By Capt. Richard Stoltz, commanding officer, Naval Hospital Guantanamo Bay and commander, Joint Medical Group. Stoltz is a clinical psychologist who began his Navy career in 1986.
(Part 2 of 3 posted on Wednesday, Feb. 22)
As often noted, it is best to begin with the end in mind. Thus, how might we prevent service members from developing post traumatic stress disorder and high levels of depression and anxiety in response to harrowing events they experience while deployed? Below is a brief list; some of these are already being utilized.
Pre-deployment training needs to be as close to the real thing as possible. While deployments are unpredictable, it is helpful to provide specific information about what to expect during the deployment both before and shortly after the deployment begins. For example, what kinds of food and shelter will likely be available? How might this deployment compare and contrast with their prior deployments? What will their primary duties involve? Proactive involvement in providing realistic expectations strengthens mental preparation. The more we tell the truth to our deploying troops up front, the more likely they will express the truth when they return.
It is also best to educate them on the things that they can do to become more resilient. Resilience is a complicated subject that involves multiple factors. There is no firm agreement on what resilience is or on how to measure it. And, while some research is attempting to find genetic and neurological differences between resilient and non-resilient people, the focus here will be on things that we can do to increase our ability to quickly recover from trauma and adversity.
Obviously, chronically high levels of stress can decrease resilience. Therefore, strategies commonly considered to reduce stress such as exercise, good nutrition, healthy sleep and a strong social support system will also serve to bolsters one’s ability to withstand mental trauma. However, stress management is only one component of fortifying resilience. Learning how to prepare for and best respond to traumatic situations is another.
I once had a female patient whose young son was brutally murdered. The killer was caught and convicted. After being in treatment with me for several months for her grief, the mother, without any suggestion from me, decided to forgive the man who was found guilty of murdering her son. After doing so, she felt less burdened and functioned more effectively than ever before both as a mother to her surviving children and as a contributing member to her community. If we want to be resilient it is beneficial to work through and let go of our anger and resentments. It is helpful to focus more on understanding and less on blame, to realize and accept how flawed we human beings can be.
It is also valuable to recognize that sometimes things happen, often largely beyond our control, that throw our lives into upheaval. How much time do we take rebelling against these events before we finally accept that our life and perhaps our mission has changed? Accepting that life sometimes suddenly changes the cards we are dealt is far better than desperately seeking over and over again to get back the cards that are gone. Adopting an accepting attitude towards ourselves and our world makes a significant difference in how resilient we are.
Developing and enhancing a sense of purpose and meaning is another important component of resilience. It is my experience that those who examine fundamental spiritual and existential questions such as, “Why am I here?” and “What will happen when I die?” more effectively cope when distressing incidents occur. When something disturbing happens they are not shocked by crucial questions that they have never seriously considered before.
A final patient example — an alcoholic who killed an 18-year-old pedestrian while driving drunk. After going through huge doses of anger and anguish and gloom, and persistently fighting intensely within himself, he finally pleaded to a higher power, “What am I supposed to do?” After that his life started to move forward and he blessed the world with numerous acts of kindness.
When we confront our worst nightmares and fears, learn to grieve our losses, work through the pains from our past, follow the advice we so often hear in stress management classes, and have faith in the power of empathy and love, we are more likely to respond to highly stressful and traumatic situations with resilient acts of kindness and service instead of becoming overcome by confusion and fear and developing a pattern of avoidance that makes us more vulnerable to PTSD and high levels of depression and anxiety.
Of course, all of this is much easier said than done. And, all of us are vulnerable to being overwhelmed and needing help.
Reason for Hope
Although there is still plenty of smoke, confusion and fear obstructing our ability to navigate through and heal the psychological problems that returning service members experience, PTSD, depression, anxiety, and substance abuse are highly treatable conditions. We have learned important lessons from prior wars and far better understand how best to respond to those who wear the cloth of our nation. We recognize the importance of bringing home deployed troops with others who were deployed with them and ensuring that, in safe settings, they spend time sharing their experiences. Our culture and our health care system are becoming more sensitive to the common struggles they have endured. Our knowledge of and skill in implementing multiple treatment modalities continues to improve.
While the patient who could not stop smoking illustrates how our subconscious mind can thwart our resilience, we are also increasingly aware of how our conscious mind can engage in healthy explorations to bolster it. We better comprehend the importance of gathering the moral, spiritual and psychological courage to face and sort through the truth. We know that what we consciously choose to do affects how our brain functions and how resilient we are.
Whether a person is facing a relatively simple and straightforward problem like smoking or suffering from a series of head injuries and psychological traumas, high-quality preparation and resilience training can bolster our spirits and lead to healthier responses. Even if we do not experience trauma, resilience lessons can lead to more meaningful and fulfilling lives. As long as our compass points towards the truth, we will not lose our way and we will improve our methods both to prepare and to treat those who so courageously venture into harm’s way.