January 2012 ushered in a new year, but an old, recurring problem for war veterans. According to a January 2012, CareerCast.com article, "The 10 Most Stressful Jobs in 2012," the No. 1 stressful vocation in the U.S. is an "enlisted soldier."
Here are just some of news headlines at the mid-month mark alone that appear to lend credence to the selection:
• An Iraq War veteran is arrested for the brutal murder of five homeless men after his friend's death in Afghanistan. His family said he had become a "troubled man" since returning from Iraq.
• A video is released showing U.S. Marines urinating on Taliban corpses.
• A picture is published of U.S. Air Force personnel charged with handling American remains pretending to be dead in an open casket with a noose around an airman's neck, with the words "Sucks 2 Be U."
• A 19-year-old Army private dies from a "self-inflicted gunshot wound" in Afghanistan, after unrelenting physical, racial and emotional torment from his fellow soldiers.
• Video is released of U.S. Army soldiers joyfully slaughtering an Afghanistan boy's sheep.
• An Iraqi war veteran kills a Washington State Park Ranger, then dies from exposure
• Defense Secretary Leon Panetta reported a "stain" on the military with 3,191 sexual assaults occurring last year, but he said that because so few victims report the crime, the real number is closer to 19,000 assaults.
What do the above incidents share in common besides making the January headlines and involving enlisted military members during a time of war? They exemplify what the American military calls "misconduct stress behaviors," present during every armed conflict, including by officers, as evident in the My Lai massacre.
Combat and Operational Stress Reaction -- or "COSR" -- is the new DoD-approved term referring to the adverse reactions military personnel may experience when exposed to combat, deployment-related stress or other operational stressors. The U.S. military recognizes a continuum of COSRs ranging from adaptive stress reactions to "misconduct stress behaviors." Misconduct stress behaviors describe a range of maladaptive stress reactions from minor to serious violations of military or civilian law and the Law of Land Warfare, most often occurring in poorly-trained personnel, but "good and heroic, under extreme stress may also engage in misconduct" (Department of the Army, 2006; p. 1-6). Examples include: mutilating enemy dead, not taking prisoners, looting, rape, brutality, killing animals, self-inflicted wounds, "fragging," desertion, torture and intentionally killing non-combatants. The military has identified factors that may increase misconduct stress behaviors, including:
• Boredom and monotonous duties, especially if combined with chronic frustration and tension.
• Rapid return of soldiers to close contact with noncombatant military, civilians, or families after an intense battle experience without a unit stand-down period in which to defuse.
• Commission of atrocities by the enemy, especially if against U.S. personnel, but also if against local civilians.
• Racial and ethnic tension which can occur within the U.S. civilian population and among army personnel. Tension and misconduct may also stem from major cultural and physical/ racial differences between U.S. soldiers and the local population.
• Local civilian population may be perceived as hostile, untrustworthy or "subhuman."
• Failure of expected support, such as inadequate medical support.
• Popular opposition at home to the war; lack of understanding or belief in the justness of the effort.
What can be done to prevent misconduct stress behaviors?
It would be an accurate statement that none of the service members that made the January 2012 headlines got there without a long trail of opportunities for someone(s) to intervene. Expert consensus within and outside the military is that early identification and intervention is critical in order to avoid severe, chronic COSRs such as PTSD, depression and suicide, substance abuse and misconduct stress behaviors. The military's deployment cycle health screenings, Combat Operational Stress Control programs, anti-mental health stigma, resiliency training and a plethora of post-deployment and transitional support programs, along with the Department of Veteran's Affairs (DVA) mental health outreach and suicide prevention programs, all represent notable efforts to stem the tide.
However, military, government, media and multiple other sources all point to dramatic escalations in rates of military and veteran suicides, domestic violence, divorce, mental health diagnoses such as PTSD, sexual assault, substance abuse, homelessness, joblessness, health problems and misconduct stress behaviors including homicides. What else can be done?
Alternative early interventions in the war zone and back home
One possible early intervention strategy that has yet to be fully explored is EMDR therapy. Clearly not a panacea, however EMDR should be strongly considered as a frontline treatment option for the full continuum of COSR-especially while the service member remains within the supportive framework of the military, and hopefully before the commission of any serious misconduct stress behaviors.
Since 2004, EMDR has been recognized by the DVA and DoD as a top evidence-based treatment for post-traumatic stress disorders according to their own clinical practice guidelines. With high rates of mental health stigma in the military, EMDR has the unique advantage of being noticeably different than standard talk therapy. Service personnel are not required to self-disclose details of events that they have witnessed or participated in, and the effects tend to be more rapid and generalize to other contributing experiences that often underlie difficulties associated with depression, suicide, anger, substance use, aggression, medically unexplained conditions, and so on.
As a recently-retired military psychologist, former enlisted Marine and OEF/OIF veteran, I have successfully treated hundreds of military personnel with EMDR therapy before, during and after deployments including problems involving combat-related acute stress disorder, traumatic grief, depression and suicidal ideation, phantom limb pain, PTSD and aggressive impulses.
This is not to suggest that any of the January incidents would definitely have been prevented even if those veterans had received EMDR. However, there is no doubt in my mind that EMDR therapy can significantly reduce and/or relieve a lot of pain and suffering for many military members and veterans, and doing so would prevent an untold number of misconduct stress behaviors and chronic war stress injuries such as PTSD and depression. If you are interested in finding an EMDR therapist that specializes in veteran treatment, try the EMDR International Association or the EMDR Institute.
That war changes everyone is an irrefutable fact of military life. Tragically, it is also a fact that warring Western societies have repeatedly neglected to learn the so-called "psychiatric lessons of war," resulting in monumental failures to anticipate and meet the mental health needs of those sent in harm's way. Consequently, there is always more that can and should be done to prevent the tragedies that have occurred in January 2012. If we prevented one incident, saved one life, it would be worth the time and investment.
For more by Mark C. Russell, Ph.D., ABPP, click here.
For more on PTSD, click here.