Healing Combat Trauma

Quotable Quotes -- The Dalai Lama on Life Purpose and Satisfaction

That Dalai Lama -- he's amazing! If "personal outlook" were a software package, I'd ask for the Dalai Lama upgrade: because I like how he thinks. So compassionate and kind and reasonable, but not afraid of science. A fascinating, compelling combination. 

Some of his great quotes lately:

"We can't be useful to ourselves unless we're useful to others. Whether we like it or not, we're all connected, and it is unthinkable to be happy all by oneself. Anyone concerned only with his own well-being will suffer eventually. Anyone concerned with the well-being of others takes care of himself without even thinking about it. Even if we decide to remain selfish, let us be intelligently selfish -- let us help others." -- The Dalai Lama.

And another:

"Once you shift your focus from yourself to others and extend your concern to others, this will have the immediate effect of opening up your life and helping you to reach out. The practice of cultivating altruism has a beneficial effect not only from a religious point of view but also from a mundane point of view; not only for long-term spiritual development but even in terms of immediate rewards."

And another:

"The world's major religious traditions all give the development of compassion a key role. Because it is both the source and the result of patience, tolerance, forgiveness and all good qualities, its importance is felt to extend from the beginning to the end of spiritual practice. Even without a religious perspective, love and compassion are clearly of fundamental importance to us all."

And another:

"Satisfaction is characterized by inner peace. It arises from generosity, honesty and what I call ethical conduct, a way of behaving that respects others' rights to be happy."

---

Bringing this all back around to veterans with combat-based PTSD and their families, think how crucial what he's expressing are. Eighteen veterans a day kill themselves -- a shocking statistic -- and we seem to be at the beginning, not the middle or the end -- of that particular trend. Army and Marine suicides -- they see the bulk of the action, after all, in these wars -- are both up, despite the "best of intentions" on the part of the services to bring down the numbers. Pep talks on prevention and more prescriptions aren't solving the problem, nor are they likely to. Because, as one combat vet with PTSD said, "pep talks are hard to take seriously because that is for the normal life of a normal person, not for a veteran contemplating suicide because of combat trauma." True, that.

It's coming up on two years, shortly, of my first phone conversation with the combat vet, a Vietnam vet, Marine, with 40 years(!) of severe, chronic PTSD, which plagued his life, despite "all the best" of what the VA threw at him (his words, not mine), including an inpatient, residential PTSD program that was cutting-edge at the time. (Would it surprise you to know that most of his classmates in that program, according to him, are now dead, also from suicide?) After our first conversation, which seemed relatively pleasant and positive, he followed up with an email about wanting to drink and put a gun in his mouth to end it all, because he was sure God hated him; after all, he himself did. Sparkly stuff. Lots of unicorns and rainbows and fluffy clouds there...not one bit.

Of course, the end of his story is quite a bit more positive, mostly because it didn't end. He's made the transition from bleak, grim and grisly to mostly inspirational and awesome. And it took a while, a solid footing, a hand reaching across the abyss and pulling him up and out -- a hand which he importantly grabbed (it doesn't work if you don't ;-). It took some specific therapeutic treatments to help remove trauma from the body. We tried a few, intentionally, and they worked; there are others that might as well. And it took a huge motivation on his part to reach out -- however ugly his mess at the time -- to get some help and be real about where he was really at. For years, decades really, he'd been the one other vets' wives called to take the gun out of the mouths of their husbands. Now he finally had some hope to offer others. But it took commitment on his part, believing that the hope was out there, and going after it with all he had. Not always pretty, but effective :-)

(He's the veteran in the "Eyewitness to Combat" series on the site. Here are two items about his turnaround, linked here and here. The second is in his own words.)

Anyway, the upshot of the whole experience is wanting to build a program to bring other combat veterans with PTSD through, and help their families as well, who are often left holding the bag (of misery) but not really getting the help they need either. Combat veterans with PTSD have often lost their life purpose completely, and as we've been talking about lately, purpose is key.

The "eyewitness to combat" veteran, described above -- he and I share a purpose. It's helping others overcome. It's possible. And as the Dalai Lama says, that's being intelligently selfish -- taking care of those 18 vets a day who'll be killing themselves, BEFORE it happens. So it doesn't HAVE to happen. That's the best use that you and I could put our time and energy and compassion to. Please join in helping others so that they don't have to suffer so intensely, when there is a way out.

Editor's Note: A California-based psychology grad student is doing a Ph.D. thesis on Iraq vets with PTSD and life purpose. If you qualify based on the above criteria, he'd like to talk to you, and will pay you $50 for your efforts if you participate. Here's the link to his study. His brother is a combat vet. 

Additionally, you can "follow" the Dalai Lama on Twitter -- @DalaiLama -- and you can follow us on Twitter as well @HealingPTSD.

Going to the Bunker: A Combat Veteran with PTSD on the Purpose of Protective Isolation

Every combat veteran with PTSD knows what is meant by their "bunker," or what "going to their bunker" means. It's a walled-off, isolated situation that allows them to get some space to themselves, away from other people (including family and friends), when they feel particularly triggered, and they need to stay in there for, well, as long as they're going to. They come out when they're ready, and not a moment before. Obviously this situation can be very frustrating to others in the vet's life, but for the vet it affords him or her some very necessary, protective isolation.

The rest of us who aren't combat vets with PTSD I suppose could think of it as the vet putting himself or herself in a time-out from the world, by taking themselves out of the mix, and away from people and stimulation, both bad and good. And the time-out will be over when it's over, because they decide when it's up.

The recent Fourth of July with its fireworks that remind many vets of combat was a classic bunker situation. Many, many vets were making plans before the Fourth for how to protect and insulate themselves from being triggered by the fireworks (noise, smoke, crowds). One Gulf War vet with PTSD who had already isolated himself, wrote of putting a pillow over his head and just wanting it to be over, so that he didn't have to experience it. The next day, fireworks all exploded, he was better. But during, he had to be in the bunker. Another combat vet with PTSD, from the Iraq war this time, talked about staying in her bunker for days, making brief provision runs, every fourth day or so, to the grocery store and then...back to her bunker. When she needed to be in her bunker...

The bunker concept/construct is so typical to combat vets with PTSD that I thought I'd ask one who I know fairly well how he'd describe it. He has decades of PTSD "experience" under his belt, and I've also seen him retreat to his bunker at various times. A month one time, a week another time, the last time, a day. Sometimes even a few hours. But however long the episode lasts, during that time: totally unreachable. And realistically, you better not even try...because it just makes the situation worse. 

The more chances I've had to experience this with him, the more certain I can be that, short time or long, he'll emerge from his bunker, when he's good and ready, and with a new and improved outlook on why he went in the bunker in the first place. (For those who don't know, the bunker can be anywhere...a shed, a garage, a spot in the woods, a room in a house, even a chair. But it's sacred, inviolate, untouchable space...and the vet goes there in retreat, partly to spare those around him, but also strongly to get control over what he's feeling. (He or she, obviously.) So I figured he'd be able to offer his personal/expert advice on this.

Here's how the conversation went.

Me: "What typically sends vets to their bunkers?"

Him: "Any situation -– losing a job, losing their cool, a fight with their kid -- that makes them lose control sends them back to their bunker, so they can regain control. It may not be much, but while they're there, at least they have control over that little room they're in."

Me: "What's the longest time you've ever spent in your bunker?"

Him: "A year."

Me:  "!!!"

And then he clarified. (Remember, this is just his opinion, but it's worth sharing, because of the number of vets he knows and has observed, as well as what he knows about himself.) "Each time a vet goes into their bunker, they go in for a longer period of time. Until one time they go in and they don’t come out." (He does know an awful lot of other vets who have sadly killed themselves. That happens in bunkers, too. No wonder families and friends are justifiably concerned.)

The progression he just mentioned...vets spending longer and longer times each time in their bunkers...is actually the opposite of what he's been doing, since I've known him (which coincides with his getting better). Each time he goes to his bunker, it's both less frequent, and for shorter and shorter times each time, to the point that the last "bunker" episode I observed him in was actually only about half an hour.

In the middle of a frustrating conversation, not quite an argument, but one where emotions were high and we weren't communicating smoothly, he "withdrew" to his bunker of self-enclosed, protective space -- without moving from the couch he'd been sitting on. I saw him cross his arms, very agitated, close his eyes, and start doing something that looked like huffing and puffing. Even on an animal instinct level I knew, give this person his space. All the body language was daggers. I stepped away, and a short while later, he bounced back, and resumed where things left off, able to manage the conflict without any undue strain. Turns out what he'd been doing during the huffing and puffing phase was actually deep breathing, to calm himself down and regain control. Very smart. On the outside, he looked furious. On the inside, he was doing what he could to get back under control. As a result, he was able to "emerge" from his bunker in record time -- which speaks to the tremendous benefits of learning coping skills and stress-reduction techniques, as he has.

When I first knew this vet, he talked about what he'd learned at an inpatient PTSD program at the VA years ago. It was the cutting-edge program at the time, and he speaks of it with great appreciation, even though many of the guys he went through the program with sadly did not make it. ("Did not make it" is euphemistic code for "sadly, later killed themselves.") One of the biggest things he learned in the program, according to him, was about "red flags" and "triggers," and how to get away before you make things worse. Heading for the bunker, just like in the description of the vet with the pillow over his head,  is one way to keep things from getting worse. For the vet, that is -- for the family or loved ones, it's very difficult to experience, and hard to ignore, though one of the secrets seems to be, going on with your own life, while maintaining a compassionate (but not nagging) concern for how they're doing.

One of the distinctions he likes to make, though, between what he learned from the behavioral modification skills, above, in the VA program, and what he's learned since then, following more of a healing path, is that now he has some ability to not just "avoid" triggers but also "deal with" situations as they come up. The red flags still show that the problem is coming, but instead of being ONLY triggered, there are now new ways to deal with it that don't only involve avoiding or isolating.

The situation above, of being in conflict but being able to "be" with it, and breathe through it, meant that the conflict didn't have to explode into a multi-day saga or a physical exit to an actual bunker, which could last for weeks or months -- or even a year(!) Ahhh, progress is a beautiful thing...

Editor's note: For Part II, "Busting Out of the Bunker at Last," go here.

Too Long a Sacrifice Can Make a Stone of the Heart: The Tao of Self-Care

"Too long a sacrifice can make a stone of the heart," wrote Irish poet William Butler Yeats. He wasn't necessarily a caregiver to anyone, like a veteran, with PTSD -- but he sure seems to understand the predicament. 

The "365 Tao" book that I'm so fond of -- what's not to love about an item at Amazon that has 65 ratings, and they're ALL five stars?! -- had a wonderful item today about how caring for another appropriately is wonderful, but that there is "too much" of a good thing, and it can backfire terribly on the caregiver. Read what it says:

CARING

"Don't go out looking for good deeds to do

But if one comes your way, do not refuse.

If you meet someone who is suffering, you must help them."

And then, importantly:

"Those who follow Tao believe in using sixteen attributes on behalf of others : mercy, gentleness, patience, nonattachment, control, skill, joy, spiritual love, humility, reflection, restfulness, seriousness, effort, controlled emotion, magnanimity, and concentration. Whenever you need to help another, draw upon these qualities. Notice that self-sacrifice is not included in this list. You do not need to destroy yourself to help another. Your overall obligation is to complete your own journey along your personal Tao. As long as you can offer solace to others on your same path, you have done the best that you can."

It's so crucial to note what the author says about "notice that self-sacrifice is not included in this list." (And, previously, that non-attachment was.) So many people on this path or journey, trying to help vets with PTSD, in their own families, their brothers and sisters they served with, etc., are bound to follow the completely self-sacrificing path. We understand that impulse...but see where it leads? It leads to personal disaster. Please take better care of yourself than that. It's not necessary to give your complete and entire all to do your best, to give your best. There has to be a "you" left at the end of the day, or the night. Please find and treasure that self...and don't let it be destroyed, even in the guise of being...the care-giver. 

What can you do for yourself today to improve your health and stress level? What nurtures you and gives you peace of mind? Is it exercise, spending time with friends, having alone time -- what is it? There are many things you can do for yourself that are inexpensive and take good care of you. Please make a list for yourself of what those are, and find a way to bring them back into your life. It will make a world of difference. Some of the very same recommendations or suggestions for veterans with PTSD are ones you might like yourself. A simple exercise like Qi Gong, which creates a feeling of being "relaxed, balanced and energized" -- is just one example of positive self-care, and there are many others.

At the opposite extreme, of not taking care of yourself, what can we guess happens with too long a sacrifice, for others, no matter how worthy, needy or deserving? According to the poet, it can "make a stone of the heart." And following this along...what happens to a stone heart? It shatters and breaks. Keep a soft heart...take care of yourself first...so you can continue to care for others. Not instead of yourself. Importantly, after yourself. So that you can give the best care of all...and not be depleted, broken or crushed. 

Military Spouses and Families -- Resource List of Books and Articles

In honor of today being "Military Spouse Appreciation Day" -- hey, shouldn't that be all year long, given what they do?! -- here's a really stupendously great bibliography of books and articles relating to military families, spouses and children and all the various issues they can encounter in the mental health/social work realm.

Unfortunately, I don't remember where I found it on the Web back in February of this year, so I can't credit it appropriately. (And I've Googled it a bunch of different ways to find it again, but with no luck.) Like every bibliography, there are possible additions, subtractions and revisions -- but "as is, where is," it's a tremendous resource of information for finding out more about these very important subjects.

REFERENCE LIST: Military Families 

Children

Barker, L. H. and K. D. Berry (2009). "Developmental Issues Impacting Military Families With Young Children During Single and Multiple Deployments." Military Medicine 174: 1033-1040.

Barnes, V. A., H. Davis, et al. (2007). "Perceived stress, heart rate, and blood pressure among adolescents with family members deployed in Operation Iraqi Freedom." Mil Med 172(1): 40-3.

Brom, D., R. Pat-Horenczyk, et al., Eds. (2009). Treating Traumatized Children: Risk, Resilience and Recovery Taylor & Francis, Inc.

Chandra, A., S. Lara-Cinisomo, et al. (2010). "Children on the Homefront: The Experience of Children           From Military Families." Pediatrics 125(1).

Chandra, A., L. T. Martin, et al. (2009). "The Impact of Parental Deployment on Child Social and      Emotional Functioning: Perspectives of School Staff." Journal of Adolescent Health In Press,         Corrected Proof.

Chandra, A., R. M. Burns, et al. (2008). Understanding the Impact of Deployment on Children and    Families: Findings from a Pilot Study of Operation Purple Camp Participants R. Corporation: 69.

Chartrand, M., D. A. Frank, et al. (2008). "Effect of parents' wartime deployment on the behavior of young children in military families." Arch Pediatr Adolesc Med. 162(11): 1009-1014.

Chartrand, M. and B. Siegel (2007). "At War in Iraq and Afghanistan: Children in US Military Families " Ambulatory Pediatrics 7(1): 1-2.

Cozza, S. and A. Lieberman (2007). "The young military child: Our modern telemachus " Zero to Three 27(July): 27-33.

Cozza, S. J., R. S. Chun, et al. (2005). "Military families and children during Operation Iraqi Freedom." Psychiatric Quarterly 76(4): 371-378.

Ender, M. G. (2006). Voices from the backseat: Demands of growing up in military families. Military Life: The Psychology of Serving in Peace and Combat, The Military Family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International. 3: (pp. 138-166). viii, 262.

Flake, E. M., B. E. Davis, et al. (2009). "The Psychosocial Effects of Deployment on Military Children." Journal of Developmental and Behavioral Pediatrics 30(4): 271-278.

Fallon, M. A. and T. J. Russo (2003). "Adaptation to stress: An investigation into the lives of United States military families with a child who is disabled." Early Childhood Education Journal 30(3): 193-198.

Goodman, R. F. (2002). Caring for Kids After Trauma and Death: A Guide for Parents and Professionals. A. Gurian, The Institute for Trauma and Stress at The NYU Child Study Center: 57.

Hardaway, T. (2004). Treatment of psychological trauma in children of military families. Mass Trauma and Violence: Helping families and children cope. N. B. Webb. New York, NY, Guilford Press: 259-282.

Horton, D. (2007). The impact of deployment on children in military families, Horton, Denise: Walden U , US.

Houston, J. B., B. Pfefferbaum, et al. (2009). "Children of Deployed National Guard Troops: Perceptions       of Parental Deployment to Operation Iraqi Freedom." Psychiatric Annals 39(8): 805-811.

Huebner, A. J. and J. A. Mancini (2005). Adjustments Among Adolescents in Military Families When A           Parent is Deployed, Military Family Research Institute at Purdue University: 50.

Huebner, A. J., J. A. Mancini, et al. (2007). "Parental deployment and youth in military families: Exploring uncertainty and ambiguous loss." Family Relations 56(2): 112-122.

Hutchinson, J. W. (2006). "Evaluating risk-taking behaviors of youth in military families." Journal of Adolescent Health 39(6): 927-928.

Jensen, P. S., S. N. Xenakis, et al. (1991). "The "military family syndrome" revisited: "By the numbers."." Journal of Nervous and Mental Disease 179(2): 102-107.

Kelley, M. L. (1994). "The effects of military-induced separation on family factors and child behavior." American Journal of Orthopsychiatry 64(1): 103-111.

Kelley, M. L., Hock, E., Smith, K.M., Jarvis, M.S., Bonney, J.F., and Gaffney, M.A. (2001 ). "Internalizing and externalizing behavior of children with enlisted navy mothers experiencing military-induced separation." Journal of the American Academy of Child & Adolescent Psychiatry: 40(4): 464-471.

Lamberg, L. (2004). "When military parents are sent to war children left behind need ample support." JAMA: Journal of the American Medical Association 292(13): 1541-1542.

Lemmon, M. and L. Chartrand (2009). "Caring for America's Children: Military Youth in Time of War."          Pediatrics in Review 30(6): E42-E48.

Lincoln, A., E. Swift, et al. (2008). "Psychological adjustment and treatment of children and families with parents deployed in military combat." Journal of Clinical Psychology 64(8): 984-992.

Mmari, K., K. M. Roche, et al. (2009). "When a Parent Goes Off to War  Exploring the Issues Faced by Adolescents and Their Families." Youth & Society 40(4): 455-475

Morris, A. S. and T. R. Age (2009). "Adjustment among youth in military families: The protective roles of effortful control and maternal social support." Journal of Applied Developmental Psychology 30(6): 695-707.

Paden, L. B. and L. J. Pezor (1993). Uniforms and youth: The military child and his or her family. The Military Family in Peace and War F. W. Kaslow. New York, NY, Springer Publishing Co: 3-24.

Ryan-Wenger, N. A. (2001). "Impact of the threat of war on children in military families." American Journal of Orthopsychiatry 71(2): 236-244.

Warren, Z. E. (2006). Cognitive and behavioral development of at risk infants and toddlers exposed to stressful life events: The effects of trauma in early childhood, Warren, Zachary E : U Miami, US.

Wethington, H. R., R. A. Hahn, et al. (2008). "The Effectiveness of Interventions to Reduce Psychological Harm from Traumatic Events Among Children and Adolescents: A Systematic Review." American Journal of Preventive Medicine 35: 287-313.

 

Communities of Support

 

Huebner, A. J., J. A. Mancini, et al. (2009). "Shadowed by War: Building Community Capacity to Support Military Families." Family Relations 58(2): 216-228

Kudler, H. and K. Straits-Tröster (2009). "Partnering in Support of War Zone Veterans and Their      Families." Psychiatric Annals online 39(2): 64-70.

Levin, A. (2009). "Military Hopes Civilian Clinicians Can Shrink Treatment Gap." Psychiatry News August       21, 2009 44(16): 16.

 

Culture

 

Danieli, Y. (2007). Assessing trauma across cultures from a multigenerational  perspective. Cross-Cultural Assessment of Psychological Trauma and PTSD. J. P. a. T. Wilson, Catherine So-kum. New York, NY, Springer Science + Business Media. Part 1: . (pp. 65-89). xxvi, 405.

Harris, J. J. and N. G. Jones (2007). African-American military service members and their families: A different environment. Human Behavior in the Social Environment from an African-American Perspective. L. See, A. New York, NY, Haworth Press: (2007).  (2nd ed.). (pp. 133-150). xliii, 782.

Lowe, T. B., J. G. Hopps, et al. (2007). Stressors experienced by African-American armed service personnel during the Iraq War. [References]. Human behavior in the social environment from an African-American perspective. L. A. See. New York, NY, Haworth Press: 519-542.

Osterman, J. E. and J. T. V. M. de Jong (2007). Cultural issues and trauma. Handbook of PTSD: Science and Practice. M. J. Friedman, Keene, Terence M. and Resick, Patricia A. New York, NY, Guilford Press: pp. 425-446.

 

Death

 

Bonanno, G. A. (2004). "Loss, Trauma, and human resilience, Have we underestimated the human capacity to thrive after extremely aversive events?" American Psychologist 59(1): 20-28.

Goodman, R. F. (2002). Caring for Kids After Trauma and Death: A Guide for Parents and Professionals. A. Gurian, The Institute for Trauma and Stress at The NYU Child Study Center: 57.

Lieberman, A., N. Compton, et al. (2003). Losing a Parent to Death in the Early Years Zero To Three Press.

Network, N. C. T. S. (2008). "Traumatic Grief in Military Children." Traumatic Grief in Military Children: Information for Medical Providers, from http://www.nctsnet.org/nctsn_assets/pdfs/military_grief_medical.pdf.

Network, N. C. T. S. (2008). "Traumatic Grief in Military Children." Traumatic Grief in Military Children: Information for Families, from http://www.nctsnet.org/nctsn_assets/pdfs/Military_Grief_Families_final3.pdf.

Pearson, G. (2007). "Review of Military Widow: A Survival Guide." Perspectives in Psychiatric Care 43(1): 65.

Pfefferbaum, B., S. J. Nixon, et al. (1999). "Posttraumatic stress responses in bereaved children       after     the Oklahoma City bombing." Journal of the American Academy of Child and Adolescent         Psychiatry 38(11): 1372-1379.

Ronel, N., U. Lebel, et al. (2006). "When parents lay their children to rest: Between anger and forgiveness." Journal of Social and Personal Relationships 23(4): 507-522.

Stoppelbein, L. and L. Greening (2000). "Posttraumatic stress symptoms in parentally bereaved children       and adolescents." Journal of the American Academy of Child and Adolescent Psychiatry 39(9):           1112-1119.

Wright, K. M., L. M. Burrell, et al. (2006). Military Spouses: Coping with the Fear and the Reality of Service Member Injury and Death. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 64-90.

 

 

 

Deployment

 

Basham, K. (2009). "Commentary on the Keynote Lecture Presented by Dr. Jonathan Shay, Friday, June      27, 2008 titled <i>The Trials of Homecoming: Odysseus Returns from Iraq/Afghanistan</i>, and additional reflections." Smith College Studies in Social Work 79(3): 299-309.

Basham, K. (2008). "Homecoming as safe haven or the new front: Attachment and detachment in military couples." Clinical Social Work Journal 36(1): 83-96.

Bowling, U. B. and M. D. Sherman (2008). "Welcoming them home: Supporting service members and their families in navigating the tasks of reintegration." Professional Psychology: Research and Practice 39(4): 451-458.

Burton, D. L. (2009). "Commentary on the Reaction Panel in Response to the Keynote Lecture presented      by Col. Carl Castro and Dr. Mark Chapin titled <i>The Deployment Cycle: Expectations and     Implications</i>." Smith College Studies in Social Work 79(3): 283 - 285.

Garran, A. M. (2009). "Commentary on the Reaction Panel in Response to the Keynote Lecture presented     by Dr. Jonathan Shay titled <i>The Trials of Homecoming: Odysseus Returns from         Iraq/Afghanistan</i>." Smith College Studies in Social Work 79(3): 310 - 313.

Haas, D. M. and L. A. Pazdernik (2006). "A Cross-Sectional Survey of Stressors for Postpartum Women during Wartime in a Military Medical Facility." Military Medicine 171(10): 1020-1023.

Herzog, J. R. and R. B. Everson (2007). The crisis of parental deployment in military service. Play Therapy with Children in Crisis: Individual, Group, and Family Treatment N. B. Webb. New York, NY, Guilford Press: 228-248.

McFarlane, A. C. (2009). "Military deployment: the impact on children and family adjustment and the need for care." Current Opinion in Psychiatry 22(4): 369-373

Packman, J., T. Paone, et al. (2006). When a Parent Gets Deployed: Helping Military Families Deal With Stress. Compelling Perspectives on Counseling G. Walz, Bleur, J. and Yep, R. Alexandria, VA, American Counseling Association: 67-69.

Pawlowski, L. M. (2005). Coping with military deployment: The C.A.R.E.S. resource for couples, Pawlowski, Lisa M : Regent U , US.

Peebles-Kleiger, M. J. and J. H. Kleiger (1994). "Re-integration stress for Desert Storm families: Wartime deployments and family trauma." Journal of Traumatic Stress 7(2): 173-194.

Rand, H. and R. N. S. R. Division (2008). Post -Deployment Stress: What Families Should Know, What Families Can Do, Rand Health and Rand National Security Research Division.

Russell, D. and D. Hamilton (2008). Reunion and re-integration with the family after deployment. Proceedings of the 6th Rocky Mountain Region Disaster Mental Health Conference. G. W. Doherty. Ann Arbor, MI, Rocky Mountain DMH Institute Press/Loving Healing Press: 95-98.

Scaturo, D. J. and P. M. Hayman (1992). "The impact of combat trauma across the family life cycle: Clinical considerations." Journal of Traumatic Stress 5(2): 273-288.

Shay, J. (2009). "The Trials of Homecoming: Odysseus Returns from Iraq/Afghanistan." Smith College          Studies in Social Work 79(3): 286 - 298.

Slosky, L. H. (2008). The use of rituals and routines in military families experiencing deployment, Capella U , US.

Taft, C. T., J. A. Schumm, et al. (2008). "An examination of family adjustment among Operation Desert Storm veterans." Journal of Consulting and Clinical Psychology 76(4): 648-656.

Warner, C. H., G. N. Appenzeller, et al. (2009). "Psychological Effects of Deployments of Military      Families." Psychiatric Annals 39(2): 56-63.

           

 

 

Grandparents

 

Bunch, S. G., B. J. Eastman, et al. (2007). "A profile of grandparents raising grandchildren as a result of parental military deployment." Journal of Human Behavior in the Social Environment 15(4): 1-12.

 

 

Intergenerational Transmission of Trauma

 

Brom, D., R. Pat-Horenczyk, et al., Eds. (2009). Treating Traumatized Children: Risk, Resilience and Recovery Taylor & Francis, Inc.

Dekel, R. and H. Goldblatt (2008). "Is there intergenerational transmission of trauma? The case of combat veterans' children." American Journal of Orthopsychiatry 78(3): 281-289.

Egolf, J. (2008). Flyboy's daughter. [References]. Proceedings of the 6th Rocky Mountain Region Disaster Mental Health Conference. G. W. Doherty. Ann Arbor, MI, Rocky Mountain DMH Institute Press/Loving Healing Press: 67-78.

Leiner, B. (2009). "The Legacy of War: An Intergenerational Perspective." Smith College Studies in Social     Work 79(3): 375 - 391.

Scharf, M. (2007). "Long-term effects of trauma: Psychosocial functioning of the second and third generation of Holocaust survivors." Development and Psychopathology 19(2): 603-622.

           

 

 

Interventions 

 

Brom, D., R. Pat-Horenczyk, et al., Eds. (2009). Treating Traumatized Children: Risk, Resilience and Recovery Taylor & Francis, Inc.

Budzik, C. L. (2008). "Providing well child care for military families: what every provider needs to consider." Pediatr Ann 37(3): 185-8.

Collins, R. C. and M. C. Kennedy (2008). "Serving families who have served: Providing family therapy and support in interdisciplinary polytrauma rehabilitation." Journal of Clinical Psychology 64(8): 993-1003.

Erbes, C., R., M. A. Polusny, et al. (2008). "Couples therapy with combat veterans and their partners." Journal of Clinical Psychology: In Session 64(8): 972-983.

 

Gambardella, L. C. (2008). "Role-exit theory and marital discord following extended military deployment." Perspectives in Psychiatric Care 44(3): 169-174.

Faran, M. E., M. D. Weist, et al. (2005). Promoting resilience in military children and adolescents.     Community Planning to Promote Resilience on Children. C. Clauss-Ehlers and M. Wiest. New York,             Kluwer Academic/Plenum Publishers: 233-248.

Goodman, R. F. (2002). Caring for Kids After Trauma and Death: A Guide for Parents and Professionals. A. Gurian, The Institute for Trauma and Stress at The NYU Child Study Center: 57.

Guha, V. (2005). Stress, coping and adaptation to wartime separation by families of National Guard personnel, Guha, Vatsala: U Hartford, US.

Hall, L. K. (2008). Counseling military families: What mental health professionals need to know. New York, NY, Routledge/Taylor & Francis Group.

Herzog, J. R. and R. B. Everson (2007). The crisis of parental deployment in military service. Play Therapy with Children in Crisis: Individual, Group, and Family Treatment N. B. Webb. New York, NY, Guilford Press: 228-248.

Hutchinson, J. and L. Banks-Williams (2006). "Clinical issues and treatment considerations for new veterans: Soldiers of the wars in Iraq and Afghanistan." Primary Psychiatry 13(3): 66-71.

Jenkins, D. M. and M. J. Barry (2007). "Relationship 101: Couples therapy in theater." Military Medicine 172(6): iii-iv.

Lemmon, K. M. and E. M. Stafford (2007). "Recognizing and responding to child and adolescent stress:         The critical role of the Pediatrician." Psychiatric Annals 37(6): 431438.

Moon, P. K. (2006). Sand Play Therapy With U.S. Soldiers Diagnosed With PTSD and Their Families. [References]. Vistas: Compelling perspectives on counseling 2006. G. R. Walz, J. C. Bleuer and R. K. Yep. Alexandria, VA, American Counseling Association: 63-66.

Saldanha, D. (2002). "Family intervention in the treatment of post-traumatic stress disorders." Journal of Projective Psychology & Mental Health 9(1): 57-61.

Schumm, W. R., R. J. Crock, et al. (2008). "Reliability and validity of the Kansas Marital Satisfaction Scale with different response formats in a recent sample of U.S. Army personnel." Individual Differences Research 6(1): 26-37.

Storey, C. L. (2009). "The Psychotherapeutic Dimensions of Clinical Case Management with a Combat          Veteran." Smith College Studies in Social Work 79(3): 443 - 452.

Webb, N. B., Ed. (2007). Play therapy with children in crisis: Individual, group, and family treatment (3rd Ed.). New York, NY, Guilford Press.

Wilson, R. M., S. Leary, et al. (2009). "Military Veterans Sharing First-Person Stories of War and      Homecoming: A Pathway to Social Engagement, Personal Healing, and Public Understanding of             Veterans' Issues." Smith College Studies in Social Work 79(3): 392 - 432.

 

           

Maltreatment 

 

Bradley, C. (2007). "Veteran status and marital aggression: Does military service make a difference?" Journal of Family Violence 22(4): 197-209.

Clark, S., B., K. Koenen, C., et al. (2007). "Intimate Partner Psychological Aggression and Child Behavior      Problems." Journal of Traumatic Stress 20(1): 97-101.

Gibbs, D. A., S. L. Martin, et al. (2008). "Child maltreatment and substance abuse among U.S. Army soldiers." Child Maltreat 13(3): 259-68.

Gibbs, D. A., S. L. Martin, et al. (2007). "Child maltreatment in enlisted soldiers' families during combat-related deployments." JAMA: Journal of the American Medical Association 298(5): 528-535.

McCarroll, J. E., Z. Fan, et al. (2009). "Alcohol Use in Nonmutual and Mutual Domestic Violence in the U.S. Army: 1998-2004." Violence and Victims 24(3): 364-379

McCarroll, J. E., J. H. Newby, et al. (2008). "Responding to domestic violence in the U.S.Army-The Family    Advocacy Program." Family and Intimate Partner Violence Quarterly 1(1): 5-23.

McCarroll., J. E., R. J. Ursano, et al. (2004). "Classification of the severity of US Army and civilian reports           of child abuse." Military Medicine 169(6): 461-464.

McCarroll, J. E., F. Zizhong, et al. (2008). "Trends in US army child maltreatment reports: 1990-2004."         Child Abuse Review 17(2): 108-118.

Newby, J. H., R. J. Ursano, et al. (2003). "Spousal aggression by U.S Army female soldiers toward employed and unemployed civilian husbands." American Journal of Orthopsychiatry 73(3): 288-293.

Rentz, E., S.W. Marshall, et al. (2007). "Effect of deployment on the occurrence of child maltreatment in military and nonmilitary families." American Journal of Epidemiology 165(10): 1199-1206.

Rentz, E., S. L. Martin, et al. (2006). "Family violence in the military: A review of the literature." Trauma, Violence, & Abuse 7(2): 93-108.

           

 

Marriage        

 

Adler-Baeder, F., J. F. Pittman, et al. (2005). "The Prevalence of marital transitions in military families." Journal of Divorce & Remarriage 44(1-2): 91-106.

Goff, B. S. N., J. R. Crow, et al. (2007). "The Impact of Individual Trauma Symptoms of Deployed    Soldiers on Relationship Satisfaction." Journal of Family Psychology 21(3): 344-353.

Huffman, A. H. and S. C. Payne (2006). The Challenges and Benefits of Dual-Military Marriages. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 115-137.

 

 

Military Families        

 

Adams, G. A., D. B. Durand, et al. (2005). "Direct and Indirect Effects of Operations Tempo on Outcomes for Soldiers and Spouses." Military Psychology 17(3): 229-246.

Adams, G. A., S. M. Jex, et al. (2006). Work-Family Conflict among Military Personnel. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 169-192.

Bowen, G. L., J. A. Mancini, et al. (2003). "Promoting the adaptation of military families: An empirical test of a community practice model." Family Relations 52(1): 33-44.

Castro, C. A., A. B. Adler, et al., Eds. (2006). Military life: The Psychology of Serving in Peace and Combat The Military Family. Westport, CT, Praeger Security International.

Chapin, M. (2009). "Deployment and Families: Hero Stories and Horror Stories." Smith College Studies in      Social Work 79(3): 263 - 282.

Clark, D. (2006). "Review of Courage After Fire: Coping Strategies for Troops Returning From Iraq and Afghanistan and Their Families." International Journal of Emergency Mental Health 8(3): 218-219.

Durand, D. B. (2006). Army Wife, Army Mother. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 3-10.

Harmon, A. L. (2008). A descriptive study of military family needs following a polytraumatic injury, Harmon, A Lisa: Virginia Commonwealth U, US.

Henderson, K. (2006). While They're at War: The True Story of American Families on the Homefront, Houghton Mifflin Harcourt

Hoshmand, L. T. H. a. A. L. H. (2007). "Support for military families and communities." Journal of Community Psychology 35(2): 171-180.

Huitink, J., M. Rajnik, et al. (2006). "International Adoptions by Military Families: A Reexamination." Military Medicine 171(12): 1201-1205.

Kelley, M. L., M. J. Schwerin, et al. (2007). "A participant evaluation of the U.S. Navy parent support program." Journal of Family Violence 22(3): 131-139.

MacDermid, S. (2006). Multiple Transitions of Deployment And Reunion For Military Families The Military Families Research Institute at Purdue University.

MacDermid, S., R. Samper, et al. (2008). Understanding and Promoting Resilience in Military Families.          Military Family Research. M. F. R. I. a. P. University. West Lafayette, Purdue University: 1-28.

Martin, J. and M. D. Sherman (2009). The Impact of Military Duty and Military Life on Individuals and           Families: Resources and Intervention. Families and Change: Coping With Stressful Events and   Transitions. S. J. Price, C. A. Price and P. C. McKenry. Thousand Oaks, CA Sage Publications.

Matsakis, A. (2007). Back from the front: Combat trauma, love, and the family. Baltimore, MD, The Sidran Press.

Palmer, C. (2008). "A theory of risk and resilience factors in military families." Military Psychology 20(3): 205-217.

Pavlicin, K. M. (2005). Surviving Deployment: A guide for military families Elva Resa Publishing LLC.

Pinder, R. J., D. Murphy, et al. (2009). "A Mixed Methods Analysis of the Perceptions of the Media by            Members of the British Forces during the Iraq War." Armed Forces & Society 36: 131-152.

Richard, E. M. (2008). Constructing and contesting the public and private lives of military families, Richard, Elizabeth M : Arizona State U , US.

Rieth, L. S. (2007). Changes in the air force couple's ability to pay debts: Evidence from the 1997 and 1999--2000 air force community needs assessments, Rieth, Linda S: Capella U , US.

Robbins, L. S. (2005). Disorganized attachment in a military sample: Contributions from maternal trauma history, expressed sadness and narrative errors, Robbins, Leah Susan: Alliant International U, San Diego, US.

Sayers, S. L., V. A. Farrow, et al. (2009). "Family Problems Among Recently Returned Military Veterans       Referred for a Mental Health Evaluation." Journal of Clinical Psychiatry 70(2): 163-170

Schachman, K. A. (2010). "Online fathering: the experience of first-time fatherhood in combat-deployed        troops." Nursing Research 59(1): 11-17.

Taylor, N. E., S. M. Wall, et al. (2005). "Mother and Soldier: Raising a Child With a Disability in a Low-Income Military Family." Exceptional Children 72(1): 83-99.

Ursano, R. J., H. C. Holloway, et al. (1989). "Psychiatric care in the military community: Family and military stressors." Hospital & Community Psychiatry 40(12): 1284-1289.

Wiens, T. W. and P. Boss (2006). Maintaining family resiliency before, during, and after military separation. Military life: The Psychology of Serving in Peace and Combat: The Military Family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International. 3: 13-38.

           

 

 

Military Service Members

 

Castro, C. C. (2009). "Impact of Combat on the Mental Health and Well-Being of Soldiers and Marines."        Smith College Studies in Social Work 79(3): 247 - 262.

Cohen, S. P., C. Brown, et al. "Diagnoses and factors associated with medical evacuation and return to                     Freedom: a prospective cohort study." The Lancet 375(9711): 301-309.

 

Hoge, C. W., C. A. Castro, et al. (2004). "Combat duty in Iraq and Afghanistan, mental health problems,       and barriers to care." N Engl J Med 351(1): 13-22.

            Kennedy, C. H. (2006). Understanding one of our nation's greatest assets: Military personnel, PsycCRITIQUES Vol 51 (38), 2006.

Litz, B. T. (2007). "Research on the impact of military trauma: Current status and future directions." Military Psychology 19(3): 218-238.

Pierce, P. (1998). "Retention of Air Force Women Serving During Desert Shield and Desert Storm." Military Psychology 10(3): 195-213.

           

 

Moving Relocation     

 

Burrell, L. M. (2006). Moving military families: The impact of relocation on family well-being, employment, and commitment to the military. Military Life: The Psychology of Serving in Peace and Combat, The Military Family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International. 3: 39-63

Weber, E. G. and D. K. Weber (2005). "Geographic Relocation Frequency, Resilience, and Military Adolescent Behavior." Military Medicine 170(7): 638-642.

           

 

National Guard Reserves

 

Chisolm, J. S. (2007). The emotional impact and pastoral care implications of mobilization and deployment on national guard and reserve military members and their families, Chisolm, Joseph Steven: Texas Christian U , US.

Darwin, J. (2009). "Families: They Also Serve Who Only Stand and Wait." Smith College Studies in Social      Work 79(3): 433-442.

Edwin, J. A. (2008). An evaluation of a military family support program: The case of operation: Military Kids in Indiana, Edwin, James Augustine: Purdue U , US.

Faber, A. J., E. Willerton, et al. (2008). "Ambiguous absence, ambiguous presence: A qualitative study of military reserve families in wartime." Journal of Family Psychology 22(2): 222-230.

Guha, V. (2005). Stress, coping and adaptation to wartime separation by families of National Guard personnel, Guha, Vatsala: U Hartford, US.

Renshaw, K. D., C. S. Rodrigues, et al. (2008). "Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: Relationships with spouses' perceptions of veterans' experiences and symptoms." Journal of Family Psychology 22(4): 586-594.

Renshaw, K. D., C. S. Rodrigues, et al. (2009). "Combat exposure, psychological symptoms, and marital       satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to         2006." Anxiety Stress and Coping 22(1): 101-115.

Sahni, N. (2005). Perceptions of those left behind: An exploration of family dynamics within military reservist families during the 2003 Iraq wartime deployment, Sahni, Nameeta: Alliant International U, San Diego, US.

Tollefson, T. T. (2008). "Supporting spouses during a military deployment." Family & Community Health 31(4): 281-286.

 

Policy

 

Jackonis, M. J., L. Deyton, et al. (2008). "War, Its Aftermath, and US Health Policy: Toward a          Comprehensive Health Program for America's Military Personnel, Veterans, and Their Families."    Journal of Law Medicine & Ethics 36(4): 677-689.

 

 

Posttraumatic Stress Disorder/Mental Disorder

 

Browne, T., L. Hull, et al. (2007). "Explanations for the increase in mental health problems in UK reserve      forces who have served in Iraq." British Journal of Psychiatry 190: 484-489.

Evans, L., T. McHugh, et al. (2003). "Chronic posttraumatic stress disorder and family functioning of             Vietnam veterans and their partners." Australian and New Zealand Journal of Psychiatry 37(6):          765-772.

Frenz, M. (2007). Combat Veterans Diagnosed with Post Traumatic Stress Disorder: The Effects on Their Children: A Phenomological Study, University of Phoenix. Doctor of Management in Organizational Leadership: 187

Galovski, T. and J. A. Lyons (2004). "Psychological sequelae of combat violence: A review of the impact       of PTSD on the veteran's family and possible interventions." Aggression and Violent Behavior         9(5): 477-501.

Grieger, T. A., S. J. Cozza, et al. (2006). "Posttraumatic stress disorder and depression in battle-injured        soldiers." American Journal of Psychiatry 163(10): 1777-1783.

Litz, B. T. (2007). "Research on the impact of military trauma: Current status and future directions." Military Psychology 19(3): 218-238.

Manguno-Mire, G., F. Sautter, et al. (2007). "Psychological Distress and Burden Among Female Partners of Combat Veterans With PTSD." Journal of Nervous and Mental Disease 195(2): 144-151.

Nemeroff, C. B., J. D. Bremner, et al. (2006). "Posttraumatic Stress Disorder: A State-of-the-Science            Review." Journal of Psychiatric Research 40: 1-21.

Outram, S., V. Hansen, et al. (2009). "Still living in a war zone: Perceived health and wellbeing of    partners of Vietnam veterans attending partners' support groups in New South Wales, Australia."            Australian Psychologist 44(2): 128-135.

Rand, H. and R. N. S. R. Division (2008). Post -Deployment Stress: What Families Should Know, What Families Can Do, Rand Health and Rand National Security Research Division.

Ray, S. L. and M. Vanstone (2009). "The impact of PTSD on veterans' family relationships: An         interpretative phenomenological inquiry." International Journal of Nursing Studies 46(6): 838-      847.

Riddle, J. R., T. C. Smith, et al. (2007). "Millennium Cohort: The 2001-2003 baseline prevalence of mental    disorders in the U.S. military " Journal of Clinical Epidemiology 60: 192-201

Samper, R. E., C. T. Taft, et al. (2004). "Posttraumatic stress disorder symptoms and parenting satisfaction among a national sample of male Vietnam veterans." Journal of Traumatic Stress 17(4): 311-315.

Stein, M. B. and T. W. McAllister (2009). "Exploring the Convergence of Posttraumatic Stress and Mild           Traumatic Brain Injury." American Journal of Psychiatry 166(7): 768-776.

            

Psychological Toll      

 

Karney, B. R., R. Ramchand, et al. (2008). Invisible wounds, a working paper, Rand Health and the Rand National Security Research Division: 182.

Richardson, J. D., J. Sareen, et al. "Psychiatric problems in medically evacuated service members." The       Lancet 375(9711): 257-259.

           

 

Reference Handbook 

 

Ainspan, N. D. a. W. E. P. (2008). Returning Wars', Wounded, Injured, and Ill, Praeger Securit International

 

 

Schools

 

Aydlett, A. E. (2006). Dealing with Deployment: a Small-Group Curriculum for Elementary and Middle     School Students. Alexandria, VA: American School Counselor Association

Fitzsimons, V. M. and C. A. Krause-Parello (2009). "Military children: when parents are deployed              overseas." J Sch Nurs 25(1): 40-7.

Horton, D. (2005). "Consultation with military children and schools: A proposed model." Consulting          Psychology Journal: Practice and Research 57(4): 259-265.

Network, N. C. T. S. (2008). "Traumatic Grief in Military Children." Traumatic Grief in Military Children:    Information for Educators. from                http://www.nctsnet.org/nctsn_assets/pdfs/military_grief_educators.pdf.

Secondary Traumatization

Bride, B. E. and C. R. Figley (2009). "Secondary Trauma and Military Veteran Caregivers." Smith College      Studies in Social Work 79(3): 314 - 329.

Burton, D. L. (2009). "Commentary to Reaction Panel in Response to the Keynote Lecture presented by        Drs. Brian E. Bride and Charles R. Figley titled <i>Secondary Trauma and Military Veteran      Caregivers</i>." Smith College Studies in Social Work 79(3): 330 - 334.

Chara, K. A. (2008). Secondary PTSD transmission among survivor families of World War II sailors of the United States ship Emmons: A descriptive and correlational analysis of reported and perceived long-term symptoms among veterans, their wives, and adult offspring, Chara, Kathleen A : Capella U , US.

Dekel, R. and Z. Solomon (2007). Secondary traumatization among wives of war veterans with PTSD. [References]. Combat stress injury: Theory, research, and management. C. R. Figley and W. P. Nash. New York, NY, Routledge/Taylor & Francis Group: 137-157.

Dekel, R. and H. Goldblatt (2008). "Is There Intergenerational Transmission of Trauma? The Case of Combat Veterans’ Children." American Journal of Orthopsychiatry Vol. 78(3): 281-289

Fals-Stewart, W. and M. Kelley (2005). "When Family Members Go To War--A Systemic Perspective on Harm and Healing: Comment on Dirkzwager, Bramsen, Ader, and van der Ploeg (2005)." Journal of Family Psychology 19(2): 233-236.

Figley, C. R. (2005). "Strangers at Home: Comment on Dirkzwager, Bramsen, Ader, and van der Ploeg (2005)." Journal of Family Psychology 19(2): 227-229.

           

Single Military Parents

 

Kelley, M. L. (2006). Single military parents in the new millennium. Military life: The psychology of serving in peace and combat C. A. E. A. Castro, Amy B (Ed); Britt, Thomas W (Ed). ,Praeger Security International. 3: 93-114.

Roper, L. L. (2007). Air force single parent mothers and maternal separation anxiety, Roper, Lawanda L : Capella U , US.

 

Spouses          

 

Dana, K. L. (2006). Careers of their own: Role-identity negotiation among air force officers' wives, Dana, Krista Lorrell: U Oklahoma, US.

Dekel, R., H. Goldblatt, et al. (2005). "Being a Wife of a Veteran with Posttraumatic Stress Disorder." Family Relations 54(1): 24-36.

Gorbaty, L. R. (2009). "Family reintegration of reserve service members following a wartime deployment:    `A qualitative exploration of wives' experience." Dissertation Abstracts International: Section B:    The Sciences and Engineering 69(7-B): 4421.

Hobson, T. A. (2006). The impact of deployment on the stay-behind spouse of active duty navy women, Walden University.

Jebo, J. L. (2008). An untraditional life: Male spouses of female military personnel, Jebo, Jennifer L : Virginia Polytechnic Inst And State U , US.

Keener, M. (2007). Shared Courage: A Marine Wife's Story of Strength and Service Minneapolis, MBI            Publishing Company.

Mansfield, A. J., J. S. Kaufman, et al. "Deployment and the Use of Mental Health Services among U.S.          Army Wives." N Engl J Med 362(2): 101-109

Matsakis, A. (2005). In harm's way: Help for the wives of military men, police, EMTs & firefighters. Oakland, CA, New Harbinger Publications.

Orthner, D. K. and R. Rose (2009). "Work Separation Demands and Spouse Psychological Well-Being." Family Relations 58(October): 392-403.

Sahlstein, E., K. C. Maguire, et al. (2009). "Contradictions and Praxis Contextualized by Wartime       Deployment: Wives' Perspectives Revealed through Relational Dialectics." Communication         Monographs 76(4): 421-442.

Spera, C. (2008). "Spouses's ability to cope with deployment and adjust to Air Force Family demands." Armed Forces & Society 35(2): 286-306.

Westman, M. and D. L. Etzion (2005). "The Crossover of Work-Family Conflict From One Spouse to the Other." Journal of Applied Social Psychology 35(9): 1936-1957.

Wright, K. M., L. M. Burrell, et al. (2006). Military Spouses: Coping with the Fear and the Reality of Service Member Injury and Death. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 64-90.

           

Traumatic Brain Injury          

Anderson, M. I., T. R. Parmenter, et al. (2002). "The relationship between neurobehavioural problems of      severe traumatic brain injury (TBI), family functioning and the psychological wellbeing of the            spouse/caregiver: path model analysis." Brain Injury 16(9): 743-757.

Cernak, I. and L. J. Noble-Haeusslein (2009). "Traumatic brain injury: an overview of pathobiology with       emphasis on military populations." J Cereb Blood Flow Metab.

Collins, R. C. and M. C. Kennedy (2008). "Serving families who have served: Providing family therapy and    support in interdisciplinary polytrauma rehabilitation." Journal of Clinical Psychology 64(8):     993-1003.

Committee on Gulf War and Health: Brain Injury in Veterans and Long-Term Health Outcome, Board on       Population Health and Public Health Practice, et al. (2008). Gulf War and Health: Volume 7: Long       Term Consequences of Traumatic Brain Injury.

French, L. M. and G. W. Parkinson (2008). "Assessing and treating veterans with traumatic brain injury." J Clin Psychol 64(8): 1004-13.

Friedemann-Sanchez, G., J. M. Griffin, et al. (2008). "Communicating Information to Families of       Polytrauma Patients: A Narrative Literature Review

            " Rehabilitation Nursing 33(5): 206-213.

Groom, K. N., T. G. Shaw, et al. (1998). "Neurobehavioral symptoms and family functioning in         traumatically brain-injured adults." Archives of Clinical Neuropsychology 13(8): 695-711.

Griffin, J., G. Friedemann-Sánchez, et al. (2009). "Families of patients with polytrauma: Understanding         the evidence and charting a new research agenda." Journal of Rehabilitation Research &       Development 46(6): 879-892.

Hoge, C. W., D. McGurk, et al. (2008). "Mild traumatic brain injury in US Soldiers returning from Iraq."         New England Journal of Medicine 358(5): 453-463.

Jaffee, M. S., K. M. Helmick, et al. (2009). "Acute clinical care and care coordination for traumatic brain   injury within Department of Defense." Journal of Rehabilitation Research & Development 46(6):          655-666.

Kreutzer, J. S., T. M. Stejskal, et al. (2009). "A preliminary investigation of the brain injury family    intervention: Impact on family members." Brain Injury 23(6): 535-547.

Lezak, M. D. (1978). "Living with the Characterlogically Altered Brain Injured Patient." Journal of Clinical      Psychiatry 39: 593-598.

Lefebvre, H., D. Pelchat, et al. (2005). "The experiences of individuals with a traumatic brain injury,             families, physicians and health professionals regarding care provided throughout the continuum."          Brain Injury 19(8): 585-597.

Lew, H. L., J. H. Poole, et al. (2007). "Program development and defining characteristics of returning           military in a VA Polytrauma Network Site." Journal of Rehabilitation Research & Development     44(7): 1027-1034.

Perlesz, A., G. Kinsella, et al. (1999). "Impact of Traumatic Brain Injury on the Family: A Critical Review."    Rehabilitation Psychology 44(1): 6-35.

Pessar, L. F., M. L. Coad, et al. (1993). "The Effects of Parental Traumatic Brain Injury on the Behavior of             Parents and Children." Brain Injury 7(3): 231-240.

            Ponsford, J., J. Olver, et al. (2003). "Long-term adjustment of families following traumatic brain injury          where comprehensive rehabilitation has been provided." Brain Injury 17(6): 453-468.

Rand, H. and R. N. S. R. Division (2008). Post -Deployment Stress: What Families Should Know, What Families Can Do, Rand Health and Rand National Security Research Division.

Sahlstein, E., K. C. Maguire, et al. (2009). "Contradictions and Praxis Contextualized by Wartime       Deployment: Wives' Perspectives Revealed through Relational Dialectics." Communication         Monographs 76(4): 421 - 442.

Sinnakaruppan, I. and D. M. Williams (2001). "Family carers and the adult head-injured: a critical review     of carers' needs." Brain Injury 15(8): 653-672.

Uysal, S., M. R. Hibbard, et al. (1998). "The effect of parental traumatic brain injury on parenting and          child behavior." Journal of Head Trauma Rehabilitation 13(6): 57-71.

Verhaeghe, S., T. Defloor, et al. (2005). "Stress and coping among families of patients with traumatic           brain injury: a review of the literature." Journal of Clinical Nursing 14: 1004-1012.

Wells, R., J. Dywan, et al. (2005). "Life satisfaction and distress in family caregivers as related to specific     behavioural changes after traumatic brain injury." Brain Injury 19(13): 1105-1115.

Social Support a "Powerfully Protective Factor" Often Not Available to PTSD Sufferers

A quote about PTSD and its impact on the individual sufferer's ability to receive support from those around him or her:

"Social support is a powerful protective factor (Brewin, Andrews & Valentine, 2000) that includes the capacity of an individual to accept or utilize social support when it is made available (Benight & Bandura, 2004). This may be especially problematic in PTSD where symptoms such as avoidance, alienation and detachment impair affected individuals from benefiting from available marital, family, and social support."

Source: Oxford Handbook of Anxiety and Related Disorders, by Martin M. Antony, Murray B. Stein, linked here.

Upcoming Seminar on Warrior Health: PTSD, Depression and TBI

The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., presents:

A Center for Deployment Psychology Training Program:

"Addressing the Psychological Health of Warriors and Their Families: PTSD, Depression and TBI."

When: Mon 22 Jun 2009 through Fri 26 Jun 2009.

Where: The Cheyenne Mountain Resort, Colorado Springs, Colorado.

What: This intensive course, which is comprised of 4 modules, will train civilian mental health providers to better address the behavioral health needs of military personnel and their family members throughout the deployment cycle.

Who: The intended audience is civilian mental health providers who provide behavioral health care to the military population or military family members, including veterans and their loved ones.  This training is NOT intended for active duty military providers, but rather for civilian or private practice/community providers.

Supported by: Fort Carson Soldier Readiness Center, National Organization on Disability, Operation TBI Freedom and Regis University.

For more information about this upcoming seminar or to register online, click here.

Travis Twiggs: The Un-Happy One Year Anniversary of Combat PTSD's Perhaps Most Visible Death

Just a brief note to mention, it was one year ago today that Travis Twiggs passed from this earth, by his own hand, the veritable poster boy of combat-based PTSD.  It also marks his brother Willard's passing, who left this earth with Travis, apparently by Travis' hand.  It's an absolute tragedy, for any number of reasons -- from the family members and friends the Twiggs brothers leave behind -- to the fact that Travis, personally, was making an impact as a Marine who broke the code of silence, so to speak, and spoke openly about his PTSD.  Twiggs wrote about his ordeal in the January, 2008 issue of the Marine Corps Gazette, in an article that has been widely circulated, and is still available on the Web.

Travis Twiggs' suffering was something that really stood out to me -- perhaps because of his very willingness to speak openly about his struggles, something Marines.Just.Don't.Do.  We actually broke the news of his death on this blog, before the mainstream media had reported on it -- and in fact, the early reports were wrong on the facts but widely repeated, making the damage that much more painful.  (He and his brother were reputed to be hardened criminals, for example, which they were not, although they had been -- at the last -- involved in a carjacking, as part of their initially ill-fated but ultimately successful desire to end their lives.  In fact, Twiggs was a much-decorated Marine with multiple combat tours behind him, who had recently met the president, and whose Marines (and his family) deeply loved him.  His brother, Willard, was well-loved as well.  A year later, not a day goes by that people don't find this site out of a search they're doing for Travis or Willard; and in the days after their death, searches for Willard were almost as popular as those for Travis, though Willard was obviously shyer and less well known. And these tragedies were not the only ones the Twiggs family suffered in a very short amount of time: their beloved grandmother also passed away within days of the Twiggs' brothers' deaths. Hard, hard times for the Twiggs' family, and for all those who loved Travis and Willard.

It's hard to explain my own involvement in this saga except to say, I had a bad feeling about how Travis was really doing, without even knowing him, just based on reading what he wrote, and how it didn't seem to add up.  So the month before, without realizing he'd already been confined to an inpatient PTSD program at Bethesda Naval Hospital, and was therefore unable to answer, I repeatedly tried to get ahold of him and/or the Marine Corps Gazette, which had published his somewhat optimistic article months before.  When neither would reply, I started to really worry that something was amiss.  Then when the first news reports came out of the National Park Service about the "armed, tattooed and dangerous" Twiggs brothers, involved in a carjacking, I just knew it had to be Travis, and that things had somehow gone terribly wrong. Hoping to offset the "bad news" (and mistaken news" about who Twiggs really was -- not a lifelong criminal, but a decorated Marine, who everyone loved, who'd struggled mightily with PTSD -- I went out on a limb, and wrote, as I realized he was dying, what became a "PTSD obituary" to this at the time unknown Marine, who'd undoubtedly died from the consequences of his uncured, but not untreated PTSD.

In the days that followed, as I waited for any national attention to be focused on his case -- none was -- the blog here received heavy, heavy traffic, as those who loved Travis and his brother came to essentially pay their respects, much as I had tried to myself, and also tried to come to terms with the brothers' passing.  Over time, various reporters kicked into gear and started covering the Twiggs' story in lengthy pieces. (I had to put the "use with attribution" notice up on this blog when one reporter spent, no joke, 40 hours mining this site, without acknowledging where he got his information.  Ugh.) Richard Ruelas wrote about the saga for the Arizona Republic (the brothers had died in Arizona), Bill Finnegan's at the New Yorker magazine, and there was a two-part series in the New Orleans-based Times Picayune. CNN, to its discredit, never once mentioned the brothers' passing.  I think once they missed the initial window, it was too embarrassing to catch up, but to this day, they never have, whereas pretty much everyone else has had something to say about it -- or them.

While many, many aspects of being the one to break this story -- on a blog, not in a newspaper or a wire service -- have been exceedingly frustrating, I'll spare you my angst on that one.  The blessings have also been there -- getting to "meet" online and sometimes in person, some of the key players in the brothers' lives, and have them express their appreciation for what I did to help to humanize their brothers, while the rest of the print world was essentially doing the opposite (at least initially). I'm still concerned for how Travis' wife, now his widow, Kellee, to whom the news of Travis' whereabouts and obviously his death, came about as a shock, as well as for the Twiggs' parents, whose loss of two sons at once is just incalculable.

In the New Age-y world, people do talk about being careful about what your intention is, and how your intention will carry the day.  Without going into what "intention" means, overmuch, it can be simplified to say, whatever the vision is of an outcome, that you carry in your heart, or that you express to the world.  In this case, it was very, very clear.  Back exactly a year ago today, as Travis Twiggs and his brother were in their last moments, and time was running out, I wanted the world to NEVER FORGET who Travis Twiggs was, and what the legacy of unresolved PTSD looks like.  If ever there were a poster child for PTSD, it was Travis Twiggs.  He took the first step when he told the world his secret in that powerful, much-read article in the Marine Corps Gazette, when he broke the silence for his Marines, and the rest of OEF/OIF veterans.  What I held in my heart that day -- despite the professional disappointments that may have followed -- was that when people thought of PTSD, they would think of Travis Twiggs.  And given that his legacy is still very much alive, one year later, I do believe that intention accomplished exactly what it was supposed to.

As Twiggs himself said, he was willing to come forward and talk about what he went through, because he wanted no other soldier, sailor, airman or Marine to suffer like he had -- in silence.  With his death, and that of his brother, unfortunately for the much-beloved Twiggs brothers, but mercifully for the rest of us -- it's a conversation we will all keep having.  RIP, Travis and Willard Twiggs. You are not forgotten.

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Editor's note: The original blog entries about Travis Twiggs from a year ago are: "One Marine Reflects on His Battle with PTSD," linked here (before his death); "PTSD -- "The War Within" -- Claims Another Victim," linked here; "RIP Travis N. Twiggs, USMC PTSD Sufferer," linked here; "The Ballad of Travis Twiggs," linked here; "Travis Twiggs' Suicide - Only Questions Remain," linked here; "The PTSD Obituary for Travis Twiggs," linked here; "Bleeding Green with PTSD," linked here; "Twiggs' Wife: 'The PTSD Drove Him Crazy'," linked here; "The Tragic Last Days of Travis 'T-Bo' Twiggs," linked here; "Travis Twiggs' Widow, Kellee, Puts a Human Face on the Suffering of PTSD," linked here;and, finally, "SSgt. Travis Twiggs - Well-Loved U.S. Marine and Hurting PTSD Hero - the Update," linked here.

Domestic Violence: Personal and Family Safety Pocket Guide

The Washington state Dept. of Social and Health Services puts out these excellent pocket cards, in English and other languages, called the "Safety Plan Pocket Guide" for victims of domestic violence.  It looks like they were produced over ten years ago now, but Seattle-area businesses and medical offices still have them available, and the suggestions look current and practical.  Here they are:

Domestic Violence National toll-free hotline: 1-800-799-SAFE (7233)

Within Washington state: Domestic Violence Hotline: V/TTY: 1(800) 562-6025.

Safety Plan Pocket Guide:

PLAN AHEAD:

• Develop a plan with your children;
• Arrange to have a place to go;
• Make copies of important papers and hide them;
• Have available important phone numbers;
• Pack and hide an overnight bag;
• Put aside money and spare keys;

DURING AN INCIDENT:

• Call for help (9-1-1);
  Get out if you can;
  Bring important items listed above;

IF YOU CAN'T LEAVE THE SITUATION:

• Avoid rooms with only one exit;
• Avoid the kitchen, bathroom and garage;
• Call for help;

IN YOUR HOUSE:

• Change lock, secure doors and windows;
• Arrange to have someone come stay with you;
• Change your phone number(s);
• Obtain a protection order;
• Notify trusted friends and family;

AT THE WORKPLACE, SCHOOL AND PUBLIC AREAS:

• Inform your work, daycare and schools;
• Change your daily routine;
• Plan ahead for unexpected contact with the abuser.

Editor's note: For previous coverage of domestic violence, PTSD and combat veterans, look to this blog post, linked here, or the index of blog posts on the topic, linked here.

"Love Shouldn't Hurt": Combat Veterans, PTSD, and the Deadly Serious Topic of Domestic Violence

Domestic violence is an enormous public health problem in our society today. Domestic violence among families of combat veterans is also a significant problem -- if you take "significant" to mean, "important to those it affects." According to a fact sheet produced by the National Center for PTSD (NCPTSD), part of the VA, domestic violence is "the most frequent cause of serious injury to women, more than car accidents, muggings, and stranger rapes combined."

Among veterans, studies show that "domestic violence rates among veterans with post-traumatic stress disorder (PTSD) are higher than those of the general population. Additionally, according to studies, domestic violence rates among "active-duty military men (Heyman & Neidig, 1999), couples seeking relationship therapy (O'Leary, Vivian, & Malone, 1992), and Vietnam veterans with and without post-traumatic stress disorder (PTSD; Jordan et al., 1992) have been found to be higher than those from the general population." 

One academic paper adds, making a crucial point, "Research has yet to study couples seeking relationship therapy in which the veteran has PTSD to explore how these relationships compare with other couples. Given the elevated risk for violence among these couples due to the PTSD, the treatment-seeking behavior, and the relationship distress, couples seeking relationship therapy are an especially vulnerable population." (And of course, couples not seeking relationship therapy might be even more under-served -- it's just they can't be as easily surveyed.)

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Casey Taft, M.D., an associate professor of psychiatry at Boston University, has recently been awarded a $1.5 million grant from the Department of Defense to study this topic. From an article published by BU, announcing the grant, quoting Taft, and linked here:

"People who are exposed to trauma, and in particular those who develop PTSD, are at very high risk for aggressive behavior,” says Taft, who also works at the Boston Veterans Affairs Medical Center and the National Center for PTSD. “In one Vietnam war study, they found that among vets with PTSD, one third had engaged in physical violence against their partner in the past year. This rate was almost three time the rates they found among vets without PTSD. Since we know that current vets in Iraq and Afghanistan have been exposed to significant trauma and many of them have been on multiple deployments and they’re coming back with high rates of PTSD and other mental health issues, it would stand to reason that they would also engage in high levels of aggression and partner violence, though we don’t have the specific data to back that up.”

(Hence the study).

In the meantime, know that domestic violence can be "deadly serious."

Domestic violence is serious. Risks include death, serious physical injury, and psychological injury as well -- including PTSD and secondary PTSD. Just some of the psychological effects (often less obvious initially than the physical effects) are: depression and being at greater risk for subsequent suicide.

Again, according to the NCPTSD, "60% of battered women report depression," and "25% of suicide attempts by Caucasian women and 50% of suicide attempts by African American women" have been "preceded by abuse."

Some more sobering statistics about the magnitude of the problem:

• 20-30% of American women will be physically abused by a partner at least once in their lifetimes; 
• 30-40% of women's emergency room visits are for injuries due to domestic violence;
  
• 30% of women killed in the U.S. are killed by their husbands or boyfriends;
  
• 50% of men who assaulted their female partners also assaulted their children;
  
• 3.3 million children witness domestic violence each year.
• 1.3 million women and 834,732 men are physically assaulted by an intimate partner annually;
• 201,394 women are forcibly raped by an intimate partner annually;
• 11% of women in homosexual relationships and 23% of men in homosexual relationships report being raped, physically assaulted, and/or stalked by an intimate partner;
• 503,485 women and 185,496 men are stalked by an intimate partner annually;
• 1-25% of all pregnant women are battered during pregnancy;

What to do if you're in crisis?  There's a

National toll-free Domestic Violence hotline: 1-800-799-SAFE (7233)

There's an excellent "Fact Sheet" put out by the NCPTSD, linked here; and

There's a "safety plan pocket guide," linked here.

The NCPTSD's fact sheet, they say, provides "information regarding the definition of domestic violence, the prevalence of domestic violence, the dynamics of abusive relationships, the effects of domestic violence, treatment for victims and perpetrators, and resources offering assistance."

There are also some good resources at other websites, including FamilyOfAVet.com, linked here.

The Good Work of Elmo: Sesame Street Special Supports Military Families

In celebration of April being "Military Family Month," the venerable public television institution Sesame Street rolled out a half-hour special called "Coming Home: Military Families Cope With Change," which they consider one of their most important efforts in a 40-year history.  The show features Queen Latifah,
who mentions on the show that she was raised by a Vietnam veteran with PTSD, who later got help; plus John Mayer and Elmo.

According to press material, "This half-hour special tells stories of service members who return home with injuries, visible and invisible, and explores the heroic struggles their families face in discovering a new way of finding a new normal. It salutes the extraordinary courage and strength of these military families and offers the general public a powerful glimpse into what they often must endure. The special will air on PBS on April 1, 2009 at 8PM (check local listings)." For more information about the program, click here.  To see videos about the behind the scenes making of the special, choose either one of the following links:Behind the Scenes, I and Behind the Scenes, II.

Kudos to Sesame Street for taking on this important issue, in such a positive and accessible way.