(This article is the opinion of the above person and not meant to represent Department of the Defense or Department of the Army. Demographics have been changed to protect patients' privacy.)
Soldiers are trained to selflessly put the mission first. They experience great losses during combat, but maintaining the mission must always be their focus of concentration. Avoidance is a common coping mechanism in this environment. There is no time or place for grief.
In the safety of a non-combat environment, the significance of those losses may emerge, but giving in to them is perceived as a sign of weakness. Great stigma is attached to seeking mental health services. Most soldiers who seek a career in the Army are afraid of being labeled, so they don't seek treatment.
John, a 35-year-old high ranking solider in the Army, had done well throughout his 18 year career until his wife died in a motor vehicle accident, leaving him to raise two teenage daughters. Six months later, still wearing his wedding ring, John reluctantly contacted Adult Behavioral Health at Fort Campbell for counseling. He was sad, depressed, and hopeless. He couldn't talk about his wife without becoming tearful. His daughters were acting out. About all that was holding him together was his strong faith. After twelve individual counseling sessions, John was no better.
Before becoming a social worker in the Army, I was a TSSNT therapist and had the privilege of facilitating the organization's Trauma Grief Groups. As I thought about John, I remembered the joy of seeing people change so much after just a few weeks of the group. John had experienced many military-related deaths, but his presenting pain was not about those but about the death of his wife.
So I started a Trauma Grief Group with the working hypothesis that if people weren't getting better in dealing with their military losses, perhaps it was a function of having unresolved personal tragedies. The group met for eight sessions. Most had experienced both personal and military losses.
One female had been married only four months when her husband had a seizure and died suddenly. An 18-year-old had lost his mother, grandmother, and a friend in one year. Others had lost friends to suicide. The group members bonded fairly quickly and the group process was extremely effective. After the first session, four members chatted in the parking lot for over an hour. They instantly felt camaraderie with each other and supported one another. Rank is extremely important in the Army, but in this group it was not a factor. They saw each other as people, not as soldiers.
In adapting the original curriculum to a military population, I learned to pay closer attention to the role of avoidance and honor its value in emotional survival. I also learned about anger. Soldiers are taught to be aggressive in combat and when they return home, they have no sanctioned outlet for their anger. The group provided a safe place for them to vent their anger.
John has now completed the Trauma Grief Group and a little over a year has passed since he lost his wife. He no longer wears his wedding ring. He is back at work in a position of leadership. He can talk about his wife without crying. He engages in conversation with others and is open to the possibility of dating in the future. He no longer believes he has to "get over it" but understands he can still hold the memory of his wife in his heart and, at the same time, look forward to a meaningful life.