By Rosemary Freitas Williams
After eight years of war, the mental wellness of today's service member and to a lesser degree, his or her military family is garnering increased attention. Whether as a national security issue or moral imperative, it is quickly becoming evident that in order to maintain a strong, mission-ready military, America must deal with the excessive stress and burden today's military and their families have endured and continue to face.
The record-setting numbers of Army suicides in 2007 and 2008 were widely reported by news media, only to be overshadowed by another record set in January of this year, when more soldiers took their own lives than were killed in combat. Since January, Army suicides are on pace to set yet another record for this year. Typical causal theories for the high rate of suicides range from combat stress to trouble at home.
The response to the suicide rate from both the Army and Congress has been strong, yet not well-coordinated.
In addition to a number of congressional hearings, the Army has commissioned a $50million study with partners such as the National Institute of Mental Health and experts from academia to better understand what brought on this increase. The Army has also mandated all 1.1 million of its soldiers participate in emotional resiliency training that begins in October. Unfortunately, because of the lack of research available, the training will be modeled after the best available practices based on techniques proven effective in middle schools, certainly modified to be appropriate for soldiers -- both in terms of age and also related to the issues they are dealing with that are of course quite different from middle school children.
The shockingly high rate of suicide is not a problem that ends with America's service members. The intense pace of military operations has held steady for almost eight years, putting extraordinary pressure on not just the 2.2 million service members but also their families which include over two million children. News of a possible delay in drawing down the number of troops in Iraq, along with a situation in Afghanistan that Chairman of the Joint Chiefs of Staff Admiral Mullen has termed "deteriorating," forecast a continued difficult path for the military and their families.
For a nation that has been at war since 2001, there are few studies on the effects multiple wartime deployments have on military spouses and their children. The Journal of Developmental & Behavioral Pediatrics (JDBP) published a longitudinal study last month by four doctors that examines the social and mental well being of 101 school-aged military children during deployment, and is the first study of its kind since 9-11 and the beginning of Operation Enduring Freedom in 2001. The study concludes that stress on military children is more than double national averages of the general public, and that one-half of military children are at "high risk" for psychological and/or behavioral problems.
Multiple deployments are frequently labeled as the single greatest cause of increased levels of anxiety, depression and aggression in the affected military children. Surprisingly, instead of being directly affected by the multiple deployments, or by the threat of injury of death of the deployed parent, the JDBP study cites the mental state of the remaining parent as the single most influential factor in determining how well a child adjusts. This relationship between the stress of parenting and children's behavioral issues is consistent with studies done with the general public regarding the parent - child relationship.
The word "caregiver" in the phrase, "stress of the caregiver" is taking on a new definition - today's non-deployed military spouse.
For some non-deployed spouses, the stresses of this high OpTempo are too much to handle. A 40 year old Army wife at Ft. Bragg, North Carolina who was four months pregnant was found dead with what appeared to be a self-inflicted gunshot wound. The woman had called 911 with threats of hurting herself but the police arrived too late. Her husband is an Army Sergeant who worked in Civil Affairs and had deployed multiple times.
The news of this death incited a surge of email traffic among the leadership of Blue Star Families, a non-profit, non-partisan group of military spouses who work to promote awareness of the myriad issues facing today's military families. The majority of the Blue Star Families members are veterans of three, four and five deployments and at least one member has endured eight deployments in the past seven years. Many of the members expressed surprise at the age of the victim - that a woman 40 years old would have the coping skills necessary to seek help before taking her own life. Sadly, the suicide of this Army wife was not an isolated incident.
While statistics on depression and mental wellness among military spouses are not available, anecdotally, the typical wife of a junior enlisted service member, whose ranks make up almost 44% of our active duty military, is 19 to 22 years old. Many of these spouses have very young children, are far removed from extended family, are on a limited and usually single income (approximately $1500 per month for a family of four), and few have the coping skills that come with age and experience.
Mental health experts remind us that depression knows no boundaries - not age or income level, and is certainly not limited to the junior or enlisted ranks. A few members of the Blue Star Families leadership admitted to being treated for depression. One spouse of a senior NCO in Special Forces said that the combination of her husband's three recent tours to the dangerous Helmand Province of Afghanistan and the stress of taking care of two young children led her to deep despair, thoughts of suicide and hopelessness and, eventually, to a depression diagnosis and a prescription for anti-depressants.
The stressful conditions of running a household while a spouse is serving in combat operations are not new. In fact, military spouses have dealt with the same stressors since our military first sent its soldiers overseas. What has changed is the availability of news and information brought on by globalization and the information revolution. One member of Blue Star Families described how military spouses get addicted to the news cycle during deployments, despite knowing the information could upset them and increase their level of stress. The internet allows today's military family access to every bit of reporting on the area where their soldier, Marine, airman or sailor is deployed. The constant availability of this information can so preoccupy a spouse that the remaining requirements of raising children, working, and paying bills can suffer or become marginalized.
Unlike the military, spouses are not trained to detect symptoms of depression, burn-out or what another generation called "combat fatigue" - either in themselves or in each other. Secondary post traumatic stress disorder (PTSD) is a term that is beginning to reemerge, a mental health issue that has been lurking around this country since at least the conflict in Vietnam.
Secondary PTSD occurs when the non-deploying spouse and/or family member responds to their changed environment or the stress experienced by their soldier with symptoms of primary PTSD, such as anger, nightmares, and flashbacks, often resulting in many of the same difficulties, such as substance abuse or violence, that are commonly observed in those who directly experience the stressor.
Programs designed to help military families are available across the country and in every service, including a push for more mental health counselors on bases. There are also a number of civilian-military partnerships beginning to take hold, such as The Citizen Soldier Support Program in North Carolina and Give an Hour, a program through which mental health professionals give an hour of their time to provide critical mental health counseling to service members and their families.
There are teams of Military Family Life Consultants funded by the Department of Defense who are available to all services and they provide counseling to service members and their families, without chain of command notification or paperwork. When the Army begins its intensive emotional resiliency training in October, families are invited. These programs are all positive steps in addressing this issue which threatens the bedrock of our deployed military--the families. Most existing programs focus on identification and treatment after the fact. What is needed is a set of tools and programs to prevent stress disorder for the family before they happen.
The doctors who conducted the study in JPBP recommend a study that spans the entire deployment cycle; pre-deployment, deployment and reintegration, to more fully understand the impact of deployment on the military child.
Marine Colonel Drew Doolin, a Fellow at the Brookings Institution thinks the same way. After conducting extensive research into the mental health crisis of America's veterans, Doolin recommended an "optimal combat operational stress control program" that also focuses on the three phases of the deployment process and adds that the study "must include families." Until a whole family approach is taken to understand the full scope and impact of secondary PTSD, it will remain a problem that will undercut force readiness.
In addressing the importance of the family, the U.S. Navy says, "enlist the sailor, retain the family." It is time to close the loop on mental health and our military families. In lieu of a patchwork of separate studies of the potentially harmful effects of repeated long term deployments, a longitudinal study that examines each member of the military family over the three phases of deployment answer a single objective - to keep service members and their families at home, mission ready. Now more than ever, studying the mental wellness of the entire military family is critical.
Rosemary Freitas Williams is Co-director of Communications for Blue Star Families,a 5013c non-profit, non-partisan group of military families that covers 70 bases around the country. She was Executive Producer of MSNBC directing news coverage of Washington, DC and politics from 1996 to 2002. During that time she was awarded a National EMMY for Team Reporting on the attacks of September 11th. She was a National Air War College Fellow in 2001 and is the author of the recently released, Maritime Annapolis - A History of Watermen, Sail & Midshipmen (The History Press).