BANGOR, Maine — Long after they return to civilian life or the relative normalcy of their bases stateside, service members exposed to the stress of combat can experience pronounced feelings of fear, grief, guilt, anxiety and anger. These symptoms often are normal and temporary, the military says, but left unacknowledged and unaddressed, may linger on or even escalate into serious clinical conditions such as post-traumatic stress disorder or clinical depression.
Now, military experts are encouraging returning veterans to participate in therapeutic counseling sessions to help them work through their feelings.
At a recent two-day conference in Bangor sponsored by the Maine Army National Guard, about 100 civilian therapists learned more about the risks faced by members of the military, the obstacles they may encounter in seeking help, and new programs aimed at helping them get the care they need.
One important goal is to persuade therapists to delay diagnosing any specific mental health disorder, both to avoid stigmatizing combat veterans and to hold the line on unwarranted mental health disability claims.
“We’re not trying to get around diagnosing them,” said Gretchen Breyller Hegeman, director of psychological health for the Maine Army National Guard. “We are trying to do early intervention, to get them in for help sooner rather than later, so these remain just symptoms and not diagnoses.”
Especially for members of state-based Guard units and other noncareer military members, help is more likely to come from civilian mental health providers than from either the Department of Defense or the Department of Veterans Affairs.
Military officials are “coming to us in a genuine effort to work with us, out of concern for the welfare of their soldiers,” said Portland social worker and Gulf War veteran Glenn Selwood, who attended the conference. “Now more than ever, there is concern and validation for the mental health of the troops.”
According to Lt. Col. Andy Gibson, chaplain for the Maine Army National Guard, civilian therapists typically are not familiar with the particular stresses of military service. They don’t know about its written regulations and implicit codes. They may have stereotypic notions — for example, that lower-ranked service members are violent, uneducated or unsophisticated. They may know little about the military culture that places ultimate value on the ability to perform at a high level despite personal pain, injury or emotional strain.
Obeying difficult or dangerous orders, witnessing the violent deaths of loyal comrades and innocent civilians, encountering harsh environmental conditions and enduring the exhaustion of staying alert to danger 24 hours a day — these pressures and others affect each person differently, Gibson said.
In addition to the direct stresses of serving in a combat zone, he said, service members may be deeply disillusioned to learn that not all Americans appreciate their sacrifices or support the war effort. Or they may be thrown into despair by learning that a spouse or domestic partner has been unfaithful while they have been away.
For all these reasons, Gibson emphasized, it is normal and even healthy for service members to experience intense feelings, including some very negative and frightening ones, as they reintegrate into the families and communities they left behind. It can take time, personal resilience, the understanding of friends and family and, sometimes, professional counseling, to effectively work through those feelings, he said.
“We think if we pretend it’s not there for long enough, it will go away,” Gibson said. “And sometimes that’s true, but sometimes it’s not.”
But for returning combat veterans, the resolution of stress is made more difficult by a number of factors. For one thing, military culture places a high value on “the nonacknowledgment of pain and injury,” Gibson said. Service members struggling against strong emotions may fear appearing weak or vulnerable. They may dread the ridicule of their comrades, or the devastating perception that they cannot be trusted in high-stakes combat situations.
“We honor people who can tough it out,” Gibson said. “The problem is that when you come home, it makes you less likely to seek help.”
In addition to having been steeped in this tight-lipped culture, some service members have signed formal nondisclosure contracts, agreeing to hold secret the events they have participated in, the names of others involved, the places they’ve been, and what they’ve done. Violating these agreements can have serious legal repercus-sions, including dishonorable discharge, incarceration and other disciplinary actions.
“I was angry when I got back [from Iraq],” said Sgt. 1st Class John “Adam” Knoblach, a security manager for the Maine Army National Guard who also presented at the conference. “I had some definite issues. … I had been on a top-secret mission, and I didn’t expect to come home. I couldn’t talk about it. I said [to a counselor], ‘Fix me’ — but I couldn’t talk about it.”
Knoblach told the conference participants that they should ask whether there are particular issues their military clients cannot legally share, and avoid pressuring them for information they are prohibited from divulging.
Psychological health specialist Hegeman said that civilian therapists usually are required to come up with an approved diagnosis for their clients in order to be paid for their services.
But several programs, including the Military One Source program, the Tricare health plan, and Portland-based Martin’s Point Health Care, now will pay qualified therapists to see veterans without requiring a formal diagnosis.
“This means I can talk with you, educate you and help normalize the situation,” Hegeman said. “It means we don’t have to make something ‘wrong’ with you.” It is a normal physiological process, she said, that soldiers’ brains memorize stress, and also normal that certain activities and experiences can trigger intense memories and physiological responses. It takes, time, she said, for the brain to “unlearn” those responses.
Hegeman said service members can be helped by avoiding violent video games, spending quiet time with friends and family, staying away from alcohol and other drugs, and watching their diets. But most helpful of all, she said, is understanding that there is nothing inherently pathological about the feelings many returning serv-ice members experience.
“In the first year back, those feelings will decrease,” Hegeman said. “And for some, they’ll decrease faster if they get some help.”