1. Presented by Alicia Bogard, MSW, LISW-S, CFLE

2.  Introduction  Cultures of War  Compassion  Communication  Conclusion

5.  Branch of the Military (Army, Marines, Air Force, Navy and Coast Guard)  Draft vs. Enlisted  Not Stereotyping  Cultures from Each War…

6.  World War II: ◦ Heroes and Praised. ◦ Did not speak about what happened ◦ “Shell Shock”& “Combat Fatigue” “During the war, I earned a lot of metals, but did not speak about them because I did not want people to know what I did. “ * World War II Veteran

7.  Korean War: ◦ Viewed a “Conflict” ◦ Not supposed to be any wars after WWII ◦ Feel overlooked  “ and when the war was over, the Chinese military puts their guns down and wanted to shake our hands because they called a truce.” * Korean War Veteran

8.  Vietnam War: ◦ Media Coverage ◦ Divided Country ◦ No gratitude or appreciation for veterans “Being in Vietnam, I believe was a waste and there was no reason. “ * Vietnam Veteran

9.  Gulf War/Dessert Storm Veterans ◦ Exposed to nerve gas ◦ Increased rates of brain cancer, lung cancer, debilitating chronic diseases and pain, increased risk for Alzheimers  Iraq/Afghanistan Veterans ◦ Struggling when they return to civilian life ◦ Job skills do not translate from military

10.  Person came home a different/changed person ◦ Veterans returned home & their family told them they did not know or recognize them  Veterans worried about their family finding out what they did/had been through  Rape in Military/Conceiving Children  Substance Use to Cope

11. “ I left my family because I went to get milk and never came back.” * Vietnam Veteran  Domestic Violence due to still being in “combat mode”  Being military family is a different lifestyle ◦ Stoicism ◦ Different Lifestyle (traveling/changing roles) ◦ Loss of Friends (technology not the same) ◦ Concern about Pensions

12.  Post Traumatic Stress Disorder (affects them in large crowds, ability to keep jobs and relationships, interactions with the law)  Veterans can have a distrust of any authority  Co-morbid conditions are often present (anxiety, depression, substance abuse, social or family issues)

13.  Addressing all areas of health: Spiritual, Emotional, Social, Physical & Cognitive  Looking at possibility that physical pain can be related to underlying pain in other areas

14.  Forgiveness Issues  Isolation  Guilt  Guided Imagery  Use Ritual to help bring healing (memorial rocks, pinning, bracelets, letters to the living or the dead)

15.  EMDR returns information processing to normal, the memory is still there but it is less upsetting, less intense, less stressful  EMDR is a eight-phase integrative treatment approach  EMDR uses bilateral stimulation(eye movements, taps, audio tones) to reprocess information, which appears to be similar to what occurs naturally during dreaming or REMsleep

16. “There are not documents for everything I went through, but you do not dream up stuff like this.” * Vietnam Veteran/P.O.W.

17.  Communication with Veterans IS different than other patients you serve  Veterans are trained at a young age how to communicate the necessary and hold everything else in  Stoicism  Triggers

18.  Do NOT ask if they are veteran. ASK if they ever served in the military.  Do NOT assume- not all veterans view their military experience as negative. ASK THEM.  When asking if they are in pain- ask if they are “uncomfortable” as many veterans will not admit they are in pain.

19.  Lead in questions about other topics to develop trust  Some military leaders believe the word “disorder” makes soldiers reluctant to ask for help- they would like to change the name to Post Traumatic Stress Injury  This is a debate if the military environment needs to change and not the disorder.  Be present and have time to listen when Veteran does open up – this may take time

21.  Bolte-Taylor, J. (2008). Stroke of insight.  DMS-IV- Diagnostic & statistical manual of mental health disorders 4 th edition.  Grassman, D.L. (2010). Peace at last: Stories of hope and healing for veterans and their families. Vandamere Press: Florida.

22.  Koepell, Barbara. (2015). U.S. Nerve Gas Hit Our Own Troops in Iraq. http://www.newsweek.com/how-us-nerve- gassed-its-own-troops-then-covered-it-317250  McKay, Heather. Dementia Care for America’s Heroes.  Padin-Rivera, Edgardo. Post Traumatic Stress and End of Life Concerns.  The Hospice-Veteran Partnership of Ohio Fact Sheet 2010