The V.A.'s answer to the treatment of PTSD 30 years after the Viet Nam War is the same as the response given to concerns raised at Walter Reed Hospital in early 2007.  In their own words, they admit, "There is much that is unknown about how soldiers adjust to the enormous demands in these new war zones."
--"The Proper Care of the Returning American War Veteran," Part II, Dr. Theophilus Green

This is the crux of the problem faced by all troops and their families who face multiple deployments to the ongoing (endless) wars in Iraq and Afghanistan, and that is that military families have never had to face anything like this, and consequently, nobody really knows what the toll is going to be, both psychological and physical, on these soldiers and Marines and their families, nor does the psychiatric community really have any idea how to treat the stress associated with repeated deployments, extended deployments, and deployments that expose the combat troops to DAILY hypervigilance and fear of death or mutilation--not just 24 hours a day, seven days a week--but months and months and months on end.

And although combat troops face the brunt of it, even non-combat support troops find themselves thrust into all sorts of violent situations, due to suicide bombers, mortar attacks, and harrowing cross-country travel, whether by vehicle or helicopter.

Female troops, for instance, who are technically not supposed to be deployed in combat situations, nevertheless man 50-cal machine guns on top of Humvees and encounter numerous IED, rocket-propelled grenade, and small-arms attacks while out on supply convoys.  They have performed many heroic acts, and have served bravely in combat alongside their brothers.  They also have to deal with the same post traumatic stress--even worse, in some cases, because 30% report having to handle serious sexual harrassment and even rape from the very men who are supposed to be watching their backs.

You're not even spared if you join the Navy or Air Force.  The American military is stretched so ridiculously thin by the demands of its commander-in-chief that they are now routinely using airmen and sailors to drive supply convoys and guard various sites.  These men and women literally have to undergo special combat training to prepare them for a job they never expected when they enlisted.

As retired general William Odom points out:

No U.S. forces have ever been compelled to stay in sustained combat conditions for as long as the Army units have in Iraq.  In World War II, soldiers were considered combat-exhausted after about 180 days in the line.  They were withdrawn for rest periods.  Moreover, for weeks at a time, large sectors of the front were quiet, giving them time for both physical and psychological rehabilitation.  During some periods of the Korean War, units had to fight steadily for fairly long periods but not for a year at a time.  In Vietnam, tours were one year in length, and combat was intermittent with significant break periods.
--Lt. Gen. William Odom (ret), writing for Neiman Watchdog, July 7, 2007

There are no "front lines" in this war, and I want to scream whenever I hear TV commentators use that term.  The whole damn country is on fire, and our troops are getting their feet burned no matter where they stand.

That isn't the only thing that makes this war different. 

Modern technology has changed everything.

When my brother was deployed to Vietnam, my college roommate was his girlfriend, and now, his wife.  He wrote her pretty much every day, and she did so to him as well.   And it usually took two weeks for their letters to arrive.  Sometimes, there would be a backlog.  She would get a letter from him stating that he had not heard from her in over a month, and she would freak out, and then she'd get a letter saying he got seven letters in one day or something.

Once, and I do mean, ONCE, he stood in line for hours and hours in order to place one three-minute phone call to her, and it had to be set up weeks in advance so that she could be there to take the call.  I took a snapshot of her face when she answered the phone
and have it to this day, in an old scrapbook.

Now, troops that are stationed on some of the gigantic American bases scattered throughout the country, can call home virtually every day, or at least, exchange e-mails.  Some can even communicate via webcams and see their family's faces even as their families see theirs.  Some keep blogs or visit their families on MySpace and so on--though I don't know how much anymore with the new army censorship rules in place.

Combat troops like my son's Marine Corps unit, do not have Internet access, for the most part.  They are out on patrol for ten days or two weeks at a time.  They don't have access to showers or hot meals, much less webcams, although they sometimes cart around a platoon satellite phone that they pass back and forth every now and then, checking in on families.  Then, they'll go in for a 24-hour rest.  They'll get a shower and hot meal and wait in line for the phone, and they'll have a half-hour.  That half-hour has to be split between dear old mom and hot young girlfriend or wife and kids, and time constraints prevent long lazy chats or even serious conversations about much of anything.

But this technological umbilical cord between deployed troops in a war and their families back home is a two-edged sword.

On the one hand, they are a blessing beyond measure.  Hearing that weary voice, knowing he or she is all right, at least in that precious moment in time, having the chance to say I LOVE YOU and Honey, I'm praying for you, please take care--is a gift I for one would never trade.

On the other hand, this younger generation is closer to their parents than previous generations, more used to discussing all kinds of things with them.  And, in many cases, that includes the horrors of war.

Parents sometimes sit in horrified silence and listen to their cherished child tell them about the bomb that took the life of their best buddy, or the close call that nearly killed them, or the battle they thought they might not survive.  They hear, in that child's voice, the grief and the exhaustion and the edgy fear, and they have to live with that when the phone call is over.

Not all troops feel as if they can talk to anyone on such intimate terms back home, and I thank God for those parents who have provided such a safe place for their loved one to fall--and I'm including spouses, of course. 

I know that when Dustin would take me into his confidence, I felt as if a great honor had been bestoyed upon me, a sacred trust, and I did my best to respect it.  I will always treasure that he trusted me with such a sad burden, even though, in the end, he must always carry it alone.

But previous generations did not have to have a war's terrible emotional costs delivered into their homes through the worn-out voices of their loved ones, or the rambling mis-spelled exhausted e-mail that comes into their computers. 

So not only do they have no one older and wiser who can give them any sorts of suggestions for how to deal with this, but they don't know anybody else who knows, either. 

This country was at peace for an entire generation.  Many families have no one who has served in the military since World War II.  People can find themselves at work or at a social gathering and they are the ONLY ONES who have a loved one deployed in this war.

Less than one-percent of our population is shouldering the burden of fighting this war, and they are being asked to make the same sacrifices over and over and over again while no one else--NO ONE--is being asked to sacrifice ANYTHING.

The president seems to think that watching the evening news constitutes "sacrifice" on the parts of the American people.

It doesn't.

And even if it did...what's one two-minute story every couple of days when all you have to do is hit the remote control and move on to something entertaining?

No, the only ones sacrificing are military families, and not all of them live near a base, which means, they are alone.  They must carry this burden alone.

There is absolutely no question that family members of deployed troops in this endless and immediate-access horror of a war suffer a post traumatic stress of their own every bit as tough to deal with in its own way as what their loved ones encounter, although, of course, it is different.  We are not dodging death all day or pulling body parts of our best friends out of burning vehicles, but we may be listening to our children who had to.

And then what do we do?

I strongly urge all military families to visit amazon.com and look up Dr. Theophilus Green.  He has written a landmark, five-part study on just this subject.  You can buy each individual part for 49 cents.

That's right.  It's not a mis-print.

This decorated combat veteran and practicing psychologist of 30 years (now retired), offers this unparalleled discussion for 50 cents a pop.  It only takes a few quick clicks to order it, and the entire thing is available online.  You can click right on the "media library" section of your order, and up it comes, in readily printable form.  You can pay your half-dollar and be reading it in less than five minutes.

The section I'm using today, "The Proper Care of the Returning War Veteran, Part II: War and Its Effects on Emotions" is available at the following link:

http://amazon.com/gp/product/B000Q66J7Q/ref=dp_bib_1/002-7626408-7384064

There is a Part V (this is Part II) that I will draw on for a future post.

Although Dr. Green rambles a bit at the end and gets off the subject and onto illegal immigration (never thought I'd say this, but sometimes editors DO have their place)--the majority of the piece is an outstanding commentary on the emotional effect of war not just on the troops but on their families.

He points out that not only is the psychological community unprepared to deal with this, but the VETERAN'S psychological community also is, for the one simple reason that NONE OF THE RANKING SHRINKS WHO SERVE ON THE NATIONAL BOARD OF POST TRAUMATIC STRESS AND ON THE VETERAN'S ADMINISTRATION PTSD SERVICES HAS MILITARY EXPERIENCE.

That's right.  Not just that they don't have COMBAT experience, but that they don't have MILITARY experience.

He says the the psychiatric field tends to think of the depression associated with PTSD to be a disability.  His point is that, if you live with a hypervigilant fear of getting killed or maimed day in and day out for months on end, come home briefly to train for more combat, and have to go do it all over again...then if you are depressed or angry or fearful or anxious, BY GOD YOU HAVE A RIGHT TO BE!

It is, in fact, NORMAL for returning vets and their families to experience such problems.

Prescribing drugs and then cutting loose the veteran is another thing that is often done, but is ineffective if they have no one to talk to about their experiences.  In the same token, having to talk to say, an Indian or Pakistani shrink who works for the VA and barely speaks English and who has no idea what you've been through is not very helpful EITHER.

He says we have to look at the traumas of war in a way most of us can understand it:  like the THE GRIEVING PROCESS:

A soldier who goes from battle to battle cannot take time emotionally to mourn the dead or express his feelings.  The emotions build up like interest on a bank account.  Those emotions, while not expressed at the time, are never lost or discarded.  When the soldier gets his first prolonged period of tranquility, the grieving begins to flow, sometimes uncontrollably, whether wanted or not.
--ibid

Our guys--as I refer to ALL troops, both men and women--will be experiencing the entire range of grief, from rage to depression, and they may also feel conflicted.  It could be they left for war all gung-ho for the cause, completely trusting their president and leaders to know what they were doing.  But what they saw on the ground and what they heard people like Donald Rumsfeld say on-camera did not match up, and they may come home embittered, frustrated, disillusioned.  This, too, is normal.

Another problem with this connection between troops in combat and families--Dr. Green also discusses this--is that when we do have a chance to talk to each other, we will each be very concerned with the welfare of the other. 

Our guys who are living in hell may only want to check and make sure the aging family dog is well, or that grandma is doing okay after her surgery.  They may be more interested in what their kids are doing in school than talking about what they're going through.

I find that many young spouses these days sometimes seem to forget that their husband or wife is not simply away on a business trip.  They will unload all kinds of problems during those phone calls, from car trouble to bounced checks to misbehaving children. 

Sometimes they will even quarrel with their loved one over the phone.

Those young spouses are going through hell of their own, and their responsibilities are grave indeed.  I know it gets hard and they get frustrated and exhausted, but they need to remember that these kinds of distractions can sometimes be deadly to the troop who is deployed. 

It depends upon his or her situation.  Sometimes the soldier or Marine wants to feel as if their input is still important and that they are still having an influence over their families. 

They want to feel needed.

But many times they are in such a harrowing situation that they can't be distracted by problems over which they have no control and then be sent out on patrol as if it's another day at the office.  We have to keep that in mind when talking to them, even though some of those conversations sound as if they're only in the next room.

They're not.  They are at war.

They are at war.

They are at war.

We must never forget that when talking to them.  A phone conversation with our deployed troop is NOT the time to pick a fight, even if they seem angry and combative or in a foul mood.  Of course they are angry--you have no idea the frustrations they are dealing with.  Don't take their provocative remarks as a personal assault on YOU.  It isn't. 

Just be glad they have a safe place to vent.  Know that when they can, they will call back and apologize.  And that's okay, too.

I used to save up funny stories.  Stuff I heard somewhere, gossip, whatever.  My goal was to make my son laugh at least once before he hung up.  Sometimes, when he was in a bad mood, I could even get him to laugh about it.  His sweet and lovely girlfriend, Janna, was especially gifted at that.  He always felt better after talking to her, and I will always be grateful for that.

Another thing family members need to keep in mind, as pointed out by Dr. Green, is that during leaves home, either mid-deployment for army or post-deployment for all the branches, our guys are undergoing a culture shock, not just from war to civilian life, but as Dr. Green calls it, "Family Shock."

One day they're dodging bombs and sniper fire and a relatively short time later, are home listening to the kids squabble or fending off their obnoxious uncle who drinks too much and talks too much or whatever.

Well-meaning families often throw big parties for their guys, not understanding that large crowds--even of loved ones--make the returning combat vet very nervous.  Small gatherings, intimate dinner parties with a few close friends or relatives are much easier to handle for the combat vet and will help them relax in a much better way.

Families eager to invite all the cousins and aunts and others over for big reunions need to be told this and made to understand.  Let them know that the combat vet will make the rounds and visit each family during his or her leave, but that one big huge gathering is a bit overwhelming just yet. 

If it pisses somebody off, does it really matter?

I mean, REALLY?

I've been all over the map with this post, and I'm sorry.  Sometimes I've jumped from how to act when they're deployed to what to do when they get back.  I'm sorry if I've rambled, but many military families like to read this, and some have loved ones deployed, some have loved ones about to deploy, some have loved ones soon to return.  I try to hit all the bases.

I want to conclude this particulary installment of How to Send a Child to War Without Cracking Up by emphasizing the single BEST idea I have ever had, ever seen, or ever read about for helping your loved one cope with combat.

It is very, very simple, and very inexpensive.

Before they leave, or when they are over there, give them a gift:  a small, sturdy, spiral-bound journal.

That's right.  The old-fashioned kind you actually write in.

I recommend the kind with sturdy cardboard covers; about 5 by 7 is a good size.  Compact, easy to pack and carry around.  Durable.  Handsome leather will just get filthy and sweaty--pick something that will hold up to being carried around in a pocket or rucksack in a place where sand is EVERYWHERE.

Most young people nowadays rely on the Internet for their journaling.  They call in blogging, but journaling is what it is.  But most combat soldiers and Marines don't have access to a blog, and if they do, the new opsec rules have pretty much shut that down.

It does not matter if your child likes to write or not.  I suggest an unlined journal.  They can draw in it, or jot down poems or thoughts.  Encourage them to write in that journal in their down time, whenever they can.

My son kept one through two deployments, one for each deployment.  He has a degree in psychology, and he says it was perfect for helping him process the titanic emotions he was dealing with, both good and bad.

Other troops he knew, who buried themselves in video games when they had down time, preferred not to think at all.  And these were the ones who drank too much when they got back, and who got into barroom brawls and domestic disputes that sometimes turned violent.

There have been genuine psychological controlled studies on the subject of journaling, asking one group to journal while going through crises and one group not to.  The group that actually took a pen in hand and wrote down what they were dealing with were far more well-adjusted than those who did not.

Dr. Green even mentions journaling as a far better way for a combat soldier or Marine to deal with the stress of battle than even support groups, which he scornfully derides as "gossip."

A journal can also be a record that loved one can take out and read through the years, maybe share with loved ones--an indisputable, powerful record of the most exhilerating and terrifying experience of his or her life.

A record that says:  I stepped up.  I did my part.  And I'm damn proud of it.

Unlike blogging, they don't have to worry about opsec rules.  And if they don't take time while deployed to write in their journal, they might do it when they return.  They might find it an invaluable way to cope with the emotional rip tide washing over them on a daily basis.

I would also suggest that we as parents and spouses also journal, or find some way to write down what we are going through as well.  It will help us all deal with a situation for which there is no roadmap, no rule book, no self-help book, and no way out.

We can pour out our hearts on the page or computer screen (be careful blogging; always remember that anything you write online could wind up in places you don't want it to go and be seen by people you never imagined would see it.  If you are a typer and not a scrawler, you might do it offline, in a Word document.)

In any event, we can use the written word to help us cope.  We can seek each other out on places like Blue Inkblots and military parent support groups.  We can accept that these tumultuous emotions are NORMAL and TO BE EXPECTED. 

And in the end, we can take it one day at a time.