Social Science Associates Community Education Workshop

1. Social Science Associates Community Education Workshop Coming Home to College After Deployment to Iraq and Afghanistan

2. Warning Presentation content may be disturbing or harmful to those who have experienced combat or other trauma. Feel free to leave during videos if you need a break. Mike is in a nearby room. If you feel you need to talk to someone after this workshop, please seek help or contact me (Steve Darman) at 315-868-2155.

3. Politics, language, music • This workshop is designed to reveal the experience and effects of war- not the politics of any particular war. • Language of soldiers and Marines is raw, often filled with expletives. • Music in videos- contemporary tastes of young people in the military.

4. War is hell- and more… • Understanding what happens to military men and women during deployment is crucial to understanding how they feel and think when they return home. • War experiences vary- but have similar themes.

5. War is more than “action”. • Long hours, constant fatigue, • Boredom and prolonged uncertainty, • Responsibility for the lives and well-being of others. • The worst times of your life… and the best times. • Intimacy: “You’ll never have friends like the friends you went to war with.”

6. Only veterans know the truth about war (Tick) Steve Banko, 2-tour Vietnam Vet, CNY Veterans Expo

7. There is no safe place • Video- Vietnam Vet and VA counselor • No one is safe • Trapped • Bad things happen to good people • You do what you have to do to survive and come home • …but what you have to do has profound effects

8. And it’s hard to feel safe once you’re home Video- 26 year old USC film student and Iraq vet

9. Iraq/Afghanistan & Vietnam Similar Wars • Undefined enemy • Enemy dressed as civilians • Front lines are everywhere • Shifting mission objectives • Territory taken- then given back • Initial support at home wanes- then fades to a minority of Americans • War continues with no end in sight

10. Different Wars Differences from Vietnam • Deployment length longer/stop loss • Deployment frequency 449K > 1 • Use of contractors for support • Units train, deploy, return together • Urban combat- more troop exposure • Wounded to killed ratio much higher today- more TBI (vehicles vs. ground) • Public support for US troops stronger

11. A Different Force • More professional, volunteer, older • Many more women • More small town, less urban • More Reserve and National Guard: Guard, Reserve troops often older- more have careers, spouses, children, homes, embedded in communities • Repeat, extended deployments are common- vs. 1-yr. single deployment in Vietnam. Guard units deploy for 18 mos.

12. Everyone is affected by military service and by war • Some changes are very positive and carry over to civilian life, e.g. increased maturity, discipline, new work skills and habits. • Most adjust and return to productive lives -although they may still have wounds. • Some changes are negative- leading to short and long-term problems.

13. PBS Frontline “Bad Voodoo Platoon” • Missing- the smells and sounds of war. • Killing and the death of soldiers and civilians. • What did you react to?

14. End of Part I • Short discussion • Break • Next sessions • Coming home and the effects of war • Veterans in your college

15. “Total Institution” -Goffman • Military, prisons, some rehab hospitals • All aspects of life are structured all the time (24/7) in a total institution • Your work, where you live, when you sleep, how long you sleep, who lives with you, what and when you eat, your social and sex life, what you do for recreation, your language and ideology, etc. • Challenge to go from a total institution to a semi-structured or unstructured situation.

16. Initial Return and Reentry:The “pseudo-return” • Initial relief quickly followed by anxiety (similar to the “gate fever” experience by released prisoners) • Family, intimate partner reunification is awkward and sometimes traumatic. • Normal daily activities like driving, being in public places, working are very difficult

17. The honeymoon is over • Strains develop in intimate relationships • Vets have trouble connecting and communicating with friends and family • “I need time away…” • Hero status fades. Vets told to “put it behind them”. • Attitudes toward an unpopular war affect vet’s perceptions of their war activities and the sacrifices they made

18. Trouble begins for many • Difficulty sleeping, adjusting to new schedule • Hyper-vigilance is common • Anxiety while driving leads to anger, road rage • Generalized anger- “I am pissed and have seen too much killing.” • Alcohol and other drugs used for sleep aids, to cope with intrusive thoughts • World moves too slow- some vets seek adrenaline rushes (fights, speeding) • Time to think leads to depressing thoughts related to war experiences • Difficulties relating to civilians, friends, intimate partners- no one understands…

19. A Soldiers Heart • Soldier’s Heart, Shell Shock, Battle Fatigue, Post-Vietnam Syndrome- and now… “Post Traumatic Stress Disorder” (PTSD) • PBS “ A Soldier’s Heart” (excerpt)

20. Combat Trauma:Normal reactions to abnormal circumstances “PTSD is a complex response by humans to protect themselves from a systemic or prolonged threat to their well being.” SOURCE: Paulsen and Krippner. Haunted by Combat, 2007

21. PTS symptom clusters • Intrusive: includes recurrent, incontrollable recollections of the traumatic event- and flashbacks • Avoidance: avoiding circumstances that trigger recollections or flashbacks… a protective emotional numbing that sucks the joy from life and the vitality from relationships. • Hyper-arousal: difficulty sleeping, violent outbursts, exaggerated startle response • Penny Coleman, Flashback, Beacon Press, 2006

22. War and the Soul -Tick • Ed Tick argues that PTSD is not a “mental illness” – but a disturbance of the soul that results from exposure to and involvement in actions that cross moral boundaries. • Jonathan Shay- when “themis”- or “what’s right” is violated, effects of exposure to violence are greater.

23. Prevalence Self-reported psychological symptoms 90-120 days after return from deployment • 38% of soldiers (Army) • 31% of Marines (“honor the Corps”- shorter deployments) • 49% of National Guard troops (longer deployments- different demographics- little institutionalized support) NOTE: Percentages are much higher for those with more than one deployment SOURCE:DoD Task Force on Mental Health, June 2007

24. Prevalence, continued • Of 103,788 veterans seen at VA health care facilities, 25% received mental health diagnosis(es), • 56% had 2 or more distinct diagnoses. • The youngest group of OEF/OIF veterans (age, 18-24 years) were at greatest risk for receiving mental health or PTSD diagnoses compared with veterans 40 years or older. SOURCE: Archives of Internal Medicine, March 2007

25. The effect of time • Evidence that psychological symptoms increase in the years after returning home from combat • Study of Gulf I Vets: Likelihood of PTSD > doubles for both men and women from time of return to US to two years later. Source: NE Journal of Medicine, July 2004

26. PTSD After Vietnam • Risk factors for persistent PTSD in Vietnam Vets (after return to the community) associated with: • Current emotional sustenance • Current social-structural support • Recent life events • Has implications for new group of vets Source: Journal of Trauma Stress, V5, 1992

27. Who is most at risk? Of those who met the screening criteria for a MH disorder: • Younger Vets • Less likely to be married or retired • More likely to be disabled • Reported more traumatic exposure Source: Am. Journal of Psychiatry, Dec. 1999

28. More than PTSD • PTSD associated with being injured and wounded: “polytrauma” • Major depression and anxiety • Misuse of alcohol and other drugs • Emerging evidence of family problems, domestic violence, other violence, suicidal behaviors

29. Suicide and Vietnam Vets Suicide risk is high • Estimates range from 20,000 to 200,000 Vietnam Vets • Lower-end estimate: official suicides • Higher-end: includes single-car drunk-driving deaths, drug overdoses, and self-inflicted gunshot wounds w/o a suicide note

30. Suicide and Vietnam Vets Suicide etiology is complex: • “General psychiatric disorders”- both pre and post war have a direct effect • Combine with substance abuse, family instability, and post-military PTSD • Social context matters: implications for colleges Source: American Journal of Psychiatry V152, 1995

31. Early suicide data: Bad news from CBS News • Over 6,200 vets commit suicide in 2005- 120/week (stats- 45 states) • Highest prevalence: Iraq and Afghanistan vets age 20-24 • Estimated to be 2-4 times higher than non-veterans • A growing epidemic that is likely to get much worse as time goes by

32. Traumatic Brain Injury • TBI called the signature wound of the Iraq War: • Kevlar body armor protects torso • Soldiers receive immediate care after IED blasts- more survive • Over one in five soldiers evacuated to Germany had injuries to the head, face, or neck (NEJM, 5/2005)

33. “Mild” TBI (mTBI) • Loss of consciousness- few seconds to a few minutes • Mild TBI prevalence is higher, more difficult to recognize • Recent NE Journal of Medicine study (Jan. 2008) of 2525 Iraq returnees • 5% with loss of consciousness; • 10% with altered mental state but no loss of consciousness-“dazed, confused, seeing stars”

34. Female Vets: Double Jeopardy • > 160,000 female soldiers have been deployed to Iraq and Afghanistan vs. 7,500 in Vietnam • 2003 DoD-funded report: one-third of female vets using VA healthcare said they experienced rape or attempted rape during their military service • 37% of this group said they were raped multiple times; 14% were gang-raped

35. The Family Dimension • While most of the draftees in Vietnam were young and single, "a lot of the guys who have gone to Iraq are older, married and have kids," • "Now you have a family in crisis, not just an individual in crisis." Army intelligence specialist Barker, San Jose, CA a Vietnam vet.

36. Not just our veterans… • Many students have intimate partners, siblings, friends who have gone to war

37. Helping veterans come home • Journey home to community and family can take years, even decades • More complicated than taking care of parts of a vet’s life • It’s a community issue: employers, colleges, faith-based and other community organizations all need to help our veterans come home.

38. Mid-Day Break

39. Resources for vets only: Very fragmented and complex system • Housing • Homeless services • Employment and Business capital • Education benefits • Healthcare • NOTE: Honorable or “better than dishonorable” discharge is necessary for most veteran’s programs • Period of service makes a difference

40. New crisis resources for vets • New national veteran’s suicide hotline: 1-800-273-TALK • OEF/OIF Team in Syracuse: 315-425-4400/ 425-3481 • A variety of resources for vets and families are available from the Feds at http://www.samhsa.gov/vets/ • Also: www.militarymentalhealth.org

41. Good books • Courage After Fire: Coping Strategies for Troops Returning from Iraq and Afghanistan and their families- good for vets and families • Matsakis, Aphrodite. 2007. Back From the Front: Combat Trauma, Love, and the Family • Coleman, Penny. 2006. Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War • Ed Tick. 2005. War and the Soul. Quest Books

42. Website Resources • http://www.healingcombattrauma.com/ • Resources for and about healing combat trauma. • http://www.ncptsd.va.gov/National Center for PTSD (affiliated with the Veteran’s Administration) • http://.iava.org Iraq and Afghanistan Veterans of America, (IAVA) • Best information and networking tool

43. For more information: About this presentation contact: Steve Darman, Social Science Associates 315-797-3642 socsci@dreamscape.com