The experience of war can change a person profoundly, and the return to civilian or active duty life stateside can be a challenge for both veterans and those who are close to them, says a specialist who has studied the subject.
Readjustment and reintegration are outlined in a new book titled "Courage After Fire," which is designed to help returning Iraq and Afghanistan veterans, their families, and the people who care for them, including employers, clergy, and community members.
"It's estimated that around a million military personnel have served in Iraq and Afghanistan, and over 300,000 have served more than one tour of duty," notes co-author Keith Armstrong, LCSW, director of Couples and Family Therapy and director of Mental Health Social Work at the San Francisco VA Medical Center. "This book's purpose is to help veterans reintegrate back into their families and communities, and to help their families with readjustment as well."
"Courage After Fire," which features a forward by Senator Bob Dole, is based directly on work with Iraq and Afghanistan veterans and their families, including Armstrong's 16-plus years of experience working with veterans of conflicts from World War II to the present day. Armstrong and two co-authors wrote the book, which is published by Ulysses Press.
An estimated one in four veterans returns from Iraq or Afghanistan with some kind of psychiatric or emotional problem, notes Armstrong, who is also a clinical professor of psychiatry at the University of California, San Francisco and a member of the Posttraumatic Stress Disorder Program at SFVAMC.
"But this book covers an even larger group," he says, "because when you're separated from your family, and then you reintegrate back, there are going to be difficulties. I think that's true for everyone. So there are suggestions in this book that will be useful to all veterans."
According to Armstrong, the book describes and explains "some of the typical issues we see with veterans and their families when veterans return from a war zone, and then provides practical strategies and solutions to address those particular issues" - including posttraumatic stress symptoms, substance abuse, anger, grief and depression, phobias, relationship difficulties, and employment difficulties.
One typical problem, he says, is that family roles have probably changed during the veteran's absence - such as who does the laundry or takes the kids to sports - and the returning veteran "may wonder how to fit into the new way of doing things." Lack of communication is often a big issue too, says Armstrong. "The veteran, reasonably enough, probably did not communicate fully to the family about day-to-day life in war, and likewise, family members back home may have held back upsetting news from the veteran. So the book helps both the veteran and family members think about what they might want to tell their loved ones, and how to ask about what they might want to know. That can be a significant way of healing and of making sense of the whole experience."
Large sections of the book address reactions to war and suggest ways for veterans to deal with situations at home that remind them of painful or stressful war experiences.
"There are methods for retraining your body to not respond to triggers that might have helped protect you in war that are no longer useful in most situations you're faced with at home," says Armstrong. Those situations might include commonplace activities such as driving through heavy traffic or being in large crowds.
There is a section for veterans on how to reintegrate back into work, and a section for employers on strategies to help employees readjust to the workplace. Armstrong stresses that the book features a large resource section with "websites and books that we have found to be extremely useful for veterans and their families, on a wide variety of topics - all contained in one volume that you can carry with you."
"Courage After Fire" was cowritten with Suzanne Best, PhD, a staff psychologist at UCSF and a clinical supervisor and research psychologist with the Posttraumatic Stress Disorder Program at SFVAMC, and Paula Domenici, PhD, a congressional fellow of the American Psychological Association.
A website associated with the book at www.courageafterfire.com contains related information and helpful links.
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