Looking Beyond PTSD: Are We Ready for Our Returning Heroes?

With an estimated 30,000 troops expected home from Afghanistan next month, the question that must be asked is: “Is the United States ready to accept these veterans back into society? Is it ready to help them reacclimate, re-socialize, and reintegrate?” The answer is not a simple yes or no. To get to an answer, we must look deeply at job searches, VA benefits, diagnosing PTSD, and cultural competency.

Many of our returning soldiers will come home as veterans whereas others will continue to fulfill their service in the military. There are more than 40,000 nonprofit organizations in the United States with stated missions that focus on the needs of service members, veterans, and their families (Urban Institute, 2012). But do those nonprofits truly understand how the longest two-war cycles in America history has impacted this generation of veterans?

Recent studies have shown that many veterans will experience trauma due to the rigors and pressures of combat experience. But here’s the rub: Not all veterans who have experienced combat trauma will be diagnosed with PTSD. The RAND Corporation’s Center for Military Health Policy Research recently published findings from a study it conducted with veterans from Operation Enduring Freedom and Operation Iraqi Freedom and they found that one-third of veterans were currently affected by either PTSD or depression or have reported exposure to a traumatic brain injury. What’s more, about 5 percent of OEF/OIF veterans had all three. RAND also found that only half of those who reported symptoms of major depression or PTSD had sought any treatment in the past year.

Readers may look at the one-third statistic and be awed. But it’s important to highlight the proportion of veterans experiencing mental health problems because it demonstrates that not all veterans come home “broken.” A large number of veterans, two-thirds of them to be exact, are ready to re-enter the workforce or are eager to finish their education. They are waiting to reintegrate into the civilian world and explore new roles. But the question remains—are we ready for them?

An important variable that needs to be factored into this discussion is stigma and its impact on accessing services. In a recent op-ed in the New York Times (“Returning From War to a Check-up Full of Holes,” October 9, 2012), Thomas J. Brennan, a sergeant in the Marine Corps, described the distant and casual demeanor a mental health professional exhibited when assessing him for thoughts of suicidal ideation while implementing the Department of Defense’s mandatory Post Deployment Health Assessment. He notes: “Her impersonal demeanor allows me to maintain a facade. A simple ‘no ’suffices, and she moves to the next question. I think to myself, ‘How easy this is?’ One word moves us to the next topic. No red flags.”

At Home Again, where we train providers and employers in a culturally sensitive way of working with veterans, we’ve heard this story countless times from veterans who describe their reluctance to share their military experience because of the stereotypes and preconceived notions people have when you say you’re a veteran. As Brennan also states: “The stigma made me nervous; I was concerned about being shunned if I got help for the feelings I had inside.” In order to best treat and meet the needs of this generation of veterans, providers, nonprofits, and the like must equip themselves with accurate information and immerse themselves in the culture and literature of the military to dispel biases and decrease stigma.

One of the primary distinctions that needs to be understood is prevalence of trauma and whether experiencing trauma leads to a diagnosis of PTSD. We have learned that going into combat doesn’t automatically lead to being exposed to trauma. Nor does being exposed to trauma lead absolutely to PTSD. Veterans are individual people and not everyone reacts the same way to similar experiences. If providers assume that all returning troops have PTSD, they will be promoting the myth of the “broken” veteran, which in turn leads to further stigma and will likely negatively impact the reintegration process.

With these ideas in mind, we can then focus on the values military culture instills. Military culture is considered collective where the needs and goals of the group come before the individual. Providers need to have a clearer picture of military culture and its effect on veterans before they can begin to serve them appropriately. Providers need accurate information as well as engagement strategies. Providers need to know what question to ask veterans, such as, “Why did you join the military? What branch did you serve in? Why did you join that branch? What was your MOS (military occupations specialty, aka job)? Did you deploy, if so where and for how long?” Asking the right questions demonstrates curiosity and a willingness to partner with the veterans and get a better sense of their experience and expertise in their own life before asking some of the heavier question such as a “Have you ever thought of hurting yourself?”

At Home Again we constantly remind our colleagues in the community that you don’t have to re-invent the mental health wheel to treat veterans and military families. However, you do need to approach this population with a culture-sensitive lens. You need to look for a veteran’s resiliency and strengths while respecting the individual’s own process in telling his or her story and combat experience. It’s a matter of looking beyond your own preconceived notions, of understanding what’s not being said as well as what is being said, and most important, of looking beyond the obvious.

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