Mass Therapy for Depressed Soldiers

Worried about the high rates of depression and suicide, the Army is planning therapy for its 1.1 million soldiers. For many years I have been developing an approach for teaching college students (and my own therapy as well) that may fit the Army's problem exactly. I propose two basic causes of depression: Hidden emotions, and no secure bond with another person. These ideas lead to a practical self/other therapy for depression that might be effective for the Army.

Temporary Lifting of Severe Depression

Many years ago in England, I observed eighty initial interviews of elderly male patients admitted to a mental hospital. They were all deeply depressed in speech and manner. They were mostly outcasts without a secure bond. However, to my surprise, I saw moments in some of the interviews that were like miracles.

The psychiatrists asked about half of the patients about their activity during WWII. For half of these, as they begin to describe their experience during the war, no matter what it was, their behavior and appearance underwent a dramatic change.

Those who changed most sat up, raised their voice to a normal level instead of mumbling, held their head up and looked directly at the psychiatrist. The speed of talk picked up and became clear and coherent. Their facial expressions became lively and showed more color. Each of them seemed like a different, younger, person.

The memory of the patients' earlier acceptance as valued members of their country under attack re-lived the feeling of a secure bond and generated pride. The pride, in turn, counteracted the shame part of their depression. Telling the psychiatrist about belonging to a community had been enough to remove the shame of being outcasts. Each question about WWII was a momentary invention of Positive Psychology.

Many persons have had the experience of community as adults, but have forgotten. These persons, like the patients described above, need only be asked the right questions, or ask them themselves. It would appear that the deficit in these cases is not in the person, but in the social environment. In the rapid pace of modern societies, it is difficult to find a true confidant that is available when needed.

Repression of Emotions and Gender

Boys, more than girls, learn early that vulnerable feelings (love, grief, fear and shame) are seen as signs of weakness. In modern societies most boys learn to hide their vulnerable feelings in emotionless talk, withdrawal, or silence. In situations where this option seems unavailable, one may cover vulnerable feelings behind a display of hostility. Young boys, especially, learn in their families, and later, from their peers, to suppress emotions they actually feel by acting out anger whether they feel it or not.

Vulnerable feelings are first hidden from others, and after many repetitions, even from self. In this latter stage, behavior becomes compulsive. When men face what they construe to be threatening situations, they may be compelled to silence, especially about their emotions.

Even without threat, men seem to be more likely to silence than women. With their partners, most men don't talk freely about feelings of resentment, humiliation, embarrassment, rejection, loss and anxiety, or for that matter, joy, genuine pride and love. They seem to be backed up on a wide variety of intense feelings.

Numbing out fear, particularly, is a catastrophe. Fear is an innate signal of danger that has survival value. When we see a car heading toward us on a collision course, genetic endowment has given us an immediate, automatic fear response: Wake up, your life is in danger! Much faster than thought, this reaction increases our chance of survival; repressing it is dangerous to self and others. Yet most men are trained to equate fear with cowardice. Numbing out fear and other emotions may be the main source of the high rates of depression in the mostly male U. S. Army.

In order to avoid pain inflicted by others, we learn to repress our emotions. After thousands of curtailments, repression becomes habitual and out of consciousness. As we become more backed up with avoided emotions, we have the sense that experiencing them would be unbearably painful. In this way, avoidance leads to avoidance and finally silence in a self-perpetuating feedback loop.

How can our soldiers escape this loop? I have been using exercises to deal with my own bouts of depression and those of my students: Best Moments, Gratitude Letters, and two exercises for finding and connecting with a confidant. I will describe them and their effectiveness in my next blog.

Comments

[Norge]

My research indicates more than a million Iraqi civilians were killed during Americas' agressive attack and ocupation of Iraq and there are at the present time 7 to 8 million very traumatized Iragis' with extensive war injuries and virtually no medical trauma system in place in Iraq... Professor. Insidently, all in violation of International Law. Though criminals should also be given medical treatment.

Humanitarian needs of civilians should have the same priority as those who caused the horrific injuries and deaths and patriotism be damned, professor.

Norge

[khanti]

Excellent Norge! I hope you are from the US. If you are then there is still hope for the future. In Vietnam hundreds of thousands of unexploded ordinance dropped by the US still litter the country limiting development and progress people including children still die/maimed by these uncleared explosive. Not to mention people still suffering from the effects of agent orange. Despite the deaths, massacre of villages (there were many unrecorded My Lai incidents) people force to live underground literally the Vietnamese had forgiven the US and welcome them to their country. Like the Iraqis they never invaded US soil before, during nor after the war.
Sigh. Why does the US create enemies half way around the world? Nobody ever apologized for all those killings. I really hope you are a US citizen. It gives me hope.

[itolduso]

Research has shown that 'being in the vicinity of an explosion' can cause injury to the brain (shockwave) even when there is no outward sign of injury (and despite wearing a helmet) Unlike a typical head injury, where the bleeding & swelling appear on the outside of the brain, the T.B.I. causes damage deep inside the brain and is harder to spot on early scans.

[itolduso]

I believe that many of our current Iraq/Afghanistan vets have more than depression - Traumatic Brain Injury has many of the same symptoms, and few are screened for them (or tested too soon, often the small bleeders are deep in the brain and are not visible until weeks/ months after the event) sleep disorders, headaches, disorientation, unprovoked anger/mood swings, panic attacks, many are misdiagnosed with battle-fat­igue/depre­ssion , severe cases with P.T.S.D., in many cases it may be a combination- but too often the brain injury is left untreated. Awareness & screenings need to be raised.

[khanti]

Dear Mr. Thomas,
A smoker crave for a puff. After that he is satisfied for the moment but where is the seed for the next craving hidden?
A child see or experience something traumatic in the day and has a nightmare at night. Where is the seed of his fear hidden?
If you find out the answers for those questions then you will know the cause of the soldier's depression.
The answers had been around more than 2500 years ago.

[dfranz]

I am a Viet Nam Infantry Veteran. I can tell you from personal experience that war in unhuman. When you are in an unhuman situation and experience carnage, or maybe even having to kill someone yourself, it changes you. I am not Hindu, but after 40 years, I believe in the idea that those events of your life leave you with a "Karma" you live with for the rest of your life. If someone hasn't experienced what you went through you can't relate to them. Without a concerted effort, these memories will live within you until, for some, it is impossible to live a normal life. As a result, the last time I saw data on it, 4 times as many Viet Nam vets had committed suicide than were killed in action.

Iraq War Vets have been immersed in this misery for many tours. . If those Veterans can be out reached somehow and shown how it can improve their lives many can be helped. But soldiers have kind of a macho feeling about themselves and asking for help is not easy. The arrogance that sent our people to Iraq is so contemptible. These dorks who never went themselves had no idea what they were doing to the soldiers. I thank God for people like Senator Murray of Washington who has made it her mission to improve services that our veterans need desperately.

War must be seen as the last resort, not the action of preference.

[itolduso]

DFranz- you are right that war changes you....we have known since the end of WWII that repeated (3 or more) & extended combat tours result in almost 100% P.T.S.D.'s. The biggest trouble comes from the false perception that those affected are somehow 'weaker', or 'not cut out for the military', or 'cowardly' (that one really gets to me because it is often the bravest, most daring soldiers that suffer after heroic service) P.T.S.D. is a psychological reaction that occurs in NORMAL people that are exposed to trauma. It is an INJURY. It's treatment should be no more 'shameful' than treating any other wound ...that so many of our finest veterans are left to suffer alone is this country's biggest shame.

[schatsie]

You know these soldiers nowadays are facing a different world....a world in which the Repugs want them to pay for their OWN care....During and after WW2, the soldiers with PTSD were treated and not ignored and they had the GI bill for their education and 50% union jobs so they could settle down and start a family..

Our soldiers now are on an ice flow and are isolated and cannot find jobs just like the rest of us and no hope for improvement in their income or even holding onto a job for a long time....SO THEY ARE DEPRESSED AND WE ARE DEPRESSED FOR THEM AND THEIR FAMILIES....

[dadw5boys]

Years ago Marines had a Doctor who made each Soldier lead 10- 2 hour group meetings.

He refered to the fact that people need to read something 7 to 10 times before they fully undersand what they have read. But to be able to take competent action on what they have read they need to read it several more times.

By leading these Group Meeting the men not only understand that they were not to blame for those things and should forgive themselves but also how to create control points in their life to prevent them from sliding back into the nightmares and daymares that can dominate their thoughts.

All I know who went thru his treatments have been able to keep it togeather without many problems for over 30 years.

[BetteB]

I am happy to see Dr. Martin Seligman’s knowledge utilized here, after reading the New York Times article on the Army’s plan. Explanatory style is an important aspect in trying to understand human behavior in yourself and/or others. I think it worth trying to help some students at risk fro dropping out of high school, as well as possibly with drug addiction. Reality Therapy proposed by William Glasser MD (1965) also comes to mind here, although with soldiers what happened in the past has to remain important because making these people learn to kill, then probably kill, and then come home like nothing happened is actually insane. Any behaviors emitted by these people after that probably appears more rational to them by comparison. Glasser had the need for connection with other with mutual respect as I see your missive here Professor Scheff, has in common. Will the rest of the military machine follow suit, is that planned as well?
Love
Bette