  Deployments themselves are overwhelming, and sometimes their coping skills including defiance, substance use, and violence get them discharged, reinforcing their childhood script.  They often leave service more traumatized and alone than when they joined.
     When a young man or woman signs up because they see a cause bigger than themselves, such as patriotic duty, or even for education and career opportunities, they are likely to be more successful than the youth who is avoiding the next life stage or escaping from a deprived environment.  The first is likely to find or make meaning from the experience while the second is prone to existential crisis.  The meaning of service is most important in the adjustment back to civilian life.  Adjustment is determined, in part, on how the service member is discharged.  An honorable discharge after a planned period of service or a long career lends itself to closing an important life chapter and starting a new one.  A conditional discharge based on behavior or an abrupt release due to disability or injury leads to a bumpy landing and an extra period of grieving.  If the service member is also dealing with the mental and physical effects of duty, they are likely to experience a pile up of post traumatic stress that started long before they joined.  Just as family support contributes to meaningful service it can also help heal the bodies and minds of veterans. So whether the veteran is young or old, whether they are working through post traumatic stress or relationship issues, I make sure I ask about their childhoods, their reasons for joining the military, and the conditions under which they discharged. 

No comments: