You’ve seen the pictures of men and women of the military rushing off planes and buses to greet their spouses and children. The smiles, the tears, the hugs and the fanfare warm the heart and cause tears to flood the eyes.

But what happens after the cameras are put away? What happens after the homecoming festivities are over? Do things go back to pre-deployment state or are they forever changed?

As a clinical psychologist who served in the United States Air Force, and as the spouse of an active duty Marine, I can personally and professionally report that for many, the homecoming is harder than the goodbye.

Military families are strong and resilient. They are masters at organization and pulling oneself up by the proverbial bootstraps. The spouse left behind when the active duty member deploys becomes “the one.” The one who grocery shops, the one who mows the lawn, the one who gets the children ready for their day and the one who puts them to bed, the one who handles calling the plumber and the cable person, who takes care of the laundry, who fixes the flat tire, who kisses the kids’ boo-boos.

The family remaining at home anxiously awaits a 30-second phone call or two minute Facetime session. They obsessively check their email.  They count down the days until they get to once again meet and greet their military loved one, get to witness the fanfare and get to settle back into old routines.

What many do not expect upon homecoming is that old routines are now obsolete. Everyone has fundamentally changed. The military member has been exposed to many life-and-death situations. They have faced a myriad of stressful circumstances. They have closed off part of their emotional abilities in order to get through the deployment.

Meanwhile, the ones who stayed at home have become the one who handles it all. They too have closed off part of their emotional capacity in order to get through the deployment. They have pondered life if their loved ones do not come home. They have experienced a myriad of emotions and stressful situations. They have most likely mastered the most complex of school, work and home schedules.

Pre- and post-deployment briefings discuss the likelihood that becoming reacquainted with loved ones takes time (I distinctly remember one briefing saying 2-3 weeks). They explain the one returning may have trouble sleeping, may appear hypervigilant and may drink to excess to calm down. These briefings (many of which I gave) did not include the fact that when your loved one returns your grocery bill will triple. They did not account for laundry quadrupling. They did not address the process of going from “being the one” to again “being two.” They do not prepare military families for the difficulties in reestablishing bonds and trying to be patient in re-learning one another’s strengths and weaknesses.

They did not account for the mixed feelings of relief your loved one is home, resentment they have a hard time acclimating to being home, and jumping right back into familyhood would be a process … a very long process. Right when you get it to where you want it to be, another deployment happens.

Military families are in a constant state of adjustment. If you, a loved one or friend, find the welcome home is not all it’s cracked up to be, help is available. Military One Source is an excellent resource. Tricare allows for up to eight sessions for military dependents to see a mental health professional without needing a referral.

Many MTFs (military treatment facilities) will authorize the active duty member to be seen off base due to limited availability of service and many prior military providers are now civilians, ready and willing to help. Chaplains and Military Family Life Consultants are available on base. Setting realistic expectations for homecomings will help as well.

More life advice from YourTango:

• Life Coaches: Who We Are & What We Do
• Why Do I Need A Life Coach?

In any case, that train of thought got us to thinking about the allure of certain attire and how it can influence impressions (whether we’re conscious of it or not).

A classic example is men in uniform, and since I’ve experienced Fleet Week in New York City, I can pretty much attest to this (rather universal) theory.

So what are the psychological implications of men in uniform?

I casually asked my friend for her opinions, and she said that women probably look for a hardworking and brave man. “Certain professions dictate a certain dress code. In the case of those who fight wars, they often have to dress in camouflage. When women think of servicemen they think that their character is heroic and strong. So perhaps it isn’t necessarily the clothing that the women finds attractive, but what their profession may say about their character.”

An article in The Times of India suggests that uniforms relay a sense of comfort and security, along with the notion that men dressed in this attire exhibit chivalry.

Men in service all have reasons to be coveted. Their profession is such that they cannot help but exude chivary in their mannerisms, which is enough to impress women.

The act of being courteous is perceived to be more respectful than intended to impress. Opening the door for the lady to enter first, holding the chair and allowing her to sit, practicing basic table manners while eating together are just some of the practices that come naturally to them.

The psychological gravitational pull toward a man in uniform isn’t new. A 1995 article in the Los Angeles Times showcases this concept as well. In the article, Midge Wilson, a psychology professor at DePaul University, explains how a man dressed as such delves into the female’s psyche. “A man in uniform taps into… father figures, heroism, protection and power,” he said. “He also suggests a chance for excitement and adventure.”

It sure sounds like it speaks to the fairy tale mindset.

However, the longing for a knight in shining armor (or a man in uniform) does come with a price.

The Times of India article references insight from Barnali Mishra, a PR professional who’s dating an Army officer. She conveys that communication is a challenge. And she notes that — in general — men in the Army may have difficulty expressing their feelings verbally, especially since they’re used to being unreachable due to the nature of their work. Yet “our exchange of thoughts via e-mails is the part I enjoy most,” she said.

All in all, it’s interesting to dig below the surface a bit as to why women tend to go weak in the knees when they see a guy donning his Navy gear.

“Women prefer a partner who can protect them. It has been so since ancient times,” Dr. Geetanjali Sharma, a marriage and relationship counselor, was quotes as saying in the Times article. “It can be assumed that men in uniform are the modern day ‘saviours’ and hence the attraction.”

Among active troops, suicide rates increased 18 percent from last year.  Rates among veterans were also at distressing levels, with a veteran dying by suicide every 80 minutes, according to an estimate from the Department of Veterans Affairs and reported in this month’s Monitor on Psychology.

When faced with a problem of these proportions, it is vital to understand what factors increase the likelihood of suicide and which interventions are the most effective.

In response, the Army has prepared training for soldiers and families — to help them recognize signs of suicidal behavior, and to inform them of interventions and ways to access support. And this past August, President Obama signed an executive order that strengthened suicide prevention efforts for service members and veterans.

Lisa Brenner, PhD and her colleagues are working on ways to prevent suicide among veterans and lower completion rates. Brenner, is a director of the Department of Veterans Affairs’ Mental Illness Research, Education and Clinical Center.

Service members and veterans face an array of stressors that might be linked to suicide, including lengthy and multiple deployments in the wars in Afghanistan and Iraq.  These wars also have left veterans wounded. Many of them have profoundly disabling head injuries.

Brenner reports that “among the U.S. military personnel who were injured while taking part in Operation Enduring Freedom and Operation Iraqi Freedom, between 10 and 20 percent suffered traumatic brain injuries.”

Brenner led a study examining suicide risk in 49,626 VA patients with a history of traumatic brain injury (TBI). She and her team found that overall, veterans with TBI have an increased risk of dying by suicide compared with veterans without brain injury.

Greater understanding of the effect of TBIs on suicide is needed. Research is beginning to suggest that mild brain injury is very different than moderate to severe injury, says Brenner.  Looking at these injuries separately will help begin to clarify their connection with suicidality.

Beyond research, evidence-based interventions for those with TBI are needed, Brenner said.

Although no studies have been done on ways to make suicide less likely among brain-injured veterans, a recent study in Australia found that it was possible to reduce hopelessness among adults with TBI through the use of cognitive-behavioral therapy.

Feelings of hopelessness strongly predict death by suicide, making this study significant in the search for effective evidence-based treatments.

Brenner and Grahame Simpson, the Australian researcher who carried out the earlier research, plan to tailor the therapy for use with U.S. veterans and will run an initial trial on several dozen participants to study its effectiveness.

But when powerful men — most recently CIA Director General David Petraeus — admit to infidelity, we’re often taken aback. (Or maybe some of us aren’t that shocked, after all.)

Petraeus joins a long line of philanderers in prominent positions: Anthony Weiner, Eliot Spitzer, Bill Clinton and John Edwards, just to name a few.

But regardless of whether you’re surprised to hear these men strayed, the question is the same: Why?

Why do powerful men with such pivotal professions and important responsibilities commit adultery? Why do men with so much to lose — great positions, families and reputations — risk it all for a fling?

Power certainly may play a role. For instance, in a survey of 1,561 professionals, Joris Lammers, an assistant professor at Tilburg University, and colleagues found that the more power people had, the more likely they were to cheat. Plus, the more power people had, the more confident they were.

(They also found no gender differences in past cheating or the desire to cheat. Women were just as likely to cheat or want to cheat as men were.)

Initial research also points to fascinating brain findings when people are given just a fleeting sense of power. Lammers told NPR, “You can see the brain structure associated with positive things, with rewards, is just much more activated than the part that is steered toward preventing the bad things from happening.”

The piece also talks about interesting research in college students, which found that when both male and female students were given a temporary sense of power, they tended to flirt more with a stranger of the opposite sex who sat next to them.

According to Orbuch, the sheer presence of temptation may explain why powerful men cheat. Power – and all that comes with it, such as wealth and fame – is attractive to many women, she said. And, sometimes, these women can become aggressive with their advances, she said.

Loneliness might be another reason. Men in power, including General Petraeus, are often away from their families for days, even weeks, Orbuch said. As a result, they end up yearning for female companionship, she said.

Some powerful men might crave the adrenaline rush. “They perform well under high stress and continually need and enjoy excitement or challenges to drive them forward. An affair gives them that same type of exhilaration in their private life,” Orbuch said.

These individuals also are surrounded by yes-men who placate them – and, often, their bad decisions. “Powerful men tend to be surrounded by people who protect them, idolize them, and even ‘enable’ their vices in order to remain inside their influential orbit.”

Having people in your inner circle who constantly approve of your actions can swell your ego. And it can make you feel like the limits you once put on yourself are loosening – and loosening, she said.

Powerful men might believe they’re impervious to getting caught or can conceal their transgressions because of the resources at their disposal, Orbuch said.

She also noted that powerful men – and people in general – cheat when they want change. “Something in the man’s life or his relationship isn’t OK, and the affair creates the trigger for change,” she said. That something might be boredom after many years together, she said.

Powerful men may cheat for a variety of reasons. But the result is usually the same: Positions, reputations and families are irrevocably broken.

Why do you think
powerful men cheat?

With over 150 active military suicides so far in 2012, if you’re in the U.S. military, you’re more likely to have died by your own hand than you were to have died in combat.

This, then, is apparently not a good time to be in the military.

Farah Mohamed, writing for McClatchy Newspapers, has the story.

Panetta made his comments while he was dragged before Congress to discuss the military’s budget.

He made his comments in response to questioning by Senator Patty Murray, who chairs the Senate Veterans’ Affairs Committee. In Murray’s home state of Washington, over 100 soldiers have had their post-traumatic stress disorder (PTSD) diagnoses reversed — denying them benefits and access to mental health care at the VA:

Some patients in Madigan have complained that their diagnoses were lessened or altered in an effort to save money and meet Army cutbacks, Murray said. Others, according to Murray, were accused of exaggerating their conditions and subsequently denied proper medical care.

“You can’t imagine what it’s like to talk to a soldier who was told he had PTSD,” said Murray. “His family was working with him, and then when he went to the disability evaluation system, he was told he was a liar or malingerer. He was taken out of it and he went out in the civilian world not being treated. That’s a horrendous offense.”

Ouch.

The VA is, generally, a great system. Every American would benefit if they had access to the level of care we offer our veterans (shhh — yes, this is a form of socialized medicine, but don’t tell anyone).

The problem arises because each VA hospital and system is run somewhat independently — like little fiefdoms. This means that the care you get at one VA may not resemble the care you get at another. Some VAs have stricter criteria for getting a diagnosis, while others are more lax.

This creates a level of inconsistency in both care and benefits that vets pick up on, because they now communicate across state boundaries thanks to the many online vet communities that exist.

So Joe says, “Hey, I just got diagnosed with PTSD after expressing my fears of loud noises and flashbacks I’d been having after having been involved in that attack that happened outside of Kabul.” Then Henry replies, “Wow, I was in the same attack, and have similar symptoms, but they denied I had PTSD at my VA.”

Which, unfortunately, goes right to the heart of the matter of the wild inconsistency of mental disorder diagnoses across the board. Scientifically-speaking, the interrater reliability of these puppies just stinks. This is a real-world example of the consequences of poor diagnostic reliability across differing VA hospital systems.

There are no easy answers to the problem, since the problem exists not only at a VA system-wide scale, but also more deeply at the level of the mental disorder diagnostic system itself.

Because when you tie benefits to diagnoses, suddenly diagnoses mean a whole lot more to an individual.

Read the full article: Panetta: ‘Huge gaps’ in military’s review of mental health cases (sorry, a horrible ad-laden site, I know)

I give thanks for the hundreds of thousands of fallen men and women who have served in our armed forces. It is but for their sacrifice that we enjoy living in this country of immigrants, who helped free Europe from the evil terror of the Nazi regime, and who helped find a way to balance the Soviet Union’s naked aggression after WWII.

In memory of all of those who have given their lives to help keep our country free, you are remembered and honored for your courage, loyalty and bravery in service to our country.

Federal investigators revealed yesterday that half the veterans who seek out mental health care in the VA system waited about 50 days — not 14 — before receiving a full evaluation. That’s not just a tiny lie. That’s a lie covering up a wait time that is 350 percent greater than the VA’s original claims. A wait time that clearly demonstrates that demand is outstripping supply of qualified mental health professionals.

But wait, it gets better. Because that’s not the only thing the VA has been fudging the numbers about.

First, let’s check out the metrics the VA was previously using to measure patient wait-times:

Under the VA’s protocol, patients seeking mental health care are supposed to get an initial evaluation within 24 hours in case care is urgently needed. Barring an emergency, the department seeks to provide a full evaluation within 14 days. However, the VA measures how long it took to conduct the evaluation, not how long a patient waited to receive an evaluation.

For example, if a patient is referred on Sept. 15 and the evaluation is scheduled and takes place on Oct. 1, then the VA would show that the veteran waited zero days, when in reality the patient had waited 15. Investigators called the VA’s tracking as “having no real value.”

In what twisted world would this way of measuring things be considered logical and providing practical information to administrators?

And now the cynic in me comes out…

Knowing the federal investigator’s report was forthcoming and having been told the gist of what it would reveal, the VA announced late last week that 1,900 new “mental health staff” would be added.

But that’s a lie as well.

Only 1,400 of those new positions are professionals who will offer direct care to individual veterans. The other 500 are support staff and professionals who will man related services — but who don’t provide direct clinical mental health care. For instance, 100 of them will be claims examiners — important positions, no doubt, but not mental health professionals helping veterans in treatment.

It’s an effort to “pump up the numbers” to suggest the VA is addressing the problems proactively in a bigger way than they are.

What it looks like they’re doing, in my opinion, is more covering their ass… Knowing a negative report was about to be released demonstrating that they were lying to veterans about the timeliness of services offered, they had no choice but to make an attempt to quell critics immediately by proactively offering more staff.

The real question we should ask ourselves is what would’ve happened if federal investigators hadn’t looked into the VA’s claims about their mental health service provisioning? Would the VA still have increased clinical staff?

It’s no wonder vets question their care by the VA… Because the VA seems not to be doing a very good job in meeting the mental health needs of returning soldiers and those who need the VA’s services.

Read the full CBS News article: Report: VA failing to provide timely mental care

It’s a good step forward as the military struggles with the hundreds of thousands of returning vets who have increasing mental health needs. Most of the new hires — about 1,400 — will be clinicians that work directly with vet patients.

But let’s also put this into some perspective, too. According to its website, the VA operates 172 hospitals across the United States, and 837 outpatient clinics. That’s 1,009 places where a vet can go to get help. That means that, on average, each clinic or hospital will get 1.4 new clinicians.

One and a half new clinicians per facility? Not nearly as impressive.

It’s not like the VA has been sitting on its hands over the past few years. It has tried to meet the rising mental health demand of returning soldiers from the wars in Afghanistan and Iraq, but it simply hasn’t really kept pace:

The veterans department says that it has worked hard to keep pace with the tide of new veterans needing psychological care, increasing its mental health care budget by 39 percent since 2009 and hiring more than 3,500 mental health professionals.

The department says it has also established a policy to do mental health evaluations of all veterans not in crisis within 14 days, a goal it says it meets 95 percent of the time.

However, the inspector general’s report is expected to question the validity of that claim.

That inspector general’s report is going to claim the VA is basically fudging the numbers, to show that it meets its “on time” goal 95 percent of the time. The reality is that it’s nowhere close to that number in a significant number of high-traffic, high profile facilities.

Is a 39 percent increase sufficient? It ultimately depends upon what the utilization rates are for mental health services by returning soldiers. I couldn’t find any data that sheds light on this number, so all we can do is look at other factors demonstrating that supply is not keeping up with demand. Things like wait times to obtain service — something the inspector general’s report will help with.

That report could be published as soon as next week. We’ll keep you updated.

Read the full article: Veterans Affairs Dept. to Increase Mental Health Staffing

The current drama now playing out in the media related to US Secret Service agents’ procurement of prostitutes while on assignment is without question the tip of the iceberg of a concern that is both under-recognized and misunderstood by both military leaders and the general public.

I believe that it is neither salacious nor unpatriotic to hold an honest discussion of the increasing, documented incidents of inappropriate problem sexual behavior occurring among the ranks of our servicemen and women on a daily basis.

While the majority of our military demonstrate great respect for their role and fully understand what it means to represent our nation both nationally and abroad, there are more than a few troubled soldiers, sailors, and officers who regularly engage in problem sexual behavior both on and off duty. This issue has a profound affect on the morality, dignity, and long-term health of our armed forces.

The problem of inappropriate sexual acting out in the military is not simply one of a few servicemen “blowing off steam” when on short-term leave — activity that has a time honored rite of passage aura. Of much greater concern are issues related to those active servicemen and women who experience profound sexual harassment and rape by fellow servicemen, along with the abuse of porn and prostitutes via military owned computers, laptops, and smartphones.

Having been tasked to train on these bases, which involved being both a listener and an educator, I have been told firsthand of the underreported concerns of:

• Male on male rape in the barracks as a show of power
• Sexual harassment and rape of female sailors and soldiers, both on and off base
• Military professionals downloading Internet porn onto government owned computers while on duty
• Officers procuring prostitutes for soldiers and sailors when on leave, making sure each man has a room, key, and woman waiting for him during off base leave.
• Officers encouraging soldiers to use porn and masturbation as a means of relieving the stress of active duty, which can bring long-term consequences related to PTSD and post-discharge trauma resolution
• Inadequately trained mental health professionals tasked to treat and manage servicemen who have sexually offended on base and been moved to the brig
• Rape and sexual harassment carried out off base – a problem with profoundly negative consequences for those bases outside the US having to then deal with the anger and frustration of local communities, who are left with a bitter taste for our very presence in their countries

These issues are not new and they are not unique to this time, but much like the kinds of problems that occur and go unmentioned in any “looking-good” family, they are swept under the rug, deferred to the mission at hand, or, worse, handled idiosyncratically depending on who is in command that day, in that location, etc.

This moment may well be one in which we all shake our heads, look the other way, and view what happened in the Secret Service as an isolated, unique problem that will go away when “these individuals” are disciplined.

But I challenge the powers that be within our military, as an invited professional who has spent a great deal of time training those tasked to support our servicemen and women, to view this incident as a wake-up sign. This moment provides an opening to review overall military policy and procedure related to problem sexual behavior, while internally but openly addressing the larger problem of sexual acting out within the US Military.

 “You have to make the mind run the body.”
~General George S. Patton Jr.

A recently published article in the Journal of Clinical Psychology by Kearney, McDermott, Malte, Martinez, and Simpson (2012) may have broad implications for veterans suffering with symptoms of Post-traumatic Stress Disorder (PTSD). 

These researchers demonstrated that engagement in mindfulness-based stress reduction (MBSR) showed significant improvements after six months in reducing soldiers’ symptoms of PTSD, depression, behavioral activation (the ability to engage in activities to achieve a goal in spite of aversive symptoms), and self-acceptance. 

Forty-seven percent of the veterans in the study showed clinically significant improvements in their PTSD symptoms. This highlights the fact that sustainable symptom reduction may be possible by employing a mindfulness technique. MBSR and other mindfulness-based meditation practices may provide broad-based ancillary interventions in the treatment of PTSD that can complement the current psychotherapeutic and pharmacological practices.

PTSD is a particularly nasty collection of symptoms.  Some of the more difficult indications include hyperarousal, rumination about the event, depression and anxiety. In addition to the study noted above, other researchers (Vujanovic, Niles, Pietrefesa, Schmertz, & Potter, 2011) have also found a link between mindfulness meditation and reduced PTSD symptoms in veterans.  In both studies it appears that accepting one’s emotional pain appears to actually help alleviate that pain.

This is good news for the toolbox needed to treat PTSD — because there is also evidence that being unable to accept and adequately regulate trauma-activated emotional responses may cause poor interpersonal relationships (Roth, Newman, Pelcovitz, ver der Kolk, & Mandel, 1997). In turn, poor relationships may make using the more traditional exposure-based treatments (such as desensitization) a risk for exacerbating symptoms (Cloitre, Koenen, Cohen, & Han, 2002).  What is valuable about mindfulness techniques is that they can be practiced independently after training.

Mindfulness meditation has largely been derived from Buddhist practices known as the eight-fold path.  Of the eight, mindfulness is specifically devoted to enhancing the ability to focus our attention. Developed to cope with human suffering, it involves a cultivation of private experiences with the aim of nurturing calmness.  The primary goal is to help achieve self-acceptance.  According to Pema Chodron (2001), an American Tibetan Buddhist nun (or Ani), there are four components of this self-acceptance: commitment; awareness; willingness to experience emotional distress; and attention to the present moment.

Over the years, a number of researchers have shown that meditation practices — including cultivating self–acceptance and the tolerance for emotionally distressing experiences — both reduce stress and increase well-being (Kabat-Zinn, 1990, 1994; Simpson, et al., 2007; Thompson, & Waltz, 2008; Smith, et al., 2011).  But the question has always been if these changes are sustainable.  At least one study has indicated that they are.

Researchers Michael A. Cohna and Barbara L. Fredrickson (2010) demonstrated that, after an initial meditation practice was introduced, subjects sustained positive experiences for fifteen months. Although veterans were not part of the investigation, this was one of the first studies to show a link between meditation and sustainable positive experiences.

Acceptance-based therapies such as mindfulness provide an alternative to traditional Western approaches for dealing with pain (Folette, Palm and Pearson, 2006).  As Ekman, Davidson, Ricard and Wallace (2005) have pointed out, mindfulness is used to tolerate emotional distress rather than to try to control or overcome negative feelings. In other words, trying to control or avoid negative emotions may not be the most effective way to manage them.

It also appears that mindfulness may facilitate resilience.  In another study, Jha, Stanley, Kiyonaga, Wong and Gelfand (2010) found that providing military personnel mindfulness training (MT) might help to guard against functional impairments in stressful contexts.

The more mindfulness meditation is researched, the more it appears to be able both to prevent and correct trauma, particularly for military veterans.

In the past few years the Army has invested in training soldiers to be psychologically as well as physically fit. The Master Resilience Training (MAT) program (Reivich, Seligman, & McBride, 2011) has a series of modules designed to help soldiers maximize their potential and cope with combat stressors.  Meditation is specifically identified as a technique to be taught as part of the larger resilience effort and part of Comprehensive Soldier Fitness program.

Self-acceptance through mindfulness meditation is an ancient tool that is needed now more than ever, but it is no easy task. In the words of Pema Chodron: “The most fundamental aggression to ourselves, the most fundamental harm we can do to ourselves, is to remain ignorant by not having the courage and the respect to look at ourselves honestly and gently.”

References
Chodron, P. (2001). The places that scare you: A guide to fearlessness in difficult times. Boston: Shambhala.

Ekman, P, Davidson, R. J., Ricard, M., & Wallace, B. A. (2005). Buddhist and psychological perspectives on emotional well-being. Current Directions in Psychological Science, 14(2), 59–63.

Follette, V., Palm, K. M., & Pearson, A. N. (2006). Mindfulness and trauma: Implications for treatment. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 24(1), 45-61.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life (1st ed.). New York: Hyperion.

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing.

Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2012). Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample.Journal of Clinical Psychology,

Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, D. (1997). Complex PTSD in victims exposed to physical and sexual abuse: Results from the DSM-IV field trial for posttraumatic stress disorder. Journal of Traumatic Stress, 10(4), 539–555.

Simpson, T., Kaysen, D., Bowen, S., MacPherson, L., Chawla, N., Blume, A., . . . Larimer, M. (2007). PTSD symptoms, substance use, and vipassana meditation among incarcerated individuals. Journal of Traumatic Stress, 20(3), 239-249.

Smith, B. W., Ortiz, J. A., Steffen, L. E., Tooley, E. M., Wiggins, K. T., Yeater, E. A., . . . Bernard, M. L. (2011). Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters.Journal of Consulting and Clinical Psychology, 79(5), 613.

Thompson, B. L., & Waltz, J. (2008). Self‐compassion and PTSD symptom severity.Journal of Traumatic Stress, 21(6), 556-558.

Vujanovic, A. A., Niles, B., Pietrefesa, A., Schmertz, S. K., & Potter, C. M. (2011). Mindfulness in the treatment of posttraumatic stress disorder among military veterans. Professional Psychology: Research and Practice, 42(1), 24.

Sherman, who also served as the Inaugural Distinguished Chair in Ethics at the Naval Academy, delves into the emotional toll war takes on soldiers. Her book is based on her interviews with 40 soldiers. Most of the soldiers fought in Iraq and Afghanistan, while some fought in Vietnam and the World Wars.

She poignantly looks at their stories from the lens of philosophy and psychoanalysis, using these frameworks to better understand and analyze their words.

Sherman writes:

And so I have listened to soldiers with both a philosopher’s ear and a psychoanalyst’s ear. Soldiers are genuinely torn by the feelings of war — they desire raw revenge at times, though they wish they wanted a nobler justice; they feel pride and patriotism tinged with shame, complicity, betrayal and guilt. They worry if they have sullied themselves, if they love their war buddies more than their wives or husbands, if they can be honest with a generation of soldiers that follow. They want to feel whole, but they see in the mirror that an arm is missing, or having bagged their buddies’ body parts, they feel guilty for returning home intact.

In Chapter 4, “The Guilt They Carry,” Sherman reveals the various ways soldiers feel culpability. For instance, before their first deployment, soldiers worry about killing another human being. They worry how they’ll judge themselves or be judged by a higher power. Even if soldiers aren’t legally or even morally culpable, as Sherman writes, they still struggle with guilt.

This struggle can stem from accidental misfires that have killed soldiers or from minor but murky transgressions. One Army Major in charge of an infantry company in Iraq doesn’t go a day without thinking, at least in passing, about the young private who was killed when the gun from a Bradley Fighting Vehicle accidentally misfired. He still struggles with his “own personal guilt.”

A World War II veteran, who was part of the Normandy invasion, still feels uneasy about stripping their own dead soldiers, even though they were — understandably — taking their weapons. Another vet who served in the Canadian army in WWII wrote his family about the tension he felt eating German chickens. Yet another felt great guilt after seeing the wallet of a dead enemy soldier. It had contained family photos just like the American soldier had carried.

Soldiers also feel a kind of survival guilt, or what Sherman refers to as “luck guilt.” They feel guilty if they survive, and their fellow soldiers don’t. The phenomenon of survivor guilt is not new, but the term relatively is. It was first introduced in the psychiatric literature in 1961. It referred to the intense guilt Holocaust survivors felt — as though they were the “living dead,” as though their existence was a betrayal to the deceased.

Being sent home while others are still on the frontlines is another source of guilt. Soldiers spoke with Sherman about “needing to return to their brothers and sisters in arms.” She described this guilt as “a kind of empathic distress for those still at war, mixed with a sense of solidarity and anxiety about betraying that solidarity.”

As a society, we typically worry that soldiers get desensitized to killing. While Sherman acknowledged that this might happen to some soldiers, this wasn’t what she heard in her interviews.

The soldiers with whom I have talked feel the tremendous weight of their actions and consequences. Sometimes they extend their responsibility and guilt beyond what is reasonably within their dominion: they are far more likely to say, “If only I hadn’t” or “If only I could have,” than “It’s not my fault” or simply leave things at “I did my best.”

Their guilty feelings often get mixed with shame. Sherman writes:

[The topic of guilt] is often the elephant in the room. And this is so, in part, because guilt feelings are often borne with shame. Shame, like guilt, is also directed inward. Its focus, unlike guilt, is not so much an action that harms others as on personal defects of character or status, often felt to be exposed before others and a matter of social discredit.

Sherman stresses the importance of having a society that understands and appreciates the inner war soldiers also fight. As she concludes in the Prologue:

Soldiers, both men and women, often keep their deepest struggles in waging war to themselves. But as a public, we, too, need to know how war feels, for war’s residue should not just be a soldier’s private burden. It ought to be something that we, who do not don the uniform, recognize and understand as well.

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You can learn more about Nancy Sherman and her work at her website.

A soldier wouldn’t jump out of a plane without checking their parachute to make sure it was secured and in working order. Yet they are jumping out of active duty into a system that isn’t prepared for their needs, and remains underfunded and under-resourced.

For instance, last week we discussed these continuing challenges with mental health services and the rate of suicide in the military today, among vets and active duty soldiers.

Each year in the U.S. approximately 35,000 – 37,000 people die by suicide. It’s the 10th leading cause of death in the U.S., ahead of things like hypertension, homicide and Parkinson’s disease (all things that get a lot more news and research attention than suicide).

About 100 people kill themselves each day. Nearly 20 percent of those who take their lives is a veteran — or about 18 vets a day. Let that sink in for a moment, because it’s a big number.

As we discussed last week, there are no easy, quick-fix solutions to these problems. Suicide is the result of untreated depression in the vast majority of cases, so the long-term solution is to increase the number of people who get treatment for depression.

But before you can go down that road, you need to let people know that it’s okay to seek out treatment for depression. Or even to just be assessed for it in a confidential environment. For active duty personnel, these can be career-ending decisions — to seek out and obtain needed mental health services.

For vets, the situation is only a little better. While most VA hospitals are staffed by caring, determined and dedicated health care personnel, they often lack all the staffing and resources they need to meet the needs of their burgeoning veteran population. Only a minority of VA hospitals are fully funded and staffed to their budget levels; the rest are skimping along with inadequate mental health staffing levels.

So I’ll once again repeat what we suggested as some possible solutions to the current problems faced by the military when it comes to their people’s mental health needs:

• Fully fund to recommended staffing levels all mental health professions in both active military and veterans’ roles.
• Acknowledge the connection between increased suicidal ideation and other mental health concerns with serving in combat roles.
• Increase health record privacy protections and disconnect a person’s military health record from their formal personnel evaluations, so that admitting and seeking treatment for a mental health concern doesn’t negatively impact a person’s career. If this cannot be done, then:
• Support and fully fund the use of external mental health services for a soldier once stateside, with complete patient privacy rights for such treatment.
• Support greater use of peer-to-peer programs that seek to lessen the stigma associated with mental health concerns.

On this Veterans Day, we acknowledge the sacrifice of all of those who have served our country with honor and an unerring sense of duty. I hope one year soon to not to have to write an entry like this that bemoans the lack of quality mental health care available to many of our vets.

The numbers are staggering. In July 2011, 33 active and reserve component service members died as a result of suicide — a record high month. Additionally, the U.S. Department of Veterans Affairs estimates 18 veterans die by suicide each and every day.

While the military has worked hard to focus on the problem in recent years, the new report released by the Center for a New American Security suggests it still has a long way to go.

Part of the problem remains staffing levels, which are still inadequate to meet the needs of most VAs:

Also cited as problematic is a shortage of mental health care providers to treat both active duty troops and veterans. Research by the VA has found that suicide rates decreased by 3.6 deaths per 100,000 in seven regions where staff numbers increased to levels recommended in the 2008 Veterans Health Administration Handbook.

Sixteen regions are still not manned to these levels, the report says. In addition, the Army has filled only 80 percent of its psychiatrist positions and 88 percent of its social work and behavioral health nurse jobs.

Given the current economy and so many people looking for work, it’s odd the military hasn’t been able to staff up to recommended levels across the board.

Nearly half of all suicides in the Army are caused by drug or alcohol overdose. But about 14 percent of active soldiers in the Army are on an opiate medication for pain — the exact same medication that’s ripe for abuse and use as a suicide method.

And while the report commends recent progress on changing the attitude toward mental health issues in the military, it’s clear we still have a long way to go:

[The report] raps the “prevailing wisdom” in the military that suicides are not linked directly to deployments to war.

While an estimated 31 percent of Army suicides are associated with factors that can be traced back prior to enlistment, recent reports have shown that soldiers who have deployed are more likely to die by suicide.

Talk about burying one’s head in the sand… How could the two not be related? Astounding.

Last, because of the ongoing stigma connected to admitting to mental health problems while serving in the military, most personnel are reluctant to volunteer information about their own concerns:

The report also finds flaws in the mental-health screening process following deployment, in which troops are asked to fill out a health-assessment form that asks questions about their physical and psychological status. A 2008 study found that when Army soldiers completed an anonymous survey, their reported rates of depression, PTSD, suicidal thoughts and interest in receiving care were two to four times higher than the responses on the official forms.

The CNAS researchers said that many returning troops lie—and are encouraged to lie—for fear that if they admit to mental health problems, they will not be allowed to go home.

Such assessments also follow military personnel throughout their career, affecting their career advancement and forward movement.

The report isn’t entirely negative. It notes that while the percentage of service members seeking help has improved — from 36 percent in 2009 to 57 percent in 2010 — “the stigmatization of mental health care remains an issue.”

The solutions are fairly simple:

• Fully fund to recommended staffing levels all mental health professions in both active military and veterans’ roles.

• Acknowledge the connection between increased suicidal ideation and other mental health concerns with serving in combat roles.
• Increase health record privacy protections and disconnect a person’s military health record from their formal personnel evaluations, so that admitting and seeking treatment for a mental health concern doesn’t negatively impact a person’s career. If this cannot be done, then:
• Support and fully fund the use of external mental health services for a soldier once stateside, with complete patient privacy rights for such treatment.
• Support greater use of peer-to-peer programs that seek to lessen the stigma associated with mental health concerns.

Read the full article here: New Report: U.S. Losing The Battle Against Military Suicides

Read the full report here: Losing the Battle: The Challenge of Military Suicide

This year’s event focuses on Veterans and Active Duty Military. The event features a keynote speech by Colonel Holzworth, as well as Ret. Lt. Colonel David Glassman, Ret. Colonel George Patrin M.D., and Ret. Col. Robert A. Strom. Psych Central is one of the sponsors of the event.

We’re joining the IMAlive team, Kristin Brooks Hope Center (founders of 1-800-SUICIDE), iFred, Post Secret, invited Congressmen, Senators and Press, along with Veteran Service Organizations on the lawn of the US Capitol to bring attention to this issue, as military suicides continue to climb.

This year’s event focuses on Veterans and Active Duty Military. The event features a keynote speech by Colonel Holzworth, as well as Ret. Lt. Colonel David Glassman, Ret. Colonel George Patrin M.D., and Ret. Col. Robert A. Strom.

Mr. Holzworth and Mr. Glassman are national heroes who have worked together for eight years and have collectively trained over 15,000 men and women at the Marine Aviation Training Support Group in Pensacola, Florida.

WHAT: 8th Annual Capitol Hill Event and Global Night for Hope:
Prevent Active Duty Military and Veteran Suicide
WHERE: Taft Memorial Park, located north of the Capitol, on Constitution Avenue between New Jersey Avenue and First Street, NW. Look for the 100-foot marble tower.
WHEN: September 10th, Noon – 2:00 pm ET
COST: Free!

They are speaking on September 10th because they believe that if all Veteran Service Organizations, the VA and Department of Defense work collaboratively we can lower the 12% unemployment rate among military veterans and the pandemic of the annual loss of more than 6,500 US Veterans to suicide due to Post- traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI).

Visit www.globalnightforhope.org for more info on this event. Attend to get your free yellow light bulb, and put it in your porch on the night of September 10th to shine a positive light on the issue.

This event is part of the 1st Annual IMAlive crisis center conference.

Can’t attend in person? Show support by changing your facebook photo to the yellow light bulb on September 10th – shine a positive light on the issue. Time for hopeful action.

Participating Charities include:

• Center for Strategic Military Excellence
• Operation Second Chance
• Seredipity
• NAMI, Montgomery County
• Kristen Brooks Hope Center
• Veteran’s Dream Foundation
• Veteran’s Advocacy Services
• Veterans Education Project
• Family of a Vet
• Blue Star Families
• iFred
• The Soldier’s Project
• Vet2Vet
• The Mommies Network

Click here to read more about this event on Facebook: 8th Annual Capitol Hill Event and Global Night for Hope