The P.E.R.C.V.D Principles
by
Edward Crenshaw
SMASHWORDS EDITION
* * * * *
PUBLISHED BY:
Steeltown Publishing
The P.E.R.C.V.D Principles
Copyright © 2011 by Edward Crenshaw and Steeltown Publishing
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Learn more about Edward Crenshaw at the P.E.R.C.V.D Principles at:
THE P.E.R.C.E.V.D PRINCIPLES:
Preparing Employers to Reintegrate Combat
Exposed Veterans with Disabilities
From camouflage to pinstripes—a provocative look at the culture, conditions and challenges of transitioning Veterans and people with disabilities in the modern-day workplace.
This book provides a practical guide for employers and collegiate institutions towards raising diversity awareness. It also illustrates how best practice HR strategies, proactive intervention programs, support and innovative workplace accommodations can reinforce the business case for hiring, retaining and optimizing the potential of transitioning Veterans and people with various hidden, physical and combat-related disabilities.
This book is dedicated to…
All of the outstanding and brave Veterans who
protect the freedoms that we enjoy in our beloved
country, along with their families;
All of those who cared, shared, and broke bread with me
during the less than convenient times; and,
My incredible family, co-workers, and network of
dear friends, for all of your inspiration, unwavering encouragement, and steadfast support—
you mean the world to me.
Acknowledgments
Many acknowledgments and sincere thanks go out to:
Family: (The late) Eddie and Nina Crenshaw, Gwen, Zena, Sylvia, Betty and Ernest. Nina Crenshaw, Tayleur Brown-Crenshaw, and Skye Robinson-Dunbar. Gordon, Gregory, Jacquice, Monique, Joe, Shan, Ernest, and Jeremy. Xavier, Jeremy, Allen, and Trystin. Margie (Sister) Perry, Ken Goodwin, Herb, and the entire Moore family. The late (Pam Crenshaw) all of my dear cousins, aunts, uncles, and many of my other cherished Crenshaw relatives.
Dear Friends: Dr. Cynthia Washington, Steven LaBroi, Doug Humprhey, Dr. Shirley Davis, Katherine McCary, Joyce Davis, (the late) Deirdre Williams, Mary Frances-Winters, Kelli Boyer, Alan Muir, Keith Earley, Deidre Davis, (the late) Janice Fentriss, James Taylor, Morris Martin, Lisa Green, Pamela Colby, Michelle Ford, Missy Dowdell, Jennifer Ward, Tonya Courts, Victoria Carter, Erica Motley, Anthony Berry, Cherice Crawford, Anthony Banks, Sonjha Crawford, (the late) Ruby Carlisle, Ruthie Darling, (the late) Derrick Parks, Dr. Roosevelt Thomas, Delia Johnson, Berri Wells, Sandra Massey, Michele Evans, Lynn Currie, Keith Wade, Darlene Avery, Frank Drake, Sheila Mitchell, Jacqueline Sapp, Joycelyn Barnett, Doug Harris, C.F. Jackson, Erica Walker, Lisa White, Wanda Cumberlander, Terry Quattlebaum, Denne Adams, Davon Kelley, Dr. Bill Harvey, Pierre Schoolfield, Denise Martin, Lori Coppin, Dr. Leonora Johnson, Roosevelt (Chief) Pulliam, Bea Young, Paul Reickoff, Shauna Anderson, Karen R. Gingerich, and Leonard Nathaniel Fisher.
Organizations and institutions: ADMAG, AIMD, SHRM, The U.S. NAVY, AW2, Walter Reed Army Medical Center, CVS Pharmacy, Portsmouth Naval Hospital, Sewells Point Clinic, Balboa Hospital, USBLN, NOVAD Corp., Northrop Grumman Corporation, Merck Pharmaceuticals, IAVA and the National Organization on Disability.
Last, but not least: The great OIF and OEF veterans, their families, caretakers and other stakeholders, the great people of the global disability community—stay forever strong!!!
All those not mentioned, it is by limitation of space and not love.
Preface
To date, there are 54 million people in the U.S. living with some form of diagnosable disability. Some individuals may have been born with physical and/or mental health conditions such as Spina Bifida or Down Syndrome; others may have acquired their disabilities through any number of degenerative medical conditions such as diabetes or multiple sclerosis. Still others may have acquired their disabilities from an unfortunate situation or circumstance such as becoming paralyzed from an auto accident. And some may have impairments caused by exposure to a certain substance or environment, such as alcoholism or skin cancer.
The definition of disability…
Cornell University states: “There is no single, universally accepted definition of disability. Mashaw and Reno (1996) document over 20 definitions of disability used for purposes of entitlement to public or private income support programs, government services, or statistical analysis. An explicit goal of the Center for Disease Control and Prevention’s (CDC) Healthy People 2010 (HP2010) program is to include a standardized set of questions that identify people with disabilities in HP2010 surveillance instruments.”
The following is what the McNeil (2001) report used to determine disability from the Survey of Income and Program Participation (SIPP) data.
The report used a variety of different angles to try to define disability that differed significantly from the disability determination used in the Current Population Survey and the Decennial Census 2000:
Definitions of disability status, functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs); Individuals fifteen years old and over were identified as having a disability if they met any of the following criteria:
Used a wheelchair, a cane, crutches, or a walker.
Had difficulty performing one or more functional activities (seeing, hearing, speaking, lifting/carrying, using stairs, walking, or grasping small objects)
Had difficulty with one or more activities of daily living. (The ADLs included getting around inside the home, getting in or out of bed or a chair, bathing, dressing, eating, and toileting).
Had difficulty with one or more instrumental activities of daily living. (The IADLs included going outside the home, keeping track of money and bills, preparing meals, doing light housework, taking prescription medicines in the right amount at the right time, and using the telephone).
Had one or more specified conditions (a learning disability, mental impairment or another developmental disability, Alzheimer’s disease, or some other type of mental or emotional condition).
Had any other mental or emotional condition that seriously interfered with everyday activities (frequently depressed or anxious, trouble getting along with others, trouble concentrating, or trouble coping with day-to-day stress).
Had a condition that limited the ability to work around the house.
If age 16 to 67, had a condition that made it difficult to work at a job or business.
Received federal benefits based on an inability to work.
Individuals were considered to have a severe disability if they met criteria 1, 6, or 9, had Alzheimer’s disease, cognitive challenges, or another developmental disability; or, were unable to perform or needed help to perform one or more of the activities in criteria 2, 3, 4, 7, or 8.
Regardless of the nature of the condition or type of impairment, people with disabilities represent the largest minority population (19%) in the United States. As the largest minority demographic, they face a wide range of challenges and misconceptions in society, on college campuses, and in the workforce. This book examines the different perspectives, circumstances, challenges, and other issues facing transitioning Veterans with combat-related conditions, and others with physical and hidden disabilities.
It also suggests several practical diversity solutions that can help create a higher level of disability awareness and sensitivity.
As an author and Veteran, I have strived to make a statement: that all of us (regardless of ability or disability) are capable of making a valuable contribution to society. People with disabilities are, in many cases, highly capable individuals who deserve respect and the right to enjoy a lifestyle and collegiate/employment experience that is fair, flexible and free of stigma, stereotypes and discrimination.
DESTIN Enterprises, LLC established the “Preparing Employers to Reintegrate Combat exposed Veterans with Disabilities” (P.E.R.C.E.V.D) Diversity Consulting and Training program in 2006 to provide employers and educational institutions with a specifically designed program to promote diversity and cultural awareness towards transitioning Veterans and people with hidden, physical and combat related disabilities.
The goal of P.E.R.C.E.V.D is to emphasize the business case for creating fair and conducive workplace and social environments where people of all abilities may thrive.
The training also strives to equip organizations with a diversity road map towards becoming “Veteran and disability friendly” organizations by using best practice Human Resource strategies. P.E.R.C.E.V.D diversity training further distinguishes itself by providing various diversity metrics that can measurably determine the impact of the program’s effectiveness and return on investment (ROI).
This book will provide you with numerous valuable insights that will enhance sensitivity and increase awareness in the workplace, educational institutions, at home, and in other social environments. Thank you!
Section One
Understanding the Situation
Chapter One
The Culture and Challenges of a
Modern Asymmetrical Warfare Environment
Healthy relationships between employers and employees are critical towards achieving workplace diversity. It is also a necessary component for enhancing productivity, establishing employee and customer loyalty, reducing workplace disruption, preventing high attrition rates, and mitigating litigation.
If we as employers are to gain a level of understanding and trust with the transitioning Veterans and people with disabilities we seek to hire, we must first understand their various experiences, appreciate and sensitize ourselves to their adverse challenges, and learn to see the world through their unique prisms. To date, 1.9 million American Veterans, along with a substantial number of coalition forces, have been deployed to Iraq and Afghanistan under the Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) initiatives. Special Forces, NATO, coalition troops, contractors, intelligence, humanitarians, aid workers, journalists, politicians, entertainers, clergy, and peacekeeping personnel, are also among the groups of people who have been significantly influenced, wounded, injured, and killed during their exposure to the dangerous (and equally unpredictable) environment of war in Iraq and Afghanistan. This now includes places like Yemen, Pakistan, North Korea, Iran, Libya, and other areas in the Middle East and North Africa.
Politics aside, we, the American people, owe a great deal of respect to the brave and valiant men and women of the U.S. military for their dedication to duty and their sacrifices for our freedoms in this country. They willingly and passionately share the collective mission to protect, serve, and defend our country and its citizens from foreign and domestic threats, including the serious and growing threat of global terrorism.
Since the terrorist attacks on September 11, 2001, the U.S. has been engaged towards fighting an elusive and unconventional enemy with varying degrees of adversity and success. From the launch of our initial military engagement in Iraq in March of 2002, many of our traditional war philosophies, strategies, tactics, and overall goals have now been re-examined and adjusted to meet the necessary challenges of a more formidable, defiant, and resourceful enemy.
Generally speaking, the modern enemy is inexorable and unrelentingly committed to their ideological jihad (holy-war) philosophies, using global terrorism tactics as the “tool of choice” to enervate their enemies, create mayhem and fear, accomplish their political goals and objectives, and to establish themselves as martyrs. The challenge is more amplified and compounded by the need to confront this “significant threat” in some of the world’s most difficult cultures, regions, and topographies to control, secure, and navigate.
This more modern-day enemy has effectively learned to use these difficult and rugged geographies, environmental hazards, cultural barriers and religious demagoguery of Western culture. Their jihadist propaganda offers a distinct advantage for hiding their targeted leaders, developing and executing their complicit and nefarious terrorist endeavors, terrorizing and intimidating civilians, and recruiting more young and loyal crusaders, kamikazes, and insurgent extremists.
The modern enemy is certainly not one to be underestimated. They have mastered the art of financing their endeavors by unconventional means, communicating covert operations (with and without modern technology), and have established covert networks of terrorist cells and militias throughout the world—including the United States.
This enemy also depends more on the elements of stealth and surprise, as well as the capability of hiding in remote areas and blending into the public with innocent civilians. These tactics keep our forces on constant alert of potential deadly, asymmetrical threats.
Many of these unforeseen factors have fostered adaptation and change in our traditional tactical military maneuvers, and have altered our thinking and approach towards everything from strategic assaults, intelligence gathering, and prevention of cyber terrorism to innovations in more effective and clandestine machines of war.
Examples of these types of adjustments include enhanced protective clothing, intelligent and unmanned weaponry, and more protective transportation vehicles.
Since the beginning of the OIF and OEF wars, military clothing, transport vehicles, weaponry, and essential combat gear have all been significantly redesigned and improved to enhance efficiency, ensure the safety of U.S. troops while in theatre (combat environments) and enhance survival rates.
All things considered, these wars have challenged the U.S. and coalition forces physically, financially, intellectually, and strategically. These two wars have had direct and indirect impact on everyone involved, from the office of the United States Commander in Chief and it’s high-level Cabinets to the operations of federal agencies, Homeland Security, Border Patrol, FBI, CIA, TSA, state and local law enforcement, Veterans Affairs, and health care providers, federal contractors and civilian employers, as well as tax payers, Veterans’ family members, and of course…the Veterans.
Iraq and Afghanistan represent the longest wars in U.S. history. According to a Congressional Budget Office (CBO) report published in October, 2007, the U.S. wars in Iraq and Afghanistan could cost taxpayers a total of $2.4 trillion by 2017 when including the huge interest costs, because this combat is financed with borrowed money.
The CBO estimated that of the $2.4 trillion long-term price tag for the war, about $1.9 trillion of that will be spent on Iraq ($6,300 per U.S. citizen).
Various elements of these wars have changed the U.S. and world economy, security, communications, business, technology, transportation, medicine, politics, and policy, along with everyone and every other aspect of our social culture. As a result, no person and nothing about our culture in the post 9/11 world will ever be quite the same.
Along with change comes inevitable adaptation towards evolution. We must all now begin to reconsider our traditional thinking and subscribe to permanent paradigm shifts and related consequences associated with life “after 9/11” and the Iraq and Afghanistan conflicts…especially as it pertains to business and other social and cultural issues.
Chapter Two
Improvised Explosive Devices (IEDs)
One of the more unconventional forms of combat used by current enemy forces has been the deceptive implementation of improvised explosive devices, or IEDs. IEDs have been commonly manifested in the forms of road-side bombs, as well as the use of people carriers, anarchists, or mules, otherwise known as “suicide bombers.” This destructive force and unconventional form of warfare has been used since the early twentieth century, and has exposed many of our Veterans to significant levels of uncertainty and a more treacherous and dangerous playing field.
Generally speaking, an IED is a very effective weapon for various insurgent groups, militias, and other prominent terrorist organizations such as Taliban rebels and Al-Qaeda. An IED is considered a form of homemade bomb that often delivers a lethal, destructive, and powerfully explosive force that can be measured in small-to-wide geographical ranges. In fact, the destructive force of these explosives, coupled with the ammunition contained in an IED (typically shrapnel-generating objects such as nails, molten copper, or ball bearings), have been known to penetrate armored tanks, body armor, walls, and other enforced barriers.
IEDs are very diverse in nature. Their explosive charges can be activated by simple, everyday, remote control detonation devices such as cell phones, washing machine timers, pagers, toy remote controls, or garage door openers.
IEDs may also be detonated by infrared beams, strings, wires, magnetic triggers, chemical combinations, or pressure-sensitive devices. These weapons are becoming more and more sophisticated, and are responsible for a significant number of fatalities, injuries, impairments, and serious medical conditions to U.S. servicemen and women and other coalition forces. Presently, IEDs have caused more than 40% of U.S. casualties in Iraq and Afghanistan. Two-thirds of all current combat-related injuries are from bombs, and of these, 28% involve brain trauma. IEDs have also produced hundreds of thousands of casualties and life-threatening injuries to Iraqi and Afghanistan civilians.
IEDs generally weigh about four to five pounds, and can be planted in many different spaces for concealment. These cleverly-hidden devices are considered a significant form of intimidation and psychological warfare. They create a sense of unease and vulnerability as they surprise, maim, and kill U.S. and coalition troops.
The enemy has been known to hide IEDs under paved roads and other pathway areas, in roadside trash cans, within road-kill and human cadavers, under bridge-type structures, in abandoned vehicles, and any number of other carefully considered places and high-traffic thoroughfares used by U.S. and coalition forces and convoy vehicles. The rugged, precipitous and mountainous regions of Afghanistan provide a clear advantage towards hiding these types of weapons.
IEDs can range in levels of size and sophistication, from small explosives to heavily-compacted devices using components such as TNT, nitroglycerin, dynamite, and gunpowder. These so-called “dirty bombs” are also IED tools associated with terrorism, and may contain potent toxic chemical and biological agents such as chlorine gas and/or other harmful radioactive agents.
The physiological and psychological effects of this portentous brand of warfare have proven to be extremely damaging to the mission of the military and overall morale. These deadly weapons of war have inflicted serious injury and death to Veterans and innocent civilians.
To the victims of these devices, they form indelible, detrimental, horrific, and debilitating memories of carnage, disaster, and the dangerous and often-times cruel realities of war.
Unlike in many of the previous U.S. wars, the enemy no longer wears a standardized uniform, causing U.S. troops to now consider all foreign and domestic pedestrians (everyone not wearing a U.S. or coalition uniform) as a potential IED suicide bomber threat. The modern enemy can now be completely indistinguishable from innocent civilians. Just as disturbing are the rising concerns over homegrown terrorism. This unsettling trend has also become a factor, as acts of terrorism have now been attempted in the U.S. by the hands of American-born citizens and other terrorist sympathizers.
The modern enemy is represented by men, women, and children of all ranges of education, race, and demographic backgrounds. Prospective young loyalist extremists are often recruited, brain-washed, and trained to serve as martyrs or insurgent soldiers.
Conservative Middle-Eastern attire such as burqas (robe-like dresses) for women and dishdashas (robe-like garments) for men can effectively conceal deadly objects like explosive vests and belts, and create ideal, inconspicuous conditions for potential suicide bombers. The indistinguishable enemies can also more easily carryout ambushes in villages and high-traffic public venues under an array of conditions. IEDs, suicide bombings, along with the collateral damage of military assault missions, are responsible for a substantial number of U.S. military casualties.
There have also been substantial Iraqi and Afghani civilian casualties and damage to local infrastructure. These combined factors make it extremely difficult to carry out peacekeeping missions intended to help gain the trust of Muslims, Iraqi, and Afghanistan civilians and their families.
About 100,000 Iraqi civilians—half of them women and children—have died in Iraq since the invasion, mostly from airstrikes by coalition forces, according to the first reliable study of the death toll from Iraqi and U.S. public health experts. The study, which was carried out in thirty-three randomly-chosen neighborhoods of Iraq representative of the entire population, shows that violence is now the leading cause of death in Iraq. Before the invasion, most people died of heart attacks, stroke, and chronic illness.
The risk of a violent death is now 58 times higher than it was before the invasion.
In 2007, 7,295 civilian Iraqi died—nearly 20 a day—from improvised explosive devices. Another 21,970 Iraqis were wounded.
More than ever, our U.S. military has been exposed to a myriad of potentially lethal hidden dangers. Although U.S. forces represent the most organized, well-armed, resourceful, and powerful military force in the world, our military transport vehicles are not impervious to IED blasts. Our troops have had to maintain a defensive posture towards the significant dangers of an unseen, unconventional modern enemy in a decisively asymmetrical warfare environment.
The good news: many of the new adaptations, tactical improvements, strategies, and other necessary adjustments that have been made have proven to be very effective towards enhancing and ultimately accomplishing our military objectives, while minimizing potential casualties and injuries.
Advances such as modernized, armor-plated military Humvee vehicles, top-secret satellite and drone vehicle surveillance, highly sensitive bomb-detecting equipment, and high-tech infrared imaging are among the ”forward-thinking” innovations that have proven to be effective towards helping our troops carry out their military endeavors while preserving their safety and resources.
Advances in modern field medicine procedures have also significantly helped decrease the number of casualties among U.S. and coalition forces. These developments have helped to save countless lives that likely would have been lost in previous U.S. conflicts. Physicians, engineers, and scientists are working tirelessly to discover more ways to adequately address combat-related medical conditions and to better ensure the safety of troops in combat situations.
Veterans with significant and life-threatening physical injuries (including those with major burns, shrapnel wounds, and amputations) are treated with the latest medical procedures, pharmaceuticals, and rehabilitation, and outfitted with the latest advancements in prosthetics, allowing them to resume their post-injury lives with a substantial degree of functionality.
However, injuries from IED blasts, rocket-powered grenades (RPGs), and other related weapons have taken a significant toll on our troops. The constant, ever-present threat of a modern, unconventional, and sometimes indistinguishable enemy (in an asymmetrical war environment) has tested our national resources and produced lingering, residual mental, emotional, and psychological affects to transitioning Veterans. Prior to 2007, the US military prohibited the use of medications for servicemen in combat, due to the inability to regulate usage. However, with the implementation of the 2007 military surge offensive, psychiatrists were authorized to prescribe numerous anti-depressants and sleeping pill medications with the intent of keeping troops with certain psychiatric conditions maintained on the battlefield.
Many of these prescribed medications came with “black box” type warning labels indicating that the controlled substance can become habit forming. It also suggested the user may experience unusual behaviors as side-effects such as: anxiety, impulsivity, aggression, anger, depression, decreased inhibition, irritability and suicidal thoughts. The medications also came with warnings for the user not to operate dangerous machinery nor perform critical task(s) while taking the drugs -– war easily qualifies as both.
The demanding and laborious rigors of multiple combat tours (some as many as six or seven tours) with an average of fifteen-month intervals have tallied a significant cost to our dedicated military servicemen and women.
The increased time in combat impacts morale and adds significant stress to the veterans and their families. Studies now indicate that the rate of mental health conditions in combat-exposed Veterans has increased concurrently with the number of combat tours experienced.
Furthermore, even as improved field medicine techniques and procedures continue to save more lives, the U.S. military now has to contend with the aftermath of debilitating physical and lingering hidden emotional wounds.
Chapter Three
Coming Home: Some Things May Have Changed and I Will Never Be The Same
Similar to actions in Iraq in 2010, U.S. President Barack Obama has committed to the withdrawal of troops from Afghanistan in July of 2011. Many of our servicemen and women who are returning home from combat will begin the phase of readjusting to familiar and modified environments and circumstances. For the transitioning Veteran, the adjustment back to home and family life is complex, and ultimately represents both a welcoming and frightening experience.
Amid many of the obvious burns and shrapnel wounds to the body’s extremities and internal organs, survivors of combat-related IED blasts and other forms of mortar attacks commonly experience visible and non-visible head injuries. These conditions are known as traumatic brain injuries, or TBIs.
A TBI is defined as an assault on the brain caused by a person’s head being hit, shaken violently, or penetrated, resulting in mild to severe injury or death. This type of injury can occur as a result of direct exposure to a blast, or through the inertia force of secondary/indirect exposure. Generally classified as either “mild” or ”severe,” TBIs are either open or closed and manifest in a broad array of debilitating symptoms and conditions including: speech and memory deficits, sight and hearing impairments, headaches, cognitive challenges, attention and concentration problems, mood swings, uninhibited behavior, dizziness, nausea, black-outs, and depression.
Other midrange to long-term TBI effects includes amnesia, concussion, epilepsy, stroke, paralysis, Parkinson’s disease, Alzheimer’s, swelling of the brain, and death.
Over-stimulating social environments such as shopping malls, crowded conferences and airports can become an overwhelming experience for a person with a TBI. One may become easily frustrated from simple experiences such as forgetting where they placed an airplane ticket, or lost recollection of their gate number or airline they are flying with all together. No two TBI conditions are exactly alike; therefore, symptoms, deficits, abilities, needs, accommodations, cognitive function, levels of personal frustration and recovery (if any) can vary. Some people have no memory of their life experiences prior to experiencing their TBI.
A TBI is not exclusive to transitioning Veterans. In fact, 1.4 million Americans per year experience TBIs. Of those injuries, fifty-percent are caused by auto accidents. Various physical sports such as boxing, martial arts, rugby, football, baseball, and soccer can also produce the condition. Recovery from TBI is attainable with proper medical treatment and time.
“War invariably changes the perspectives of its participants. Ideals and moral values are often challenged and identities are (in many cases) permanently reshaped. Some military Veterans face ongoing physical and mental health challenges – both seen and unseen—as they deal with the remnants of battle,” says Cynthia Washington, M.D., a board certified psychiatrist, OIF veteran, and Chief Medical Consultant for DESTIN Enterprises, LLC.
She further states, “The execution of strategies of war often includes conducting exercises that are extremely brutal in nature, and being exposed to barbaric, truculent, and inhumane circumstances.
Our troops are thoroughly trained to do a job. The job is harsh, extreme and oftentimes violent. Death, carnage, and destruction are ingrained parts of the job description. Most servicemen and women will tell you that it is quite difficult to simply turn the trained internal mechanisms of war ‘off’ once an individual has returned from combat. The result of this experience is often an assortment of many mental and emotional complexities.”
A recent study by the Rand Corporation reports that roughly one in every five U.S. troops who have survived bomb blasts and other dangers while in Iraq and Afghanistan, now agonizes from major depression or post-traumatic stress disorder (PTSD).
PTSD is defined as a disorder or condition that develops after a person experiences an extremely psychologically distressing or life-threatening event. PTSD can feel like having an eidetic vision of a real-life tragedy reoccurring in real time.
Because PTSD (like TBI) can be a non-visible injury, there can be many assumptions and misconceptions made about a person who is demonstrating ‘other than normal’ behavior. It is not unlikely for some people in our society to apply the label of “crazy” or “over emotional” to people with PTSD conditions.
Within our brain is a small, almond-shaped organ known as the amygdala (from the Greek word “almond”). Located just above the hypothalamus gland, it provides our primary social processing and storage of emotional events (including fear). When the amygdala has been severely affected by the witnessing or experiencing of an extreme traumatic event, the impact may deregulate the neuro-transmission process of vital hormones that dictate our normal emotional responses to situations (including fear and other forms of mental challenges) within the secondary prefrontal cortex areas of our brains.
Thus, PTSD can be considered a physiological and psychological mental health condition.
Gender is also a factor, as women are two to three times more susceptible to developing PTSD than men. Following the tragic bombing of the Federal building in Oklahoma City, 45% of the women vs. 23% of the men developed PTSD. PTSD improves in most cases with proper treatment, medication, and time.
Factors such as hazardous sand particles can also lead to health challenges and other PTSD like symptoms among returning veterans.
Veterans redeploying back from combat face a number of challenges as they strive to resume their lives in post-combat civilian society. For many of these transitioning Veterans, things are now as much different as they are the same.
To a Veteran returning home to his or her family, the initial reunion can usually be a remarkable, exulting, momentous, and joyful experience. However, after an average fifteen-month absence from loved ones, many of the traditional roles and responsibilities within the family structure can easily and naturally shift and change. Generally speaking, about 60-days after returning home from war, some Veterans will discover that their family relationships have been slightly, yet significantly, altered as spouses and children have consequently adjusted to being more independent, mature, and developing with popular culture. Many Veterans are deeply impacted by this change and often have sensitive reactions to very general, innocuous situations, such as their own child developing a more close, trusting, and intimate relationship with their spouse or other immediate family members. Or, in some cases of small children, the child may not recognize or respond to the transitioning Veteran parent due to a lack of familiarity.
When a military serviceman leaves the home for war, the balance of family life is once again invariably disrupted.
Once a family has made the mental and physical adjustments to this significant, distant relationship, they may become circumspect, and it is often difficult for them to feel comfortable “getting close” to the Veteran for fear of the inevitable emotional pain of losing him or her again. Family members and loved ones make the adjustment to be stronger, less dependent, and more resilient in the absence of their transitioning Veteran, and often develop emotional walls as a protection from hurt.
Some spouses also feel a reluctance to surrender control of such things as making major family and educational decisions, driving themselves, paying bills, and managing the family checkbook.
After numerous deployments, some family member perspectives can migrate to feelings of resentment towards the ideologies of war, the military and even political representatives—despite consistent support and concern for their Veteran spouses and relatives. The general unpopularity of war with U.S. citizens can sometimes cause Veterans to feel that their patriotic, life-risking sacrifices and dedicated service have gone underappreciated.
Around the 60-day coming home period, many family members may feel that there is a sort of disconnect, or something that is unfamiliar or different about the person they knew prior to their deployment to combat duty. It may take some time for marital partners to become back in-sync with each other.
To returning troops, some seemingly simple tasks, such as being asked to go to the local Mall and decide on a product from a busy and congested department store, can appear distressing, meaningless and trivial after the conditioning of bottom-line necessity, limited choice of brands, and lack of convenience in war-related situations. Veterans and their spouses may also argue about money-related issues, as marital partners may have different spending habits, perspectives, and contrasting philosophies regarding credit, bills, and other expenses.
Some Veterans feel as though it is difficult to confide their war-time memories to family members and friends who can’t fully relate to the experience. Preoccupations with day-to-day civilian life issues can lead to drudgery for transitioning Veterans. It is easy for Veterans to become detached and long for the feelings of being “needed” and ”valued” from the experiences of performing military endeavors that had significance to the mission and the lives and circumstances of fellow soldiers in combat.
Often, wounded or not, some servicemen and women may feel compelled to leave their civilian family and circumstances and actually return to combat. Some simply feel more at home on the battlefield.
Anxiety, intrusive thoughts, and nightmares can also have a debilitating impact. Some Veterans toss violently in their sleep and even wake up in the position to fight, or even accidentally strike their sleeping spouses. Some wear mouth guards to keep from intensely grinding their teeth during PTSD-related nightmares. Marital relationships may also experience a lack of intimacy, as some troops with different degrees of PTSD may experience problems such as irritability, impaired social functioning, insomnia, depression, premature ejaculation, and even impotency.
Relationships with children may also seem strained as hyper-vigilant behavior (often associated with the residual effects of PTSD), may cause the Veteran parent to take a more guarded position with children who may have already developed a greater sense of independence in their absence. Many Veterans may feel a deep preoccupation with the need to feel secure and to remain guarded at all times.
Some may feel completely uncomfortable without being in reach of their weapon or multiple weapons. Some may also place or hide multiple weapons throughout their home and personal areas in order to feel more protected, comfortable, and safe. Veteran family members may be extremely concerned about this type of behavior, particularly in households with children.
It may also take a while for family members to get adjusted to a parent or spouse who may be perceived as “overreacting” to being surprised or startled. Some may see the transitioning Veteran as frequently agitated, depressed, or withdrawn.
There are some servicemen and women who express a personal preference towards physical injuries as opposed to having non-visible injuries or conditions. Their rationale is “at least people can clearly and justifiably understand what’s wrong with them.”
Ultimately, coming home can produce some trying times for the Veteran and his/her family as they all make the adjustment to life back home after combat.
While in theatre, Veterans serve side-by-side with their war-time comrades. Significant bonds often develop that can easily rival their relationships with spouses and family members.
Servicemen and women become accustomed to a lifestyle that deemphasizes individuality over teamwork, and places a premium on the virtues of honor, duty, uniformity, and trust. The military believes in a code that leaves no wounded man behind, and the ideology and culture of watching each other’s backs during critical war-related exercises and situations – is taken very seriously. After returning home, some find it very difficult to open up and actually discuss their cherished relationships with their fellow Veterans or the harsh rigors of war with family and friends; thus, creating more of a disconnect and chasm in their relationships. Many often experience deep feelings of guilt and regret that center around haunting experiences and subsequent war-related decisions.
While in combat, troops are generally exposed to ever-present danger and extreme situations, including dead and rotting corpses, constant and sudden mortar attacks, hospital environments, hostage encounters, etc. Although some servicemen and women may feel very fortunate to have made it back home safely, guilt and intense images of experiences and people left behind can easily plague and consume one’s thoughts and memories. Intense guilt can also manifest in the form of regret.
Survivor guilt is also a form of PTSD that can be considered significantly debilitating and may produce a depressive syndrome for some transitioning Veterans. Many of our Veterans have lost treasured friends, associates, and family members to hostile combat situations. The “brotherhood” culture between military Veterans often makes it very difficult to cope with the death or injury of fellow Soldiers, Marines, Airmen, and Sailors. The memories of certain freakish combat related situations can forever plague the survivor of an accident.
Dr. Washington recalls the situation of two (very close) soldiers that amicably traded positions in Humvee vehicles that were out on a convoy mission. “Unfortunately on that day, the lead vehicle of the convoy was destroyed by a massive road-side bomb. The surviving veteran consequently developed severe PTSD, believing that he should have been the victim of that unfortunate incident opposed to his very close friend and colleague.
Since his discharge from the Army, the soldier continues to struggle with his condition.”
The joint friendships, experiences, and bonds established by their devotion to duty, love for country, trust, and valor in the most difficult situations are significant, and often too difficult to fully discuss with family members, fellow employees, and/or other civilians who cannot fully relate to the experience. These issues can cause more introverted behavior.
Exposure to poverty can also become a major factor towards PTSD guilt, and may create hindering conditions for the Veteran. Simple, everyday social experiences, such as an evening at a restaurant with family, can sometimes produce a variety of strange occurrences.
It’s not uncommon for a combat-exposed Veteran to feel disconsolate, and have extreme emotional reactions (such as crying or depression), as a result of witnessing a person leave uneaten food on a plate or not showing proper appreciation for things that most people take for granted.
While in theatre, many troops have had close contact and significant relationships with the families and children whose lives have been permanently disrupted and damaged by war. These indelible images and memories can have a profound impact on their reactions, emotions, and perspectives towards everyday situations. Some Veterans may feel very isolated—even among large groups of loving and supportive family and friends.
Physical scars from surgery, burns and shrapnel wounds, amputations, speech impediments, reactions to loud music or other images, and delayed ambulatory issues can often make their interactions with their social counterparts feel cautious or uncomfortable, and subsequently produce a negative effect on the Veteran’s personal image, confidence, and self-esteem. These issues sometimes evoke insensitive questions and comments such as, “At least you lived,” “I’m glad I didn’t enlist in the military,” “Did you kill anyone?” and/or “It’s a shame what they did to you over there.”
Although some people may mean no harm to the Veteran, many would consider these types of comments to be very insensitive and highly offensive. PTSD-related social withdrawal is a very serious manifestation of PTSD and should not be taken lightly. In some cases, the signs and symptoms of abnormally introverted behavior can serve as a prelude to self-medicating or other coping mechanisms.
The condition of PTSD can take a serious toll on one’s body. High blood pressure, anxiety, overeating, insomnia, impotence, depression, and high-levels of stress from war can manifest in the appearance of premature aging for a relatively young person.
Unfortunately, recent studies have demonstrated that a significant number of Veterans may choose to turn to alcohol or drugs as a way of masking deep and extreme internalized feelings.
Even more tragic is the inclining number of Veterans who consider and elect suicide. A common misconception regarding suicide is that the person has lost the passion for life. However, in some cases, suicide is an option that some may consider to ultimately make all of their very personal pain go away.
Sudden withdrawals from smoking, alcohol and substance abuse, or abuse of certain sleeping or depression medications, may also induce such symptoms as overeating, social withdrawal, irritability or lack of energy, and appetite and sleep disorders. Increased thoughts of suicide may also become prevalent.
Suicide is not always related to depression. Many other factors may contribute to one’s decision to take his/her own life, such as external frustrations, severe self-esteem issues, hopelessness, heredity, pain, disappointment and loss, abuse of controlled substances, revenge, and/or a personal refusal to become a burden to loved ones.
Many may be reluctant to admit suicidal thoughts for fear of the drama and embarrassment associated with police interactions and the personal humiliation of being restrained and/or taken to a psychiatric ward. Many who attempt suicide will tell a physician that they were not serious about the action in order to be discharged as soon as possible. Once they have returned home, they may become even more guarded and private with their internal thoughts. If a person admits to having suicidal thoughts, in many cases it is important to discover if he or she has ever previously attempted to take his or her own life.
It may also be comforting for the person to be given a glass of water to drink and be allowed the opportunity to talk and confide their feelings without interruption, judgment, or the reminder that other time-sensitive priorities exist. Persons considering suicide should be encouraged to contact the suicide hotline of 1-800-273-TALK.
They are exceptionally trained and experienced with properly addressing the situation and providing a level of comfort and reassurance to the individual.
For family members, friends, and loved ones of Veterans, it is important to realize that although the Veterans have evolved with their recent experiences, we must continue to support and value who they are to us, beyond what they have adjusted to. We must get educated regarding their post-combat related conditions and acknowledge their service, accomplishments, and sacrifices for our country. They deserve a great deal of respect. We help them by showing patience and support, and encouraging them to get evaluated, seek support groups and organizations, take their medications, and choose treatment if necessary.
For employers of transitioning Veterans, it may be necessary to engage their human resources, diversity, employee assistance program (EAP), and other representatives to provide resources for marriage, family, and substance abuse counseling, as well as other personal challenges. Furthermore and most importantly, we must never be tempted to view our beloved Veterans as “damaged goods.”
Chapter Four
A Culture of Pride, Machismo and Denial
Many Veterans will admit that having preoccupations with emotional thoughts regarding missing their relatives and friends and the sentimental comforts of home, is considered taboo during combat. Worry over returning home can produce certain feelings of vulnerability during critical war-time situations. Concentrating on these thoughts could adversely distract Veterans and allow them to lose focus on the immediate mission at hand, perhaps causing them to second-guess themselves within the heat of battle.
Many of these sentimental thoughts of home and people often get replaced by the mission, surges of adrenaline, heroism, valor, and sometimes personal disregard of one’s safety in lieu of confronting eminent danger and immediate, life-threatening experiences. The adrenaline rush mechanism or “fight or flight” response can allow the Veteran to better accept adverse situations, function more fearlessly, and overcome life-threatening danger and uncertainty. The sometimes gruesome realities of war have introduced the Veteran to a very different, more capable side of his or her natural self. He or she has in many ways changed from an amiable, peace-conscious civilian to a highly trained soldier and survivor.
The Veteran is now a capable warrior and a champion of the battlefield who is no longer innately intimidated or afraid of carnage, danger, inconvenience, and uncomfortable circumstances. Indeed, there may be some lingering elements of the “fight or flight” Veteran psyche that may yield reprobate behavior upon return to civilian life, and even welcome a challenge reminiscent of their battle experience.
Many Veterans may actually feel more comfortable and at peace back on the battlefield. In some cases, migrating back home to the serenity of a more civilized and cultured atmosphere can be as intimidating and scary as their wartime experience.
Some have a difficult time making the paradigm shift. Making the transition back home also includes learning to resolve the internal aggressions and thrill-seeking, adrenaline rush urges resulting from extreme and dangerous situations. It is not uncommon for Veterans who survive war to view themselves as hardened, invincible, and even a tad narcissistic.
However, when emotional issues begin to haunt the thoughts and dreams of transitioning Veterans, it may be very difficult for them to put pride aside to ask for help. Soldiers are trained to be strong, resilient, resolute, and solution-oriented. They have been a part of a military culture that focuses on readiness and does not easily tolerate retreat from danger, or accept personal discomforts, excuses, and/or complaints. When a Veteran has been physically wounded, these issues can be particularly compounded by the need to incorporate help and sometimes lengthy rehabilitation just to resume such normal aspects of functionality such as: walking, speech, performing basic cognitive tasks, vision and hearing. Some injuries require multiple life-saving and complex surgeries just to achieve basic functionality. For some, rehabilitation can become a very long, frustrating, and arduous journey.
Some obvious battle scars to facial and body areas of men and women may be disfiguring, unflattering, and permanent. It takes an incredible amount of faith, strength, patience, and internal resolve to recuperate from these combat-related physical and emotional injuries. These medical issues can take a tremendous toll on one’s self-esteem. When confronted by family members, associates, and co-workers with concerns over issues such as: nightmares, quick tempers, alcohol and drug-related binges, the compulsive need to carry a weapon, overprotective tendencies, social anxieties, and occurrences of crying, sadness, and depression, many Veterans can shut down emotionally and become even more withdrawn from the people who are closest to him or her. For this and other reasons, some studies suggest that upon processing out of the military, many Veterans do not fully disclose the seriousness of residual effects from war and its impact on their mental health status.
When the opportunity presents itself, some may feel the need to simply expedite their discharge and not fully or immediately acknowledge and/or disclose the magnitude of their physical, mental, or emotional health conditions. Some fear that disclosing these “nuance” conditions may delay their separation. Others are afraid of possibly losing their valued security clearances.
Many may feel that as proven Soldiers, Marines, Sailors and Airman they can manage their mental health situations on their own. Some simply let pride, ego and mistrust get in the way of receiving proper care for their hidden and emotional wounds. When their emotional issues eventually prove outside of their control, it leaves some Veterans with the need to self-medicate, as opposed to admitting that they may need help. Denial of the issues is a major obstacle for employers, organizations and family members that wish to provide support and treatment for transitioning Veterans.
“Blast injuries typically include four elements: The primary characteristic is the atmospheric pressure created by the blast wave, followed by a vacuum. The wave pushes, then the vacuum pulls. The effect on the brain is not entirely clear, but it can wreak havoc with brain and spinal fluid, creating tiny bubbles that affect the vascular system,” Barth said. A secondary effect is created by rocks and other items that can be blown into a person standing near the blast—similar to the blunt trauma in sports injury. A third effect is the force of the blast can pick up a person throw him or her around—also similar to the rotational brain injuries found in sports.
“Then there’s a [fourth] level of injury, which is the toxic fumes and so on that may occur in the blast,” Barth said. “The toxins can affect brain tissue, increase a soldiers’ blood pressure and leave burns.”
We must take a closer look at the effects of certain injuries and their subsequent impact on behaviors in the home, social environments, and in the workplace.
Much like the common cliché exhibited in certain sports, “If you can walk, you can play.” The macho sports culture suggests that it is improper to admit an injury to an opponent. The consensus among players, coaches and fans in sports is; “when you experience a violent hit, you immediately pop back up and shake it off.” The admission of pain and hurt can generally be perceived as weakness. Many of our military Veterans are also accustomed to this culture of personal pride.
For someone with a TBI, the very dangerous game of masking pain can ultimately result in a debilitating cycle of personal torment that culminates from a concussion to other forms of serious brain damage.
Although studies like this regarding TBI and CTE are particularly revealing in the relationship between brain injury and extreme behavior (including thoughts of suicide), there is much more to be learned about the behavioral issues with transitioning Veterans and others exposed to IEDs and similar explosions in combat.
More training and educational programs must be made available to family members, support personnel, collegiate representatives, and employers. Organizations can then apply initiatives and programs that help to create the type of sensitive, yet “non-judgmental” employment atmospheres that garner more compassion and understanding. These types of awareness programs can better inspire Veterans (or any person with a non-visible brain injury) to feel more comfortable disclosing TBI and PTSD-related challenges.
As a rule of thumb, anyone that reveals a hidden mental or emotional condition should always be assured that they are loved and valued. We must also convey that getting proper treatment is never considered a sign of weakness.
Chapter Five
Stereotypes, Misconceptions, Myths and Related Stigma Regarding Hidden Disabilities
The OIF and/or OEF Veteran is now back home from combat and is looking to reintegrate into a world that is as much different as it is the same. There are varying degrees of reactions from people as the public views him or her in uniform and in the community. As much as the Veteran may want to quickly resume a civilian identity and persona, there are still many aspects of his or her internal compass that now have to redefine what “normalcy” is after their combat hiatus.
One of the stark realizations associated with redeploying back home includes exposure to the modern media. Generally speaking, modern technology and the fierce competition for desired audiences have thrust the global media to robust and far-reaching proportions.
Most journalists will testify that national and local media coverage of war-time news and events has dramatically changed to a more sensationalism approach than that of previous U.S. wars.
For example, Veterans of World War II and the Korean War may remember a time when news coverage served as a force that united the country regardless of party affiliation and demographic background. Back then, there was an overwhelmingly unified sense of patriotism and support for all Veterans. The entire U.S. got more into the act when industry boastfully proclaimed a sense of pride in developing materials, products, and goods that helped support Veterans in winning the war and consequently sparked the economy.