As we approach the tenth year of Operation Enduring Freedom and the ninth year of Operation Iraqi Freedom, the wars’ impact on American families is becoming a major focus of study. As one of the co-founders and co-directors of SOFAR (Strategic Outreach to Families of All Reservists), a pro-bono mental-health project that identified extended families of National Guard and military reservists as an underserved population in 2004, I feel both angry and relieved. I am angry that our message, “Families are the invisible wounded of the war,” took so long to be embraced and that this delayed providing services by both the military and the public sector. I am relieved that the empirical studies demonstrating the strains on families—that will provide the evidence necessary for public and private funding—are being published with alacrity.
In a war in which 2 million service members have deployed, we estimate that more than 28 million family members contend with the strains of deployment and the challenges of reunion and reintegration. We assume that each Soldier, Marine, and Sailor has seven people in his or her immediate family: a significant other, children, parents, and siblings, accounting for 14 million people. If we include grandparents, aunts, uncles, cousins, and grandchildren, the figure becomes 28 million people.
Of the 2 million individuals who have deployed in OEF and OIF in the military, 787,000 have been members of National Guard and military reserve units. Their families are additionally challenged because they often live at a distance from the support of military bases and may be the only ones in their communities with a deployed or reintegrating family member. The relief they feel when their veteran returns home is short-lived. For many, this is when the challenges begin.
First Deployment
At the onset of Operation Enduring Freedom, almost 80 percent of those deployed were members of National Guard and reserve forces because of the downsizing of the military that occurred at the end of the Cold War. According to updated figures from the Department of Defense Web site, currently, approximately 120,000 citizen-Soldiers are deployed. Many have served multiple deployments—a radical change from drilling one weekend a month and two weeks a year.
These deployments have plunged family members into a new status of serving on the home front. When any Soldier, Sailor, Marine, or Airman goes to war, the entire family is affected. Every parent remaining at home becomes a single parent.
Children and siblings of National Guard or reservists may be the only ones in their schools coping with a deployment or reintegration. They may be subjected to scorn at school from those who oppose the war and confuse the roles of those who make government policy with the role of the military.
While many active-duty service members do not live on base, they inhabit military towns where even the civilian-run establishments are sensitive to the strains and rhythms of deployment and return. They are also familiar with the process of reintegration and with the sense of dislocation that accompanies the readjustment of their nervous systems from the hyper-vigilance of the combat theater to the apparent safety of life at home.
The present wars are extraordinary because of communication channels that are available for the first time. The war occupies the living room, and the living room occupies the war. Skype, cell phones, Internet chatting, and instant-messaging permit constant communication in the combat theater despite the geographical distance. Social networking sites such as Facebook and YouTube allow families to monitor what’s going on overseas. Families and those serving must decide how much to share or to conceal. Should those at home talk about financial worries or health concerns about aging relatives? Should the service members share the risks they face or stories of those they have seen wounded or killed?
Many at home spend the entire deployment fearing the knock on the door signaling the death of their loved one. When they learn of a fatality in the vicinity where their family member is serving, they wait anxiously for a phone call assuring their relative’s safety. When they receive good news, their relief may be followed by guilt because they know another family elsewhere has not been so fortunate.
Many on the home front are horrified at the suggestion they might resent the burden of worry and added responsibility. Indeed, part of increasing the coping skills of families is to help them distinguish between what they feel and what they do with those feelings. They may assume that they must express the anger directly to the service member rather than coping with these feelings themselves.
War’s Effects on Children at Home
Approximately 70 percent of National Guard and military reservists are parents. According to available statistics, 2 million children have had a deployed parent since the wars began. Parents who remain at home must manage their and their children’s anxiety about the safety of the deployed loved one while performing all the everyday chores. Thus, one is not surprised to learn the rate of child abuse and neglect rises between 30 and 60 percent when one parent is deployed.1 In one case, SOFAR was asked to diagnose a mother of three children under the age of four who was unable to get out of bed. A diagnosis was needed to permit her husband to return from Iraq on emergency leave. She refused to go to the emergency room because she had no one to look after her children. Here was a woman who thought she was protecting her children and instead was putting them at risk.
Children of parents who have deployed cumulatively for more than 19 months demonstrate a decrease in academic achievement.2 Outpatient visits for pediatric behavioral disorders for children ages 3 to 8 with deployed parents were 18 percent greater than for military children without a deployed parent.3 The rate of military children taking antidepressants and anti-anxiety drugs has risen 18 percent since 2005. Children between the ages of 3 and 5 with a deployed parent show heightened levels of aggression in nursery school.4 Children ages 11 to 17 show a higher rate of emotional problems than a comparable group of non-military children.5
In one case, a 12-year-old boy’s father was deployed twice. During his first deployment, the father had suffered a life-threatening illness. His son’s aggressive behavior escalated at school during the second deployment, with multiple suspensions. The school initiated court action to compel his mother to seek additional services. The school refused to acknowledge any connection between the family’s situation and the son’s worsening behavior. The presiding judge, furious at the school’s punitive attitude toward the family, appointed a guardian ad litem to assure the school tailored a program to meet the son’s needs.
The spouses of the deployed suffer from rates of anxiety and depression that are comparable to those of their partners overseas.6 The more extended the deployment, the greater the emotional challenges for those at home. One possible and alarming conclusion is that the cumulative impact of multiple deployments may lessen the resilience of the family, a resilience as badly needed when military members return as when they are overseas.
Coming Home
Reunion and reintegration pose many challenges. The long-anticipated return provides both relief and disappointment. The family is reassured and relieved, yet so much has changed. It can take months to reacclimate to being home. Service members go from a 360-degree kill zone to a physical safety they may not be prepared to enjoy.
The hyper-vigilance and numbness required by the combat zone take time to dissipate. Many return from deployment sleep-deprived. One Army sergeant who served with Special Forces said it took ten months to regulate his sleep cycle. There are jokes about not letting service members drive home from their return ceremony for fear that they’ll zigzag down the road to avoid potential improvised explosive devices. When eating in a restaurant, service members often choose to sit with their backs against the wall—as their families soon learn.
All returning veterans have two families; the family they fought alongside and the family to whom they come home. They may want to talk about combat experiences only with their comrades. This leaves the family feeling excluded. But for National Guard and military reservists and their families, reintegration can be especially isolating. It takes place away from comrades or other families, alone in their often non-military communities. As with all service members, even those who return physically unscathed to a family that coped well with the deployment, they must negotiate the natural changes that occur during a yearlong separation. Children have reached new developmental stages; new babies have been born, and elderly family members have died. Roles and responsibilities have been reassigned. Only National Guard and military reservists, however, must move from a military to civilian milieu within a week of their return. They may be back at a civilian job where they also are confronted with changes. Many discover that their jobs disappeared during the recession. Massachusetts, for example, passed a law forbidding laying off a National Guard or military reserve member until 30 days after return, because receiving pink slips in the war zone was becoming more common than “Dear John” letters.
All returning service members may suffer from transient stress reactions as well as post-traumatic stress disorder (PTSD) and traumatic brain injury. Families might have to contend with ambiguous loss, where the returned family member is physically present but psychologically absent.7 Substance abuse is endemic in returning veterans as they try to self-medicate. The impulsiveness and emotional lability also heightens the rate of domestic violence.8 According to the Veterans Administration, as of January 2010, an average of 18 veterans a day were committing suicide. For families with suicidal veterans, the return home begins another period of worry and danger. Even in the absence of a diagnosis of PTSD or traumatic brain injury, marital problems threaten relationships.
Coping Strategies
We face two problems in providing services to these National Guard and reservist veterans and their families. The stigma of mental illness discourages them from seeking treatment, and those who seek services may find a scarcity of trained mental-health professionals.
Forty percent of National Guard members and 34 percent of their significant others met the screening criteria for one or more mental-health problems. Of those, 53 percent reported seeking help of some kind (50 percent of Soldiers; 61 percent of their partners). The stigma associated with mental-health care and concerns about its appearing on military records ranked high. Concerns about the influence of mental-health issues on career advancement were notable. Among veterans’ partners, barriers included the costs of mental-health care, trouble with scheduling appointments, difficulty in getting time off work, and not knowing where to get help.9
SOFAR recommends several approaches to helping veterans and their families. First, psychological education prepares family members to anticipate and cope with the stresses of deployment and return. By attending Family Readiness Groups, Yellow Ribbon Reintegration events, and grassroots veteran support groups, families can understand, normalize, contextualize their reactions, and increase resilience.
Second, we train volunteers and mental-health providers in the community to be culturally competent about the military. The SOFAR Guide for Helping Children and Youth Cope with the Deployment and Return of a Parent in the National Guard or other Military Reserves was written in 2008 for teachers, school nurses, pediatricians, and parents to deal with the reactions of children to deployment and return at each stage of development.
Third, we decided that if families and veterans were reticent to seek mental-health services from the Veterans Administration or veterans’ centers, we had to come up with alternative sources. We designed a workshop for primary-care medical providers. Providers are urged to begin each appointment by asking if anyone in the family is serving or has returned from military service. If the answer is yes, providers are trained to make appropriate mental-health referrals to relevant resources.
Finally, we hold workshops to train family members to identify veterans at risk. We try to help them determine what may be a transient symptom of readjustment or when to be alarmed. Since family members see the veteran every day, they are uniquely equipped to sound the first alert. During a Yellow Ribbon Reintegration event, I spoke to a veteran who had returned from Iraq 90 days earlier. He told me he slept with his weapon for the first month after he had returned home. I asked him why he stopped, and he told me he realized it didn’t make sense anymore. It had been a transient symptom.
Families are the invisible casualties of war. They are deeply affected during their loved ones’ deployment and return but may also suffer all their lives from the effects of their relatives’ service in combat. They must be given the same resources and care as the veterans returning from the front lines.
1. D. A. Gibbs, S. L. Martin, L. L. Kupper, and R. E. Johnson, 2007. “Child maltreatment in enlisted Soldiers’ families during combat-related deployments.” Journal of the American Medical Association, Volume 298, No. 5, pp. 528–535. E. Rentz, S. W. Marshall, D. Loomis, S. L. Martin, C. Casteel, and D. Gibbs, 2007. “Effect of deployment on the occurrence of child maltreatment in military and nonmilitary families.” American Journal of Epidemiology, Volume 165, No. 10, pp. 1,199–1,206.
2. E. Flake, B. Davis, P. Johnson, S. Middleton, 2009. “The psychosocial effects of deployment on military children.” Journal of Developmental & Behavioral Pediatrics, Volume 30, No. 4, pp. 271-278.
3. G. Gorman, M. Eide, E. Hisle, 2010. “Wartime military deployment and increased pediatric mental and behavioral health complaints. Pediatrics, Volume 126, pp. 1,058-1,056.
4. M. Chartrand, D. Frank, L. White, T. Shope, 2008. “Effect of parents’ wartime deployment on the behavior of young children in military families.” Archives of Pediatric & Adolescent Medicine, Volume 162, No. 11, pp. 1,009-1,014.
5. A. Chandra, S. Lara-Cinisomo, L. H. Jaycox, T. Tanielian, R. M. Burns, T. Ruder, B. Han, 2010. “Children on the homefront: The experience of children from military families.” Pediatrics, Volume 125, No. 1, pp. 16-25.
6. K. E. Eaton, C. W. Hoge, S. Messer, A. Whitt, D. McGurk, 2008. “Prevalence of mental health problems, treatment need and barriers to care among primary care-seeking spouses of military service members involved in Iraq and Afghanistan deployments.” Military Medicine, Volume 173, No. 11, pp. 1,052-1,056. Mansfield et al., 2010. “Deployment and the use of mental health services among U.S. Army wives.” New England Journal of Medicine, Volume 382, No. 2, pp. 101-109.
7. P. Boss, 1999. Ambiguous Loss: Learning to Live with Unresolved Grief. Cambridge, MA: Harvard University Press.
8. A. Marshall, J. Panuzio, and C. Taft, 2005. “Intimate partner violence among military veterans and active duty servicemen.” Clinical Psychology Review, Volume 25, pp. 862-876.
9. L. Gorman, A. Blow, B. Ames, and P. Reed, 2011. “National Guard families after combat: Mental health, use of mental health services, and Perceived Treatment Barriers.” Psychiatric Services, Volume 62, No. 5.