Invisible Wounds

THE face of war

Lt. Col. David Grossman’s 2009 landmark study On Killing: The Psychological Cost of Learning to Kill in War and Society pointed out an interesting fact — most soldiers are loath to kill. (Only the sociopath and psychopath depart from this norm.) Armies, however, have of necessity developed sophisticated ways of overcoming this instinctive aversion in order to win wars. War is, after all, about killing. Yet they knew little — and oftentimes cared even less — about the long-lasting effects killing has on soldiers and its correlation to the present societal afflictions of escalating violence and suicide among Veterans. According to Grossman, this ignorance or neglect is responsible for this new plague.

8. Invisible Wounds-1On Killing goes to great lengths to explain the trauma that soldiers who kill face when they return to civilian life. This is particularly apparent in Vietnam Veterans, who had been psychologically conditioned and trained to kill via the military’s revolutionary use of desensitization, operant conditioning, and even psychotropic drugs. These were techniques that had never before been used. This conditioning, coupled with the fact that there was no “counter agent” in place to help them in the readjustment process, left many in a state of frightening emotional turmoil. No, they are not all potential miscreants, just at times acutely alert.

Modern technology, too, made it possible then and especially now for troops to be transported out of the milieu of adrenaline-infused jungle or desert combat and back onto Main Street, USA, in about 18 hours. There was no time to de-tune — or de-fuse. And, when they returned home, they endured the taunts of “murderers,” “baby killers,” and myriad other vitriol of the anti-war protest movement. (Today’s returning troops, fortunately, do not encounter this attitude.)

Today’s Dilemma

Hundreds of family members around the country have been gathering in gymnasiums and other venues to greet their fathers, sons, mothers, and daughters (think about those last two for a moment) coming home from or departing to the various fronts of the Global War on Terror (GWOT). Mothers balanced a child with one arm and a handmade welcome sign with the other, as the room quickly filled with hugs and tears of joy or sadness. In some cases of poignant dichotomy, fathers watched their children walk for the first time — or the last.

As our troops return home from (sometimes several) 12-month deployments, however, experts warn to be on the lookout for the tell-tale signs of what many refer to as those “invisible wounds” — depression, isolation, stress, anger, and divorce — all of which can lead to violence or suicide. These are just part of the emotional challenges facing some of the troops. For many, the images of the horror they saw and / or participated in are memories that are not easily forgotten.

The depression rate is enormous, and suicide rates are off the proverbial charts. In general, troops find it difficult to speak about their experiences to anyone but another Veteran. How do you describe the aftermath of an intense, close-quarter firefight or an IED explosion that costs a buddy his legs to someone whose worst experience in life was breaking up with a significant other or the breakdown of his or her smartphone?

The Invisible Wound Has a Name: Post-Traumatic Stress Disorder (PTSD)

Since October 2001, approximately 1.6 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom in Afghanistan and Iraq — many had multiple deployments. Early evidence suggests that a great number of returning service members suffer from PTSD and depression. Traumatic brain injury (TBI), too, is a major concern, but there is limited evidence about the scope of the problem. Additionally, there is still debate about the most effective treatments for both conditions at this point in time.

All soldiers who experience the hell of combat will have some type of reaction after returning from an “imminent danger” environment. These behaviors and feelings are commonplace, especially during the first few weeks at home. Despite the challenges of reintegration, most of these service men and women will successfully readjust. Not all, however, so easily adjust.

Signs and Symptoms

Those with PTSD often exhibit a high level of arousal and awareness which causes them to react strongly to sounds and sights around them. For example, a combat Veteran may suddenly swerve while driving down the street because he or she thought they saw the tell-tale signs of a roadside IED.

Of special note for law enforcement, they will typically be armed as, subconsciously, they are unsure that the war is over; and besides, it was something they equipped themselves with every day — just like their underwear and socks. Confusing thoughts about what happened to them was unfair or unjust can also arise. They might not understand clearly why a certain thing happened and why it happened to them, and these kinds of thoughts can elicit intense anger.

Trauma survivors commonly experience stress reactions. This is true for Veterans, children, and disaster rescue or relief workers. Understanding what is happening when you or someone you know reacts to a traumatic event and is having an episodic reaction will help you handle more effectively what could be a confrontational situation. PTSD sufferers often:

•    Feel hopeless about the future

•    Are detached or unconcerned about others

•    Have trouble concentrating or making decisions

•    Feel on guard and constantly alert, usually armed

•    Have disturbing dreams and memories or flashbacks

•    Experience trouble sleeping and feeling very tired

•    Avoid people, especially crowds

•    Become easily upset or agitated

•    Have negative views of themselves or the world

• Distrust others, get into conflicts, become over-controlling

So, after a trauma, almost every survivor finds it impossible to stop thinking about what happened. The best remedy is to use a personal support system — family and friends — to work through some feelings. Recovery is an ongoing and gradual process; it does not happen overnight. Most people will recover from trauma naturally over time, but for many, emotional reactions will get in the way of relationships, work, and other important activities.

Law Enforcement and Crisis Intervention Teams Training

The Salt Lake City Police department trains Crisis Intervention Teams (CIT) statewide. Officers are trained to identify mental health issues and avert a potentially volatile situation, as well as contact resources to help persons in crisis.

Since 2001, the Department has offered several training academies per year, training over 500 officers from 42 agencies across the state. From its inception in the Salt Lake City Police Department, the leaders of the CIT program have informally evaluated its success internally. Data collected during this informal evaluation suggest the program is effective both from the perspectives of the officers (with respect to their training and feelings of preparedness) and from outside mental health agency perspectives.

CIT officers receive training in identifying characteristics of various mental disorders. Along with a new-found empathetic approach, officers in this program are trained to provide a safer intervention for the person experiencing a mental health crisis, their family members, the community, and the officers themselves. One need only recall the dismal outcome of the 2009 Brian Cardall incident to see the importance of this training. (Cardall was experiencing a manic episode, running naked on a rural stretch of state Route 59, and died after he was hit by a Taser and given several jolts of 50,000 volts. He had been diagnosed with bipolar disorder but was off his medications.)

The teams do not necessarily respond to a returning Veteran differently than any other person creating a situation; i.e., they don’t get a free ride. What they do is try to identify for certain they are dealing with someone who is emotionally charged, perhaps due to PTSD, TBI, or some other type of mental disorder, and calm the person by reasoning with him or her and offering options for help. Oftentimes treating them with respect and thanking them for their service is all it takes; and, if the officer has any experience as a Veteran that, too, can be used to connect with the Veteran. No, it doesn’t work all the time. There are still many instances when officers have to employ physical restraints and even consider tactical options. But, numerous lives have been saved and confrontations avoided through reason. (See Man surrenders after Cranston Standoff on previous page.)

Ideas for First time Responders

We are all aware of the fact that the job law enforcement does nearly always requires a physical, authoritative, and commanding presence. But, such tactics may not be the most desirable when confronting someone who has PTSD and is in a crisis episode. Using some form of intervention training to de-escalate the situation instead; i.e., taking a step back, being patient, and allowing the person vent generally yields better results.

To ease potential confrontations between police and Veterans in PTSD crisis, the following are some very general approaches / tactics to consider. (Most of these are the foundation of FBI negotiator training):

•    Avoid the tendency to label people with PTSD as “sick.” Some may be, but most are regular people who are just hypersensitive to danger.

•    Depending on the circumstances, do not immediately take an aggressive stance with Veterans or touch them, if avoidable. Getting “in the face” or the physical space of combat Veterans will most likely agitate them more. If possible just talk to them and give them some space.

•    Communicate with them in a manner that will allow you to approach them in a respectful, non-threatening way.

•    Earn their trust. That encourages them to open up to you. Opening a line of communication with Veterans in crisis and expressing a willingness to listen to their laments is a key item.

•    Try relating to them as equals and as servants of the greater good who may not always be understood or appreciated. Police officers have a better chance than almost anyone to earn a Veteran’s trust.

Building Rapport

Responding law enforcement officers may or may not have military experience. They do, however, share many common bonds with military personnel. Police officers face dangerous situations and life-or-death decisions almost every day. They share the same desire to serve and feel that they are honorable men and women. Many have lost sisters and brothers on the force and faced their families with guilt and pain. They also have witnessed humankind’s capacity for evil and depravity. And, at the end of the day they, too, go home and attempt to separate the nastiness of the job from their family life. They are not always successful. Remember, however, while most Veterans have the utmost respect for law enforcement, there are others who may, justly or unjustly, view combat as unique and significantly different from police work.

Some specific closed and open-ended questions can help engage a distressed combat Veteran. Employed with the foundational approaches to negotiation given above (e.g., listening and being reasonable), they can help officers and negotiators connect with someone in crisis.

•    How long were you in the military? Are you still in?

(They may have a strong bond or commitment to members of their unit.)

•    What was your MOS (military occupational specialty)?

(Some have experienced direct combat and may be more problematic than others.)

•    Were you ever deployed? How long? (The chance of potential problems rises in direct proportion to the length of deployment.)

•    How many times were you deployed? (As above, the more times they are deployed, the more likely they are to suffer residual effects.)

•    Where were you deployed? (Certain areas are more dangerous than others.)

•    What was it like for you? Do you miss it? (The answer to this question may offer profound insights into their frame of mind.)

•    How long have you been back? (It takes time to readjust to the civilian world.)

It is important to remember that these questions are simply a guide that may help officers clarify a position influencing the Veteran. They should not be used with individuals in crisis who do not want to talk about their war-time experiences.

Help Is Available

In recent years, programs have been developed to keep war Veterans with mental health problems from being put into jail or prison. The programs aim to assist Veterans who become involved in the justice system to get treatment for mental health problems that may exist. This includes Vietnam Veterans and the numbers of Veterans returning from the GWOT.

Veterans Treatment Court

Veterans Treatment Courts are based on the Drug Courts and Mental Health Courts begun in the 1990s. As in these models, the goal is to keep those with mental health issues out of the traditional justice system. Instead, the courts give them treatment and tools for coping with their problems. Each Veterans Treatment Court is part of a community’s justice system. They often partner with the local VA and Veterans Service Organizations (e.g., American Legion, VFW, etc.).

8. Invisible Wounds-2One example of how a Veterans Treatment Court operates is when a person is arrested, police officers promptly ask whether he or she is a Veteran. If so, the Veteran’s eligibility for Veterans Treatment Court and for VA benefits is assessed. Only Veterans charged with non-violent crimes and who are in need of mental health or substance abuse treatment may go to treatment court.

Veteran Identification on Driver License or ID Card

Effective 1 July 2011, applicants applying for a Utah driver license or a Utah ID card have had the option of adding a VETERAN indicator to their certificate. All that is needed to obtain it is acceptable proof of honorable discharge from the U.S. Military (Form DD-214 or a discharge certificate).

This new indicator has the potential to save lives. There have been numerous instances of Veterans having confrontations with police, usually the result of (PTSD) or other emotional states attributable to wartime service, which is the principal reason the Utah Department of Veterans Affairs pushed legislators to enact the law (not just to help Veterans receive discounts from retailers, which it does). When a police officer stops an individual for whatever reason, that Veteran identifier can make a big difference

as to how the encounter might play out. The officer would have the information to decrease the likelihood of having the encounter escalate into a potentially dangerous situation. It gives the police a chance to palliate a situation and handle it differently than they might normally do.

Utah Department of Veterans Affairs Director Terry Schow said he presented the idea to Representative Greg Hughes to make things a lot easier for Utah Veterans to prove they are Veterans. Hughes got the bill passed. “Instead of having to carry around or make available all kinds of different forms, now you can just present your driver’s license,” Schow said.

Conclusion

Efforts such as Veterans Treatment Courts, the VA’s Veterans Justice Outreach program, and the driver license identifier may prove helpful to Veterans who become involved in the justice system. The goals are to keep eligible Veterans out of jail or prison and to make sure they get needed treatment and support.