The Blog

ALL THE WAY HOME

FORT HOODAs the Fort Hood memorial services wind to a close, we are called as a country to cultivate an abiding empathy for the strengths and struggles of our Armed Forces and their families as they continue to navigate the complex challenges of military service compounded by over a decade of continuous wars. The stories they carry cannot be shouldered alone; the same holds true for civilians. Our founders knew this truth; from the many, one. Truly, we are all in this together.

Over the coming months and years, several hundred thousand service members will depart military service, voluntarily and through budget-driven force reductions, comprising part of the roughly 2.6 million troops who have returned from multiple deployments since 9/11. Many are thriving; many are struggling. All possess essential values, skills and experiences from which our nation could greatly benefit at this historic juncture. Keep in mind, as one sergeant put it, “Veteran is a verb!”

Our veterans and their loved ones do not return to the Pentagon or to the VA. Rather, they are returning to communities in every county, state and region of our country. Our communities must be ready to provide a safety net for healing and a springboard for launching the next phase of their journey – bringing our warriors, veterans and their families all the way home. As another sergeant put it, “communities are the unit cohesion of civilian life.”

While the DoD and VA are working together at all levels to improve and even transform services, neither agency can possibly bear the entire responsibility to care for those who have borne the burden of battle.  War, after all, is a communal experience.  As a nation, we send our sons and daughters to act on our behalf; embracing their needs and harnessing their strengths following deployment is a national imperative, reflecting our character as citizens and as a country.

Fortunately, this generation of warriors is not alone. Joined by millions of fellow veterans who served from WWII through 9/11, the total number of US veterans numbers over 22 million. Vietnam veterans, in particular, deserve special recognition for their role in welcoming returning troops at airports, deploying the Patriot Guards to maintain the sanctity of memorial services, and providing timely leadership and community resources in support of post 9/11 veterans and their families. Indeed, their selfless actions embody their generation’s pledge ensuring that “never again will one generation of warriors abandon the next.”

Bringing today’s veterans all the way home, however, has proven more challenging than ever. Compared to veterans of previous U.S. wars, today’s generation of warriors has been exposed to far more continuous conflict. Most have been deployed on repeated tours, each lasting from four to fifteen months, and in all cases, extending well beyond the roughly 90 days identified as the breaking point for the average WWII rifleman.

Notably, it is common for today’s veterans to have experienced well over 1,000 days of direct combat exposure in Iraq and Afghanistan, where insurgents are indistinguishable from noncombatants and no area is safe. Further, modern communications and war fighting tools create information overload – at war and home – taxing the brain and mind-body system in ways we have yet to fully understand.

Every veteran, no matter when he or she served in uniform, deserves the enduring support of a grateful nation. All wars involve destruction, carnage, wounds and death, exposing the depths of human depravity in stark contrast to selfless acts of heroism. But each war carries its own particular burden upon service members, families and the nation as a whole. Volunteering to serve, well before the recession struck, in what has become our nation’s longest war, this generation has earned its accolade to become our next “greatest generation.”

Historic developments yielding advanced integrative therapies and promising new technology are necessary yet insufficient.  As important as clinical treatment is, we simply cannot treat our way out of this daunting public health challenge, with several hundred thousand lives at stake in communities across the country.

Accordingly, we must exercise humility in our quest for evidence-based solutions, incorporating recent neurobiological findings regarding human responses to threat, trauma and fear. Interventions must go beyond cognitive restructuring and exposure therapy to include emerging innovative approaches that are designed to stabilize the nervous system, a vital prerequisite for sustaining success on the job, in the classroom, at home with family and friends, and in the community at large.

In the words of a military community Chaplain who attended a 3-day training workshop: “Experiencing trauma, stress and distress can make your mind-body system go ‘catywhompus‘. . . It’s kind of like blowing a fuse at home — you can rant and rave in your kitchen all you want, maybe feeling a little better . . . but you cannot actually get better until you go to the basement [survival brain} and reconnect the circuit breaker {mind-body system}!”

Think of it as a matter of timing and sequence within the mind-body system to achieve maximal positive impact (greatly simplified to make this concept accessible for non-neuroscientists) as follows:

  1. Self/peer care: Start laying the foundation for mind-body system balance and safety by practicing attentional self-regulation skills (e.g., download free iChill  app) and participating in integrative retreats with peers and loved ones;
  2. Restorative health community programs: Build on this foundation to restore capacity for trusting relationships through equine/service dog programs; sports/recreation/writing/arts/cultural activities; healing spaces; and mindfulness practices, including yoga, meditation, qigong etc.
  3. Clinical treatment/interventions: Individuals continuing to experience disturbing symptoms, e.g., sleep problems, depression, anxiety, substance abuse, and behaviors involving extreme risk, resulting in impaired relationships and performance at work, school and/or home should pursue clinical treatment, which may likely combine cognitive-behavioral/processing/exposure therapies and/or medication.

VET FORT HOODDespite these advances in knowledge and insight, we still risk letting this generation down.  Certainly, this is not due to a lack of effort or resources, as evidenced by the billions spent during these past several years of intense focused leadership. Rather, we have allowed the unseen wounds of war to be treated foremost as an individual medical concern rather than the searing gash in our social compact and collective soul that any war of choice is bound to become. The spiritual costs of war, stemming from cumulative moral distress and deadly injuries, defy human calculation and capacity to fathom. Sadly, suicides, homicides and broken families keep the score.

Simply put, we must summon the courage to move the front line of intervention from clinicians to communities. More empowerment, less medications. More social support, less clinical care. More community Vet Clubs, less homelessness, academic failure, domestic violence, suicide and unemployment. More treatment, less jail time.

Imagine a veteran presently isolated in her apartment, self-medicating with alcohol and the internet – it’s easy if you try. . .

  • What if her surrounding community was informed regarding the nature of war zone trauma and trained in applying simple self-regulation skills that actually stabilize the human nervous system and deepen one’s resilience zone?
  • What if she belonged to a ‘Vet Club’ that harnessed the power of community and supported her in pursuing her school, work, family and life goals?
  • Can you imagine if Veteran Support Organizations in communities across the country transformed their existing facilities to house Vet Clubs, engage veterans and civilians in meaningful dialogue and thus reimagine their role in sustaining relevance for generations to follow?

With over 300 suicides in the Active Component, National Guard and the Reserves during 2013 and 22 suicides occurring daily among the broader veteran population – we do not have a moment to waste. For those currently in uniform, their families and those who have served, this epidemic of needless tragedy is far from an abstract or theoretical policy interest. These are our sisters and brothers; sons and daughters; husbands and wives; partners, friends and battle buddies.

Acts of war performed in our name are wounds endured by each of us, irrespective of our political views. PTSD’s point of entry is the heart and soul, yet our interventions focus on the head and body. Traditional warrior cultures knew this to be true, and developed re-entry practices forging a new and honorable identity and responsibility for renewing a returning veteran’s ethos of mission-oriented service within the context of a healing community. This is sacred work.

So, what then must we do differently?

Much could actually be gained by accelerating the pace of selected evidence-based initiatives, including the following:

  •  trained peer-to-peer community mentoring in support of service members and their families pursing work, school and life goals;
  •  train-the-trainer programs to sustain nervous system balance through attentional practice of self-regulation skills;
  • confidential tele-mental health platforms and social support networks via secure web-based connection;
  •  architectural design and creation of healing spaces within communities and neighborhoods;
  •  full implementation of Veteran Courts in every state;
  •  timely access to service dog and equine-assisted therapy; and, lastly,
  •  establishment of ‘Vet Clubs’ across the country.

Think of the potential impact:

  •  resilience-informed communities empowered to serve as first responders to the unseen wounds of war;
  • individuals equipped to maintain mind-body system balance and to obtain 24/7 support independent of geographic location or time zone;
  • community public settings incorporating the holistic benefits of design, culture and arts;
  • effective therapeutic interventions offered rather than jail time following return from combat;
  • trusting relationships built through the timeless power of the human-animal bond; and
  • clubs for Veterans and their loved ones to join, belong, thrive and continue their commitment to serving others.

In short, we need to create a different kind of healing culture – one that invests in community-based peers, self-regulation skills training, sustainable holistic programs and public-private partnerships as well as technology, clinical therapies, medications, and bio-markers. The Pentagon and the VA are not our enemies; they are essential partners in this journey of healing, health and wholeness. Spread the word . . . . and continue to advocate for the legal authority to forge enduring partnerships and robust community coalitions as though your life depended upon it. Because many do.

Meeting these reintegration challenges is not charity. It is our national duty. Together, let’s keep after it!

  — Brigadier General (Retired) Loree Sutton, MD

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