Finding Purpose in Pain

clouds-golden-hour-hands-670720 (1)Photo by Lukas Rychvalsky from Pexels

“I’m just glad that my pain can be used to help someone else”. (Quote used with permission by a combat veteran who decided to seek therapy as a way to heal)

As had happened many times before, the combat veteran came to see me for issues that seemed (at least to him) to have nothing to do with his time in combat. His transition from military to civilian life was seemingly smooth as he was able to obtain certifications that led to jobs enabling him to provide for his family. Yet, being referred to my office by his boss because of his “aggressive” style of leadership in his civilian job would soon lead to discussion surrounding how that style was reinforced by his time of service to country.

With all veterans or citizen soldiers (National Guard) I see in my practice, I ask about service-related history. This includes inquiry about their military occupations, their leadership status and stresses, and deployment or training history. For him, deployment included two tours in Afghanistan with the second having ended nearly ten years prior to when he first stepped into my office. The quick turn our conversation took from rather benign to being charged by strong and painful emotion stunned even me. Up to that point, the initial interview was progressing in a rather perfunctory fashion. Within seconds of mentioning the deployments, his face turned red and he became unable to speak – he was too busy choking back tears. He skipped the details and went straight to the impact of two particular incidents. In both, he walked away physically unscathed though witnessed the loss of battle buddies. Like many warriors, he’d taken full ownership for the fate of the comrades flanking his left and right in combat, so it was no wonder he perceived having failed at being able to save their lives. I can’t imagine the chaos experienced when being ambushed in war. The noise of weaponry flying within inches of one’s head, the cries of fellow warriors as they fell prey to wounds being inflicted. He placed his head in his hands and bent over his knees as he found himself overwhelmed by the memories. He described the desperation of trying to yell out guidance to the young fighters under his care. When he realized they were unable to hear or unwilling to heed what he was saying (perhaps frozen by the immense fear that surely engulfed them), the scene apparently gave way to moments few of us could survive. He explained that this is when he had to make a decision between two belief systems. Either his voice did not matter, or he needed to use it more intensely so that others were safe. He chose the latter and came home from war. He buried that belief in the footlocker of his mind and continued the mission of becoming a civilian.

That’s where he learned that what we bury doesn’t disappear. It just waits its turn. Fast forward to his leadership role in the civilian workplace where the frustration of watching a supervisee ignore on-the-job warnings to stay safe on the work site grew into a gentle suggestion from his own supervisor that “maybe you should talk to someone about that”. So, here he was in my office, claiming he just needed to figure out why they thought he was a “tad bit aggressive” in giving guidance to others. He seemed genuinely perplexed. After all, he was just trying use vocal tone and intensity to ensure their safety on the tenuous construction site.

For many veterans-turned-psychotherapy-clients in my office, the storytelling of deployments ended as abruptly as they’d started. The sudden unleashing of emotions gives way to the Oscar-worthy performance of staunch and unaffected countenance that is compartmentalizing. That’s when he looked up at me and said, “Well, I guess I’m not over it after all”. He flashed a boyish grin and we agreed that perhaps his boss was right. Maybe he should talk to someone about that. I also made sure to point out that still being affected by such powerful moments didn’t mean he wasn’t “over it”. It just meant he was human. We talked a bit about how the body keeps the score (in reference to Dr. Bessel van der Kolk’s classic book on how trauma affects the brain, mind, and body) and decided we would honor his stories by being careful to rightfully identify whether he was truly storing trauma, if moral injury was lurking unidentified, or if his grief was demanding to be heard. In any event, he was relieved to know that it was not unusual to still be affected by war and loss so many years after the fact. That’s also when he decided that he wanted to become so intimate with his pain that he could repurpose it to help others who might be suffering the same invisible wounds. Hence, his proclamation “I’m just glad that my pain can be used to help someone else”. His courage was a testimony to the leader he’d been in those two fateful battles and to the leader he wanted to be in his transition as a civilian.

Any fear he had that he was weak for acknowledging his emotions or his pain gave way to a fervor for learning more about mental health and wellness.

I took note as a reminder to myself of how powerful our bodies and minds are in serving as the vessels for our stories. I continued working with him and remained in awe of his willingness to study everything he could about trauma, psychological injury, and mental health. Rather than minimize the humanity of his story, he embraced it and committed to advocating for the mental health and wellness of others in his circle.  Any fear he had that he was weak for acknowledging his emotions or his pain gave way to a fervor for learning more about mental health and wellness. In fact, the education he adopted with respect to mental health became one of his greatest strengths. We can only pray that everyone in today’s society would empower themselves with such knowledge.

Any similarities a reader might find between their own story and the elements of this writing are purely coincidental. All efforts are made to change identifying details (rank, time period, campaign served, gender, etc.) to protect the identity of any person mentioned. The essence of the story, however, remains authentic in honor of the men and women who have humbled me with their disclosures.

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When the Body Speaks

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Photo by Nathan Cowley from Pexels

Recently, I worked with a service member who’d been deployed multiple times in his 20 years as a soldier.  He’d come to see me at his wife’s urging and he began our work together by describing recent conflict in his marriage that left him feeling unsure of nearly everything about his life.  He’d considered his wife’s decision to stand by him for deployment after deployment one of his greatest sources of strength and something he could count on.  After having survived multiple separations due to his service, the potential for divorce and losing daily access to his family was taking its toll.  He couldn’t understand what she meant when she explained that who he was as a person had slowly eroded into an unrecognizable blur to her.  She was frustrated at his lack of emotional expression.  As she put it, “he doesn’t seem like human. He seems like an empty shell”.  Except of course, when he would explode into unexplained verbal rage against her.  After all, they’d made it through half-dozen deployments without any conflict between them.  Now, they were confused about how they’d become two people who couldn’t stand each other.  To make matters worse, he wasn’t sleeping, he wasn’t eating healthy anymore, and he found it hard to concentrate in his new civilian job.  His perception of these functional changes was that his civilian employer didn’t know how to make maximum use of his skills, and while that might have been true, the verbally explosive episodes he was having each night at home didn’t match up.  During the initial interview, I learned that while he’d struggled with what he shrugged off as “typical combat stress” after the last 2 deployments, he’d decided he “didn’t want to bring that junk with me as I transition to civilian life”.  He described making, what to him, was a marked decision about not addressing any residue from war that might have indicated a post-traumatic stress injury.  He stated “if I don’t talk about it, it won’t have power over me”.  To reinforce this decision, he told me that this effort to ignore traumatic pain had worked for him after surviving childhood with abusive parents.  While I admired his determination to minimize the enemy I call the trauma monster, I couldn’t help but wonder where that monster was hiding inside him.

What he would soon learn was that, while he wasn’t giving his trauma story actual words, his body was starting to speak it for him. 

He’d been a well-trained combat warrior and suppressing any sense of vulnerability was vital to survival in a combat zone.  The fact that his traumatic childhood hadn’t interrupted his ability to have an outstanding military career only served to embed his belief in avoidance even more.  But now, as a civilian in a struggling marriage and a new post-service career, he faced a situation where admitting his vulnerability and working through it could be the one thing that saved his life.  Initially, he wasn’t having any of my suggestion that we consider talking about his experiences.  “No ma’am, not giving it a voice”.  What he would soon learn was that, while he wasn’t giving his trauma story actual words, his body was starting to speak it for him.  As I nudged him to face difficult questions and consider how the answers made him feel, I would notice his knee begin to shake and he would begin frantically wringing his hands.  When I would ask him how he was feeling in that moment, he initially couldn’t come up with feeling words, or any description of his experience for that matter.  I encouraged him to check in with his body and any physical sensations he noticed.  He was eventually able to describe the trembling inside, feeling nauseous and tense.

His somatic experience became his body’s way of trying to process what he’d held back for so long.

When asked if he’d ever felt this way before, he recalled the trembling and nausea after certain firefights in Iraq, but had written it off as flushing adrenalin.  He said he was confused about his ability to engage with the enemy, look after his men in the platoon, and come out seemingly unscathed, without any apparent distress in the throes of such dangerous times.  But he decided he was just resilient – which, to him, meant he was immune to any lingering effects of exposure to trauma.  We talked about what it must have taken to get through those events without complete emotional collapse.  In the course of our conversation, and as he tried to keep us focused on just his marital conflict, he wondered aloud how talking about his marriage could keep bringing up his memories of combat.  Over the course of several sessions, he discovered that he almost couldn’t contain his body’s strong reactions to either topic – marriage or combat.  At one point, he looked at me and said “Who knew marriage and combat could feel the same?”  I suggested that while the two scenarios seemed very different, some of the thoughts and feelings experienced with both might have a common thread.  For him, that common thread was facing the unknown and the possibility of losing people who were important to him (battle buddies in combat and his wife of 20 years).  While he’d learned to compartmentalize that idea into the deepest part of his mind, his body had absorbed the sensation of the actual losses he’d witnessed in war and the potential loss of his marriage – both of which he desperately tried to suppress.  His somatic experience became his body’s way of trying to process what he’d held back for so long.

Bessel van der Kolk, MD, psychiatrist and author of the book “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma”, describes in great detail the physiological changes our body endures when it has had to absorb the injury of trauma.  His work in research, along with other works in the field of trauma, have helped us understand how powerful a story-teller our body can be in its effort to record and speak the stories of egregious events in our lives.  It’s as if our body knows the story must be spoken and so it keeps the story recorded deep in our cellular being – our muscles, our breath, our stomach – sometimes every fiber of our being.  Storing up such painful details such as tension, smells, sounds, and even emotions wreaks havoc on a person’s nervous system.  And while sometimes giving us time to pen the words ourselves, if we insist on avoiding that task, our bodies will begin telling the story via uncontrolled emotions, sleep deprivation, unexplained reactivity to even the slightest threat, and even entanglements with those we love.  If the recorded stories have been many in number, the files of untold trauma store up, sometimes for amazingly long times.

It always pains me to see a veteran or service member having to endure the injury of psychological trauma.  Most of them I’ve known initially work hard to hide the story from me.  But if I listen and watch closely, the impact of those stories begins to leak out before they utter a word.  If this happens, part of my responsibility as their therapist is to help them redirect their attention to what their bodies are trying to tell them and give them new and tolerable ways to join in that story-telling.  In this way, they can hopefully find balance and relief in their lives.

June is PTSD Awareness Month.  If you or someone you love may be experiencing symptoms of PTS (post-traumatic stress), please reach out to a local mental health provider in your area or to the nearest VA.  There is a way to listen when your body speaks and this way can bring healing.  If these symptoms are leading you to consider self-harm, please call:

National Suicide Prevention Hotline – 1-800-273-8255

Note: This information is not intended to replace the medical advice or treatment of a trained professional.  If you feel your needs are creating an unsafe situation for you or someone else, seek emergent care through your primary care physician or local emergency room.

 

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The Sounds of Silence

IMG_3109photo credit – chris cannida

A Memorial Day reflection

The Last Roll Call – a military unit’s profound measure of bidding final farewell to a fallen comrade.  If you’ve never witnessed one – and I hope you haven’t had intimate cause to do so – it is brief, yet chilling.  During Memorial services, a senior NCO (non-commissioned officer) of the unit will feign the standard procedure of ‘roll call’, or taking attendance at formation.  He or she will call the names of individual service members who will then sound off in affirmation of their presence.  After several affirmations are heard, the name of the fallen is shouted out as if in full expectation we’ll hear their voice in response.  Of course, there is silence.  It is shouted again.  Silence.  It is called out one more time – full name, rank – silence.  This deafening silence is often followed by Taps being played in the background.

Describing this event doesn’t begin to convey the weight of its significance.  The silence heard in the wake of a fallen warrior’s absence is a loud cry of sorrow for the plights of mankind. The haunting process of the moment is a reminder that war has heavy cost.  It’s a price that is not just paid ultimately in the moment the life is lost.  It is eternally paid by the family and loved ones over the course of time as they experience many more moments unable to hear the sounds of their own hero’s voice.

Finding moments of silence is not always possible amidst the bustle of daily life, but it is necessary.  There is some evidence in research that the human mind regularly needs a measure of silence in order to remain flexible and maintain its strength.  I counsel many people who struggle to tolerate silence.  They busy their lives and minds with worry, drown their emotions with substances and anger, or let so much anxiety marinate inside that they crumble in a noisy mess of their own creation.  If we’re not careful, we tend to do the same with occasions such as Memorial Day.  Drown it out.  As a society we create the noise of cookouts and drunkenness, shopping mall sales and political rhetoric – perhaps all to avoid sitting in a moment of silence or reflection on the losses for which the remembrance was built.  Without a personal reason to observe the day, many spend little time reflecting on its meaning.  Originally dubbed “Decoration Day”, we’ve now morphed into a focus more on the decorations of the day rather than the loss of men and women who gave their all for country.

On Memorial Day weekend, I try to practice what I preach and seek silent moments of respect for those who’ve fallen in combat.  Without my own personal, military-related loss to hold, that includes bearing witness to the significance it yields for countless others.  In silence, our minds can begin to search and rest on the very emotions and thoughts we seek to escape.  Silence leads to reflection that sometimes yields sadness and confusion as we grapple to understand how life rains down on us the eventual losses we all experience.  Maybe that’s why we try to avoid it.  Yet it is necessary that these feelings find space to be processed and expressed – to move through us and begin to take a shape in our souls that is easier to carry.  Silence can give our emotions that space.  We need only to allow it.

I’ve sat through multiple final “roll calls”, holding my breath fearing the rise and fall of my chest while breathing would interrupt the reverence of the moment.  There to support the Gold Star families and unit friends grieving the loss, I would find myself searching for my own internal response to the idea of sacrifice.  Sacrifice that had been paid by those who never knew me, yet stood in battlefields to give me freedom.  For several years I sat in that silence more times than should have been.  No discomfort I felt compared to that of the loved ones for whom I was present to support.  The silence of each final roll call has taught me lessons in living, losing, and honoring.  It is possibly a lesson we must all learn.

This Memorial Day take a moment and reflect on how valuable are those who would lay down their lives for others.  Set your intent to be part of a grateful nation.  In return for their sacrifice, both in living and dying while serving, invite a moment of silence.

If you are a veteran or Gold Star family member struggling to cope, please reach out for support.  

Veterans Crisis Line – 1-800-273-8255

Feel free to follow me for support and tips on coping as an active duty service member, family member, or veteran at chriscannida.com.

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“You Get It” – 3 Tips for Civilian Therapists Working with Military Clients

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I’ve worked closely with members of the armed forces, honored as they handed me their trust, sometimes reluctantly.  While humbled they would allow me in to their world by way of painful disclosures, I find myself especially so (humbled) when one says to me, “You get it”.  I graciously say ‘thank you’ and embarrassingly admit to myself an uncertainty about exactly what they meant. What do I “get”?  It’s important for me to know so I can recreate this space for the next one to venture into much needed healing.

I overheard a colleague once say, after meeting with a group of soldiers just home from deployment, “I’m not sure there’s anything I can do to help them.  Their experience is not like any other”.  She was intimidated by their unique set of circumstances and its emotional residue.  Her comments made me even more determined to be clear about what I was doing so I could help my fellow civilian mental healthcare providers create healing opportunities for our military community.  For various reasons, warriors may find themselves seeking therapy from civilian providers who’ve known little of their unique experience.  Here are a few tips to remember when a warrior asks for help from a civilian therapist.

  • Respect the uniqueness of their life while finding the shared human experience.  In the past decade, it is estimated that less than one percent of America’s general population is actively serving at any one time.  I’ve had to agree with soldiers when they say to me, “You can’t understand. You’ve never done what I’ve done”.  They’re right.  I’ve never been trained for or participated in war.  However, I’m a person who’s been through stuff.  My goal then becomes to build a bridge between my knowledge of life with theirs by helping them see our shared experience as fellow humans – the one that includes the similar reactions our bodies, minds, and souls may have in response to horrific events in our lives.  Despair, sorrow, feeling lost in one’s own skin – these are a part of the human condition depending on the paths we’ve walked.  While the particular steps may vary, there is common ground in the journey.
  • Reframe any seeming resistance.  I’ve been auditioned as a therapist by many a service member’s initial (and only seeming) resistance to the therapy space.  In the military, warriors are specially trained for reconnaissance missions.  Their job is to be the eyes and ears for command while on the battlefield.  Most warriors are very familiar with the mission.  They gather information in order to help the unit know how to proceed.  You and I function in similar fashion.  We move forward in new spaces and relationships with some level of caution until we’ve gathered necessary information that lets us know if it’s safe to step forward.  It allows us to build trust in ourselves and our surroundings so we can function effectively.  Military/veteran clients do not lay those skills down when they enter therapy.  In fact, they may begin counseling with a heightened sense of awareness because it is foreign for them.  In conversation with a wary battalion commander, I was reminded that while encouragement to disclose is at the cornerstone of therapy, for a warrior disclosure of “intel” could lead to danger.  It may take time for them to understand that this premise doesn’t translate into the therapy dialogue.  Reframing this posture as a protective device rather than an opposition can help send a message that they are safe with you, respected and understood.  Your military client has been conditioned to withhold information in unfamiliar spaces.  It is not resistance. It is survival.
  • Be unafraid of tapping in to your own humanity.  I’m not suggesting as therapists we do much self-disclosing to clients.  The therapy space is reserved for the client’s story, not ours.  I am suggesting we be willing to access our own experience as fellow humans so we can express authentic empathy – fully understanding the intense levels of fear, uncertainty, and moral or spiritual warfare often gripping the souls of these men and women.  We need to access and understand the psychological space inside us that sometimes resist help, that puts up a wall to any effort made to encourage a brave and full disclosure to another person.  We must allow our own intimate awareness of what effectively lowers the walls around a hurting and cautious soul so that healing can take place.  Show the warrior client you’ll walk with them to the darkest places of invisible wounds without falter and with reverence.

As global relationships change, so do the requirements of our military community evolve in response.  Our education about advances in warfare that beckon new responsibilities for service members is never-ending.  Respecting the battle-mind of a warrior requires dutifully educating ourselves on the mindset that is forever embedded in them for survival.  The military community truly does have its own culture, language, and cognitive framework.  Pursuing in-depth understanding of their world (life as a warrior), while maintaining excellence in pursuit of best-practices in ours (therapy) will help us and our warrior clients make the best use of time together in healing.  They deserve our efforts and we can surely gain by learning what they have to teach us about survival and the human spirit.  If you don’t yet “get it”, build a bridge to get there.

For free education on helping our military community, go to PsychArmor Institute.

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Staying Connected While Serving Apart

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photo credit: chris cannida, 2012

A young military spouse I know just received the best Christmas gift ever. Her husband returned safely from deployment – just in time for the holiday season. It’s been a long deployment and while she’s survived at least one other, this one was even more tender because they now have a child. Thanks to social media, many of us were able to support her and share, albeit in a very small way, the pangs of deployment separation.  She was gracious enough to also share the joy of his return. On both counts, nothing we witnessed from Facebook could compare to the experience she had in walking this year’s journey with her soldier. And to be clear, while he was the one off fighting a battle in distant lands, she did walk the journey with him from her place at home. The military spouse serves in a role equally as powerful as her (or his) service member. Much of my own service as a military spouse has been honed in learning ways to honor the needs of a soldier transitioning into civilian life. Now, as a civilian psychotherapist who works with couples, I accept the charge of bridging the civilian-military divide by further understanding how to help these couples stay connected while serving apart.

I’ve watched many military spouses endure the absence of their lover, their best friend, their copilot in parenting. Deployments, long or brief, can be overwhelming. If the tour of duty is into a combat or danger zone in the world, there is an added distress of worrying about safety.  The reality is that wartime is not the only threat of separation for these couples. Military spouses are separated many times throughout the service member’s career when there is less risk of danger. Being called away to trainings and special schools, the service member is often absent from home for a few weeks to a few months at a time. Even without the risk of danger that war brings, these frequent separations are equally difficult for the union. I’ve often considered that the end of a military marriage is the other ‘casualty of war’. That’s why we must dedicate as much energy toward understanding the keys to securing marital bonds as we do in helping to heal a warrior’s invisible wounds of war upon return from deployment. The military has offered many good efforts to encourage the strengthening of the military marriage (Strong Bond retreats are one example).  Thanks to gracious army chaplains and military spouses like my young friend, I have garnered valuable lessons in helping military couples grow in this mission of marriage.  If you are a military spouse or service member seeking to hold sacred the attachment to your life partner, consider a few of these lessons:

  1. Define the relationship – In watching couples survive deployment, I’ve observed that the ones who fare better are those who knew who they were in marriage before the separation. When meeting with them prior to deployment, I ask them to consider defining what type of military couple they want to be. If they define themselves as being a strong, securely attached couple who will survive these separations, this helps them set an intention for endurance.
  2. Communicate, Communicate, Communicate! – While setting the intention to thrive, verbalizing that intention becomes a powerful adhesive for the union. Whether with the guidance of a chaplain or counselor, or having the dialogue in intimate privacy, voice to each other the desire to thrive and grow from the experience of surviving deployment together!
  3. Store up and Shore up – In between deployments and necessary separations, store up positive deposits into the union. This happens through the daily kindnesses offered to each other and by exercising the courage of vulnerability that leads to deeper conversations. The daily kindness is like an oil that keeps the union in constant positive motion. “Shore up” literally means propping against a structure placed to provide support. Those deeper conversations serve to strengthen the immunity of the bond. The chemical response our brain has to feeling deeply connected to another person creates a powerful memory of closeness that lasts throughout the time apart. This memory becomes the support that a marriage can lean on in times of duress generated by lengthy or frequent separations.
  4. Celebrate the Thrive! – Once reuniting takes place, strong military marriages continue the mindful focus on their connection. Some couples make specific time to connect again, and not just physically. They not only celebrate a safe return for the warrior, they celebrate the endurance as they held tight to the attachment even while apart. That is no small feat!

Not many of us can fathom being constantly separated from the one we love. Remaining connected to someone for a lifetime is hard work, even without being apart from them on a routine basis. Many couples who see each other every day of their lives struggle to maintain the meaningful bond most of us crave. Can you imagine how much more difficult it would be with frequent absences from each other?  “Out of sight, out of mind” becomes a real threat. But, for the military marriage, there are ways to conquer the threat.

During this holiday season, I pray safe returns and gracious reunions for every military marriage. If you are a military spouse or service member enduring a deployment separation, there are great resources to help you with this mission.  Consider some of the following:

PsychArmor Institute (www.psycharmor.org) – a free resource that offers support for our military and the caregivers who love them. 

Give An Hour (www.giveanhour.org) – helping healthcare providers in the community ‘give back’ by offering free services to the military community.

Military OneSource (http://www.militaryonesource.mil) – Military OneSource serves the mission of helping our military families live the best military life possible.

 

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A Good Soldier

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“A good soldier is always trying to improve. Always striving to be better.” That was part of my husband’s response offered to a civilian co-worker who asked if he (my husband) thought he (the co-worker) would have made a good soldier. My husband, a US Army veteran, spent a portion of his career as a Drill Sergeant, so shaping men and women into “good soldiers” was the air he breathed. He still walks into a room as if he could call an inspection on his troops at any moment or as if at the ready to respond to high expectation handed down by command. It’s not been unusual for his civilian colleagues to become interested in his veteran status. No matter what the tasks have been in his civilian jobs since transition, he’s always striving to be two steps ahead of the game.  A good soldier doesn’t abandon his leadership stature once the mission is complete.

“A good soldier is always trying to improve. Always striving to be better.”

We’d viewed the movie “Thank You For Your Service” just prior to his sharing about the exchange with this colleague. It was a natural shift to begin discussing the challenges facing veterans. We both agreed that, as much as a Hollywood movie can, it did a fairly good job of highlighting some of those struggles. I knew his disclosure of the dialogue represented one of those. Veterans are sometimes wary of civilians asking about their time in service. Reluctant to believe anyone could sufficiently comprehend the life of a soldier, many of them will avoid those conversations at great cost. With little full understanding of what service members face on a daily basis, let alone in a war zone, the questions and attention sometimes create more isolation for them in this new territory (civilian status). Not only do they want to protect us from the egregious stories of combat, they know that we may not understand the mindset with which they approach most every endeavor – one filled with high standard and the need to exercise highly-developed leadership skills. For a good soldier, every single moment is important. That’s not to say civilians don’t or can’t have the same standards. However, the drop from being called on to live those standards with every breath to being unable to feed one’s family is a long fall for a veteran.

Even without the invisible wounds of PTSD or moral injury, the fall from leadership to underling is a distressing jolt.

I’ve witness in my clients the need to continue being leaders once they’ve separated from the service. Unfortunately, for some there is no unit to lead once they’ve discharged. Many must once again start at the bottom of a pay grade even after spending years managing more than most of us manage in a lifetime of vocation. It’s a difficult move to go from 100 to zero so suddenly. When your every day revolved around training to stay alive, having the primary goal of enrolling as a college freshman or working to stock shelves for the local retailer can leave a veteran feeling everything from confusion to shame.

I’ve worked with both active duty and veterans closely for some years. Underneath the invisible wounds that bind them and the physical wounds that stifle their movement are always the positive attributes that helped them serve.  While we commit ourselves to helping them heal, we should unequivocally develop ways to remind them of the good they still carry upon transition into their new civilian reality.

The next time you meet a veteran, regardless of what visible needs you see, know that one of those needs is to exercise their traits of strength. This veteran that you meet is someone who is goal-directed, has a need to improve, and is able to have an incomparable allegiance. Chances are you’re standing in the presence of a leader who needs a new team to lead. Let’s work together to make sure they have more than enough of those opportunities.

The Hollywood film, “Thank You for Your Service” was, at times, an eerily and necessarily accurate portrayal of what many veterans face upon transition. It wasn’t comfortable to watch. Yet, if you have any proximity to veterans and care about the nation’s response to their homecomings, films like these are necessary to see. I look forward to finally viewing the documentary of the same name.  I want to be a ‘good soldier’ in my efforts to serve those who’ve served our nation.  Let’s be a nation of good soldiers when it comes to supporting our veterans of all branches.

To our veterans, thank you for your leadership.

If you are in a position to honor veterans by reminding them of their leadership status in our nation, but aren’t sure what to do, please consider the following resource:

PsychArmor Institute (www.psycharmor.org) – a free resource that offers training on how to effectively engage the military community. PsychArmor has an extensive library of trainings that includes helping corporations/business leaders engage our transitioning veterans, as well as trainings for veterans on how to offer valuable peer-to-peer support.

 

 

 

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Finding Life after Service

In war, there is nothing more definite than the line between life and death. For many who’ve seen combat and have developed their sense of self within the parameters of war, this line can become a barrier to successful reintegration or psychological recovery. It becomes the means by which a service member’s value system is defined. When they return home, every decision is weighed against the likelihood that it might bring death or save life. Even in the relatively safe confines of training, where mishaps can bring serious consequence, decisions are like a two-edged sword that can either muster success or dire straits. Even as I read these words, I realize there is no way we, as civilians, can understand the heaviness of carrying such a measure. The description seems like emotional hyperbole, yet when briefed by active duty members and veterans I know, I’m told it fits the mold for many who are now bound to their new normal by discharge or retirement.

If their sense of worth has become dependent on the stringent conditions of the military culture or the valor and grace of surviving war, then being without the structure provided by those conditions can seem like a disintegration of self. On the other hand, because service members have been trained to make decisions by using definitive guidelines while being prepared for flexibility, their transition can bring great asset to the civilian world. The mission for transitioning veterans includes shedding a now unnecessary “battle” mindset and shifting to one based on new parameters and guidelines for survival. Or perhaps that’s not it at all.

It might be helpful to encourage our veterans to shed nothing, holding fast to this “battle-mind” while, as civilians, we learn to help them apply those tenets to new situations.

With the task of transition upon them, many veterans are reliant on civilians who extend a hand of gratitude, yet that hand is void of the necessary understanding required to make the move successful. In addition to the necessities of providing for themselves and their families, veterans need support for clearing any detrimental residue of the military career. These effects include frequent separation from loved ones, loss of battle buddies, moral injury, or possibly post-trauma wounds. Each of these has effects that can be lasting if not responsibly addressed. Once separated from the military, they are often also separated from the cohesion of a unit that fed the need all humans have – a need for connection and validation.

The reinforcement that came from within this group of battle buddies could sustain an otherwise weary warrior and remind him or her of their worth. Without it, there is often a profound sense of loss – loss of self and purpose.

It becomes more valuable than ever that transitioning veterans retain the positive attributes of their development while building on the same with post-military growth. It is never surprising when a military or veteran client in my office includes disclosure about their lives prior to their service career. This includes their original trait development and how it may have affected or been affected by their military service. In these disclosures we often find the compass that directs their healing and growth toward a balanced, centered being. In helping them integrate their pre-military identity with their post-military growth, I often share with veteran clients the words of Edward Tick, author of War and the Soul, who stated, A warrior is a servant of civilization and its future, guiding, protecting, and passing on information and wisdom”. Together we decide that the virtues of “guiding, protecting, and passing on information and wisdom” are not specific to being a combat warrior and can be expanded to a greater sense of selfhood. For many, these qualities were present prior to their military connection and can certainly be nurtured after service discharge.  Reminding a veteran that their identity does not exist only within the confines of war (or training for war) is paramount to helping them find fulfilling lives after service.  Equally important is the message that they need not abandon their mental Kevlar and dismantle their battle-mindset in order to join the ranks of the civilian workforce.

Reminding a veteran that their identity does not exist only within the confines of war (or training for war) is paramount to helping them find fulfilling lives after service.

As a psychotherapist, my role is to help veterans eradicate, or effectively manage, any debilitating effects of time served while helping them rejuvenate and repurpose all that is positive about their core identity. At the same time, we call on our corporate and business community to create an understanding of how the transitioning veteran can move seamlessly into the civilian workforce and continue a mission of contribution, using vocational success toward a grounded sense of presence in society as a whole. Taking proactive steps in this mission can yield benefits we should hope are deemed worthy by every community.

Want to join the mission of helping transitioning veterans? Consider the following:

PsychArmor Institute (www.psycharmor.org) – a free resource that offers training on how to effectively engage the military community. PsychArmor has an extensive library of trainings that includes helping corporations/business leaders engage our transitioning veterans, as well as trainings for veterans on how to offer valuable peer-to-peer support.

Give An Hour (www.giveanhour.org) – helping healthcare providers in the community ‘give back’ by offering free services to the military community.

 

Posted in Military Mental Health, Uncategorized, Veterans, War | Leave a comment

Lessons from the Military Child

by Chris Cannida, LPC (April, 2017)

April is the Month of the Military Child

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She was a tiny, freckled soldier. Sitting alone. Frown on her face. Undistracted by art and activity all around, the significance of the day was not lost on her. Meant to shift her focus to being a carefree child again, to take her mind off of all that brought her to this moment, nothing seemed more worthy of focus than whatever was on her young mind. Not to say that the other children there weren’t equally aware of this part in their life’s journey. Being a Gold Star child is surely worn as an uninvited string of heavy pearls around such young hearts. Yet, she stood out to me as she sat alone, eating her lunch, soft hair falling over her face. The others were at least tolerant of efforts made by the adults who had planned this day of honoring and nurturing. She was having no part of it.

Being a Gold Star child is surely worn as an uninvited string of heavy pearls around such young hearts.

I don’t even know how many days or months had passed since her father had been taken from her during a deployment in Afghanistan. Stepping carefully into her circle of contemplation, I wasn’t sure if my effort to strike up a conversation would be met with disdain. Initially, I just planted myself 3 feet to her right in an effort to join her in quiet, parallel presence at the table. The noise of 20 other children playing ‘obstacle course’ and face-painting was nearly drowned out by the way she commanded that space with her stern look and pursed lips. Very aware that any dialogue she chose to have with me was on borrowed time and with all the graciousness a nine-year, fatherless daughter could muster, I started by offering my name and asking hers. I’ll never forget that 45-minute conversation for as long as I live. Etched forever in my mind is how her dad’s BDU (Battle Dress Uniform) jacket hung around her small shoulders. She offered me more than her name. She allowed me to hear her pain and her plans for the future. “I’m going to be a soldier when I grow up. Like my dad. I’m going to be a fighting soldier. Because I’m going to find the bad guys who killed my dad and I’m going to stop them from doing it again”.

Not one tear fell from her face. It was as if she’d decided to share the sorrowful moments of grief with the determination it would take to survive them. Today, in this moment, she was intent on using that determination to make decisions about how she would live her life. I was compelled by my maternal instinct to hug her and brush the hair from her big brown eyes. Instead, I just listened. She continued by telling me everything she knew about the day her father died. Thankfully, I’m sure she was spared the most egregious details. Yet, clearly, she used the strength it took to fill in the blanks with her young imagination of war in order to forge through the pain and find a decision to thrive.

I’m not sure where she is today.  She’d be in the midst of her adolescence by now. That BDU jacket would still be loosely fitting her tiny frame. I want to have no doubt she continues to grow. I worry that teachers in her schools probably don’t have the awareness to understand what she’s been through and may even minimize that it would still have such a profound effect after so much has passed. Her community may or may not produce the financial and emotional support she needs to launch into young adulthood.

My mind wanders to the entire military child community, to the ones who continue withstanding deployments of parents, moving every two to three years, and waking up in a new place before they’ve had a chance to fully grieve the dimensions of loss that come with constantly leaving friends and comforts behind.  I grew up in the same community from birth until I left for college. I was never separated from my family for more than a week at a time for the occasional visit with cousins. My kindergarten friends were the ones who walked across the stage with me at high school graduation. The first time I grieved the losses that come with a geographical move was when I, by my own choice, moved away to college. There’s never been summer camp held in my honor because one of my parents died in combat.

April is the month of the military child.

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Most of the time my work with service members has been focused on the adults – the active duty soldier, marine, or spouse. Thankfully, on that weekend, I was assigned to support the smallest warriors. One military child taught me more about resilience in that 45 minutes than most grown-ups could teach me in a lifetime. She’d learned to quiet herself long enough to figure out a way to manage her pain, wasn’t afraid to focus on that pain long enough to make a decision of fortitude to see her way through and had the courage to allow some support along the way.

Here’s to the Military Child. Thank you for the teaching us. May we always be dedicated, fully present learners.  

If you’d like to learn more about how you can support the military community, consider the following resources:

TAPS (Tragedy Assistance Program for Survivors) @ TAPS.org – a not-for-profit organization dedicated to providing compassionate care to those grieving the death of a loved one serving in the Armed Forces.

PsychArmor Institute @ PsychArmor.org – Dedicated to bridging the gap between the military/civilian divide by offering no-cost, high-quality online training to civilians, caregivers, veterans, employers, and healthcare professionals.

Give An Hour @ Giveanhour.org – an organization that helps providers in the mental health community ‘give back’ by offering free counseling services to our prior and active duty service members.

Photo credits: 1: Green Ramp 2003;  2: Used with permission by a military spouse and friend gracious enough to offer a rare photo of her own military child with “daddy”.

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lessons from the field

IMG_1474this is dedicated to my father who was in France on that day in the 1940’s.  he taught me my first lessons in loving a veteran. 

*Most come prepared. I wouldn’t expect a former green beret, a navy seal, a marine, or even the best infantry soldier, to attend a first-time therapy appointment any other way. Often, they’re carrying a clipboard or notepad that I watch them use to store notes and therapeutic assignments. The other hand they use to shake mine firmly.  What stands out is the contradiction of their seeming preparedness running parallel to the visible anxiety that engulfs them. Their palms are sweaty when we shake hands and their eyes wide open.   During our second appointment, they are surprised to learn that in the first session I’ve noticed how they quickly scan my office for potential harm while mapping an escape route. I ask all my veteran or active duty clients about SERE training. For those who have been through the training, they can quickly assess which phase their physiology is set on during the initial therapy hour. The acronym, SERE, standing for Survival-Evasion-Resistance-Escape, is a program provided to US military personnel that prepares them for worst-case scenarios. Once, I had a soldier tell me he was preparing for “escape” because the standard questions I was asking as part of my initial interview felt “like incoming fire”. To this day, information-seeking in the form of questions takes a backseat when I’m meeting a service member for their first session.

Once, I had a soldier tell me he was preparing for “escape” because the standard questions I was asking as part of my initial interview felt “like incoming fire”.

I usually hear some version of their presenting issue as “I’m about to blow” and are concerned that building anger will create an unbearable loss. They’ve often alienated nearly everyone in their families by vacillating between days of stonewalling and sudden bursts of rage. They describe, at times, being trapped in a corner with memories of hell and mayhem while painfully aware they want to protect loved ones from the uncertainty that they can survive this post-war battle. Even with me, they spend the first few sessions apologetically explaining that they’ve done “horrible things, ma’am”.

 They frequently express feeling foolish for what is perceived as a failure in overcoming the perils of being “outside the wire”.

For some, its been 10 years or more since they discharged from the military and even longer since they’ve trusted anyone other than their band of brothers. That first session is usually a big day for both of us. For me, I feel the urgency of needing to be at the top of my therapist game. For them, the step toward asking for help and trusting the process is nothing short of a quiet miracle.

Though the daughter of one and wife of another, I am not a veteran, so some would argue I am not the best person to help these strapping, tenuous warriors.  Yet, the courageous trust many of them have placed in me, coupled with my insistence on excelling at my calling, has taught me some lessons about the road to recovery many veterans must walk. On this Veteran’s Day, 2016, I reflect on some of those lessons in honor of the men and women who have become my most treasured teachers.

  1. Veterans need an absence of reactivity. Stories of combat are some of the most egregious ever told. Hearing them may evoke images and strong emotions in the listener.  The veteran needs to know you are strong enough to help absorb and hold that story. The emotional and mental hurt they’ve endured is overwhelming. The last thing they want is to harm someone else with their journey.
  2. Veterans are more than just the culmination of worst combat scenarios they’ve lived. Most veterans I see in my office are sons, daughters, husbands, wives, fathers, and mothers. They have goals and dreams that reach farther than their next abreaction or trauma response.
  3. War has changed them, forever. Significant shifts in values and belief systems happen when someone is trying to kill you or your brothers- and sisters-in-arms. I never ask the veterans I treat to check those values at the door. For some of us, the intensity with which a veteran might live their life can be overwhelming. For the veteran, it is the foundation for their ‘new normal’. It’s up to us to help them build a balanced, healed life on that foundation rather than have it come crashing down around them.
  4. Wanting to rejoin their unit in a foot patrol that carries great risk does not mean they want to abandon their family stateside. For some, there is heavy grief that comes with separation from the military. It collides with the guilt they feel at being separated from their families by catastrophic memories or an unusual urge to re-enter the pangs of combat.
  5. Even without deployments or combat, the sacrifices of veterans are enough to warrant our gratitude and ongoing service in the civilian world. For a service member, the training alone is more than most civilians could withstand on any given day. Their willingness to be ready for war is an intangible to be revered. Understanding how that work ethic translates into any employment or civilian opportunity would serve us all well.
  6. Banners of thanks are tolerated. Actions of support are needed. We must abandon any romantic notions we have about welcoming our troops home on the tarmac and waving banners of thanks. We need to continue our research on best practices in mental health care, strengthen our funds of support for their transition, and be the best at it.

Oh, and those veterans that choose my space to explore healing? The road to recovery is ongoing. Some days are better than others.  I periodically ask them what our number one mission is in working together. They always answer, in some form or fashion, the same way. “I just want to trust myself again, ma’am”.

If you are a veteran in need, or you love a veteran, please consider these resources:

Veteran’s Crisis Line – 1.800.273.8255 or http://www.veteranscrisisline.net

Vets4Warriors – 1.855.838.8255 or http://www.vets4warriors.com

Give an Hour™ is a nonprofit 501(c)(3), founded in September 2005 by Dr. Barbara Van Dahlen.  By utilizing volunteer mental health providers, veterans and active duty service members can get the support they need at no cost. To find a Give an Hour provider in your area, go to:

http://www.giveanhour.org

 

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lessons from the field manual

IMG_1156this is dedicated to my father who was in France on that day in the 1940’s.  he taught me my first lessons in loving a veteran. 

*Most come prepared. I wouldn’t expect a former green beret, a navy seal, a marine, or even the best infantry soldier, to attend a first-time therapy appointment any other way. Often, they’re carrying a clipboard or notepad that I watch them use to store notes and therapeutic assignments. The other hand they use to shake mine firmly.   What stands out is the contradiction of their seeming preparedness running parallel to the visible anxiety that engulfed them. Their palms are sweaty when we shake hands and their eyes wide open.   During our second appointments, they are surprised to learn that in the first session I’ve noticed how they quickly scan my office for potential harm while mapping an escape route. I ask all my veteran or active duty clients about SERE training. For those who have been through the training, they can quickly assess which phase their physiology is set on during the initial therapy hour. The acronym, SERE, standing for Survival-Evasion-Resistance-Escape, is a program provided to US military personnel that prepares them for worst-case scenarios. Once, I had a soldier tell me he was preparing for “escape” because the standard questions I was asking as part of my initial interview felt “like incoming fire”. To this day, information-seeking in the form of questions takes a backseat when I’m meeting a service member for their first session.

Once, I had a soldier tell me he was preparing for “escape” because the standard questions I was asking as part of my initial interview felt “like incoming fire”.

I usually hear some version of their primary concern as “I’m about to blow” and are concerned that building anger will create unbearable loss. They’ve often alienated nearly everyone in their families by vacillating between days of stonewalling and sudden bursts of rage. They describe, at times, being trapped in a corner with memories of hell and mayhem while painfully aware they want to protect loved ones from uncertainty that they can survive this post-war battle. Even with me, they spent the first few sessions apologetically explaining that they’ve done “horrible things, ma’am”.

 They frequently express feeling foolish for what is perceived as a failure in overcoming the perils of being “outside the wire”.

For some, its been 10 years or more since they discharged from the military and even longer since they’ve trusted anyone other than their band of brothers. That first session is usually  a big day for both of us. For me, I feetl the urgency of needing to be at the top of my therapist game. For them, the step toward asking for help and trusting the process is nothing short of a quiet miracle.

Though the daughter of one and wife of another, I am not a veteran, so some would argue I am not the best person to help these strapping, tenuous warriors.  Yet, the courageous trust many of them have placed in me, coupled with my insistence on excelling at my vocational calling, has taught me some lessons about the road to recovery many veterans must walk. On this Veteran’s Day, 2016, I reflect on some of those lessons in honor of the men and women who have become my most treasured teachers.

  1. Veterans need an absence of reactivity. Stories of combat are some of the most egregious ever told. Hearing them may evoke images and strong emotions in the listener.   The veteran needs to know you are strong enough to help absorb and hold that story. The emotional and mental hurt they’ve endured is overwhelming. The last thing they want is to harm someone else with their journey.
  2. Veterans are more than just the culmination of worst combat scenarios they’ve lived. Most veterans I see in my office are sons, daughters, husbands, wives, fathers, and mothers. They have goals and dreams that reach farther than their next abreaction or trauma response.
  3. War has changed them, forever. Significant shifts in values and belief systems happen when someone is trying to kill you or your brothers- and sisters-in-arms. I never ask the veterans I treat to check those values at the door. For some of us, the intensity with which a veteran might live their life can be overwhelming. For the veteran, it is the foundation for their ‘new normal’. It’s up to us to help them build a balanced, healed life on that foundation rather than have it come crashing down around them.
  4. Wanting to rejoin their unit in a foot patrol that carries great risk does not mean they want to abandon their family stateside. For some, there is heavy grief that comes with separation from the military. It collides with the guilt they feel at being separated from their families by catastrophic memories or an unusual urge to re-enter the pangs of combat.
  5. Even without deployments or combat, the sacrifices of veterans are enough to warrant our gratitude and ongoing service in the civilian world. For a service member, the training alone is more than most civilians could withstand on any given day. Their willingness to be ready for war is an intangible to be revered. Understanding how that work ethic translates into any employment or civilian opportunity would serve us all well.
  6. Banners of thanks are tolerated. Actions of support are needed. We must abandon any romantic notions we have about welcoming our troops home on the tarmac and waving banners of thanks. We need to continue our research on best practices in mental health care, strengthen our funds of support for their transition, and be the best at it.

Oh, and those veterans that choose my space to explore healing? The road to recovery is ongoing. Some days are better than others.  I periodically ask them what our number one mission is in working together. They always answer, in some form or fashion, the same way. “I just want to trust myself again, ma’am”.

If you are a veteran in need, or you love a veteran, please consider these resources:

Veteran’s Crisis Line – 1.800.273.8255 or http://www.veteranscrisisline.net

Vets4Warriors – 1.855.838.8255 or http://www.vets4warriors.com

Give an Hour™ is a nonprofit 501(c)(3), founded in September 2005 by Dr. Barbara Van Dahlen.  By utilizing volunteer mental health professionals, GAH is dedicated to meeting the mental health needs of the troops and families affected by the post-9/11 conflicts in Iraq and Afghanistan.  GAH works to provide counseling to individuals, couples and families, and children and adolescents.   http://www.givenanhour.org

* The descriptions of veteran clients given are never from one, factual client. I intentionally change key details to protect the privacy of my clients and have, instead, borrowed elements of many who highlight my experiences over the course of 20 years as a counselor/therapist.  The essence of the lessons I’ve learned is completely and fully authentic.

Posted in 9/11, Military Mental Health, Therapy, Uncategorized, Veterans, War | Leave a comment