Feral Jundi

   This is a treat.  Angela has been an active reader of FJ and of PMH, and definitely has done a lot of work on PTSD issues at her Military Healing Center. She is one of the few out there in her industry that actually care about the mental health of not only soldiers in the war, but of contractors as well. So it is a pleasure to showcase some of her work as a guest author on FJ.

   You can see the theme with today’s posts, and we really need to be thinking about the mental health aspects of this industry.  In order to continue doing this kind of work, you need to arm yourself with the mental tools for longevity. Angela is a great person to talk to, if you want to assemble that mental tool kit. –Matt

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RESILIENCY AS POSITIVE DEVIANCE: Rethinking Counseling and the Military

By Angela Benedict

We live in a world that functions in a myriad of negative deviances. Child abuse and sexual trafficking, domestic violence and condoned incest, corruption and extortion, rewarded dishonesty and extreme poverty, torture of war criminals and sexual partners, embedded violence and jealousy, materialism and isolation.    We live in fear of our neighbours, foreigners, family members and ourselves.  We are on guard, awaiting the next attack from our boss, our co-worker, our spouse, to be projected at us by the news, the internet.  We often see power misused.  Most of us feel powerless.

It is not surprising that over the last 30 years there has been a steep incline in the cases of mental illness.  Depression is ranked highest followed by spikes in schizophrenia, mood disorders, anxiety disorders, and other psychotic illness.  Stress is cited as the cause.

Out of this incline another trend has appeared, that of the trauma counselor.  Trauma has begun to define us.  We are not our accomplishments as much as we are a society identified by our ailments.  We are a depressed society living in disastrous times where our expectations are that things will only get worse.  This is a tough perception.

Currently, the field of trauma counseling is receiving harsh criticism from within the ranks of psychology where it is being viewed as a reinforcement to not only illness, but to negative deviant behaviours.  Given the high stakes of the epidemic status of post traumatic stress, a solution must be found soon. Resiliency training can become the counter to the negative and be used to reinforce positive deviance.

Trauma, similarly to “crisis” and “disaster”, is undergoing consistent redefinition.  Trauma as deviance assumes that a) prior to the trauma there was a state of relative peace, b) the person experiencing the trauma will be significantly affected, c) the affect will be great enough to warrant outside professional intervention, and most importantly, d) that trauma is an uncommon occurrence that is outside of normal life cycles. “While the stress on the non-routine dimension of disasters seems close to common logic, these descriptions seem to incorporate an almost functionalist assumption of general societal equilibrium prior to disaster onset.  Such an assumption dangerously ignores that most disasters are ultimately explainable in terms of the normal order.”(Oliver-Smith, 1999.)

Who is deciding what is trauma?  What are the expectations regarding trauma?  Are they reasonable and achievable?  Recently in the Toronto Star there has been a three part series of articles regarding Canadian Forces Veterans returning from Afghanistan.  The titles of the series sum up the situation of our Vets succinctly; “ A warrant officer is unrecognizable to his family since returning from Afghanistan”, “The damage a new and dangerous class of criminal is inflicting once back in Canada”, and finally, “ An intimate portrait of two veteran’s lives in disarray.”

Part of the difficulty in supporting our troops is that they get mixed messages from the rest of society including how they are to transition back into civilian life.  One mother states, “It was war he went into and somebody else came back.  You start talking to him about the war, you can see that blackness come over him.  It’s going to take a long time to get that little boy back.” (Bruser, 2009)

As a modern, civilized society full of intelligent people, how is it that we can wonder why war has such a profound affect on people we are willing send into it?  How could it not have a profound affect and why do we wonder why they are so changed by it?  Who has the real problem here?  Perhaps it is an epidemic of denial and illusion that is really what ails us and is hurting our troops.  So the issue becomes two-fold at this point.  Firstly, we have trauma as real as it gets manifesting in the experiences of our soldiers.  Then we have trauma as it is sold to us by an industry of mental health professionals.

After 9/11, 9000 therapists, counselors, psychologists, psychiatrists descended on Manhattan responding to the panicked cries of mental health professionals who foretold that the psychological fallout would be a catastrophic event in itself.  The dire predictions of psychological injury prompted a Washington Post reporter to state, “Even though it is commonly believed that post-traumatic stress disorder is universal among trauma victims–a fallacy that some mental health counselors are perpetuating in the aftermath of this tragedy–epidemiological studies show otherwise…. In response to the apprehension about whether people could cope, a skeptical reporter with USA Today was finally forced to ask, “Does everyone who goes through trauma need a therapist?” (Satel, 2005) The answer, of course, is no.

The International Critical Incident Stress Foundation (ICISF), based near Baltimore, is the largest psychological debriefing training outfit in the world and maintains a virtual monopoly on debriefing training.  Its clients include the FBI, the Coast Guard, the American Red Cross, and U.S. Air Force bases worldwide and has training programs in Canada, Europe, the Caribbean, Central and South America, and Australia.  Anyone with a high school diploma is eligible for the foundation’s course. In some circumstances, an ICISF certificate grants the bearer access to disaster sites that an advanced clinical degree does not. In 1995 a group of psychiatrists from Yale that included respected experts in traumatic stress offered to help with victims of the Oklahoma City bombing. Emergency officials turned them away because they lacked certification from the International Critical Incident Stress Foundation.

The corporate world has jumped on the psychological debriefing bandwagon with both feet, persuaded by its mental health professionals that without their help productivity will suffer and mental health costs will soar. Organizations that do not offer debriefing for workers exposed to on-the-job trauma may put themselves in medical-legal jeopardy. Some psychologists even tell employers that they have 48 hours to act after a disaster, otherwise employees may “jump ship” or “come down against the company.” (Satel, 2005)

Hoge et. al. in their study of returning veterans; Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care states, “Little of the existing research is useful in guiding policy with regard to how best to promote access to and the delivery of mental health care to members of the armed services. Although screening for mental health problems is now routine both before and after deployment and is encouraged in primary care settings, we are not aware of any studies that have assessed the use of mental health care, the perceived need for such care, and the perceived barriers to treatment among members of the military services before or after combat deployment.” (Hoge, 2004)

Private Matthew Keddy, a Canadian infantry-man recently returned home from Afghanistan has negative views of the support he has received from the military and states, “ They say they’re going to help me but they don’t help me.  They don’t care…They don’t care.” (Bruser, 2009)  The military’s response in the recent assault case of Pte. Keddy? “There were programs set up for him that he has not been attending….they’re not in the business of 24-hour-a-day babysitting because they perceive that he is a soldier and has responsibilities himself.” (Bruser, 2009)  What seems to be becoming more obvious to the observer of the crisis taking over military forces involved specifically in Iraq and Afghanistan as US forces as well as British are facing the same issues, is that the programs set up for troops don’t seem to be working.  It could be the ‘stigma’ of mental health issues that may tarnish a budding career, but it could also be that what is being offered isn’t enough, isn’t comprehensive enough, or isn’t being presented in such a way as to be seen by troops as a viable option.

It is becoming an empirical fact that we are not winning the war on saving our soldiers.   As Satel, (2005) states most random-assignment studies of individuals who have suffered accidents, assaults, or burns show the same degree of improvement, whether patients were debriefed in a one-on-one session by a therapist, or instead received general support or no intervention at all. Two such studies, however, found that debriefing actually impeded recovery. In one, debriefed burn victims were three times as likely as the control group to develop PTSD after one year. In the other study, a three-year follow-up of car accident victims, anxiety, level of functioning, physical pain, and degree of preoccupation with the accident improved more slowly in the debriefed patients than in the control group.

Psychology is a fluid science, at least in theory, although it often may take decades for new theories to take hold even though there is a steady stream of new information flooding the discipline regularly.  There has been a change within psychology and our redefinition of illness, specifically Post Traumatic Stress Reaction.  It has only been recently in the past few years that we have begun to move away from calling it a disorder and recognizing it to be a reaction.

“Humanitarian interest in ‘post-traumatic stress’ following war or 

natural disaster reflects a globalization of Western cultural trends 

towards the medicalization of distress and the rise of psychological 

therapies. However, there is little evidence that such events create a psychological fall-out significant enough to justify a field of operations

called ‘disaster mental health’. Western psychiatric constructs and therapeutic

approaches lack validity across cultures; for the vast majority of survivors, ‘post-traumatic stress’ is a pseudocondition, a reframing of understandable suffering and misery as a technical problem to which short-term technical solutions such as ‘counselling’ are supposedly applicable. Survivors seldom see themselves as having an actual or potential mental condition, and have not 

asked for ‘counselling’. They point instead to their shattered social worlds. 

There are limitations to the Western medicotherapeutic gaze: ‘recovery’ is 

not a discrete psychological process or event. It happens in people’s lives 

rather than in their psychologies, grounded in resumption of the ordinary rhythms of life – economic, familial, sociocultural – that make the world intelligible and survivable. The longer-term legacy of a disaster is thus 

determined by what happens in the social, not mental, worlds of survivors. 

(Summerfield, 2005)

 

Disasters are failures of human systems to address the interactions of interrelated systems , producing a collapse of cultural protections which often have profound effects on humans. (Oliver-Smith, 1999)

Goleman, (1995) tells us that an emotional trauma has three parts; it was unexpected, the person was unprepared and there was nothing the person could have done to prevent it from happening.  The first two parts can be dealt with for military personal with proper pre-deployment resiliency training.  Often social constructs and institutions have broken down to the point where chaos ensues.  A soldier laments, “ I couldn’t get there.  We didn’t have what we needed.”  It is not the mental or even emotional strength of the person that was lacking or that failed in some way.  The system around them failed and they have taken the impact.

Culture shifts occur over time.  They do not happen spontaneously; they evolve and they are not societal in scope; they are begun by a few.  The theories developed by individuals are transmitted over time to others through education and practice that yields results that a larger group deem to be beneficial.  Resistance to these new practices has often proven to be comprehensive and even deadly.  Cultural shifts are necessary for humanity to evolve. Humanity has also proven that it is not a proactive species.  We are not preventative by nature.  Instead a pattern of panic and respond has developed.   Change as an intellectual construct is something understood by all of humanity.  It is the practice of incorporating change that continues to be difficult.

If 80% of the military population is experiencing Y, why are the other 20% not, or more importantly, are they experiencing X?  Is X the resiliency factor?  Special Forces have X.  Survivors of trauma have X.  People who have high immune systems have X.  X can be described as the will to live, to overcome, to endure, to succeed.  It is unseen but manifests in predictable behaviours.  The question is how do we develop it so that the behaviours will manifest?  Should the question be how do we encourage the behaviours so more people will develop it?  There is a need for cultural transformation that is more accepting of positive deviance that of negative.  This is the primary obstacle in crisis management; achieving cultural transformation.

Positive deviance is an approach to personal, organizational and cultural change based on the idea that every community or group of people performing a similar function has certain individuals whose attitudes, practices, strategies and behaviors enable them to function more effectively than others with the exact same resources and conditions. Because Positive Deviants derive their extraordinary capabilities from the identical environmental conditions as those around them, but are not constrained by conventional wisdoms, Positive Deviant’s standards for attitudes, thinking and behavior are readily accepted as the foundation for profound organizational and cultural change.

The term positive deviance was coined after Jerry Sternin’s studies and interventions to promote nutrition programs in Vietnam during the 1990’s.  It was determined that some children from poor families were in fact well nourished despite their surroundings and the obvious plight of their neighbours.  Sternin observed that there were particular tendencies on the part of these deviant families that other families were not subscribing to.

Sternin’s work has now provided us with a model to incorporate change in to communities.  There are eight parts to the model.

1. Don’t presume you have the answer.

2. Work within to have the community identify who the positive deviants are.

3. The solution has to be repeatable for everyone.

4. Raise questions but let them do it themselves.

5. Identify conventional wisdom.  Some “wisdom” leads to worsening conditions.

6.Identify and analyze the deviants.

7.Let the deviants adopt deviations on their own.  It’s not about transfer of knowledge, it’s about changing behaviour.

8. Track results and publicize them. (Dorsey, 2007)

In much of the world we seem to be experiencing a loss of common sense strategies, confidence in the body and mind to heal itself and lack of general social structures in place to support growth that is not marketable.  Much of our attention is directed outward to external stimulus rather than inward towards reflection and simplicity.  However, many solutions are simple.

Resiliency is empowerment and training is essential. “The Army can mitigate the effects of post-traumatic stress disorder by training solders to be more mentally resilient before combat.” ( Lopez, 2009) “Comprehensive soldier fitness is about increasing the resiliency of soldiers by developing all the dimensions of a soldier including the physical, emotional, social, spiritual and family elements…The Army is developing a global assessment tool to help assess all five elements of a soldier’s fitness…The GAT is in a pilot status now and is expected to be delivered across the Army this year…Based on this, you get an individual training program….And after that, if needed, soldiers can be referred to intervention programs that can help them strengthen their fitness needs — whether psychological or physical.” (Lopez, 2009)  The deciding factor in the success of initiatives such as GAT is the depth of the intervention that is offered.  The military must deem its responsibility to soldiers to be great enough to develop programs that are engaging so personnel want to attend,  are practical not theoretical with real world, simple to replicate applications, are provided to all branches, all ranks, active, new recruit, unit leader and reintegrating personnel.  “Transitioning” must take on a whole new meaning and become the new model.

Resiliency must be mandated as training, must be redefined as a positive deviance out of the negative spiral of trauma, must become what is lacking in terms of support for veterans and active duty personnel, must become part of a societal movement to understand a soldiers ‘place’ in society and special needs.

In order for resiliency to take hold in military and paramilitary forces, several factors have to become realities.  A shift out of the mythic reality into a reality where there is no denial of what war is and does to people, no illusion about what reasonable expectations are for soldiers and how they are different from civilians, no secrecy around the soldier and his or her experience that can not be shared with society at large.

“ Too often, this view of the veteran as a man apart is shared by civilians, who are content to idealize or disparage his military service while avoiding detailed knowledge of what that service entailed.  Social support of the telling of war stories, to the extent that it exists at all, is usually segregated among combat veterans. Thus the fixation on the trauma – the sense of a moment frozen in time – may be perpetuated by social customs that foster the segregation of warriors from the rest of society.” ( Herman, 1997)

Currently, society is viewing humanity as weak and incapable of dealing with high level stress, making hard decisions, dealing with death, loss, or extreme change.  Because of this view, the industry of trauma counseling is thriving to provide us with “someone to talk to”.  If PTSR can be seen as helplessness internalized, we are creating the problem, then providing the solution which we are finding is ineffective as a cure.  The vicious cycle is our own creation.  There is an alternative. “Many soldiers who have experienced traumatic events do report PTSR-related issues, such as nightmares, but many also report positive outcomes as well, something called “post-traumatic growth.” Those outcomes include enhanced self-confidence and leadership, personal strength, spiritual growth and a greater appreciation of life. (Lopez, 2005)

According to the sociologist Henry Quarantelli, a pioneer in the field of disaster research, “Mythical beliefs to the contrary, disaster victims do not panic, they are not passive, they do not become caught up in selfish and antisocial behavior, and they are not behaviorally traumatized.” Monica Schoch-Spana, a medical anthropologist with the Johns Hopkins Center for Civilian Biodefense Strategies, laments the predominance of the “pathological model.” So often, she says, officials and mental health planners neglect the positive human elements that crisis elicits, such as “reasoned caution, resourcefulness, adaptability, resiliency, hopefulness, and humanitarianism.” (Satel, 2005)

Resiliency is the ability to adapt to sociocultural environments and succeed.  We are not providing military with the tools to do that successfully.  It is not enough to spend 7 weeks, or even 12 weeks in the case of Marines, to “train” soldiers.  Historical brainwashing techniques used to instill the “warrior ethos” will not suffice if our goal is retention and reintegration.  Developing programming that steps outside of the mythical reality of war and properly trains personnel to be prepared for the eventualities of that specific and unique sociocultural environment will be a decisive moment for modern armies which now have a choice to be part of continuing crisis or participate in possibly the most significant opportunity any army has ever faced.

Link to Military Healing Center here.