Understanding deployment & homecoming: What civilians may not know & what veterans may not say

1. John Mundt, Ph.D. drjohnmundt@hotmail.com www.drjohnmundt.com Understanding deployment& homecoming:What civilians may not know &what veterans may not say

2. “VETERAN” • “Combat” or “non-combat” distinction • Character of military discharge • Active duty vs Reservist vs National Guard • “Disabled vet”

3. DEFINITIONS: “OEF/ OIF” • OEF: “Operation Enduring Freedom” • OIF: “Operation Iraqi Freedom” • OND: “Operation New Dawn” • GWOT: “Global War on Terror”

4. OEF/OIF Historical Timeline • 1991: Operation Desert Storm • 1991-2001: Enforcement of “No Fly Zones” • 9/11/2001: Terrorist attacks on US • 10/7/2001: Operation Enduring Freedom (ground combat troops increase in 2002) • 3/20/2003: Operation Iraqi Freedom • 8/31/2010: End of combat operations in Iraq (Operation New Dawn) • 12/2011: Withdrawal of “last U.S. troops” (Iraq) • 9/2012: Draw-down in US troops in Afghanistan • 2013……?

5. Basic statistics • 2 million troops deployed to Iraq or Afghanistan as of 10/1/2009 (Marine Corps Times) • 4486 US military killed in Iraq as of 9/1/2012 • 2106 US killed in Afghanistan as of 9/1/2012 • 47,000+ US military wounded as of 9/1/2012 • Iraqi war dead: estimates range from 53,000 to 655,000 • 1% of US population is directly touched by military service

6. DEMOGRAPHICS: Who are the OEF/OIF veterans? • “OEF/OIF” veterans • All-volunteer military • Many did not expect deployment • Multiple deployments the norm • Service branches • Gender • Age • Reservists

7. PTSD in Warzone Veterans COMBATPTSD

8. Prevalence of mental health problemsin returning veterans: • Problems with estimating • PTSD manifests months/years after trauma • Diagnostic issues: “PTSD” specifically versus other psychiatric disorders • Addiction as mask

9. The OEF/OIF Experience Soldier’s experience in Iraq & Afghanistan Most vets have been in a firefight Most have seen friends/buddies wounded or killed violently Most have handled human remains

10. The OEF/OIF Experience Pervasiveness: relentless threat/ need for readiness -no “rear” (contrast with Vietnam) -helmets on all the time -may alternate with periods of boredom Persistent hyperarousal, sleep deprivation

11. The OEF/OIF Experience Fear/ Terror

12. The OEF/OIF Experience Indirect threats: as opposed to direct assault/attack -IEDs, car bombs - RPGs, snipers -suicide bombings

13. The OEF/OIF Experience “Crowd control”: Ambiguity and uncertainty

14. The OEF/OIF Experience Powerlessness: threat is indiscriminate -not dependent upon skill or mastery (relationship between loss of control and PTSD)

15. The OEF/OIF Experience Ambient factors: IRAQ Desert climate: temperature Sand, grit, dust Wildlife

16. The OEF/OIF Experience Ambient stressors: AFGHANISTAN Terrain: mountainous, rugged, caves Weather: cold, snow, mud

17. The OEF/OIF Experience This generation’s war: 1st “Internet War” (Vietnam was TV war) Blogs, email, cell phones (cameras), 24hr news sites New versions of “Dear John” letter Home trouble as a leading stressor Reservists: repeated, unpredictable separations from family/job

18. Other Military Experiences & PTSD MILITARY SEXUAL TRAUMA (MST): 1995 DoD study over a one-year period: * Sexual Harassment reported by 78% of women, 38% of men *Sexual Assault reported by 6% of women, 1% of men • Reported sexual assaults in military: 1700 in 2004 2947 in 2006 3230 in 2009

19. Other Military Experiences & PTSD MILITARY SEXUAL TRAUMA (MST): VA estimates vary, but are generally higher than military’s: 1 in 4female veterans utilizing VA report at least one sexual assault Day Hospital Program: estimate 3/5 female referrals have MST

20. Other Military Experiences & PTSD MILITARY SEXUAL TRAUMA (MST): Treatment considerations May be compounded by combat trauma Frequently unreported: trauma occurs in context of where the soldier lives/works military culture emphasizes cohesion occurs in civilian contractors as well as military Male victims as well as female; female perpetrators as well as male Heavily male environment in VA

21. Other Military Experiences & PTSD Non-combat PTSD in military populations: Relief and “peacekeeping” operations Military training experiences Aircraft carriers

22. Homecoming Concept of HOMECOMING: Can be end of deployment AND end of military career (serviceperson becomes a “veteran”) Can be emotionally confusing and psychologically complex

23. Homecoming Onset of psychological symptoms: anxiety, panic attacks, “flashbacks” HYPERVIGILANCE: well-learned and engrained Change of roles: boredom, loss of power, “need for speed”

24. Homecoming Feelings of alienation Surreal nature of return to civilian society Grief and bereavement Anger

25. “Self-medication” • Anxiety and hypervigilance • Insomnia • Depression • Anger and volatility

26. CHRONIC PAIN Intractable pain as a chronic stressor Physical demands of military deployment: “Battle rattle” Headaches: PTSD versus TBI versus other medical basis Orthopedic, neurological, psychosomatic Medication of “pain”: physical versus emotional

27. Work and school: Cultural challenges Cultural challenges: • “1 per-centers”, political discussions, civilian griping • standing out as a vet: being thanked or questioned

28. Work and school: Cultural challenges • Challenge of hypervigilance: seating, crowds, workplace, classroom • TBI, tinnitus and hearing problems • Balancing medical care with other obligations

29. www.drjohnmundt.com drjohnmundt@hotmail.com