If everyone is an expert on mental health and wellness, are we listening to those who are actually experts?There seems to be a gulf, a gap, between the veteran community and the clinical mental health community that focuses on veteran mental health.
Here are ten common beliefs about service member and veteran mental health from my perspective as both a combat veteran and a clinical mental health counselor.
It’s not just about medications…
I hear it all the time; “I’m not going to the shrink, all they’re going to do is give me meds.” Inaccurate. Not all mental health professionals prescribe medications, and you’re not going to be prescribed a bucketful of medications just because you reach out for therapy. There is a significant difference between mental health professionals. Not all of us are “Docs” any more than all medical professionals are Doctors. Just like with any other important decision, do your research and find someone who is appropriate for you.
…but sometimes it could be
While therapy does not equal psych meds, sometimes both are necessary. Therapy talking to a psychologist our clinical mental health counselor can be challenging. Many times, we wait to reach out until just before, during, or after a crisis. Medications can be used to calm the waters for long enough until we learn to navigate them on our own. Antidepressants can be useful, but unless we learn to change the way we think and react to certain things, then we’re just putting a Band-Aid on stuff. And sometimes we are too dysregulated, chemically and neurologically, to approach therapy. Like everything else, we can balance medications and therapy together, until we need neither.=
PTSD and TBI are significant…
“Everybody knows” that PTSD and TBI are important. They’ve been called the “signature wounds” of the Post 9/11 conflicts. The fact that PTSD has been called many different names throughout the history of combat doesn’t change the simple fact: exposure to combat changes people. And with the improvement of medical care and equipment, survivability has increased, which leads to an increase in those who survive traumatic events. Whether we call it a disorder, an injury, a syndrome, or just Posttraumatic Stress, the fact that it’s a natural reaction to abnormal events doesn’t change how much it gets in the way of our lives. Just because it occurs naturally in the course of life…like cancer…doesn’t mean that it shouldn’t be treated.
…and veteran mental health goes far beyond just PTSD and TBI
While PTSD and TBI are significant, they are not the only aspect of mental health that veterans are dealing with. I know from my own military career, and from talking to many veterans, that addiction is significant. Beyond just the drinking culture of the military, the opioid crisis in the veteran community starts while we are on Active Duty. Another aspect of mental health is emotional dysregulation, typically anger, anxiety, and depression. There is certainly an emotional component to PTSD, but there are factors of military service that can exacerbate these painful emotions that have nothing to do with exposure to trauma.
Each of these — PTSD, TBI, addiction, and emotional dysregulation — are based on the medical model of mental health. They are diagnoses; there is a “label” that comes with each of them, just as there is a diagnosis of diabetes or cancer. And many individuals who are not in the military experience them as well.
There are unique aspects of military service, however, that go beyond just these. Many veterans struggle with finding purpose and meaning in their post-military lives. Not all veterans I see as a mental health professional are dealing with PTSD; the vast majority of them are struggling with finding something that satisfies them as much as their service did. Moral injury is also a significant challenge; what a veteran believes is “right” and “wrong” is changed by their military service.
Along with these challenges, a veteran has to learn how to meet old needs in new ways when they leave the military. Maslow’s Hierarchy of Needs does not say how needs are met, it only talks about what needs are met. If we don’t change how we meet those needs after the military, then we aren’t going to be successful. And finally, family and relationships. Veteran mental health impacts our relationships, and relationships impact our mental health.
These four areas--purpose and meaning, moral injury, needs fulfillment, and relationships--are not things that have a diagnosis. There is no medication that can make me more satisfied with my post-military life, or take away survivor’s guilt. All eight of these together, however, make up comprehensive veteran mental health, and a mental health professional can help a veteran with each of them.
It’s not all in a veteran’s head…
Another common theme I hear, often from uninformed community members or frustrated family, is that “it’s all in their head.” That veterans are making up the depression, anxiety, or PTSD. That only the “weak and broken” are suffering from these things. Nothing could be further from the truth. These are verifiable psychological conditions that exist, regardless of our judgment about them or whether we want them to exist or not. Understanding that it’s not some made-up mumbo-jumbo will go a long way to supporting a veteran.
…and it sort of is
On the other hand, in a very real way, it is all in a veteran’s head; meaning, these conditions begin and end in the brain. There have been studies that prove that exposure to traumatic events will change the neurological and chemical makeup of the brain. The amygdala, hippocampus, and limbic system have all shown to be more reactive in veterans with PTSD. With the improvement in neurological imaging in the past twenty-five years, we know more about the brain now than we have at any other point in history. PTSD is as much biological…neurological…as it is psychological. Traumatic Brain Injury, of course, is a physical injury to the brain. The rest of comprehensive veteran mental health is impacted by what we think and feel, which are regulated by our brain. So, while a veteran may not be making up what they’re going through, it is most definitely in our brain.
Not all experiences are common…
This is another thing that I hear often, mostly in the community. “I know a veteran who tried X and is feeling much better.” That’s probably true…but that doesn’t make it accurate for all veterans. This ranges from “common beliefs” like, “if a veteran really wants to take their own life, then nothing anyone can do will stop it” to “I came back from combat and there’s nothing wrong with me.” We tend to think that our own experiences are the same as others. If I don’t like something, then people don’t like it. If I’m against something, and I’m a veteran, then other veterans are likely against it. Not always true, and often detrimental to having a conversation about what is actually going on.
… but many experiences are more common than we think.
Along with that, however, is the fact that many things that a veteran is going through is commonly experienced by other veterans. I may see six or ten veterans throughout the day in my counseling practice; there are things that many veterans experience throughout their military career. Mind-numbing boredom. Toxic leadership. Exhilarating excitement. A mental health counselor is a sort of experience nexus; we have the benefit of clinical training and study, just like a medical doctor, but we also have the experience of seeing a number of veterans and finding what is common between them. A mental health professional also has the ability to know what works to relieve some of the problems a veteran is having, and that recovery is possible.
Mental health professionals know what they’re talking about…
If we have a legal issue, we find a lawyer or a paralegal. If we have a medical issue, like a broken bone or migraines, we seek out a medical provider. In many areas of our lives, when we have a question, we seek out those who have knowledge that we don’t; but when it comes to mental health, that doesn’t always happen. I’ve actually heard people say that their opinion is MORE legitimate because they DON’T have formal training in psychology or mental health.
For someone to be a licensed mental health professional, there is a requirement to have at least a Master’s degree in clinical mental health. Degree-producing programs are at least two years in length, on top of the undergrad degree; and programs that produce licensed mental health professionals require supervised clinical practice during and after the program before someone is actually licensed. These programs include training in research, diagnosis, evaluation, and the history and systems of mental health. Additionally, in order to maintain licensure, clinicians are required to get continuing education credit…to keep up on the latest developments in the field. All of this adds up to a level of expertise in our chosen profession that someone who has not had this level of formal training simply does not possess.
…and have the science to back it up
I recently had a conversation with a state lawmaker who happens to be a veteran who said, “I wish there was more science behind this mental health stuff.”
I nearly fell out of my chair. There are decades of research and science behind brain science. We know how repeated exposure to trauma of any kind impacts the physical structure of the brain. Accurate assessments for a myriad of mental health conditions have been around for decades. We don’t just know what depression feels like…we can actually measure an individual’s level of depression, and measure whether or not the treatment that is happening is working or not. When I asked the lawmaker, “what would you like to know? I can provide you research and data for whatever questions you have,” he responded, “Well, that’s just it; I don’t know what I need to know.”
The problem that we have is that we’re using our brains to look at our brains. It’s like using a microscope to evaluate a microscope; we are observing an object with the object that is being observed. How’s that for complicated? We, as humans, want to make the complicated simple; give us the headline, the update, the quick answer. The problem with mental health is that there is not a quick and simple answer. This isn’t me, as a mental health professional, trying to make something more complicated so that I can be the keeper of the secret knowledge. Instead, it's recognizing that mental health is a complicated issue with multiple factors involved in the difference between functional and dysfunctional.
When a person joins the military, they become part of something bigger than themselves, with the ultimate knowledge that their lives could potentially be forfeit on behalf of their nation. I believe that we, as a nation, have a responsibility to support those service members for that willingness to sacrifice, and that means in every way possible. Employment, housing, education, and, yes, mental health and wellness. Part of that support is allowing those who understand…mental health professionals…to be a part of the conversation.
Duane K. L. France is a clinical mental health counselor practicing in the state of Colorado. He retired from the U.S. Army after 22 years and deployed to the Balkans, Iraq, Afghanistan, and North Africa multiple times. His thoughts and opinions are based on his military experience and clinical training but do not represent professional advice. While he is a mental health professional, he is not YOUR mental health professional. Do not delay or forego seeking professional mental health advice as a result of his advice. Follow him on Twitter @thcounselingvet