On May 5, President Obama signed into law the Caregivers and Veterans Omnibus Health Services Act of 2010. Among other things, this act recognizes the role of family members in caring for wounded veterans by providing caregivers training, counseling, health care, and modest financial support.

Although the timing was coincidental, the Woodrow Wilson Center recently held a conference on military families and the wars in Iraq and Afghanistan in which many supporters of the new law participated. For nearly a decade, the two wars have demanded a herculean effort on the part of the nation's military, with soldiers, sailors, airmen and women, and marines undergoing repeated deployments. Meanwhile, America's military families have withstood the strain of war on the home front.

The April 30 conference, organized by U.S. STUDIES, surveyed the care and services provided to military families and returning veterans and recommended ways to improve available resources.

Grappling with the Emotional Wounds
"Never in the history of our republic have we placed so much on so few for so long," remarked Brigadier General Loree K. Sutton. She is director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), a facility she helped found in 2007, after recognizing the need to treat not just the physical wounds, but also the many invisible injuries experienced by those who had fought in Iraq and Afghanistan.

These psychological wounds include the guilt, shame, and empathy that, to Georgetown University philosopher Nancy Sherman, are ubiquitous components of the "interior moral landscape of war." For her recent book, The Untold War: Inside the Hearts, Minds, and Souls of our Soldiers, Sherman interviewed returning veterans and found they were burdened with several sources of guilt, including accidents, conflicts of loyalty, and deaths of civilians. In addition to their moral dilemmas, emotions such as empathy can interfere with the "steel and resilience" soldiers need to fight. Soldiers' struggles to resolve these dilemmas frequently involve their families.

But military families cannot play their role effectively without training and support, something that is often in short supply. The military's record of support for families has been uneven, according to Pennsylvania State University historian Jennifer Mittelstadt, a former Wilson Center fellow who is studying benefits to soldiers in the modern military.

"The Army incorporated families because it had to, not because it wanted to," she noted. Until the creation of the all-volunteer force in the 1970s, the Army did little to care for the families of active-duty soldiers, but when polls showed that more services and benefits would improved retention, the Army responded positively. Recently, however, Mittelstadt said, the pendulum has shifted back as the Army has sought to "make soldiers responsible for family readiness."

Underlying these policy shifts is the military's uncertainty about its own nature. In the past, according to political scientist John Allen Williams of Loyola University of Chicago, the military acted as a "greedy institution" demanding complete devotion on the part of all members, including their families. With the all-volunteer force, however, the military has become less of a "calling" and more of an occupation, with soldiers now acting like those in civilian careers, more willing to demand benefits for themselves and their families. And the military cannot afford to ignore this new focus, Williams warned. In the all-volunteer force, he said, "you recruit soldiers, but you re-enlist families."

The "stressors" affecting military families may be placed along a "combat operational stress continuum," said Shelley MacDermid Wadsworth, who directs the Military Family Research Institute at Purdue University. These range from "green needs," such as easing the difficulties of constant movement throughout the military system, to "yellow needs," including constant concerns for family members who are deployed and in harm's way, to "red needs," which comprise marital and domestic instability and the lack of medical infrastructure. While military and civilian programs are available to address many of these concerns, families don't always know about them or become frustrated trying to gain access to needed services.

Effects on Women and Children
Women are central to efforts to strengthen military families, whether deployed in active duty, awaiting their loved one's return, or caring for injured veterans. As service members, women face special challenges. Because they are officially excluded from combat, women are less likely than men to receive diagnoses of post-traumatic stress disorder (PTSD) or combat-related depression, even when they display the same symptoms, noted Lory Manning, director of the Women in the Military Project at the Women's Research and Education Institute in Washington, D.C. Those with children experience additional pressures upon their return, as they are expected to resume their maternal role, despite injuries.

Women also make up a disproportionate number of homeless veterans, said Sara Manzano-Diaz, director of the Women's Bureau of the U.S. Department of Labor, and they have trouble reintegrating into the labor market. The Women's Bureau is making a special effort to reach out to these women.

As family members, women must help loved ones navigate the complex system of services available to service members transitioning from active duty to veteran status. Until recently, said Lynda Davis, former deputy undersecretary of defense of Military Community and Family Policy, a soldier seeking psychological treatment might encounter numerous psychological case managers in one year; now a soldier has access to one care coordinator, who develops a personalized recovery plan.

Yet, "we don't do a good job of informing our [military] families of what services are available to them," said René Bardorf, executive director of ReMIND, an outreach organization sponsored by the Bob Woodruff Foundation. Bardorf's organization seeks to integrate the military community into programs provided by civilian organizations.

Being part of a military family also affects children. A cross-sectional survey recently conducted by the National Military Families Association (NFMA) found that military children manifest higher levels of anxiety and fear than the general population, with older teens affected most by a parent's deployment. Joyce Wessel Raezer, the association's director, reported these results.

Mary Keller, president and CEO of the Military Child Education Coalition (MEEC), emphasized the importance of remembering that military children "are kids first." Hence, military policymakers should work to ensure kids can develop normally by limiting the impact of variables such as repeated deployments abroad for parents. Furthermore, said Keller, parents and educators of military children must be on guard to counter the associative thinking of young children, which often leads them to blame themselves for the social and psychological changes manifested by their parents.

Approaches to Military Families
Along with the NFMA and the MEEC, members of military families have formed other voluntary organizations. One of the newest is Blue Star Families, headed by one of its founders, Kathy Roth-Douquet. She deplored the tendency among civilians to "feel sorry" for military families or see them only as "victims of a bad system," asserting that military families take pride in their status. But, she conceded, they do need help to overcome specific impediments in employment, education, and psychological care.

Within the military itself, approaches to military families varied from one branch to another. Eliza Nesmith, U.S. Air Force Chief of Family Member Programs, said in her branch, the bases remain the focal point for providing services and programs to Air Force families, mainly because every base serves as a "microcosm of U.S. society." Childcare facilities on these bases are rated the highest in the country. However, Nesmith acknowledged, more Air Force families are choosing to live off base, prompting the Air Force to implement new partnerships with organizations in neighboring communities such as the Boys and Girls Clubs of America.

The Caregivers and Veterans Omnibus Health Services Act—the result of a yearlong effort led by the Wounded Warriors Project that also included many of the organizations represented at the Wilson Center conference—will go some distance in addressing the needs of military families. But to have the greatest impact, participants said, the legislation requires intensive outreach and greater coordination between military and civilian programs. These measures will allow family members to provide the kinds of support they believe their loved ones deserve.

written by Sonya Michel, Richard Iserman, and Aldo Prosperi