The Scars of Heroes

Psychologists Explore the Enduring Wounds and Courage of Our Nation’s Veterans

“Even though it was another lifetime, I distinctly recall the feeling of taking the flight back from Vietnam in December 1969,” says Marv Dunphy (’74). “My thoughts were on the people who were still there, my fellow soldiers and the South Vietnamese who worked on our base. And what I remember vividly is the color. Everything had been olive drab, devoid of colors, and when we landed at the Oakland Army Terminal, everything was in Technicolor.”

Throughout history veterans like Dunphy, now head coach of the Pepperdine volleyball team, have returned from war with a new way of seeing the world. It’s common for families and friends to observe of a veteran, “he came back different,” or “she’s changed, and I don’t understand her anymore.” Psychological wounds persist long after vets return from combat, but stigmas surrounding therapy and cultural notions of strength and weakness often inhibit them from seeking help.

Fortunately recent studies have shown that psychological struggles among veterans are a direct consequence of the rigors of war, and do not demonstrate the quality of the solider. “Serving in life-threatening situations changes people in ways they cannot always control,” explains David Foy, professor of psychology at the Pepperdine Graduate School of Education and Psychology. “It’s important to note that the primary contributing factor is not the character of the individual; it’s the severity of the combat exposure.”

David Foy

To care for the scars of those who have served the country in combat, the federal government established the Department of Veterans Affairs (VA) in 1930 (see page 29 for more on the VA system). When the VA began, it operated 54 hospitals nationwide. Now the department’s health care system includes 153 medical centers, at which nearly 5.5 million people received care last year.

Services of this scope require a huge support staff. The VA manages the largest medical education and health professions training program in the United States; it trains and employs more psychologists than any other organization in the country. Among the many psychologists training and working in VA medical centers across the country are students and alumni of Pepperdine’s PsyD in clinical psychology program. Practicum placements, externships, and internships expose them to a variety of clients and experiences, and hone their skills in dealing with recurring issues.

“We see a wide range of ages and wars,” explains PysD candidate Terri Mansour Moriarty, “but the common denominator among vets is the struggle to fit back into society, going from being in war to being back where it’s normal. There’s a different mindset in the military. You obey. You do what’s asked. Here you lose all that structure.” Psychologists in the VA system frequently see vets coping with unemployment, fragmented family relationships, chemical dependence, or instances of violence, all of which typically result from some level of psychological turmoil.

Nina Grayson, PsyD candidate and a pre-intern with the VA Greater Los Angeles Healthcare System, remembers a young soldier in his 20s who served as a sniper in Iraq. During his first week back home, an official came to repossess his car. The veteran thought he was stealing it, and immediately reached for his gun. He shot the man three times and went to jail. “He was in a trance-like state during the whole experience,” Grayson explains. “The only thing that woke him was the sprinklers in his face after the shooting.”

The man was exhibiting symptoms of post-traumatic stress disorder (PTSD). When PTSD was first recognized as a formal diagnosis in 1980, it changed the entire framework for addressing the mental health of veterans, who finally had a name to describe what they experienced.

Foy is an expert on factors contributing to the development of PTSD among combat veterans. He spent five years in the navy during Vietnam before attending graduate school on the GI Bill®. His first job was at the VA in Jackson, Mississippi, where he served as director of an alcoholic treatment program for returning vets. “We knew we needed to treat more than just their alcohol problems, but at that time, the VA wasn’t really aware of the ramifications of combat stress,” Foy explains. “People who provided services didn’t have the benefit of studies that we do now, especially about PTSD.”

Individuals struggling with the anxiety disorder—previously known as “soldier’s heart,” “combat fatigue,” or “shell shock”—are known to vividly relive the traumatic event in their minds, avoid situations that trigger memories of it, feel numb, or feel “keyed up” (a condition known as hyperarousal). They often experience nightmares, flashbacks, anger management issues, insomnia, guilt, and fear. It’s alarmingly common among combat veterans.

“Veterans can feel like they’re in a completely different realm,” says PsyD candidate Pernilla Nathan (MA ’06), who completed her practicum at a VA in Los Angeles. “They have a sense of aloneness and loss of hope. They struggle to grasp the intensity of what they’ve gone through, and to accept what they’ve done or seen. They can remember any detail; they can smell the smoke, and tell you exactly what the blood smells like. It’s like it all happened yesterday.”

Though all returning veterans are affected in some way by their military experiences, studies indicate that the process of recovery follows one of six different trajectories. Some vets cope with the disorder for the rest of their lives without healing, while others take a delayed course on which problems develop six months to a year after returning. Some vets are destabilized by their combat experiences but make a quick recovery, while others demonstrate resilience. Some seem to be inoculated by their early combat training, and veterans who experience post-traumatic growth actually look better after the trauma than before.

Since 1985 Foy has served as a consultant and collaborative researcher with the veteran PTSD treatment center in Menlo Park, California. More than 20 dissertation topics among Pepperdine PsyD students have emerged from data gathered through his assessment programs there. Students in Foy’s research lab study health risk behaviors, such as substance abuse, firearm ownership, aggression, and obesity among vets with PTSD; preventative and/ or coping strategies, like spirituality, that alleviate PTSD symptoms; and factors that either contribute to or result from PTSD, like depression, suicidality, and family abuse.

“The general philosophy of this line of research is that we’d like to see the course of chronic stress-related problems among veterans of the current wars, Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), to be different and better than those for previous war fighters.” Multiple studies have been conducted on vets from previous wars, especially Vietnam, to examine what happens to returning soldiers. In addition to chronic PTSD, Foy and the researchers wonder, do vets live as long as civilians? Are they more likely to be successful and competitive in employment? Are they likely to develop substance-abuse problems? “These questions have not been answered yet for OIF/OEF veterans,” Foy says. “We want to learn as much as we can from the perspective of prevention, intervention, and improving the quality of life for returning vets.”

For decades the word “soldier” has conjured the image of a young male, barely out of his teenage years, with cropped hair and a uniform. Through OIF/OEF that image is changing, as more women and older individuals engage in active military duty. As the type of soldier evolves, so do the many facets of both combat and veteran experiences. “These days you see people at war with three children at home,” Grayson explains. “These aren’t just 18-year-olds anymore. And more often Mom is serving, too. That means bigger—and simply more—families are affected.” Rather than serve a single tour of duty, more soldiers are being redeployed and often don’t know when they will return. Psychologists also see differences between veterans who were drafted and those who enlisted. “Vietnam was a draft; they had no choice,” says Moriarty. “It’s a different mental experience for people who choose.”

The very nature of warfare is constantly changing as well. Just as Vietnam vets grappled with Agent Orange, “the signature injury of our most recent wars is TBI—traumatic brain injury caused by a concussion wave from a roadside bomb or IED,” says David Schafer (MA ’04, PsyD ’08) of Sepulveda Ambulatory Health Care. “The presentation of that can look like traditional PTSD symptoms.”

As veterans return home with new problems, researchers like Foy are busy gathering data to help psychologists respond with new and improved treatments. “In particular, the VA has made a push to introduce more evidence-based treatment,” Schafer explains. Examples include cognitive processing therapy, acceptance and commitment therapy, and prolonged exposure therapy. Through psychoeducation, adds PsyD candidate Elizabeth Casas (MA ’06), group therapy participants receive information that could inform and empower them to deal with their situation.

While helping veterans on the road to recovery, psychologists can’t help but remark on how the soldiers have impressed and touched them. “What stands out to me if just how resilient they are,” says Michelle Zeller (MA ’00, PsyD ’04). “The perseverance and optimism is incredible.” And so is the feeling of working with them. “When a veteran comes in with real emotional pain, and doesn’t know how to deal with that,” Schafer describes, “and we work through the treatments that we know about now, there’s a moment in which they get a little bit of lightness to them. A moment when it doesn’t carry such deep suffering. To me, that moment is incredibly rewarding. Over time guys have said to me, ‘you’ve given me my life back.’”

Meet Pepperdine Alumni Veterans magazine.pepperdine.edu/veterans

About the Department of Veterans Affairs

The provision of federal benefits to veterans and their families dates back to 1930, when president Herbert Hoover signed Executive Order 5398 to create the Veterans Administration. The office took a variety of forms and names over the years, and was established as the Department of Veterans Affairs in 1989. As the second largest of the 15 cabinet departments, the VA and its nationwide programs for health care, financial assistance, and burial benefits operate with a spending budget approximated at $93.4 billion in 2009. More than 23 million American veterans are alive today; of those nearly three-quarters served during a war or an official period of conflict. All told, about a quarter of the United States population is potentially eligible for VA benefits and services because they are veterans, family members, or survivors of veterans.

Learn more: www.va.gov

Pepperdine Joins the Yellow Ribbon Program

Military veterans will soon have the opportunity to attend Pepperdine at a lower tuition rate thanks to the University’s participation in the new Yellow Ribbon GI Education Enhancement Program, a federal effort to help military veterans attend institutions of higher learning.

Learn more about the Yellow Ribbon Program magazine.pepperdine.edu/veterans