Traumatic stress reactions and related disorders comprise some of the most prominent human afflictions in the world today, especially with the pervasiveness of war and terrorism. In the past three decades there has been growing public interest and focus on the impact of traumatic events on humanity. This interest has been reflected in a growing body of research investigating this impact, especially in the context of military combat, acts of terrorism, natural disasters, and professions such as public safety work that have a high probability for exposure to critical incidents and traumatic events. A highly significant issue revealed by this research, the media reports, and my work as a public safety worker and mental health practitioner is the high rate of mental/emotional traumatic stress injury in military combat veterans.
As a mental health clinician and an experienced and active member of the public safety culture with 20 years of experience as a Lead Emergency Medical Technician, I have specialized in counseling public safety workers and military veterans with stress reactions including Posttraumatic Stress Disorder (PTSD). Many of my clients have attempted suicide, or they tell me of their co-workers and friends in the military who have committed suicide due to occupational stress or personal life issues amplified by occupational stress. The evidence reveals that since the 9/11 attacks in 2001, suicide in these populations has been a growing problem. I am passionate about this issue as the goal of my continued practice is to distinguish how the public safety and military cultures, respectively, vary with regard to the experience of stress reactions and PTSD, and thus how effective treatment approaches must be culturally appropriate. Additionally, I plan to work within public safety and military organizations to co-create systems that effectively promote good emotional as well as physical wellness.
As a member of a learning community in the Saybrook course entitled Project X: Evolutionary Leadership for Sustainability, I presented the significant aspects of what I am learning and working on daily at my counseling practice within the culture of military combat veterans, their experiences of traumata to which they have been exposed in the line of duty, and resulting mental/emotional injury. In the remainder of this article I provide a description of what I have learned, while identifying key elements of what combat veterans faced in military action, distilled as a composite of information I gathered from the stories and cases of clinical clients, family members, friends, and acquaintances who are military combat veterans. I also describe the need for more resources and programs to help combat veterans recover, and provide ideas for initiating change.
The military combat veterans I have spoken with, including those I have treated for PTSD, when asked about the factors they think contribute to developing PTSD, have explained how they were trained to kill, with the attitude that killing the enemy was important and honorable. They are taught not to see enemy targets as human beings, but simply the enemy that needs to be destroyed, by either weapons or hand-to-hand combat. Soldiers describe this as being stripped of one’s humanity.
This is apparently especially true for military snipers. These soldiers are to shoot accurately, thus they get a clear view of the person they are killing, including seeing their faces and watching them die. This task is hard enough as it is, but to make matters worse, these soldiers have shot women and children. These soldiers tell me stories of how during service in the Middle East, they helped the children they found who were undernourished. They also generally liked to give goodies to the children of the towns as they passed through. The children remember and recognize the American Soldiers, and form good opinions of them. They welcome them with enthusiasm whenever they pass through the towns. Unfortunately, the enemy forces have often done terrible things like strap these children in the towns with bombs that will detonate upon impact. The children are young and do not know this or understand what is being done. Then, the enemies tell these kids that their friends, the US Soldiers, are coming. The kids run out to greet the soldiers and unfortunately meet their deaths. The worst part is that many soldiers are faced with an awful choice. If they do not shoot these bomb strapped children before they reach their vehicles, then they face the death of themselves and the soldiers with them. Many brokenhearted, traumatized young soldiers have told me about having to make that terrible choice, and it apparently lies behind many suicides of our soldiers, who cannot live with the fact they had to kill a child so that they and the soldiers with them would not all die. Apparently, mentally disabled women are also strapped with bombs and sent out in the street toward the US soldiers in the same manner, and the soldiers must kill them in order to prevent being killed themselves.
Soldiers who have been snipers describe a hardening of the self where one gradually becomes a cold blooded killer and comes to the point of getting a euphoric rush from killing (but not from killing women or children). This also happens with hand-to-hand combat. Some soldiers have described, with horror, how they killed an enemy with their hands, released much pent up combat related rage in the process, and enjoyed the killing. However, when they have described this to me they express feelings of horror at the fact that they enjoyed it, that they now have a deep shadowy part to themselves. Some have expressed that they view themselves as “bad” people for having done this, and can no longer recognize the good in themselves. This also tends to factor heavily into suicidality.
Another terrible atrocity that has led to mental/emotional wounding in combat veterans is witnessing of interrogation and torture of enemies and their families that sometimes occurred in addition to the soldiers having to go in and remove families from their homes for delivery to higher US officials for questioning. Sometimes, these soldiers had to be part of the physical and forcible removal of enemy suspects and their families from their homes. Other times, apparently interrogation and torture happened inside the homes. These soldiers explained to me that they had to provide protective cover as they watched higher-ranking soldiers torture the suspected enemies and their family members, children included, in unspeakable ways. As they relay these stories, these soldiers are horrified and describe this is yet another way one’s humanity is stripped away. Some soldiers I have spoken with explain that torture by US military is not legal, and yet it happens anyway. Higher-ranking soldiers in supervisory positions apparently look the other way when incidents of torture are reported to them. There is a great deal of pressure for those soldiers who commit or witness the torture to stay quiet. Soldiers who succumb to the pressure to keep it quiet feel extreme guilt on top of horror.
Many soldiers suffer greatly from losing several friends in action. I have heard stories from these soldiers of their best friends dying in their arms or being literally blown to pieces in close proximity. Soldiers have explained to me how within their units they truly become family. This is reflected in the cultural practice of soldiers referring to one another as brothers and sisters. While serving in combat, they are living together as well as fighting enemy forces together. They share everything with each other and develop strong cohesive bonds. Thus, when one of them dies, the others in the unit experience this as a traumatic loss of a close family member. It is extremely important to understand this important cultural piece and how loss of fellow soldiers can inflict significant mental/emotional wounds.
These are just a few examples of the traumatic experiences. There are also stories from soldiers who have been medics at mobile hospital units near combat zones seeing dying and seriously wounded soldiers day and night. There are soldiers who have been physically wounded, physically disabled, and mentally/emotionally wounded on top of that. There are soldiers who are canines who also witness terrible atrocities of war. What happens to these veterans when they come home with mental/emotional wounds? What care and treatment do they receive?
On returning to the US the flashbacks, nightmares, dissociation, insomnia, anger, and depression began for these combat veterans who have sustained mental/emotional wounding from experienced traumatic events during combat. Many sought help first from their physicians, and were referred to psychiatrists for evaluation. Once diagnosed with PTSD, they were offered medications but when they asked for counseling, they were added to long waiting lists. Soldiers I have spoken with, including those I have treated at my counseling practice have gone through these issues with the Veterans Administration where they are placed on endless waitlists. It often took one year or more waiting time for them to get psychiatric treatment, counseling, or even disability benefits for wounds sustained during combat service. These soldiers quite literally went through hell, only to come back and be dropped through the cracks of our public assistance systems. These soldiers are being essentially used and thrown out like yesterday’s trash. Many finished their time in the military and never received counseling. Over time, the PTSD symptoms worsened. Many stated they did not know how they could live in the world anymore after killings they made and atrocities they witnessed in military action. Several have considered suicide.
If we look at this impact on soldiers and veterans through a systems lens, two major pieces stand out. The first is the way military soldiers are trained to have no regard for the human beings they have to kill in the line of duty. Their humanity starts to become stripped away in their training. It is understandable that soldiers should be mentally prepared for their duties, but the methods of dehumanizing leave soldiers in conflict as they feel horror and confusion later that they are culturally not supposed to feel. As previously explained, this can lead to feeling trapped within the pain and confusion, unhealthy ways to reduce it, and then despair and suicidality.
The next major systems piece to note is the lack of support and treatment available to soldiers returning from combat with stress disorders. Like the soldiers from my composite example, psychiatric evaluations and medications are available, but inpatient and outpatient psychotherapy treatment is significantly limited. Many of my combat veteran clients have expressed frustration that they gave their all to serve their country in combat, but now that they need help and support their military and their country do not care enough to make sure they get good care. Couple this with feeling trapped because of the old cultural norm of not acknowledging or expressing emotional pain, and one has two major systems variables of the combat veteran PTSD problem.
There are also cultural issues that become obstacles to treatment. For example, one is not supposed to acknowledge the pain and horror of military combat. One is considered to be weak otherwise. Military combat veterans tend not to discuss painful tragic material with people outside of the culture. A major reason for this tendency is they do not want to upset or traumatize friends and loved ones with those kinds of stories. One can feel trapped between not wanting to talk about it with family and friends for the reason just stated and not wanting to talk about it with members of the culture because of not wanting to be perceived as weak. Going to counseling is often considered not an option because culturally one is considered “nuts” if one does that. This leaves the person stuck, alone with the problem. The veteran’s condition can soon exacerbate to the point of developing PTSD. The veteran feels thus disconnected from his or her life systems. Many try to kill the pain with alcohol and drugs, overeating, comfort eating, thrill seeking behavior, gambling, and sex addictions. Many veterans experience episodes of rage and out of control anger as part of their PTSD symptoms. They become physically and verbally violent, which initiates and feeds patterns of destruction to self and others, and to their relationships. The narrowing path of pain and despair often leads to suicide. When I hear news reports on television regarding the high suicide rate of combat veterans who served in the Middle East, I hear about PTSD, how these veterans had anger problems and abused family members, how they had substance abuse problems, or how many of them had a history of prior trauma such as growing up in an abusive family. I have yet to see much media coverage about how the system of the military itself does or does not factor into the mental/emotional wounding problem.
The primary and most obvious solution, from a systems, sustainability, and global perspective is to eliminate war. It will undoubtedly take huge amounts of work and time for changing cultural perspectives and beliefs about war all over the world so that war is never considered a solution to human problems. Good starts would include ensuring war strategies do not include methods that perpetuate atrocity such as dehumanization or torture, and understanding, supporting, and caring for our wounded combat veterans in ways that are culturally appropriate, adequate, and effective. Another good place to begin is educating people about the atrocities of war, and rethinking global weapons trade and military spending.
The Department of Defense (DOD) and the Veterans Administration (VA) comprise the epicenter from whence major change has to come to address the problem of emotional wounding of our military veterans from stress reactions and PTSD from serving in combat. A helpful approach includes viewing returning wounded veterans through a perspective of ability rather than disability. Coming from a perspective of disability only reinforces the brokenness that these veterans feel. Also, because PTSD is not a visible wound, it tends to be minimized and this needs to change. Perspectives and approaches that recognize PTSD as a wound and promote resilience and healing need to be applied. Additionally, DOD and VA leaders need to stay present with their humanity in order to help promote and heal the humanity in soldiers.
There are some programs and resources provided by the DOD and the VA to address and treat mentally/emotionally wounded veterans. However, the number of emotionally (and physically) wounded veterans is so huge that these programs and resources are but a tiny drop in the bucket. Mental health programs need more funding and growth to truly be effective in addressing the problem. It seems to me that the astronomical number of veterans coming home with PTSD and the resulting very high veteran suicide rate are the major reasons why the DOD and VA provide any programs and resources at all. Another reason is that PTSD and stress reactions in veterans is getting a high degree of media attention. Because of that, people who want the problem addressed have been putting pressure on DOD and the VA to do something about it. I think if these above-mentioned elements were not present, not much would have been done. Thus, as many people as possible need to speak out and increase the pressure so that the DOD and the VA must answer and thus allocate more funds and initiate more programs to treat stress reactions and PTSD.
The VA also needs to link with clinicians in the community, like me, to work with them to help those veterans who are on very long waiting lists awaiting care. A major issue that needs to change immediately is that veterans only get cost of care coverage for receiving treatment within the organization of the VA and the military. They can only get covered treatment at military or VA clinics/hospitals. They are not covered for treatment by healthcare practitioners like me who are in private practice settings. Tricare, the military’s health insurance, should cover these services. Until legislation is changed so that veterans can get care coverage outside of the military/VA, the long wait list is bound to continue.
The veterans who are under my care have been able to get treatment covered by some non-profit organizations, some of which I participate in as an affiliate clinician, or by family members who can afford to pay the fees. However, this option alone is not sufficient to address the tremendous scale of the problem. One of the nonprofits I have been working for as an affiliate counselor just recently ran out of financial resources. Apparently, these resources ran out quickly due to the huge number of veterans who needed and accessed care. This example further presses the point that more funding and growth of VA programs needs to occur, and legislation needs to change so that veterans can get mental health treatment through clinicians in the community rather than only at military clinics and through struggling nonprofit organizations. Nonprofit organizations that help veterans heal also need support from the DOD and our national community.
Changes can come from the smallest of ripples. When one throws a rock into a pond, a ripple is created regardless of the size of the rock. Ripples spread outward until they ultimately reach the shores of the pond. Even the tiniest pebble makes a ripple when tossed into a pond. As human beings, we must not underestimate the power of our individual actions. That is where it all starts. We can make a difference. There are various ways to create ripples. Individual soldiers can tell their stories orally, in writing, or through expressive art to help educate everyone in the world on the atrocities of war, the pain of mental/emotional wounding sustained in combat, and what is needed for healing. I have noticed that when each soldier can reach a new realization of purpose and meaning in his or her life, healing is achieved shortly thereafter. In the midst of a soldier’s suffering, if he or she can find a way to do good in the world once more, the shadow of atrocity and mental/emotional wounding can be shed. Some soldiers write poetry and narratives. Some ask me to share with others what I have learned from his or her suffering. Each veteran seems to find healing in helping other veterans heal and helping the world understand that war needs to cease and PTSD is to be recognized and addressed as a real wound in need of healing.
I have encouraged these soldiers to express themselves so the world may learn from them. I have taken up the cause beside them in my clinical and academic work. I have worked toward their healing in my clinical practice with individual and group therapeutic approaches that are culturally appropriate. I have splashed into the Project X: Evolutionary Leadership for Sustainability pond to share my experiences and views and to inspire others to do the same. Together, we now splash into the pond of Rethinking Complexity. There are combat veterans all around us, every day. We need to do more than just thank them for their service. We need to encourage them to tell their stories. We need to relay these stories and all that we learn from veterans so that others may learn. We can write, speak, and communicate this through expressive art. Our ripples are already growing, and now you, the reader, can take this opportunity to make a splash and create ripples with us to create needed healing and change for our military combat veterans, our Nation, and our World. Changes can come from the smallest of ripples. When one throws a rock into a pond, a ripple is created regardless of the size of the rock. Ripples spread outward until they ultimately reach the shores of the pond. Even the tiniest pebble makes a ripple when tossed into a pond. As human beings, we must not underestimate the power of our individual actions. That is where it all starts. We can make a difference. There are various ways to create ripples. Individual soldiers can tell their stories orally, in writing, or through expressive art to help educate everyone in the world on the atrocities of war, the pain of mental/emotional wounding sustained in combat, and what is needed for healing. I have noticed that when each soldier can reach a new realization of purpose and meaning in his or her life, healing is achieved shortly thereafter. In the midst of a soldier’s suffering, if he or she can find a way to do good in the world once more, the shadow of atrocity and mental/emotional wounding can be shed. Some soldiers write poetry and narratives. Some ask me to share with others what I have learned from his or her suffering. Each veteran seems to find healing in helping other veterans heal and helping the world understand that war needs to cease and PTSD is to be recognized and addressed as a real wound in need of healing.
I have encouraged these soldiers to express themselves so the world may learn from them. I have taken up the cause beside them in my clinical and academic work. I have worked toward their healing in my clinical practice with individual and group therapeutic approaches that are culturally appropriate. I have splashed into the Project X: Evolutionary Leadership for Sustainability pond to share my experiences and views and to inspire others to do the same. Together, we now splash into the pond of Rethinking Complexity. There are combat veterans all around us, every day. We need to do more than just thank them for their service. We need to encourage them to tell their stories. We need to relay these stories and all that we learn from veterans so that others may learn. We can write, speak, and communicate this through expressive art. Our ripples are already growing, and now you, the reader, can take this opportunity to make a splash and create ripples with us to create needed healing and change for our military combat veterans, our Nation, and our World.