Brigadier General Loree K. Sutton, Director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)
Nancy Sherman, Professor of Philosophy at Georgetown University
Jennifer Mittelstadt, Associate Professor of History and Women's Studies at the Pennsylvania State University; and John Allen Williams, Professor of Political Science at Loyola University Chicago; Reneé Bardorf, Executive Director of ReMIND; Lynda Davis, Former Deputy Undersecretary of Defense of Military Community and Family Policy; Lory Manning, Director of the Women in the Military Project at the Women's Research and Education Institute; Sara Manzano-Diaz, Director of the Women's Bureau at the U.S. Department of Labor; Eliza Nesmith, U.S. Air Force Chief of Family Member Programs; Joyce Wessel Raezer, Executive Director of the National Military Family Association; Kathy Roth-Douquet, Chair and Founder of Blue Star Families; Mary Keller, President and CEO of the Military Child Education Coalition; Shelley MacDermid Wadsworth, Professor in the Department of Child Development and Family Studies at Purdue University and Director of the Military Family Research Institute
Kathleen Frydl, Assistant Professor of History at the University of California at Berkeley; Walter Reich, the Yitzhak Rabin Memorial Professor of International Affairs, Ethics, and Human Behavior and Professor of Psychiatry and Behavioral Sciences at George Washington University; Philippa Strum, Senior Scholar at the Woodrow Wilson Center
For nearly a decade, the wars in Afghanistan and Iraq have demanded a herculean effort from our nation's military. Soldiers, sailors, airmen and women, and marines have risked their lives during repeated deployments to battlefields across the Middle East and South Asia. Concurrently, America's military families have withstood the strain of war on the home front. This conference assembled academics and practitioners in the fields of veteran care, health services, and military family organizations to share experiences, survey the improvements in the care and services provided to military families and returning veterans, and recommend ways to improve the resources available to them.
The conference began with a keynote address by Brigadier General Loree K. Sutton, who noted the challenges facing service members and their families: "Never in the history of our Republic have we placed so much on so few for so long." She explained that what motivated her to found the Defense Centers of Excellence in 2007 was the recognition that military health care was focused primarily on treating the physical wounds of war. Something was needed to help treat the "complex constellation of injuries" being experienced by those who had fought in Iraq and Afghanistan. Gen. Sutton detailed the framework of psychological care at the DCoE, which includes improving veterans' capacity for "Resilience, Recovery, and Reintegration." Resilience efforts include increased coordination with the Department of Veterans Affairs to provide better testing of both active-duty soldiers and veterans. Recovery initiatives have led to new protocols in the treatment of concussions and post-traumatic stress. Finally, Reintegration efforts include peer-to-peer mentoring models and partnerships with USO lounges to recognize veterans undergoing particular challenges. Gen. Sutton mentioned the effort to include family members in many aspects of this program, but also acknowledged the impact of continuing war on children. She closed on a hopeful note by reaching out to veterans and telling them, "You are not alone, the unseen wounds of war are real. Treatment works...reaching out is an act of courage and strength."
Jennifer Mittelstadt provided historical background to the issue of care for veterans and military families. "The Army," she noted, "incorporated families because it had to, not because it wanted to." Until the creation of the all-volunteer force in the 1970s, the Army did little to care for the families of active duty soldiers, she said. As it began to poll soldiers to find out how to improve retention efforts, however, it found that demands for more services and benefits for their families always topped the list and responded positively. Recently, according to Mittelstadt, the pendulum has shifted back to an emphasis on self-sufficiency for service members and their families. Instead of adequately providing care and comprehensive benefits for military families, the Army's efforts over the past two decades have attempted to, "make soldiers responsible for family readiness."
Building upon this historical analysis, John Allen Williams provided a theoretical conception of the military as a "greedy institution," one that demands complete devotion to its needs on the part of members. The military's organizational structure has an effect on families. As the military has been transformed into an all-volunteer force, it has become less of a "calling" and more of an occupation, with the result that soldiers now act like those in civilian careers and are more willing to express concern for the needs of their families. This new focus conflicts with the "greedy" military structure, but, according to Williams, the armed forces will ignore the needs of military families at their peril. In the current all-volunteer force, he pointed out, "you recruit soldiers, but you reenlist families."
Lory Manning discussed the unique challenges facing female soldiers in the wars in Iraq and Afghanistan. Historically, Manning noted, the military did not position women near combat zones and did not allow married women to enlist. The protean nature of combat zones in Iraq and Afghanistan, however, means that more female soldiers are in harm's way than ever before. Citing a 2008 RAND study titled "The Invisible Wounds of War," Manning emphasized that female soldiers exhibit a higher propensity to suffer from post-traumatic stress disorder or depression as a result of their combat experiences, Because they are officially excluded from combat zones, however, these conditions are less likely to be recognized as such. Much remains to be studied on the psychological differences between male and female reactions to combat. Manning advised that future research should focus on issues such as how children respond to military mothers with PTSD.
Lynda Davis expanded upon this discussion by broadening the level of analysis to the entire military psychological care system. Until recently, she said, the care system has not been sufficiently responsive, but there have been some important reforms. For example, in the past it was not unusual for a soldier seeking psychological treatment to encounter 34 different psychological case managers in one year; now such individuals have access to one individual care coordinator, who aids in the development of a personalized recovery plan. Such plans are comprehensive and include sociological support, spiritual wellness, housing aid, and medical care in addition to psychological care. Because such programs have been implemented, Davis stated, in response to a questioner from the audience, "I do not agree that we need a wholesale redesign of the system. We do have to integrate more with our community partners and our non-profits."
Providing the perspective of just such a non-profit, René Bardorf detailed the efforts of the Bob Woodruff Foundation and its outreach organization, ReMIND. Bardorf echoed Davis' critique of the over-complicated care system for returning veterans, adding that "we don't do a good job of informing our [military] families of what services are available to them." Her efforts with the Woodruff Foundation help to solve this problem by integrating the military community with services available on the civilian "home front." Among the specific programs she mentioned was "Operation Education" – a scholarship program designed to augment the GI Bill and provide educational opportunities specifically to veterans of Iraq and Afghanistan with traumatic brain injuries or post-traumatic stress disorder.
The second keynote address of the conference was provided by Nancy Sherman, who recently published the book The Untold War: Inside the Hearts, Minds, and Souls of our Soldiers. She asserted that emotions such as guilt, shame, and empathy are ubiquitous components of the "interior moral landscape of war." Drawing upon a plethora of in-depth interviews with returning veterans, Sherman pointed to several sources of guilt among soldiers, including luck, accidents, conflicts of loyalty, and deaths of civilians. In addressing the psychological challenges facing commanders in Iraq and Afghanistan, she noted, "You're not just trying to win the hearts and minds of the population, you're trying to win the hearts and minds of your own troops." The psychological difficulties arise from the moral dilemmas soldiers often face, but by the same token emotions such as empathy can interfere with the "steel and resilience" soldiers need in order to fight. Soldiers' struggles to resolve these dilemmas frequently involve their families.
To begin the final panel, Sara Manzano-Diaz provided an overview of the newest veterans' employment initiatives of the Labor Department, to which the Women's Bureau is contributing. Manzano-Diaz started her tenure as Director of the Women's Bureau by conducting listening sessions with female veterans throughout the country. Many of these women reported that were having difficulty adapting their military skills to the civilian labor market; they also cited a lack of gender equity in veterans' benefits. In response, the Women's Bureau has developed several programs, including small-scale job fairs for female veterans to interview with prospective employers and "stand-downs," which provide medical referrals and civilian job training to returning female veterans. Widespread homelessness among this group of veterans makes it difficult, however, to contact them.
Eliza Nesmith reported on the family and spouse programs being implemented by the Air Force, noting that different branches of the military often take different approaches to these issues. Nesmith pointed out that the bases remain the primary focal point for providing services and programs to Air Force families, mainly because every base is able to serve as a "microcosm of U.S. society." For example, the quality of the child care facilities on military bases have been rated as the highest in the country. However, Nesmith recognized that more and more Air Force families are choosing to live off-base in their surrounding communities. In response, new partnerships have been implemented to reach neighboring populations, such as a joint program with the Boys and Girls Clubs and Heartlink – an effort to help young spouses adapt to life in the military. Nesmith concluded by noting that consistency of programming across the military services must be increased.
Taking a step back from new policies and programs, Joyce Wessel Raezer presented data on the impact of the wars in Iraq and Afghanistan on military children. "In the ninth year of war," she pointed out, "we know a lot about war, but we don't know a lot about families." In response to this dearth of data, the National Military Family Association commissioned a cross-sectional survey of the children of military families. Among the findings reported by Raezer, military children function at or above the levels of the general population in the areas of school subjects and societal functions. At the same time, however, they manifest higher levels of anxiety, emotional difficulties, and fear than the general population. She also noted that older teens are the age group affected most by a parent's deployment. While more data on the effects of parental deployment on military children is needed, Raezer believes that existing military family programs should be assessed in light of the information that has already been collected.
Also representing a non-governmental organization committed to aiding military families, Kathy Roth-Douquet posed two key questions in her remarks. First, why should anyone care about military families? Roth-Douquet noted that some Americans "feel sorry for us" and that others see military families as "victims of a bad system." In her view, however, neither of these responses is helpful in attempting to understand the challenges that military families face. In order to better understand those challenges, she introduced a second question: why do military families do what they do? The answer, she said, is that "great things come to military families," including pride, safety, and a community of goodwill." Hence, it is important for the public to avoid pitying military families. Instead, the public should focus on helping them overcome specific impediments in the areas of employment, education, and psychological care.
Speaking particularly about the challenges facing children in military families, Mary Keller stressed the importance of remembering that "they are kids first." Hence, military policymakers should work to ensure that military children can develop normally by limiting the impact of variables such as repeated deployments abroad for parents. It is important to establish routines and predictability for military children, Keller stated, since all children "need loving adults around them to help frame their world." Furthermore, she said, the parents and educators of military children must be on guard to counter the associative thinking of young children, which can often cause them to blame themselves for the social and psychological changes that may be manifested by their parents. To help meet these challenges, Keller advised parents, educators, and policymakers to remember that realistic goal-setting is the most important tool to ensure successful development for the children of military families.
To conclude the panel, Shelley MacDermid Wadsworth offered a comprehensive framework for studying the needs of military families and pointed out several areas requiring further research. She placed the various stressors facing military families along the "Combat Operational Stress Continuum," which categorizes needs based on their relative importance to the psychological well-being of military families. "Green Needs," which are relatively less severe, relate to the prevention of the challenges of deployment, education, and easing the difficulties of constant movement throughout the military system. "Yellow Needs" include constant concerns for family members who are deployed and in harm's way, as well as the underemployment of military spouses. Finally, "Red Needs" comprise marital and domestic instability and the lack of medical infrastructure. Wadsworth also noted the large number of military families who are frustrated and cannot reach the aforementioned services, and suggested that the best strategy focus for future progress in policies toward military families would be one that sought to bridge the gap between the profusion of services available and the families that need them.
Less than a week after this conference--on May 5, 2010--President Obama signed into law the Caregivers and Veterans Omnibus Health Services Act. Among other things, this act recognizes the role of family members in caring for wounded veterans by providing caregivers with training, counseling, supportive services, and a living stipend and offering them certain health care benefits. A number of the participants in the April 30 conference were active supporters of this legislation, and it addresses many of the issues that were discussed that day.