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Jeffrey Bland, Ph.D Headshot

Supporting the Healthy Returning Veteran

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VETERANS
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Resilience is defined in the military as the ability to withstand, recover, grow, and adapt under adverse circumstances and to return to the state of readiness for future challenges. Being deployed in the military during a time of war tests the resiliency of every service man and woman. The outcome of spent resiliency can be seen in post-traumatic stress disorder, suicide, physical and mental illness resulting from depletion. It can occur in subtle ways that are not immediately obvious that contribute to substance abuse, domestic strife, and depression as well as increased risk of many chronic diseases. The influence of reduced resiliency can be long-term, and in a sense fulfills the definition of a chronic illness.

As we see the "wind down" of the engagement in the Iraq and Afghanistan wars and the re-entry of tens of thousands of soldiers from the Army, Navy, Marines, Air Force, and National Guard returning to the United States, the question of how to improve physical and mental resilience of this dedicated group of veterans is a top priority for the country. We have recently learned there are presently more suicide deaths to service men and women that served in these wars than the deaths in combat. This fact hits us all as a white-hot reminder of the important work ahead in providing the necessary tools upon re-entry to improve resilience for each of these veterans.

It was with this concern in mind that a meeting was held last week hosted by the Samueli Institute -- a nonprofit organization supporting the scientific exploration of healing processes -- with the title of "Towards a Systems Model of Resilience." This meeting was attended by a most remarkable interdisciplinary group of people including top ranking officers from the military, researchers in the area of stress, trauma care experts, modelers of complex information systems, medical researchers, psychology researchers, experts in neuroscience, and leaders in public health. Over the two days of the meeting one feature was very clear: The shared commitment on the part of all the participants to work toward a plan that would help to improve resilience in the returning veteran.

The representatives from the military gave presentations that helped the larger group become much more appreciative of the tremendous challenge that war presents to the service man and woman. A discussion of the challenges of training, deployment, active participation in war, and then re-entry back into life at home resulted in a deep respect and concern for the challenges to resiliency experienced by the service man or woman at each of these stages.

What was agreed upon by all the participants was that resilience is a very personal characteristic, and any program that is developed needs to be tailored to meet the specific needs of the individual. This concept is not new to the military. In fact the August 2010 issue of the medical journal Military Medicine described the military's "Total Force Fitness for the 21st Century," which incorporates military organizational structure, environment, and family in a mind-body approach to improving resilience. This Total Force Fitness program incorporates behavioral, psychological, social, physical, environmental, nutritional, medical, and spiritual components.

Fitness is more broadly defined within this concept to address all aspects that relate to improving resilience. The focus is on improving the service man and woman's management of trauma and move from a singular focus on preparation for performance during a mission to that of improving the response to stress, improving well-being, and preventing later disease or disability. As a consequence of these objectives, the program incorporates issues of the mind including psychological, behavioral, social, and spiritual issues along with issues of the body including physical fitness, nutritional status, medical fitness, and environmental factors.

This may seem as a significant departure from the stereotypical approach to military training, but what has been learned from previous wars is that in the absence of dealing with the veteran in a more "holistic" way that many hold-over issues, both mental and physical, travel with the person for decades of their life. We have learned from recent studies of the deep influences that World War II and the Vietnam War had on veterans who continued to suffer often in silence with serious mental and physical issues that were never seriously addressed after combat and return to home. Training to enhance resilience during war and then after re-entry are now being seen as important factors in improving performance and preventing the lingering mental and physical diseases associated with being in war.

It is interesting that many of these mind-body concepts introduced in a program to improve resilience in the military traditionally were viewed as outside what was considered usual and customary. Programs such as yoga or meditation or nutritional counseling would be considered "outliers," but recent intervention studies with returning veterans have demonstrated that these have significant value in improving both psychological and physical resilience. In essence these changes in thinking are similar to what has happened in athletic training, where not too long ago it was considered unacceptable to consume water during practice, and now it is recognized how important it is to hydrate during heavy physical training. What was considered "the right thing to do" at one time is now recognized to be incorrect in light of new information.

The two-day meeting on improving resilience in the military was filled with new information from which new approaches to the improvement of resilience can be developed. Discussions about the neurobiology of traumatic stress and the depletion of physiological reserves opened up potential new approaches to the prevention of depression and post-traumatic stress syndrome. The group dug deep into their knowledge to work in collaboration as to how the mind-body model of improving resilience could be successfully applied to a diverse group of veterans. What was clear is that the approaches that emerge from this discussion should prepare the person to do more than "get over" the immediate stress, but instead improve later function when exposed to change or trauma. It was recognized that one of the potential challenging events that a veteran has to deal with is the change from battlefield to the home environment. A holistic program of improving resiliency must incorporate the objective of improving re-entry into the home community and family as an important goal of the program. Work done in the Netherlands with their veterans returning from the Mideast wars found that a concerted effort in improving mind-body resilience resulted in improved performance both while in the military and during re-entry home.

When we talk about health and a healthy population, we need to remember that a very important focus needs to be on the health of our returning veterans. It is more than just providing medical services through the Department of Veterans Affairs; it extends to implementing personalized programs designed to improve resilience. We need to develop and implement programs for the veterans designed to improve stress management and encourage healthy outcomes. I wish that everyone in the country could have participated in this very informative meeting. It is my belief that when we hear directly from the very thoughtful commanding officers from the military who have the deepest commitments to the men and women in service that we all can learn extraordinarily valuable lessons about what it means for the service man or woman to be involved in war, and what responsibilities we all have in improving their resilience both while in combat and upon re-entry into their home environments.

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