Living and Surviving in Harm's Way

A Psychological Treatment Handbook for Pre- and Post-Deployment of Military Personnel

Sharon Morgillo Freeman, Bret A Moore, Arthur Freeman

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781135859336
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

In Living and Surviving in Harm's Way, experts investigate the psychological impact of how warriors live and survive in combat duty. They address the combat preparation of servicemen and women, their support systems, and their interpersonal and intrapersonal experiences. The text maintains a focus on cognitive-behavioral interventions for treating various combat-related disorders, and addresses psychological health and adjustment after leaving the battlefield. The text is logically organized for easy reading and reference, and covers often overlooked topics such as preparation and training of service personnel, women in combat, and the indirect effects of combat stress on family. This book is written by clinicians who have in some ways experienced what they write about, and resonates with mental health professionals, servicemen and women, and their families. Any clinician hoping to treat a serviceman or woman effectively cannot afford to overlook this book.

1

Introduction*

ARTHUR FREEMAN, SHARON MORGILLO FREEMAN
and BRET A. MOORE

Duty is the sublimest word in our language. Do your duty in all things. You cannot do more. You should never wish to do less.

It is well that war is so terrible, or we should grow too fond of it.

General Robert E. Lee

Throughout history, men and women have, for myriad reasons, placed themselves in harm’s way. Sometimes this choice was a personal one motivated by one’s beliefs, be they religious, political, or nationalistic. For some the role of warrior is freely chosen, and for others it is a matter of being conscripted and sent into battle. The attributed rationales and reasons may change from group to group, time to time, and person to person:

We lived in 31 houses, apartments, and, in one case a house trailer, had 20 jobs, and were always on the road–and it wasn’t the road to riches, but when my eight-year obligation to the Army was over, I decided to stay. To me, there was no greater honor–no way to be nearer to the heart of what mattered in America–than to be serving and protecting the country in the United States military.

General Wesley K. Clark, Ret. (2004)

(http://www.clark04.com/about)

Each succeeding military group views their predicament as somehow new or different. One has only to read the press or listen to media commentators who speak of the current conflict that engages a country (whatever that might be) as the worst, most challenging, or most evil empire or axis with which the national interest has ever been confronted.

Through it all, for whatever the reason, war places people in harm’s way. Whether that harm is likely to be inflicted by an arrow, flaming pitch, a gunpowder-propelled lead ball, a nuclear device, or a homemade explosive device, the fighting corps in the field or battlefront and the civilians on the homefront are impacted in many ways. For example, the German troops at the gates of Moscow were confronted by both an implacable enemy (the Red Army) and a bitter winter. The civilians in Dresden or Berlin were confronted by both daylight and nighttime bombings that eventuated in firestorms. The workers in the World Trade Center in New York came to work on September 11, 2001, and those in the Murrah Building in Oklahoma City on April 19, 1995, with the intention of doing their job. Instead, they found themselves in harm’s way.

The current conflicts in which the United States and its allies are engaged in Iraq and Afghanistan are but the latest manifestation of how harm’s way impacts individuals at the front, those who train and equip them, and those in the family systems that support the service member. Harm’s way is a broad blanket that stretches from the warfront to the homefront. Witness, for example, entire communities constructing supportive and patriotic billboards or electric signs, communities filled with yellow ribbons reminding all of those warriors who at every moment are in danger. This has not been the case in all conflicts where warriors were in harm’s way. The bitter experience of the Vietnam era showed how those in harm’s way had little support in that the war was an unpopular one in many quarters.

This is a volume on how warriors live and survive being in harm’s way and the psychological impact of those actions. It addresses service members, their support systems, their interpersonal experiences, and the intrapersonal consequences of being in harm’s way. It also addresses the psychological health and adjustment of warriors who have left the battlefield and are working at reintegrating back into the lives they put on hold prior to their military service. It is a book meant for the clinician who will likely be treating an individual who has been in harm’s way, a member of their family, or a community member. Many returning military, of all services, may have severe and significant emotional and behavioral problems that are related to their military service. Many of these individuals will be seen by therapists who do not have military experience and are therefore not competent in military culture. Our goal in compiling this volume is to inform the nonmilitary as well as the military therapist about the broad range of problems that they might encounter with veterans or active duty military personnel.

In Chapter 2, Michael Mathews addresses the issue of the soldier’s mindset. From the time soldiers complete basic training until long after the time they retire they are trained to think of their fellow soldiers as one with themselves, to act as a unit, to be mission oriented and motivated, to work tirelessly, to be respectful to the chain of command, to follow all lawful orders, to have a high moral purpose, and to act in the best interests of their country, their unit, and their service. Loyalty, duty, respect, selfless service, honor, integrity, and personal courage: These are the soldier’s values that must be understood to understand the soldier.

Chapter 3, by John Christian, James Stivers, and Morgan Sammons, describes for the reader the preparation that precedes the entry into harm’s way. These individuals are trained to be combatants and warriors. They are taught weapon usage, military tactics, survival techniques, and defensive strategies. They are taught to survive being in harm’s way. They are also inculcated with the skills to be the saviors of a country and people that are dependent on them for survival.

Greg Reger and Bret Moore, in Chapter 4, describe the threats and challenges of deployment. Being deployed has many meanings. Some are rather simple and obvious. The individuals are being sent away from home to various sites for further training or to foreign countries where there is risk of personal losses, physical injury, and possibly death. In addition to fears related to death and injury, service members are faced with challenging environmental conditions, uncertainty about relationships back home, lack of freedom and personal space, and increased conflict between peers and superiors.

In Chapter 5, by Carrie Kennedy and Rosemary Malone, the discussion is related to the integration of women into the warrior culture, which is a central issue among today’s fighting forces. In past wars, there were clear battle lines, and women generally served behind them. Now, women serve actively in combat roles. The way in which women are acculturated and treated within the military is often out of step with the traditional views and roles of women. This chapter addresses the difficulties women face as they serve in active combat and in today’s military.

Megan Kelly and Dawn Vogt, in Chapter 6, discuss the effects of acute, chronic, and traumatic stress. Stress is both a motivator and an impediment to performance. This chapter addresses the various manifestations of stress experienced by military personnel who have served in both combat and noncombat situations. The military refers to the ability to deal with stress as resilience. The military definition of resilience and how the military identifies and utilizes resilience in its personnel are introduced in this chapter and further discussed in Chapter 7.

Each individual has a set of vulnerability factors that affect their threshold of response. The higher one’s threshold, the greater the ability to cope with stressful experiences, both internally and externally generated. Vulnerability and resilience must be noted when dealing with the issues of coping and adapting to stress, whether internally or externally driven. These vulnerability factors have a summative effect so that the greater the number of vulnerability factors the lower the threshold of response. Chapter 7, by Arthur Freeman and Sharon Morgillo Freeman, provides an examination of each of these factors and how they impact the individual’s response.

Chapter 8, by Lauren Conoscenti, Vera Vine, Anthony Papa, and Brett Litz, discusses how the individual who has been trained to scan for potential threats and danger adjusts to noncombat situations. In a combat environment, any shadow, movement, or sound could signal attack. In a noncombat environment, the same or similar stimuli may trigger a trained response in the combat-trained soldier. The backfire of a car or a sudden and unexpected movement may be responded to with a defensive maneuver. If the adaptive response becomes intrusive or prevents individuals from performing their usual activities they may require assistance in reducing hypervigilant intrusive responses.

In Chapter 9, by Arthur Freeman, Sharon Morgillo Freeman, and Michael Hurst, the assessment process is described and discussed relative to the overall data collection required for treatment. The assessment of emotional and behavioral disorders among military personnel can be complex. Behaviors in a civilian setting may be labeled as paranoia, while in a military setting they may be considered exceptional acumen for a sniper. A soldier’s feelings of loss and hopelessness after being airlifted with an injury incurred in an incident in which that soldier was the only survivor are normal parts of a grieving process and do not necessarily represent major depression. This chapter focuses on the differential diagnosis of a broad range of disorders.

Chapter 10, by Arthur Freeman and Bret Moore, describes a clinical treatment model for intervening with military. Several key models important and useful for a comprehensive treatment program are discussed. These include cognitive behavior therapy as a key ingredient, with the additions of systemic and behavioral components.

In Chapter 11, Donald Meichenbaum describes a case conceptualization approach for treating returning soldiers. It involves several components, including a step-by-step process for developing the conceptualization, which then becomes the template for therapy and helps direct treatment.

Chapter 12, by David Riggs, discusses anxiety, which is among the most common of the emotional disorders. Anxiety is addressed as both a disorder and as part of the broader anxiety spectrum. Treatment issues for the individual who has been trained and habituated to the idea that the world is a dangerous place are discussed.

David Rudd, in Chapter 13, discusses the depressive spectrum and suicidal wishes, actions, and ideation. The nature and treatment of depression are discussed, along with reasonable responses of the soldier as opposed to unhealthy rumination or other types of responses.

In Chapter 14, by Sharon Morgillo Freeman and Michael Hurst, substance use, misuse, and abuse are targeted. Most members of the military enter the service in their early teens. This is also the age when most individuals are using or experimenting with substances, usually alcohol. It is not unusual for adolescents and young adults to relax and socialize with alcohol and other chemicals during social occasions and to use these same chemicals when upset, angry, celebrating, or grieving. The soldier is at high risk for development of a substance use disorder after deployment, and this chapter presents a variety of methods to evaluate, discuss, and if necessary treat substance use disorders in military personnel.

Chapter 15, by Bret Moore and Barry Krakow, discusses sleep disorders, including problems with sleep onset, sleep maintenance, and early waking. Additional issues for many after deployment include vivid dreaming and nightmares. Cognitive and behavioral interventions for sleep problems are discussed. In Chapter 16, Bret Moore, C. Alan Hopewell, and Dave Grossman address the issue of aggression and homicide. Aggression always has the potential for deadly consequences. The use of words and weapons, coupled with the combat skills acquired and mastered to survive in harm’s way, may be deadly in the civilian milieu. The problems of impulsivity, poor executive control, and potentially dangerous behaviors that are a danger to others need to be addressed with service members.

Chapter 17, by Sharon Morgillo Freeman, Leslie Lundt, Ted Swanton, and Bret Moore, discusses the myths and realities of pharmacotherapy for military personnel. Many have misunderstandings about what pharmacotherapy can and cannot do. Members of both the military and the nonmilitary may have misperceptions about what medications the military allows soldiers to take and still be allowed to serve, to work in certain jobs, and to still be deployable. In Chapter 18, Alex Mabe describes the problems inherent in dealing with children and parental deployment. The typical issues of family and parenting can present significant problems for the military family. Many families suffer emotional trauma due to multiple deployments. Military spouses feel trapped at home, fearing they will miss a phone call. Their spouses may be depressed and grieving the loss of family gatherings, children’s activities, and daily life. Every day the spouse at home fears the knock on the door heralding their worst nightmare. This chapter focuses on such problems that are common in military families.

The topic of intimate relationships and the military is addressed by Judith Lyons in Chapter 19. Spouses that have been close and intimate on a daily basis must suddenly cope with being apart for a year or more. Contact is reduced to sporadic phone calls, letters, and occasional packages. During a long deployment, there might be a brief period of leave before the soldier’s return to the combat zone and being separated again. The prospect of one’s spouse losing interest and finding someone else looms heavy for some. Others might find it difficult to get to know their spouses again and to have someone else regularly in their space. Moving from group identification and affiliation to one-on-one intimacy can present a number of issues that must be dealt with by the therapist.

Military children can become the sometimes orphans of war. The deployment of a parent means something different depending on the age of the child. In Chapter 20, Judith Cohen, Robin Goodman, Carole Campbell, Bonnie Carroll, and Heather Campagna review age-specific ideas about the concepts of time, separation, and the meaning of being away. In addition, this chapter discusses how frightening potential losses (be it a body part or parent) can be for children and how to discuss this loss with the child.

Chapter 21, by Walter Penk and Nathan Ainspan, notes that, unlike the widespread anger and c...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Acknowledgments
• Foreword
• The Contributors
• 1. Introduction
• Part I Understanding the Service Member
• Part II On Being a Service Member
• Part III The Individual Service Member—Intervention
• Part IV The Service Member’s Family and Community–Intervention
• Footnotes
• Index