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Families: “They Also Serve Who OnlyStand and Wait”Jaine Darwin PsyD. aa Massachusetts Institute of Psychoanalysis , Cambridge,Massachusetts, USAPublished online: 22 Oct 2009.

To cite this article: Jaine Darwin PsyD. (2009) Families: “They Also Serve Who Only Stand and Wait” ,Smith College Studies in Social Work, 79:3-4, 433-442, DOI: 10.1080/00377310903131454

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Families: ‘‘They Also Serve Who Only Stand andWait’’1

JAINE DARWIN

Massachusetts Institute of Psychoanalysis, Cambridge, Massachusetts, USA

Strategic Outreach to Families of All Reservists (SOFAR) is a probono mental health project that offers support, psychotherapy,psychoeducation, and prevention services to extended familymembers of National Guard and Reservists who have served inOperation Enduring Freedom (OEF) and Operation Iraqi Freedom(OIF) from deployment through reunion and reintegration.SOFAR began in Massachusetts in 2004. In this article, I discussthe plight of all families of soldiers with an emphasis on the specialburdens of National Guard and Reservists, citizen-soldiers. I alsoshow how SOFAR has helped these families and make recommen-dations for expansion of services to these family members.

KEYWORDS Reserve components, families, psycho-education,resilience

WHO NEEDS SERVICE

To paraphrase D. W. Winnicott (1958), there is no soldier without a family.When a soldier deploys, the whole family serves. When a soldier returnsfrom combat, the whole family is affected. About how many people are wespeaking? As of December 2006 (Tan, 2006), 1.69 million soldiers had beendeployed a total of 2.2 million times, 410,000 of whom are National Guard orMilitary Reservists. If we assume that each soldier has seven people inimmediate family—spouse, children, mother, father, siblings—conserva-tively 11.8 million people have been affected. If we add another seven

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1Milton (1673)

Address correspondence to Jaine Darwin, PsyD., 1619 Massachusetts Ave., #25,Cambridge, MA 02138, USA. E-mail: jldarwin@aol.com

Smith College Studies In Social Work, 79:433–442, 2009Copyright # Taylor & Francis Group, LLCISSN: 0037-7317 print / 1553-0426 onlineDOI: 10.1080/00377310903131454

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people per soldier, uncles, aunts, cousins, nieces, nephews, neighbors,friends, and colleagues, then between 60 and 90 million have been affectedby a soldier’s service. One third of these are children between the ages of 0and 18. As of 2007 (Rentz et al., 2007), 700,000 children had a deployedparent. Thirty-eight percent of the active duty women serving are mothers.Seventy-five percent of all National Guard and Reservists are parents. Someare grandparents. At a deployment ceremony for a deployment of an armyreserve medical unit, a volunteer mental health worker asked a 7-year-oldwho she was saying good-bye to that day. The little girl replied, ‘‘Mygrandma.’’ At that ceremony, the oldest person to deploy was age 62. Theyoungest family member left behind was age 2 weeks. This does not includemany babies in utero.

Families of soldiers who reside on military bases are in a milieu whereeveryone shares and understands the stresses of service. For family membersof National Guard and Reservists and for the extended family of active dutymilitary, they often must deal with the distress of deployment and return inthe isolation of a community with little awareness of the emotional rigors ofhaving a loved one deployed or dealing with the challenges of reunion andreintegration. Because many soldiers have been deployed multiple times,the stress on families grows incrementally with each additional deploymentand return. If the troop deployment level declines, the sequelae to serving incombat for those who have all ready served and for their family members,mental health services will be needed for many years.

WHAT ARE THE STRESSES FOR FAMILIES?

When a soldier is deployed the family members face anxiety and depressionthat may be caused by the pain of separation and the fear of harm befallingtheir soldier. Every parent at home becomes a single parent. Children’sdifficulties—medical, social, academic and psychological—must be dealtwith by one parent alone, or by one parent attempting to protect the soldierparent from stress at home. When the deployed soldier is a single parent orboth parents are deployed, this may be done by a grandparent or anotherrelative. For these children the burden of moving to a new community andenrolling in a new school is in addition the other stressors.

New technology has changed the families’ and the soldiers’ experienceof being at war. Soldiers leave for the combat theater with laptop computers,Skype software, and phone cards. The war is in the living room, and theliving room is in the war. Families and soldiers communicate through e-mail,instant messaging, videocam, and telephone. Each group is faced with howmuch information to share with the other. Does a soldier speak of lifethreatening dangers, or wounding or death of fellow soldiers?

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Does a family member share news of the grave illness of a family memberor that a teenage son flunked an exam? Although contact helps contain theanxiety that comes with not knowing, contact also can be blunted and lackingin spontaneous expression of affect. Pauline Boss (2007) described what sheterms ‘‘ambiguous loss’’: the soldier is physically absent, but psychologicallypresent. This ambiguity increases the challenges to coping. It is as if you wereplaced on hold during a phone call and every 30 seconds a voice was heardlong enough to remind you a person was on the other end, but not longenough to have a satisfying conversation. The soldier may make demands andtry to continue to run the household from afar. The family members may feeltheir sacrifice is unacknowledged. Mothers of teenage soldiers may bechastised for crying and punished by receiving fewer phone calls. The otherpart of the concept, someone who is physically present but emotionallyabsent, becomes relevant when the soldier returns from combat.

For citizen-soldiers, the call to active duty disrupts a life as planned.They leave civilian jobs, attendance at college, or both. The family maysuffer financial hardship because of the differential between civilian andmilitary pay. When the soldier is self-employed or is a business owner, thefinancial ramifications can be disastrous. When a deployed soldier has ahigher income because of combat pay, the family may feel guilty about thefinancial boost provided by deployment.

In what was a two-income family, the family may incur more expensesbecause of the need for more child care or the need for the remaining parentto cut back work hours to pick up the slack at home caused by the soldier’sabsence.

Spouses with infants may relocate to live with relatives; though thisprovides them with help the spouse is also challenged by adjusting to a newlocation and a new social network.

The parenting skills of the spouse who stays behind are sometimespushed beyond limits. The study, by Gibbs et al. (2007), funded by the U.S.Army Medical Research and Materiel Command, shows that the overall rateof child abuse and neglect was more than 40% higher while a soldier-parentwas deployed for a combat tour than when he or she was at home.

The greatest increase in the rate of child abuse and neglect occurredwhen soldier-husbands deployed, leaving mothers at home to care for thechildren. In these cases, the rate of physical abuse nearly doubled, and therate of neglect was nearly 4 times higher. According to the Journal ofEpidemiology (Rentz et al., 2007), ‘‘Among soldiers with at least onedependent, for every one percent increase in the number of active dutysoldiers departing or returning, we saw an approximately 30 percentincrease in the rate of substantiated maltreatment cases, … These findingsindicate to us that both departures to and returns from operationaldeployment impose stresses on military families and likely increase the rateof child maltreatment’’ (p. 1204).

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In our experience at SOFAR, these incidents are often a function ofmaternal depression. We were contacted about a mother unable to care forthree small children younger than the age of 4, one an infant. Although sheseemed a likely candidate for a postpartum depression, she insisted she couldnot leave her children to go for an evaluation. Her efforts to protect them wereharming them. The rate of postpartum depression in wives of soldiers who weredeployed at anytime during their pregnancies is 3 times the national rate(Millegan qtd. in Gellene, 2007).

The children and close relatives of citizen-soldiers may be the only childin a school with a deployed loved one. Many active soldiers also haveyounger siblings who are in high school. These children may be taunted bypeers and may develop behavior problems, somatic complaints, and orbehavior problems. School personnel may be unaware that they have arelative who is serving. A high school teacher describes grabbing a cellphone out of a youngster’s hand because cell phone use was forbidden inclass. She learned he was saying good-bye to his brother who was leavingfor Iraq. The teacher and the youngster felt terrible. Another youngster’sbehavioral problems escalated during his father’s third deployment. Theschool personnel insisted the behavior was unrelated to his father’s service,finally suspending the boy. Finally the boy’s mother was helped to file acomplaint because the school was in violation of special educationregulations, and the school was compelled to accommodate the youngster.

The families of deployed soldiers may feel they are called upon topractice stoicism during their soldiers’ service. They suppress feelings ofsadness and fear. They feel guilty if they feel anger toward the soldier,fearing their thoughts will harm the soldier. They also feel guilty if they feelhappy as they consider this inappropriate when a loved one is in harm’sway. They are constantly anxious about their soldiers’ safety. They maybecome glued to the television or the Internet in search of information.When they hear news about a battlefield fatality anywhere close to wheretheir soldier is serving, they become gripped with fear, craning out thewindow for the men in uniform from the notification to knock on theirdoors. When they learn their soldier is safe, they feel relief followed by guiltbecause they know their relief comes at the price of another family’s grief.

Although we are familiar with soldiers developing posttraumatic stressdisorder (PTSD), we are less aware of family members developing secondarytrauma (Figley, 1995). Sharing in the trauma of their soldier, or seeing,hearing, or imagining what is happening may cause them to show some ofthe same symptoms: anxiety, depression, intrusive thoughts, and images.One wife of a soldier describes feeling ‘‘not like herself’’ since she waspresent when the coffin of a fallen soldier arrived home. Mothers of soldiersoften have dark rings under their eyes, demonstrating the many sleeplessnights they endure.

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HELPING THE FAMILIES

Any experience good or bad shapes and reshapes the family. Experiences ofseparation and even loss can become opportunities for growth. WhenSOFAR work with these families, we try to build resilience, to prevent ortreat secondary trauma, and to prevent intergenerational transmission oftrauma. SOFAR wants to build resilience by addressing the predisposingissues, providing and expanding coping skills via support services, directtherapy services, psychoeducation, and outreach to teachers and pediatri-cians. Family readiness is the mechanism the military provides to supportfamilies during a deployment. They set up phone chains, publishnewsletters, and hold monthly meetings. We attend Family ReadinessGroup meetings during which we present information about the range ofreactions that may be anticipated at that phase of the deployment includinghow children might respond at different levels of development. We thendivide the larger group into small break-out groups: one for parents ofsoldiers, one for spouses, one for children. Each group, facilitated by aclinician, shares concerns and solutions to problems, makes connectionswith those who share common concerns. They are helped by learning whatthey feel is not atypical. This informal exposure to mental healthprofessionals helps create a rapport that destigmatizes mental health anddestroys negative myths about mental health professionals. More familymembers seek psychotherapy after such contacts.

These encounters also reduce the risk of secondary trauma becausethese connections stem the isolation that creates a fertile ground for trauma.We reach out to teachers, school nurses, and pediatricians who are firstresponders in the lives of children. They are the people with most likely toidentify a troubled child with a deployed love one. We talk with them aboutthe stresses on these children and families. We encourage them to ask ifanyone in the family is serving. A group of experts—a specialist in childtrauma, an educator, and a naval psychologist who had been a deployedmother and a pediatrician—wrote the ‘‘SOFAR Guide to Help Children andYouth Cope with the Deployment and Return of a Parent in the NationalGuard or Other Military Reserves’’ (SOFAR, 2008). The guide has beendistributed in hard copy or by download from the SOFAR web page,www.sofarusa.org. The guide has been distributed to every school in NorthCarolina and in Massachusetts.

THE PROBLEMS OF REUNION AND REINTEGRATION

If soldiers returned from war with no injuries, physical or mental, the periodof reunion and reintegration would be difficult for the whole family. Thesoldier and the family have been separated for up to 15 months duringwhich time everyone has been changed by passage of time, developmental

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changes in children, the acquisition of new skills, and the exposure to newthings. For a soldier who has been in an asymmetrical battle zone, one withdanger all around, the period of reintegration involves ratcheting down anervous system that has been tuned to fight or flight and readjusting to whatis dangerous and what is safe. The soldier has to renegotiate a place in thefamily. For citizen-soldiers, they may return to civilian jobs within a week ofcoming home from war.

The rate of emotional problems these soldiers manifest is higher forNational Guard and Reserves than for other groups. Fifty percent of NationalGuard and Reserves suffer from anxiety, depression, and other diagnosablemental health problems in comparison to 41% of active duty soldiers and31% of marines (Mental Health Advisory Team [MHAT], 2007). Relationshipswith family members and with partners are affected negatively bydeployment and return. Twenty percent of returned married troops areplanning a divorce. A report by the Army’s MHAT in February Mental HealthAdvisory Team surveyed mental health specialists working with soldiers inIraq and Afghanistan. It quoted one as saying: ‘‘Fifteen month deploymentsare designed to destroy marriages’’ (Parsons, 2008).

Problems in relationships in families are 4 times higher after return fromdeployment. SOFAR hopes that by preparing families to anticipate stresses,and by improving communication skills, the families will be better able tocope with the heightened level of relationship problems.

PTSD AND TBI

The signature wounds of OEF and OIF are PTSD and traumatic brain injury(TBI). More than 300,000 soldiers are expected to suffer from PTSD and320,000 from TBI. The presence of either or both of these diagnoses causesproblems for the family of the returning soldier.

The symptoms—impulsivity, irritability, moodiness, intrusive affects,and/or affective flatness—are challenging the coping skills in most families.The Rand Report (Tanielian & Jaycox, 2008) asks ‘‘What are the costs of thesemental health and cognitive conditions to the individual and to society?Unless treated, each of these conditions has wide-ranging and negativeimplications for those afflicted. We considered a wide array of consequencesthat affect work, family, and social functioning, and we considered co-occurring problems, such as substance abuse, homelessness, and suicide’’(p. xxii).

Living with a returned citizen-soldier who is at risk places the family atrisk. The soldier is more prone to domestic violence. Although therecognition of PTSD has been a major step forward, war conditions thatcreate responses like startle response, flashbacks, aggression, and high levelsof adrenaline have all played an important role in the struggle to maintain

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safety at home. The public and political view on trauma-related responsesand reactions at home have so far been viewed as domestic violence thatrequires anger management and other treatments. These responses,however, may have much more to do with the trauma experienced andcondition created in war, and much less to do with directed interpersonalviolence. To prevent these incidents that are so detrimental to familyconnection and safety, this briefing focuses on the need to educate veteransand their families regarding the impact of prolonged combat trauma and therepeated exposure to violence and how this can change the personal andfamily dynamic after returning home (Tanielian & Jaycox, 2008).

SUICIDE

The suicide rate in the veterans’ community is rising. The rate of Veteransuicides is 17.2 per 1,000; the rate in the general population is 8.2 per 1,000.Veterans make 1,000 suicide attempts per month. The number of suicidesamong Veterans of wars in Iraq and Afghanistan may exceed the combatdeath toll because of inadequate mental health care. (Thomas Insel, NIMH,3/5/08). SOFAR is training family members to be gatekeepers who canidentify Veterans at risk because they have daily exposure to their problems.In a workshop format, we teach family members about the challenges ofreunion and reintegration, we can help them learn about normal parameters.Some examples of what we might share are:

A Vet with nightmares may be normal. One who never sleeps is not.A Vet who may want to avoid crowded places is normal; one who doesn’twant to leave his or her room is not.A Vet who sleeps with his or her gun is a vet headed for trouble.A Vet who drinks to excess every night is at risk.A Vet who is having flashbacks is at risk.A Vet who commits domestic abuse, child abuse, or manifests road rage is atrisk.A Vet who denies the impact of behaviors problematic to others is at risk.

We provide them with a fact sheet, listing the symptoms of PTSD and of TBI.We also provide them with referral sources and with numbers of 24-hoursuicide hot lines.

Additionally we reach out to mental health clinicians in the community.Mental health professionals may understand trauma and how to do suicideprevention but may not know anything about military culture and thestresses of reunion and reintegration. By orienting these professionals, wecan encourage them to identify some of the 60 million people affected by thewar who may all ready be in treatment with them. We run workshops suchas Preventing Suicides in Returning Veterans: Educating Mental health

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Clinicians to Empower Veterans’ Family Members to Identify Veterans AtRisk.

We understand reunion and reintegration are processes. For thosewithout physical and psychological scars and good social networks, theprocess is shorter. For the wounded soldiers and their families, the process ismore complex. They cannot return to their ‘‘old selves.’’ We help them toaccept the concept of a ‘‘new normal.’’ The soldier and the family must workto establish a new equilibrium by acknowledging what has been lost,developing skills to accommodate to physical and psychological challenges,and forging a new vision of the future.

INTERGENERATIONAL TRANSMISSION OF TRAUMA

When trauma is untreated, suffering with PTSD, TBI, and major depressioncan impair relationships, disrupt marriages, aggravate the difficulties ofparenting, and cause problems in children that may extend the con-sequences of combat experiences across generations. People whose parentshave untreated PTSD are more at risk to develop PTSD. We have to treattrauma to stop it from passing to the next generation. Unresolved traumagets passed down to subsequent generations even though the behaviors mayno longer be adaptive. That which goes unacknowledged and unspokenpersists. Thoughts and feelings about the self can be passed down to thenext generation. Self-hatred and fear may become a destructive familylegacy. SOFAR encourages family members to identify untreated PTSD in thereturning soldier so he or she may be treated. A parent who has metabolizedthe trauma, will not pass the trauma unconsciously to the children in thefamily.

RECOMMENDATIONS

SOFAR has been working with these families since 2004. National Guard andMilitary Reservists have not received the services they need. We recommendthe following:

N Collaborations with all state and federal agencies working with Veteransand families

N Veteran’s Services, Department of Public Health, Department ofEducation

N Department of Social Services, Department of Mental Health, VAs andVet Centers, Veterans Service Organizations, and Community Groups

N Building bridges between military culture and mental health to reducestigma of seeking mental health services

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N Embed mental health clinicians in Family Readiness GroupsN End turf wars between insurers and other groups. Can we ever have too

many mental health services?N Encourage mental health state and national organizations to educate their

members about the impact of returning veterans on the larger communityand train them to help

N Encourage Department of Defense to develop programs for families ofReserve and National Guard.

CONCLUSION

Our children will not just survive the impact of the war on their families. Ourveterans and their families will achieve a ‘‘new normal’’ that allows them toresume growth as a family. They will thrive, passing on to the nextgeneration a legacy of hope and resilience.

REFERENCES

Boss, P. (2007). Ambiguous Loss Theory: Challenges for scholars and practitioners.Family Relations, 56(2), 105–111.

Figley, C. R. (Ed.). (1995). Compassion fatigue: Coping with secondary traumaticstress disorder in those who treat the traumatized. New York. Brunner/Mazel.

Gellene, D. (2007, May 26). War wives at greater risk of depression. Los AngelesTimes. Available at: http://fairuse.100webcustomers.com/mayfaire/latimes24.htm

Gibbs, D. A., Martin, S. L., Kupper, L. L., & Johnson, R. E. (2007). Child maltreatmentin enlisted soldiers’ families during combat-related deployments. Journal ofAmerican Medical Association, 298(5), 528–535.

Goldstein, A. (2008, May). Post-war suicides may exceed combat deaths, U.S. says.Bloomberg News, May 5. Retrieved May 8, 2008, from http://www.bloomberg.com/apps/news?sid5a2_71Kl02vig&pid520601124

Mental Health Advisory Team (MHAT). (2007). An achievable vision: Report of theDepartment of Defense Task Force on Mental Health. Washington, DC:Department of Defense. Available at: http://handle.dtic.mil/100.2/ADA469411

Milton, J. (1673). On his blindness. In J. Milton (Ed.), Poems (2nd ed.). London:Thomas Dring.

Parsons, C. (2008, May 6). US military families strained by long deployments.Reuters. Retrieved May 26, 2008, from http://www.reuters.com/article/latestCrisis/idUSN22289468

Rentz, E., Marshall, S. W., Loomis, D., Martin, S. L., Casteel, C., & Gibbs, D. (2007).Effect of deployment on the occurrence of child maltreatment in military andnonmilitary families. American Journal of Epidemiology, 165(10), 1199–1206.

SOFAR. (2008, May). SOFAR guide for helping children and youth cope with thedeployment and return of a parent in the National Guard or other MilitaryReserves. Boston, MA: SOFAR.

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Tan, M. (2006, December 11). By the numbers: Who’s fighting. Army Times, p. 14.Tanielian, T., & Jaycox, L. (Eds.). (2008). The invisible wounds of war. Retrieved

June 12, 2008, from http://www.rand.org/pubs/monographs/2008/RAND-MG720.pdf

Winnicott, D. W. (1958). Collected papers: Through paediatrics to psycho-analysis.London: Tavistock.

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