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Grief associated with military service

Veterans In The Contemporary Context

In the past, a veteran was often seen as a male who fought in an overseas conflict. Currently, however, veterans may be better understood as those of any gender who have served in any role in the Australian Defence Force (ADF). This change recognises increasing diversity within the ADF, the impact of training for war on an individual, and that many roles, including those involving lethal force within an international combat zone (eg, the drone technology), can now be fulfilled remotely from Australia or an allied nation.

Contemporary military operations now often involve ambiguous forces and drawn out campaigns, along with peace keeping, disaster relief, and humanitarian missions. The way society understands and supports veterans has also changed. For example, some have argued that veterans of WWI, WWII and possibly even Korea experienced service as as a whole-of-nation endeavour, with collective support being offered veterans. In comparison, those who served in Vietnam and in more contemporary operations have experienced post-service adjustment within a society that is more individually focused. This greater individual focus, in contrast to military values, can negatively impact the health and wellbeing of veterans and their families.

Loss Associated With Military To Civilian Transition

One of the most sensitive periods for veterans is transition from the military. The Department of Defence and Veteran’ affairs’ reports that transitioning veterans experience psychological distress, psychological disorders and some degree of suicidality well above community norms.1 There is increasing evidence that much of this distress is attributed to issues of loss. The veteran’s lost task (higher purpose) and lost team (significant others with whom the task was achieved) seem to be critical issues because they impact a person’s sense of identity and belonging. These losses often are followed by a painful period of limbo which can last months or years, during which time veterans are yet to establish who they will become and how they can regain a sense of identity.

The Impacts Of Military Operations

Operational service often involves traumatic stress such as participating in combat, experiencing horror, or having closely held morals, values and beliefs challenged (eg, the lack of value afforded to human life in some countries). For some, traumatic stress can result in a significant change in how a veteran experiences themselves in relation to the world, which can lead to emotional numbing and hypervigilance (ie, always being “on guard”). Traumatic stress may be worse when there is loss or maiming of significant others through enemy action, or when an individual experiences severe wounds, injuries, or illnesses themselves. Sometimes this traumatic stress can present as Post Traumatic Stress Disorder, affective disorders such as depression, or anxiety disorders (such as panic attacks)

Ongoing Cycle Of Loss And Grief

Veterans can be stereotyped by others as an angry and violent person who doesn’t fit into society. Consequently some veterans have hidden their service history, which may preserve identity on one hand but undermine it on the other. Veterans may experience this stereotyping as betrayal or rejection by the very society they sought to serve, which can further fuel alienation, anger and grief. In relationships, veterans often avoid intimacy and subconsciously put in place protective barriers to maintain distance between themselves and those they love. In this case, while things may appear “normal”, beneath the surface issues of loss and grief may continue to erode the individual and their relationships with others.

In many ways, the losses and grief veterans experience remain relatively unrecognised or misunderstood by society, resulting in a reduced capacity for society to acknowledge the losses and tolerate how veterans express their grief. This misunderstanding and reduced tolerance can contribute to a prolonged and complex grief process for veterans. The resulting traumatic grief can lead veterans to avoid reminders of what happened; to see little purpose or meaning about the future; to feel in shock and detached; and to have difficulty acknowledging their losses and grief reactions.

Prolonged or complex grief can also lead to an increase in chronic physical and mental health conditions.2

One way to help avoid or minimise chronic health conditions is through accessing early assistance when problematic physical, psychological, or social issues arise.

Coping And Supporting

In 2017 the Department of Veterans Affairs mandated that all veterans with at least one day of full-time service are entitled to non-liability mental health care. This means veterans who suffer after service, particularly as they work through issues of grief, do not need to prove  their suffering was caused by their service to receive mental health support. Application should be made to DVA for a health card against which support services may be attributed (www.dva.gov.au/providers/dva-health-cards).

Strategies veterans use to cope, grieve and support themselves can differ, depending on their strengths, needs and the availability of services. Some find that talking about what happened helps to deal with the feelings that have been suppressed, in some cases for  many years. Identifying what it is underlying their anger and expressing the grief is useful to others. For many, being accepted and understood is important. Finding out that they are not alone or different to others who have had similar experiences is reassuring. For this reason, peer-to-peer support systems are critical for the veteran community. Having a range of activities where they don’t  have to explain themselves can be helpful and often enables them to move out into community activities. It also is important to involve and support the veteran’s family and educate them about the nature of the veteran’s grief and ways of assisting their veteran family member, as well as giving them tools for self-care.

Counselling and group programs for veterans are available through various organisations (listed below). Some programs may be specific to veterans and others may be specific to a condition or location. Key resources include the Department of Veterans’ Affairs, Open Arms – Veterans and Families Counselling (formerly Veterans and Veterans Families Counselling Service – VVCS), and The Jamie Larcombe Centre at Glenside in South Australia.

References

1Van Hooff M, Lawrence-Wood E, Hodson S, Sadler N, Benassi H, Hansen C, Grace B, Avery J, Searle A, Iannos M, Abraham M, Baur J, McFarlane A (2018) Mental Health Prevalence, Mental Health and Wellbeing Transition Study, the Department of Defence and the Department of Veterans’ Affairs, Canberra

2 O’Toole B, Catts SV, Outram S, Pierse KR, Cockburn J. (2009). The physical and mental health of Australian Vietnam veterans 3 decades after the war and its relation to military service, combat, and post-traumatic stress disorder. Am J Epidemiol. 2009 Aug 1;170(3):318-30

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