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When They Come Home&hellip
Assessments of the many ways in which transitioning from high-stress combat war zones to a peaceful home community environment can be the hardest part of military service. Explaining the difficulties and what can be done to help are psychiatrist and author Jonathan Shay; VA psychiatrist Andrew Pomerantz; retired Navy psychologist Dennis Reeves; Col. Thomas Burke, director for mental health policy for the Dept. of Defense; Vietnam vet and VA counselor Jim Dooley; and Fred Gusman, a director of the VA National Center on PTSD. These excerpts are drawn from their extended FRONTLINE interviews.

Jonathan Shay
Psychiatrist and author, Odysseus in America

… In combat, you have to shut down those emotions that do not directly serve survival. So sweetness, the gentler forms of humor, grief -- all shut down. And this is profoundly disconcerting to families when a soldier comes back, and he seems to be made out of ice. It's not that he is irrevocably and permanently incapable of feeling anything. It's that this adaptation of shutting down those emotions that don't directly serve survival in combat is persisting.

Many a veteran's wife has said, "What's wrong with you? We were just at your mother's funeral and you didn't shed a tear. You didn't even look sad. You just looked like a block of stone." And that's just dreadful for both the veteran to hear and dreadful for the spouse to observe. And simple education about these things can go a long way.

Now, sex often gets shut down. So the veteran's spouse may say, "Don't you love me anymore? What's wrong? We used to really enjoy each other." Again, it's shutting down everything….

… [But] I would say that rage and the inability to have authority over anger … is the single most destructive thing in the lives of combat veterans. Now, where does it come from? The easy explanation is that, again, it's the persistence into civilian life of an emotion that does serve you well in combat. At least that's what the folk culture says. The folk culture says that we want to even cultivate rage against the enemy. …

I do want to mention one thing and this is important. And that is sleep loss makes anyone hair-triggered, makes anyone ready to get angry at the drop of a dime. And if the heavens open and God boomed down and said, "Jonathan Shay, what's the one thing you'd do for returning veterans?" it wouldn't take me a second to say, "Lord, give them all enough good quality sleep." If you have enough good quality sleep, you're very much more likely to have both emotional and ethical self-control.

… Why is alcohol use and abuse prevalent among returning veterans?

Self-medicating with alcohol and then beginning to abuse alcohol often starts with a desperate need to get to sleep and stay asleep. Alcohol is a catastrophe as a drug for sleep. Yes, it will put you to sleep. But because of its pharmacology … a person bounces awake much more wired than when he went to sleep, as a result of the alcohol. It is actually a mini-withdrawal syndrome, a hyper-excitability of the nervous system due to the particular features of alcohol as a sedating drug.

…[A combat veteran] wishing he could calm down, and being wired up, gets very wearing and people criticize you for being wired up. And if you discover that a couple drinks will make you a little bit more mellow -- and initially they might -- then that's another thing. And there's also the fact that there's a horrifying baseline level of alcohol abuse in our society. It's cheap, freely available without a prescription. And yet alcohol is an incredibly dangerous drug. It's poisonous to the brain, to the liver, to the heart, to the stomach, to the pancreas.

So, it's desperately important that veterans not fall into the alcohol trap for sleep. I would love to see every family doctor in the country feel perfectly safe about prescribing relatively low doses of Trazidone. It's a very safe drug. It's cheap, it's off-patent. And there has never been an overdose death from somebody just overdosing on Trazidone. People don't get tolerant to it.

And what about the problem of veterans who become socially isolated?

The person coming back from war is likely to become socially isolated for a number of reasons. One is that if they do suffer from a loss of authority over anger, it's not that they've lost their conscience, it's not that they don't care who they hurt. If they're afraid of their own anger, their first impulse is to run and hide. And I know as a fact that a lot of the veterans who end up living in basements and in attics or out in the woods -- almost complete isolation from everyone -- many of them are doing that not to protect themselves but to protect us. Because they're afraid that they're gonna lose control of their anger. And so that's one big reason for veterans to isolate.

But there's also the fact that many are emotionally numb, and they don't know how to negotiate relationships in the face of this numbness. And if you can imagine having no feelings -- even in the workplace, you have to have emotions to be able to negotiate the workplace. So they feel like they've been dropped in from Mars. The chasm of understanding between a civilian and someone who's come back from war is so enormous that the veteran can feel like, you know, "I'm green and I have two heads," and go and hide because they feel so freakish.

…There is one aspect of it [returning veterans from Iraq] that I think that [many] administrators may have trouble wrapping their minds around. And that is that the wave of veterans needing mental health services may not hit as soon as they think it's going to hit, because veterans come home proud and they come home angry. So someone says to them, "How you doing? You need any help with what you did over there or saw over there?" the response is likely to be "Well, I'm fine, and what's your problem?" Now that's a proud response, but it's kind of self-destructive. …

Just some simple education would just drop the level of confusion and tension all around. There are vet centers all over the country, and usually they're in the phone book under the heading vet center. The official name is the Readjustment Counseling Service of the VA. At the very top of the pyramid, they belong to the VA. The director of that organization reports directly to the Secretary of Veterans Affairs. But the vet centers aren't run by the local VA hospital. And historically, they really have been an open door, an open heart, an open mind and a fund of real, on-the-ground knowledge. And I would encourage any veteran and family member who are wondering what to do, where to go, how to deal with what they're experiencing, to think of the vet centers and to turn to the vet centers for the kind of trustworthy information that they need. …

· Information on Vet Centers is available in the "Support & Services" section of this Web site.

Andrew Pomerantz
Chief of mental health services for the VA in Vermont

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…They will be coming home to a populace that's heard a lot more about the effects of trauma on people and how combat is not really a good thing for anybody, and a population that has heard a lot more about PTSD. There's a lot of outreach going on in various community groups. ... Communities are very important in protection of individuals from the effects of trauma. Some communities are naturally more supportive and more understanding. This applies to all kinds of trauma, whether it's military trauma, sexual trauma, natural disaster trauma, whatever it is.

Some, for a lot of different reasons, have more natural supports for the traumatized individual; others, not so much. I think it's going to be more difficult for someone to come home to a town, say, dominated by the military than someone coming home to a little town in Vermont where everybody knows them, everybody is supportive of them, [where] the local organizations are waiting for them to come back and people know that something bad has happened. I think that there will be quite a differential depending on the environment that one comes home to. That's going to be very important. …

Dennis Reeves
Retired Navy psychologist

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…How do you prepare the soldiers for their return home?

Before guys actually come home, primarily our Chaplain Corps has what they call a Warrior Transition Group, and they talk about "expect the unexpected." ... They've been through some pretty harrowing experiences together. They have been in a small group, for the most part about 40 guys, and that group becomes extremely close. Sometimes, because you're there 24 hours a day, seven days a week with those same people, you create a bond that is as strong as any family tie could ever be, and most of the time stronger. And you become very dependent on each other.

And also because you've gone through similar experiences together, when you talk to somebody, they know what you're talking about, and they can relate to it. Frequently I use [an] example: Before I left, I found a thermometer that read 140.8 degrees Fahrenheit, and when you get home and you try to explain to some[one] what 140 degrees [is], [what] wind with sand coming at you is, they don't understand. There's no way they can relate to it unless they've actually been there. ...

Now, what happens when guys come home is that they sometimes hold that stuff up and keep it in their head, and they don't really talk about it until they get home. And then if they're married, they try to tell their wives about it, and they start dumping all this stuff on the spouse. So the spouse goes, "Well, you know, that was really horrible, but gosh, let me tell you what happened at the office today and what so-and-so said about me; that was really awful, too." And [it's] apples and oranges. ...

Another problem that is commonly experienced when troops return home from an extended deployment in a place like Iraq is that they experience outbursts of anger. It occurs in Iraq, and it's usually settled down. But Marines yell at each other, and they're kind of a violent group, so it's not so abnormal for them, especially in a hostile environment. But when they come home and they're with their families, and they're used to yelling and screaming and hollering and things of that nature, if they start doing it at home, it can make some major ripples in a family unit. ...

But generally speaking, after a couple of weeks you start settling down, and those spontaneous outbursts of anger dissipate, and they go away. If you have Post-Traumatic Stress Disorder, they don't go away. And you are always hyperalert, hypervigilant, and your nervous system is just on pins and needles. You're hypersensitive to everything. And if you think about it, in the environment that you were in, the hypervigilance was survival. If you weren't watching and checking everything all the time, you could end up dead. And so after six months of that, your system has been turned up and turned on to the point where you've always got your antenna out and you're always scanning and monitoring for the enemy, and so little things can really irritate you because you're just at [a] peak emotional state. …

[Some] individuals start doing what we call self-medicating, and the most common avenue is alcohol. And they start drinking. A drunken Marine who is depressed and in crisis is extremely dangerous to themselves and others, mainly themselves, because they have ready access to very deadly weapons. …

In Iraq, alcohol is very hard to get. … [S]o most of these guys are coming back with very low tolerance, and they start drinking, and they can get really crazy. But if they start building their tolerance back up, and they've had stress and are using deployment as an excuse to continue to drink, and they continue to drink to the point where it becomes alcoholism and really alcohol dependence, they will do just about anything that a normal alcoholic, a person who is an alcoholic that wasn't in the military, will do.

You don't have to be a military alcoholic to do these sorts of things. They will start making up just unbelievable stories and provide fabrications and fantastic excuses about why they're drinking to make the individuals that are with them say, "Oh, well, then it's OK," and so that other people will understand why they're drinking. ... Mainly what they're trying to do is get people to leave them alone so that they can drink heavily and they can maintain their alcoholism. And that's what alcoholics do. ... …

Thomas burke
Director of Mental Health Policy, U.S. Dept. of Defense

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… How do you prepare soldiers for returning home?

…One of the problems is that if they've been away from their families, especially if they've been away for a year, that's a long time for a family. The children change immensely in the space of a year. So when they come back to their families, their families are going to be different. … They will have expectations about what their families are going to be like. Their families have expectations about what they're going to be like. And the one thing that is absolutely true about all of those expectations is all of them are going to be wrong. They're going to have to make some adjustments in order to match their expectations with the realities of the situation.

We try and help them be prepared for that and be flexible in their expectations. We talk to them about the importance of communications and communicating with a spouse. It's not that you have to come home and tell your spouse in great detail everything that happened to you in the whole year on the first day. But keep communicating about whatever you can communicate about.

Tell me about the post-deployment health assessment that the military requires soldiers to complete before they go home. Is it possible that soldiers are answering that everything is OK with them, when, in fact, it's not?

That may happen. That's human nature. They've left the theater, so they're kind of away from the stresses ... and they're headed home. So they've got a couple of reasons why they might not look at their experience in theater with the same eyes that they looked at it a month ago. That's just human nature. Still, we need to get that information down, as much as we can, soon after it's happened.

Some of the questions on the post-deployment health assessment are questions about what happened to you: What did you see? What did you experience? Others are: What are you feeling? Are you having any symptoms? We need to ask those questions because if there are soldiers who are having serious problems with "I can't sleep. I have nightmares all the time " -- they might be feeling suicidal. We need to, at least, try and catch them. And if they won't talk, there's not a lot we can do about that. Except then, whenever they do get home, and they are more willing to talk, they have the system available there for them to go to.

There are several approaches. The military health care system is available for all of the soldiers who are on active duty. The Congress has extended the period that Reservists and National Guardsmen have after separating from active duty. They still have six months of access, plus some time based on their amount of previous service, available in the military health care system, the tri-care system.

Then the VA system is there, available for soldiers who've separated, either retired or left active duty. We are working with the VHA, to make sure that the transition for those soldiers is as seamless as possible. …

But have some soldiers have fallen through the cracks with disastrous consequences?

There were some incidents of domestic violence in soldiers at Fort Bragg, and the result of that was the deployment cycle support system.

The Army, in particular, took a look at how it managed deployments across the entire timeline of a deployment. We didn't see mental health care as something that was just provided in-theater; it had to be across the entire timeline of the deployment. Pre-deployment care. Get the families ready, get the soldiers ready. Be sure that everyone is screened properly when they deploy into theater. There were several avenues that you can provide mental health care within the theater before the soldiers come home. Start to anticipate the problems that they might have whenever they get home. Get them some education, a little bit of training.

Then there's the re-deployment process that has to be managed: the reintegration process with the families, the fact that the reserve components may be separating from active duty, getting them care, getting the transition made across to the VA. There's the whole spectrum, the whole timeline, and that it's an integrated process. There are less cracks for those people to fall through, and so it minimizes that risk. That's what we're trying to do. We're trying to improve the process, improve our understanding to minimize that risk that the soldiers are going to fall through the cracks.

What about the rash of suicides that took place at Fort Bragg recently? Did those soldiers fall through the cracks?

Any suicide is a tragedy, that's the perception of the senior leadership. They're very concerned that the families are safe. Domestic violence is a serious concern. To have several within a relatively short time span in one location causes the leadership to take a look.

What they found was not a particularly isolated problem at Fort Bragg, but it gave them an opportunity to review the entire process of the deployment cycle, and to look for better ways of doing things. It wasn't one isolated thing that needed to be fixed, but this was an opportunity to improve the system. They took that opportunity, and the system is better now.

Our way of doing things is more integrated [now], and there is [an] emphasis and awareness on mental health, on the need for families to be cared for, on the need for managing that reintegration process and getting the soldiers back with their families, the need for the One Source program, the 1-800 kind of numbers, something that's immediate access, that the soldier's families, reservists, even DOD civilians can get by just picking up the phone. …

Was this a rash, an epidemic, of suicides? Is there something going on that should cause us to intervene?

There was a cluster of five suicides in July of 2003. I would use the word "cluster" rather than the word "rash."

I think that was one of the questions that the MHAT team went over to look at. Their mission,the scope of their charter, if you will, was broader than just looking at suicide and suicide prevention in that particular cluster of suicides. They looked at the total mental health care system there and did a lot of surveys and talked to soldiers about what their experience with symptoms and with the mental health care system [has been like].

The issue with the suicides, if you look at a small enough period of time, you can get very high rates because the distribution of suicides over time is not even. It tends to clump. And, even though, at the end of the year, the Army's suicide rate was about where it had been over the past five to 10 years, for that small period, that was a lot of suicides.

When it was investigated, there was no common thread, so there was no specific intervention that needed to be made. One of the issues that we are looking at in the suicide prevention arena is [creating] a better system for standardizing how we count suicides and how we calculate the rates of suicides, so that we can make comparisons, so that we can apply modern statistical methodology to those rates. …

Jim dooley
Mental health counselor, U.S. Department of Veterans Affairs

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… Vermont has a huge number of National Guardsmen coming back right now. What would you say about those guys in particular and their experience?

In any war, you're really never prepared. [They]'re coming from northern Vermont, and they're going into 110-degree temperatures with sand and dirt and disease and a culture that's absolutely different. The cultural changes are usually really dramatic. I witnessed that with Vietnam. They [are] wonderful people in Vietnam, but their values were very different, and sometimes it became jarring to really understand that you and they think so totally differently. And I think that the returning soldiers from Vermont will have to re-adjust some of their expectations of how things are done again here.

… One of the most common stories that I've heard is when they're coming back, a lot of them are coming through the main airports, and some of their first sort of stress reactions are being in line with other Americans and watching how spoiled Americans are, and how they complain about the smallest things … to the point where a lot of these guys have told us they wanted to smoke-out the guy who's complaining [about] the flight being late. Can you describe this coming home experience?

Well, again, being in Vietnam -- it was not of this world. So, when the people talk about rotating back -- completing their commitment and being allowed to go back -- they called it "going back to the world." And that was not just something that was laughingly said, but they really meant it -- that they were in an absolutely strange place in that when they were allowed to leave, they escaped back to the world.

And the vet at the group therapy two days ago talked about it as "the Nam." It becomes a place that is not necessarily geographic in nature, but rather cultural, and I think that they will also be talking about being in Baghdad and returning back here, and it'll be a totally different world.

Is that where the anger comes in? These guys come home and are exposed to American culture again? I mean, the level of anger that I've heard from some of the soldiers is shocking. Mad at the college students, mad at the guy in the Starbucks line, wanting to like chop off someone's head for cutting them off at the supermarket. We all get annoyed, but the level and the reaction [in them] is so heightened. Is that what that's about?

… I think it's displaced anger. It's not the Starbucks guy. What [veterans] are saying is that "You have no idea what the other part of the world is like, and I do. And you should know it. If I have to know it, you should know it." And I think that's where the anger is. It's that their value systems have been fundamentally changed by that experience. And they keep that value system the rest of their life. …

Everyone has told us that every soldier who goes into war comes home changed. What does that mean to you?

I think the experience of war is absolutely unique. I think that men, women, go into war with their own histories, and some of their history is good and some of it isn't good. And I think that their experiences will forever color the rest of their life. Culturally, it's difficult for people who have not been in war to understand that.

The closest that I can describe it is two different ways. One is that it's a rape of the soul. It's a rape of innocence. You are exposed and see things and do things and not do things that really challenge a lot of your values. The other description that I have is a car accident: Bad things happen and people get hurt, and it's an instant in time that stays inside your head the rest of your life and affects you. And you are forever changed by that experience.

One of the things that feels a little counter[intuitive] to me is that soldiers coming home often they have this very wonderful reunion with their family, but slowly -- and sometimes it's quickly -- they start to distance themselves. I'm trying to understand [why] the people who are closest to them in this safe environment, are the people that they feel the least able to talk to.

It's a very interesting area. I think what happens when soldiers return is they're really beginning to struggle internally with what they experienced, what they did, and what they didn't do. And, they initially want to be reunited with the family, but what develops is usually a couple of things that sort of [happen] simultaneously. They begin to have nightmares. Now that they're safe, they actually begin to acknowledge -- in an unconscious way -- exactly what happened. Sometimes they'll have flashbacks, which are videos in real time during the daytime that do not come announced. They just [snaps his fingers] happen. And it scares them, and they don't want to talk to their families about it, because they don't want the images of what they're feeling to be transmitted to the people that they love. They don't want to contaminate [them] and, they especially don't want to talk with females. They don't want that horror. So, they look around at either relatives that have been in the service to try to talk with them or friends that have been in the service.

The other thing that happens almost simultaneously is a significant increase in substance use. Men have talked about being drunk for the first year, drunk constantly, because it's a way of not thinking. It's a way of turning your brain off, chemically. And they go for the effect because they just want to put it away. But it doesn't stay away, and that's part of the problem. It's that ultimately, they have to deal with it in some way -- either they compartmentalize it, which men tend to do -- women are much more sophisticated, they look at everything as holistic. Men tend to sort of put things in little boxes, and think that it's going to stay there. And it doesn't. It contaminates.

One of the soldiers who came home from Iraq a little while ago sat in a support group on Saturday. [He said] that alcohol is really his only friend. Can you tell me about that? What is the substance abuse link?

There's a serious problem with the culture of the military and substance use. With the younger people, it's poly-substance use: It's both drugs and alcohol. [It] is the way to stop the thinking, to relax, to not have that internal tension that you're vibrating inside. And although it stops that, it creates a whole host of other problems that ultimately lead to enormous problems. But on the short term, as a chemical, it does work. And, they use it. And nobody has to give a prescription for it.

The problem is that it creates four other problems. That's the real problem with it. They lose their jobs. They lose relationships. Their children distance [themselves], because they're inappropriate and angry. Their anger comes out. They isolate more. They have more accidents. They have more fights. Life just is not good.

In a support group we found pretty much every guy in the room talked about alcohol in that way. And this big thing -- "Nobody understands." Can that kind of barrier be overcome?

I think it can be overcome, but I think when a person is struggling with that, it's very difficult to put into words what goes on inside your head. What I find is that there are two major issues that are very, very difficult to really talk about. And one is guilt, and one is shame. One is doing things, and one is not doing things. And those things become the major problems, and the only the place that I can see myself serving people is that I do understand, having been there. …

[Another issue is] the need for these vets to feel that sense of heightened awareness -- the adrenaline rush -- that they felt when they were in combat. A couple of the guys in Chicago were describing that for me. And what are your thoughts on that?

… [I]f you look at risk-taking for veterans, it increases substantially. They begin -- a significant portion of them -- to carry weapons. They do riskier things [than] the general population would be doing. After World War II, veterans came back and they started motorcycling. Before that, it was a gentlemen's thing. Now, they were going cross-country. There's just an increase in risk that way, I find.

Jail times, drugs, fighting. I think that they really understand that there are no limits. I describe wars as organized insanity. But if you look at the rules of war, there are no rules. And as soon as you understand that, then you're really challenging the basic assumption of your society. "If there are no rules during war, then why would I want to do it? And therefore, I can do anything I want, and they have to catch me at it." And if you look at the population of veterans in jails, it substantially went up. Fueled a lot with alcohol. But I think also [they] thought that there are no rules, and "I can pretty much do what I want. Who's to stop me? And if they try, I'm going to resist." At some point, that becomes a very lethal arena. …

Is that part of the frustration that soldiers have coming home with Americans [complaining] about being late on a plane or losing their luggage?

I think so. I think they don't understand. I think American society is insulated from the rest of the world that way. When you go to almost any other place in the world, you'll see populations struggling to put food on the table and to have something that they can call a home. And we are unaware of the rest of the world. When you go to a war, you are integrated into that society to a certain extent. You are part of that experience and you take back "how little do we really appreciate what we have?"

You had mentioned that are two feelings: there's guilt and there's shame. Can you elaborate on that? What did you mean by that?

When I talk with combat vets about their difficulties -- there are memories, there are videos, there are stills, there are smells that are hard wired into their brain. They will not forget those ever. Part of what happens is they interpret what they did, and they interpret what they didn't do, from the view of the age that they are currently. And they look backward on their experiences, and they said, "I should have…" or "Why did I…?" They convict themselves. And they're angry with themselves for a moment in time and a decision.

I have a lot of arguments about this issue because I think it borders on spiritual issues, moral issues, and none of us are judges except [of] ourselves. And yet, when we judge ourselves, are we putting the judgment in the hands of a 19-year old? Or are we judging ourselves as a 57-year old, as I am today? And that's what I argue about, that they still are judging themselves in the mindset of a 19-year old. When you look around -- from my experience anyway -- at 19 years old, they're not quite adults. They're just extremely large teenagers. And you give them toys, and they make decisions that aren't necessarily the best decisions.

I went through a village [in Vietnam] one time, and I spotted coconuts up in a palm tree. [I had] a rifle, an M16, and I put it on automatic and let a burst out on the tree, and down came the coconut. And out of the hut screamed a mother, yelling at me in Vietnamese, that I had shot down her milk supply.I didn't know that at the time. I felt bad. It was like, "I was only playing." That's what it means to be in war at 19.

These soldiers, a lot of them will be coming back middle-aged soldiers from the reserve and National Guards. I think that that will be an advantage. I think that as we age, we are able to define ourselves better, and I think that will be hopefully a help to them readjusting back to their families and their life after the war. …

Something that Andrew Pomerantz has talked to me about is that there is a real treatment window: There's a window of time where if vets could come in -- returning soldiers who are here just on a year leave or whatever it is -- if they would actually talk about it sooner, that would be better.

What happens with the returning vet is that they have these feelings, these images, these smells, these nightmares, occurring frequently. And they're quite disturbed by it. They're spooked by it. Their readjustment time is much more difficult because of it. Let's call it the "golden hour" of being able to have someone surface or reach out to someone and say, "Gee, how you doin' with that experience?" They're more likely to be able to say, "These are the things that are happening to me, and I don't know what to do with them. And I'm feeling bad about myself." I think if soldiers are allowed to distance themselves from that, they encapsulate it. They put it in a box. They lock the box. And they stuff it under their bed. They don't ever want to go there again.

I began to talk with a blind World War II Navy man who was running on a board ship at the battle of Okinawa, and his small ship was directed to go near the shore just so that the enemy could shoot it out so that the bigger ships could shoot at the enemy. In effect, he was bait. He had never talked about it in 55 years. You need to be able to have this type of timely services as you would if a person is bleeding. It's the same kind of effect, but we don't acknowledge that.

A counter argument could be made: What's the big deal if he doesn't deal with it for 55 years? What does it do to that man's life?

I think it does two things. One, the avoidance of dealing with it provides no help to the veteran. The life quality is significantly short-changed. The interaction with family is very distant … You have frequent job changes, frequent divorces, the men last week at the support therapy session had five divorces. So these kinds of things really do impact the quality of the veterans' life over their lifetime. As with most preventive things, if you enter early, you'll have a much greater effect in improving the quality of the life. …

Fred Gusman
Director, education and clinical laboratory division, VA National Center for Post-Traumatic Stress Disorder

… What are the challenges we face in providing easy access to care once our servicemen and women return home?

One would assume that everybody who went to Iraq or Afghanistan -- regardless of Reserve, Guard, or regular military -- that they're all going to get the same care. Mostly people believe they get care from the military, but the reality is they don't. The people who are regular forces get care from the military or contracted through the military. The Reserves and the Guard are a little different, because the Guard are constituents of the state that they came from.

Congress in their wisdom right now has established a two-year window for [all military] people to get this treatment. But because of the issues around stigma or fear of going in for treatment, they don't seek help.

[However] it's not the stigma to stay in the military for the Guard and Reserve, it's more about maintaining their [civilian] employment. For example, some of the stories that I've heard from some of the younger Guard folks is where they've had relatives that were Vietnam veterans. And they say, "I don't want to take off work to go see somebody. I really need to see some people about how I'm feeling, because I know I'm getting more angry at home, but I don't want my boss to find out that I've got problems related to Iraq, because I might not have my job." And we ask them, "Well where do you get that from?" And he says, "Well that's what happened to my uncle. They were frightened of him because he got angry a couple times at work." So the health care benefits for Guard and Reserve are different.

We're not trying to find a way to make that sort of a seamless experience for them. But people that are in the Guard are generally younger [and single]. The Reserves are generally a little older and married. It's very unlike the regulars where you have more single men and women. So the kinds of problems that we're going to see or already are seeing is in the family; sometimes domestic violence, substance abuse, self-medicating.

We're seeing the beginning signs of early unemployment, and even a few people we're seeing that already are becoming homeless because they're not making the reintegration back home. In the [regular] military you have a family, you go to a base, you're familiar, everybody looks the same. Because you're wearing the same uniform, there's a certain structure.

When you're in the Guard and you come home, yes you have your meetings every couple weeks, but basically you're a civilian again. Psychologically, it's different too, because you don't have that kind of support, that kind of checking in where people can say, "How are you doing?" And you feel safe talking to that person cause you know they know. But in the civilian world, it's quite different. People in the civilian world want you to be OK. Understandably, society wants all these people to be OK, so they don't really want to hear that you're not OK. And if you told them, they wouldn't know what to do with it anyway. …


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posted march 1, 2005

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