Home > Public Resources > Trauma Blog > 2016 - February > Military Matters: For Veterans and Family: On Combat Exposure: A Psycho-educational Brochure Military Matters: For Veterans and Family: On Combat Exposure: A Psycho-educational Brochure Howard Lipke, PhD February 2, 2016 The brochure For War Veterans & Family: On Combat Exposure was written in late 2008 for veterans and their family members who were connected to the Stress Disorder Treatment Unit (SDTU) at what was then the North Chicago VA Medical Center (now Captain James A. Lovell Federal Health Care Center). Although there were many educational materials available on the psychological effects of combat, these mostly focused on describing PTSD symptoms, attempting to normalize them, and encouraging treatment. These certainly met a need; however, their focus on diagnosis and symptoms failed to address essential issues that would help to clarify a reasonable understanding of how the effects of combat-related stress might occur, and what paths might lead toward ameliorating the destructive effects. The standard approach in these materials also did not answer many of the initial questions that had arisen over the years from veterans and family members. In an effort to meet these needs, work began on the brochure. As was the process with many of the clinical materials developed for the SDTU, after a first draft was completed by staff it was presented to groups consisting of residents and some alumni outpatients of the SDTU program. Their feedback was incorporated into subsequent drafts. This process continued until there were two consecutive groups who found no objections to the material. The brochure was then made available to veterans and family members in its completed form. Since the original edition of this brochure some minor stylistic and grammatical improvements were made to produce the version included below. The brochure continues to be used at Lovell FHCC and is available free of charge in the form of a handout-ready flyer, here. The text of the brochure is reproduced below and is freely available for use and distribution within the public domain. For War Veterans and Family: On Combat Exposure 3rd Edition, Revised, January 12, 2016 This brochure is a brief statement on behalf of combat veterans and their families. When people go to war, the warrior and the family may experience fear, pride, hope, anger, love and sadness. They may also block out many thoughts and feelings. People show their emotions at different times, and in different ways. Everyone has emotions even if they are hidden and expressed differently. It can be helpful to understand that anger and numbness are ways people protect the self from the pain of some memories. Counseling can benefit people as they work to mentally process the impact of war. In counseling, there is some talk and some listening. When it goes well the counselor learns about the life experiences of the client, and client learns things to help the aftermath of war be less destructive. There are exercises to help embrace the spiritual or philosophical knowledge of the client and help create an acceptable level of peace with traumatic experiences. There are a variety of different counseling methods that can be helpful. Ask a prospective counselor about his or her experiences and approaches to counseling. Discuss the options and decide what to do. The vast majority of veterans and family members are pleased they gave counseling a try. COMBAT HABITS Combat training, preparation, and experience powerfully change a person. Changes that may improve survival odds in combat can be destructive to life outside of combat. One aspect of military training often results in people learning to block emotions, such as sadness and fear with “numbness” so they can stay alive and help their buddies survive. Sometimes anger or rage is used to block normal human reactions of fear/worry and sadness/grief. The life-saving numbness and anger can become habits and carry over to family, work and social life, sometimes without any awareness that the emotional blocking is occurring. Destructive Anger is the number one reason veterans come for help. It cannot be emphasized enough that destructive anger functions to block current and/or flashback fear and sadness. It often comes out before the veteran is aware that sadness or fear was there. If people permit themselves to tolerate fear and sadness, and use them as guides to understanding and protective action, the destructive anger is decreased. Sometimes people discover this on their own, but it is one area where counseling is strongly recommended. COMBAT MEMORIES These are not behaviors like blowing up with anger, or shutting family and friends out, but rather things from the past that come to mind in dreams or waking “flashbacks”. They are most often feelings or pictures, but can be words or even smells. These may or may not have combat behaviors attached to them. The best explanation for these reactions is that the memories of the events get stuck in a part of the brain where they are supposed to pass through on the way to being stored as our history. So, when something reminds us of a traumatic event, it feels like it is currently happening, not like something from the past. Sometimes these reactions start right away and sometimes they are delayed months, or even years. When the reactions don’t diminish on their own, some kinds of therapy can help so that when we do remember the events, they are remembered as an important part of our past, not like something happening right now. It is important to emphasize that what is described above are normal reactions people have from combat. THE OTHER SIDE OF COMBAT Along with the pain, combat situations can create emotional bonds, excitement, and a sense of accomplishment that is difficult to find in civilian life. The reality of this emotional connection to the combat experience and fellow warriors must be acknowledged. Likewise, families also undergo significant changes during the time of separation from their veteran. They had to make new connections and learn new skills. They may have positive feelings for having succeeded. These feelings also must be acknowledged. When families unite around life experiences, both positive and painful, from the separation and the rejoining, there is a chance for more meaningful time together in this world. It is true that the pre-combat family problems may not be evident on initial homecoming, and then return after the initial burst of relief. But, it is at least equally true that deeper understanding can develop, with time and work, to bring relationships to a new more positive level. Common Questions and Concerns Q: How do you decide whether or not to ask a veteran about combat experience? A: This depends on your relationship with the veteran, signals the veteran gives about wanting to talk, and the ability to tolerate the possible pain of what might be told. Q: How does a veteran talk about combat experience? A: The first decision is whether or not to share. It is not required. Naming the emotions you feel, or felt, and telling limited details is one option. If you are still judging yourself in destructive ways, it may be difficult to tolerate even supportive responses. Q: How do veterans and/or family members tell each other they need help? A: One general principle is to share your fears, and concerns for yourself, the family, and the other person. There are risks to both sharing and not sharing concerns. Q: What do you do when a combat veteran is lost in their war experience (flashback)? A: This kind of response is usually the result of some reminder, a sight, or sound, etc. which triggers fear, and a reliving experience. Sometimes it is best to back off. Sometimes it is helpful to gently try to bring the person back to you in the present. Do not confront anger, or do anything that might increase danger. Touching can lead to an unpredictable response. Speak gently, call their name, or say other words to remind them of the immediate reality. Sometimes it is best to call for help. Also, waking a veteran can create a startle response, and the disorientation of going from sleep to waking makes it important to keep some distance. It is important for vets and family to discuss how to safely wake the veteran.. Q: What do you do when a veteran or a family member is destructively using alcohol, drugs, gambling, or other risky behavior? A: Call a VA Medical Center or VA Readjustment Counseling Center (Vet Center) and explain the concern,. Non-veterans may also get referrals to the VA if eligible, or community resources if not. What Not to Say Avoid the statement, “Why can’t you just put this behind you?” Veterans probably don’t know the answer to the question, and may be beating themselves up by calling themselves “crazy” or “weak” for not being able to leave the war in the past. They often have in mind the example of another veteran they perceive to be untroubled (who may or may not be), which makes things even worse. In fact, as discussed in other parts of this pamphlet, the “crazy” thoughts and behavior are normal responses. Research shows the more you condemn yourself for having the post-trauma effects, such as nightmares and flashbacks, and fail to recognize they are normal and responsive to time and counseling, the longer they stay around. The more you invest in name calling, the less mental energy you have to use toward accomplishing your goals. This brochure was written by Howard Lipke, PhD with the assistance of Neysa Etienne, PsyD and veterans and staff from the North Chicago VA Medical Center (now Captain James A. Lovell Federal Health Care Center). About the Author Howard Lipke, PhD, has worked with combat veterans in U.S. VA medical centers since in 1972, when he was a VA psychology trainee. Since retiring from the VA in 2009 he has continued this work in a variety of ways in a part time clinical and consulting practice. He has been a member of ISTSS since 1989.