Finding a Light in the Dark
Meghan Moody, Psy.D., Editor

Psychological Impacts
of War

The Hidden Wounds of War
Judith Broder, M.D.

The Psychology of Suicide Terrorists
James S. Graves, Ph.D., Psy.D.

Military Sexual Trauma
Callie Wight, R.N., M.A.

Torture and its Aftermath
Michael Nutkiewicz, Ph.D
Rose Marie Durocher, Ph.D.,M.F.T., C.T.S.

LACPA Working for You

The Hidden Wounds of War
Judith Broder, M.D.

"All the troops come home different from when they left. They will NEVER be the same again, ever. They will carry their war with them for the rest of their lives. Much of what a returning serviceman or woman carries is hidden...even from him or herself."

This is a quote from Bob, one of the veterans who has been involved with "The Soldiers Project."

In March 2005, I attended a performance of "The Sand Storm: Stories From the Front." It was a heart wrenching play written by Sean Huze, an active duty Marine. It dramatized the experiences of 10 marines who served in Iraq. The play made clear that these men were forever changed by their service in war and that the psychological wounds they suffered were no less severe then their more obvious physical scars. I was convinced that when our colleagues learned about the extent of the suffering of our servicemen and women, they would want to participate in an outreach program which would provide free psychological counseling to soldiers, their families, and their loved ones. I was right.

The Los Angeles Institute and Society for Psychoanalytic Studies, of which I am a member, has an outreach arm called The Ernest Lawrence Trauma Center which agreed to sponsor The Soldiers Project. We had a series of meetings publicizing the project and, as I had hoped, there was a vigorous response from our provider community.

We've spent the past year and a half studying the psychological effects of war on our soldiers and their families. We've heard from experts in the fields of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), active duty caregivers, soldiers, and families.

We now have a deeper understanding of what Bob, the vet quoted above, told us early on. The most severe and lasting casualties of war are not always the most obvious ones, and their consequences are not always visible until after they've begun to affect families and entire communities. We know that the divorce rate is exceptionally high, and climbing, among service members who have been deployed. Over 60,000 Army marriages alone have ended in divorce. The same increasing rates are true for suicide, addictive behavior, family violence, and auto accidents.

Reservists and National Guard members, who comprise nearly 40% of the front line forces in Iraq and Afghanistan, often are notified of their potential deployment only weeks before the actual date. These are men and women who are employed in their communities--firefighters, police, nurses, doctors, and trades people. They leave their jobs and families with virtually no pre-deployment support for themselves or their families. When they return home, they do not return to a military base as do active duty service members; instead, they are discharged directly back to their communities with little preventive counseling.

To get an idea of the potential tsunami of emotional cost to our communities, consider this: Over 1,400,000 troops have been deployed, with more than 400,000 having served two or more overseas tours. Each service member has someone close: a spouse, kids, parents, aunts, uncles, grandparents, lovers, brothers, sisters, and friends. Powerful changes occur within the family and within the service member during deployment and upon return home. The joys of homecoming often dissolve under the impact of these hidden wounds of war.

How does a mom explain to her six-year-old son that Daddy can't play, while Daddy is closeted away for hours a day playing video games to escape from his nightmarish memories of battle? How does a grandma tell her ten-year-old granddaughter that her mom is going back to Iraq again? How do you explain Mom's black eye and bruises to a teenager the day after Dad got drunk? What do you say to the decorated veteran who refuses to talk to his wife because he feels so guilty about what he's done and seen, that he's afraid he'll "infect" her with his "badness." These are some of the dilemmas that we've been confronting.

John, age 22, returns from his first tour in Iraq. Several of his buddies died in combat. Sue, his bride of one year, is excited to see him, but he is often irritable, moody, and wants to be left alone. When Sue tries to talk to him, he gets mad and storms out of the house. He returns hours later drunk and belligerent. He refuses to believe there is anything wrong with him. Sue reaches out for help to The Soldiers Project. Her therapist tries to help her understand the experiences that John has been through and to find ways to talk to him so that he doesn't feel threatened.

Timmy is 5 years old. His dad has been in Iraq for six months. His mom has had to go to work to help support the family. His teacher complains that Timmy can't concentrate and teases the other kids. He often says his head hurts. Mom has noticed that he's very clingy when she's home. He used to be an energetic, outgoing boy with lots of friends. We're able to help Timmy's mom understand that his reactions are related to his dad being gone and his worries about him. The mom is then able to go to school and explain the situation to the teacher who then can see that Timmy needs some special attention.

Tony is a 25-year-old Army Reservist, home from his third deployment. At a restaurant, a balloon bursts at a nearby table. He hits the floor and begins sobbing. His family is able to calm him, and he agrees to see a therapist with his wife.

Ian, age 35, returns to his old job after his second tour in Iraq. He finds he's having trouble concentrating, is making mistakes, and can't seem to learn the new procedures. He has started to drink every night and dreads going to work. The therapist learns that a roadside bomb destroyed the vehicle Ian had been riding in. Although he lost consciousness for several minutes, he seemed okay. Familiar with the symptoms of traumatic brain injury, the therapist referred him to the Veterans Administration.

Traumatic brain injury has become one of the more serious hidden wounds of war. Such injuries can occur to the brain as a result of being exposed to a nearby blast or to severe impact. The symptoms often appear purely psychological and, therefore, the correct diagnostic studies may be missed and the treatment will be incorrect. Some of the common symptoms are difficulty concentrating, irritability, fatigue, depression, memory problems, headache, nightmares, and insomnia. Most of these are also symptoms of PTSD, and the two may co-exist. It is extremely important for therapists to be aware of TBI so that appropriate additional assessment and treatment can be provided.

We can best help our clients/patients when we understand the complexity and range of "the hidden wounds of war." What we have learned is that the most powerful stimulus to healing is the restoration of emotional connections to loved ones and to the community. To help our patients/clients do this, we as therapists do not need any special techniques, only the ability to empathize and the capacity to really listen.

Judith Broder, M.D., is a psychiatrist and psychoanalyst in private practice in Studio City. She is the Director of The Soldiers Project (www.thesoldiersproject.org) and a member of the Board of Directors of Physicians for Social Responsibility-LA.