I was in a conversation the other day with a Vietnam era psychologist, who I respect and admire a great deal, but who was nonetheless giving me static for the way I talked about "hope" in a previous blog post, as it concerned combat veterans. "You talk about it as though it's an abstract, but then immediately move into talking about its RESULTS," he said (I'm paraphrasing.) Rrrright. And that would be exactly the point. Hope is a great and a necessary thing -- but our goal here is to find ways to get over combat trauma, to the extent possible -- at least to reduce its effects on veterans -- and in that regard, yes, we're all about the results. Are there any? And what can those be? Because if they're legitimate at all, in the vacuum of hope-lessness and despair created by a complete lack of reasonable solutions, let's figure out what those are, and let's try them out. Are combat veterans game? Many are.
Here's something I ran across the other day, in the middle of a [draft] journal article. The author was talking about a type of therapy he used -- a therapy he's famous for developing, and which has been around and in use for decades -- on combat veterans, mostly from the Vietnam era, and the results he was able to achieve with them. I have some inside knowledge of his program, but this was the first time I'd read something in print about it. In the middle of quite an extensive article, charting this result and that, he happened to mention the results of one of the tests he did on the 22 vets, both before and after the two weeks of treatment. This is what he wrote:
"Scores on the Beck Hopelessness Scale fell from an average of 11 before treatment to 3 following treatment. In clinical practice, scores of 9 or more are used to indicate serious hopelessness. A score of 4 is expected in the general population. The veterans went from having pre-test scores characteristic of hopelessness, suicidal ideation and predictive of suicide attempts, to having scores typical of the general population. Thirteen veterans had scores above 9 before treatment, one had a score above 9 after treatment. (That individual's score had dropped from 17 to 10.) Nineteen out of 22 scores dropped; two remained the same (scores of 1 and 2); and one score increased [negligibly] (from 4 5o 5). Marked decreases in pessimism are indicated, and it seems safe to conclude that the treatment group felt considerably more hopeful at the program's conclusion."
Do you see what's embedded in that, if true? In two weeks of treatment, combat veterans with PTSD that went back decades started feeling better to a degree, on average, better than the general population? That's remarkable...
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So I ask you, what would HOPE do for veterans today, and their families? It's pretty clear that when it comes to suicide, people are able to go forward with the act because they've given UP hope. (That's why the Beck test, for example, is able to link the two: hopelessness and suicide, both ideation and attempts.) We've seen in previous blog posts how the "focus" of a suicidal person becomes narrower -- it's not that they "don't love their family" or "aren't thinking about the consequences to others," they simply have narrowed their focus down to an either/or choice, and the rest of the considerations, no matter how otherwise dear, are simply "not in the picture."
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Now it's entirely possible that the veterans in the above-mentioned program didn't functionally "stay" that perky and optimistic, and that's why more follow-up studies, such as retests at longer intervals, would have contributed more information worth knowing. Many times, at the end of a program, irrespective of what type of program it is, participants feel most buoyed and optimistic about future performance, lighter about their burdens, and more likely to discount the negative effect of future obstacles they may encounter. However, even so it's significant to note how good those scores seemed to be, given the great degree of difficulty the same participants had having hope beforehand.
It's not just veterans -- it's also their families. How often do family members say things like, "But you were only in the war for two years...how can you let it affect you for the whole rest of your life?"
If combat veterans are able to access health care that adequately deals with their symptoms, and reduces their symptom load to a manageable extent, and gives them back HOPE -- they will have the ability to resume their lives with some degree of normality, and prevent any number of negative consequences that come from NOT having hope, from having given up. The tremendous societal costs from combat trauma we have to start understanding not only affect the veterans involved -- they affect their families, the communities in which they live, future generations, etc. Veterans with hope -- who get their hope back -- will be functional and integrated into all aspects of their lives, and actively participate in their various roles as spouses, parents, employees, citizens, etc. Veterans who lose hope, and who we do not help to regain hope, will lose out. And this loss will affect them first, and then like the ripple effect of a pebble thrown into a pond, concentric circles of effect will spread out from them to others in their lives: their immediate families, their workplaces, their schools, their communities, even future generations in their families.
Far from being an abstraction, I believe HOPE is pretty central to the whole concept of "healing combat trauma." We've got to help combat veterans to hang on and have some, and they themselves have to believe it's possible to get better. Then we have to make sure we're connecting them with the very resources that can deliver the results.
