By Dr. L.B. (LeslieBeth) Wish, MSW

Sally had been a soldier’s wife for twelve years. She endured separations while her husband, Tom, was called to duty, and she toughed it out raising twin boys alone. But after Tom was killed in a roadside bomb in Iraq, Sally doubted whether she can be a team of one.

“I’m really not that strong,” Sally said. “It’s just a good act.”

When Rolanda was shot out of her helicopter, her husband ,Ray, said he had no choice but to “pull himself together.” He had to focus on his job and raising his stepdaughter. “I only cry at night, and then only for a second or two. We were practically newlyweds. I don’t even know what I’ll be missing.”

The first thing that came to Linda’s mind when she heard that her husband was killed in an ambush was: “At least the kids are grown.” But the relief was short; depression set in, and Linda felt ashamed for falling apart.

These stories provide a glimpse into the plight of many of the American families of downed warriors in Iraq. Each family’s grief is unique, but most share issues that are familiar to mental health professionals–adjustment, loss, grief, and anger.

Some families rely on friends, the Armed Forces community, and supportive family for help. But one of the issues that many (certainly not all) of these families also share is their reluctance to use the mental health services available to them.

Why? What makes providing counseling to these families so different from non-military families in mourning? And how can mental health professionals serve these families’ needs?

Let’s start with learning a little more about some of these families. Bear in mind, that there are many reactions to the loss of a family member and that not all families of downed warriors react the same. Yet, a constellation of beliefs, fears and adjustment issues does exist amongst many of these families, and it is important to become familiar with them.

At first, it seems that the most common issues of military families do not differ from the problems of families not in the military. But being a military family can add unique challenges.

Fear of Being Found Out

Many families worry about being seen in counselors’ halls and waiting rooms and about being judged and “found out.” They also worry about confidentiality. They believe that no matter what the organization, if it’s affiliated with the armed forces, it will keep records that could easily be shared with other branches and departments.

Non-military families may have similar feelings, but military families carry with them an extra dose of shame of being found flawed. They also say they are done with military and government rules. They long for privacy, and they have far higher doubts that their insurance can protect them.

Mental Health Services and Insurance Issues

When the emotional and behavioral problems become too great, families might reach out to the mental health services of their insurance plans. Many families experience uneven quality of services, problems of continuity of care, restrictions on the number of mental health sessions or lack of freedom to choose they want.

Yet, non-military families experience these same issues. The difference is what one of my clients called “reaching the end of her rope” with her insurance. These families have higher expectations of the quality of their care. They believe that serving and sacrificing for their country permits them better treatment.

These families feel hurt and disrespected. When these feelings become too painful, the families often avoid seeking help.

Lack of Trust in Some Services

The latest information about the unacceptable quality at Walter Reed Veterans Hospital reinforces their lack of trust in all services. However, there are many excellent Veterans Administration hospitals. When frustration peaks, it is easy to toss all hospitals and services into the “not good” pile.

Unfortunately, traveling to a quality Veterans Administration hospital is not easy. Military families may not have the financial ability or the family resources of a grandmother or aunt to assist with child-care. As one of my clients said, the families get “jaded and just give up.”

Ashamed of Grieving

Since these families have now experienced both the anguish of not being able to control their grief reactions and also the shock of seeing what they perceive as a weak and shameful self, their trust in most military mental health services finally erodes. They believe that if they can’t trust themselves any longer, then they certainly aren’t going to trust the institution that let them down.

Judgements from the Public

Like many American soldiers who fought in Viet Nam, the American soldiers of Iraq and their families risk experiencing negative judgments from the public because of the civil and military difficulties, length of time of the war and loss of lives.

Families often worry about being accepted as well as valued for their patriotic contribution and sacrifice. One wife and mother said, “In the beginning, everyone clamored to wear a 9/11 pin. Now, no one wears one anymore.”

Fear of Being Weak

Military spouses are usually viewed as hardy, “salt-of-the-earth” type of people who raise resilient children to withstand relocations, absent parents and emotional pain. When the death of a spouse and parent occurs, these families often experience shame in feeling weak, out of control, and emotional.

The comments of one daughter speak for many: “I feel like I’m a disappointment to my father’s legacy. He would be furious if he saw me crying and just being a basket case right now.”

Stresses of Widowhood

Military personnel often choose spouses whom they think can manage the anxiety of military life. The spouses often fit along a range from “independent and capable” to “can carry out orders.” Imagine, then, the shock when some spouses find that after the death of their husband or wife, their life, household and financial management abilities crumble.

“I thought I had everything under control. I guess I’ve just been a soldier, not an officer,” one wife said. She was fine as long as her husband provided a script, but she faltered at making new decisions.

Living on Two Tracks

Like trauma survivors of the Holocaust and childhood sexual abuse, many surviving military spouses and family members describe themselves as “living on two tracks.” One track takes them through daily life and the image they present to the world.

But the other track leads to their darker world inside, filled with anxiety, anger and depression. Even worse, some feel like imposters. “If you can fake it, you can make it,” becomes their rally call.

Unresolved Grief

Unresolved grief is one the biggest issues that military families report. As a result of their difficulties in handling grief, the families experience several “disconnections” between:

• what was (and still is) expected of their coping skills,
• their previous view of themselves as hardy, tough and sturdy,
• normal grief and adjustment reactions, and
• their struggle to view these reactions as normal and not weak or shameful. Families often
  say things such as “I always saw myself as strong.” Shame and confusion replace confidence.

To deal with their grief, families frequently rely on the same ineffective and often damaging coping mechanisms of non-military families. For example, depression, substance abuse or difficulty in working and parenting might occur.

What makes these grief responses of military families so different is that their unique burden of shame of not coping better, disappointment and anger in the quality of their mental health services and lack of perceived national support heightens the emotional intensity, duration, frequency and resistance to changing their ineffective coping tools.

Grief is already a lonely experience. This extra burden makes it even heavier. Soon, the families are caught in a shame-grief-shame cycle that eats away at their ability to change their behavior and negative self-view.

Reassessing Family Relationships

Finally, like many widows and widowers, the spouses often reassess their marriages. For example, wives might discover that they are “relieved” to be out of a bad marriage. Children also may see the deceased parent differently.

The difference in military families is the perceived pressure from the military community to maintain positive views of the deceased partner or parent. For example, serious flaws, such as domestic violence or child abuse might get overlooked. Children may have to work extra hard to conceal their anger at the living parent for having chosen a bad partner.

Military families often flip-flop internally between seeing the truth and glorifying the deceased. The family members sense a heightened taboo against saying anything negative about the deceased and keep secrets about their real feelings.

One of the surviving spouses described the difficulty of “keeping up appearances” that her husband and the father of her children was a “good man.” “I don’t know who I am anymore,” she said. Over time, family tensions increased. The children sensed the lie, and the truth came out only after one of the children arrived at school drunk.

How Mental Health Professionals Can Help

1. Renew your trust in mental health professionals. Try them out, just as you might try out a family physician. Find a person who makes you feel comfortable. Many professionals are willing to speak to you on the phone or provide a free consultation. Some people “Interview” several therapists. Ask openly about their willingness to work with military families. Ask if they have expertise with your specific issue.

2. Rethink your views of seeking help. You deserve to be happy and in charge of your life. Seeking help does not mean you are weak or ineffective. There is no shame in using therapists, pastors and other mental health professionals. In fact, most professionals know that the strong are often the ones most likely to ask for help.

3. Before you go to your appointment, make a list of the topics you want to discuss. Include information such as: a) when the problem began, b) what measures you’ve taken to solve the problem, c) why you think your efforts didn’t work and d) what do you think might work.

4. If you don’t like your therapist, speak up about what’s not working. Consider trying the therapist for another visit before you select another one. Keep up the momentum of seeking help. If you thought you needed help, follow through on that instinct. Problems sometimes have a way of losing their urgency, but don’t let this lull fool you. They tend to crop up again if you don’t make effective changes.

5. Contact the Counseling Network of the Special Operations Warrior Foundation (specialops.org), a select network of therapists who are providing mental health services for free to families of downed warriors of the Iraq war.

Resources

• The MySECO website is a one-stop online career and education toolbox filled with valuable information, resources and interactive features, designed for military spouses looking to meet career and education goals.
• The Military Spouse Employment Partnership, a targeted recruitment and employment solution that creates employment connections by providing companies and organizations with direct access to military spouses seeking career opportunities, and connecting spouses with employers.
• The Spouse Ambassador Network, is a group of like-minded organizations who are affiliated with the Military Spouse Employment Partnership and are dedicated to raising awareness of military spouse education and employment.
• Military Family Resources: Blue Star Families
• Resource Database for Veterans and Families: Veterans Families United
• Resources for Veterans and Families: Military One Source
• Financial Support and other Family Resources: Operation Homefront

You’ll find these and additional resources at the Family Outreach and Support Services section of the Special Operations Warrior Foundation website.