War and Peace (of Mind)

Today is Veteran's Day in the U.S., and therefore an important opportunity to think more about the needs of vets - particularly this year, as we move toward the end of military action in Iraq. There are a lot of people facing the challenge of reintegrating into civilian life after months or years of service. There are a lot of people still struggling to reintegrate, many years after facing combat in past wars. There are also too many who have been unable to make the transition, and have died of suicide or substance abuse - the invisible casualties of war.

My father's best friend committed suicide not long after returning from Vietnam. My friend's father coped with life after Vietnam by never speaking about it, ever. A student I worked with, attending college on the GI bill, couldn't sleep in a double room, and often had to leave class because he was having a flashback. Other vets I've treated have minimized and normalized their difficulties, seemingly in defense against the stigma of PTSD within the military - all while using substances daily, and suffering setbacks in relationships and career as a result of their anger.

We need to work harder to remove the stigma from PTSD, for all survivors of trauma, but especially for veterans. We need to communicate more effectively that the symptoms are perfectly normal and understandable responses of the human body to an abnormal and often incomprehensible life-threatening experience. When the experience lasts longer, the body's responses are more debilitating.

We also need to work harder to notice and help vets cope with symptoms that don't meet the threshold for diagnosing PTSD - just because the symptoms don't qualify for a diagnosis does NOT mean that they don't cause significant distress and impair functioning. Disproportionate anger can be a form of hypervigilance. Nonchalance, inappropriate humor, and lack of motivation or interest can all result from overall numbing. Reexperiencing may be flashbacks and nightmares, but less dramatically, can also be rumination, risk-taking, engaging in conflict, or warding against such symptoms with the artificial numbing of drugs and alcohol.

Finally, we need to make it easier for those who have sacrificed part of their lives for the country to obtain the opportunities so many of us take for granted - the opportunity for an education, to find meaningful work, to have safe housing and assistance acclimating to the nuances of civilian life: utilities, taxes, banking, credit, health care....

What else should we be doing, as a social worker, or as a society, to help our veterans transition to civilian life in sustainable and satisfying ways?