It is just one of those days. I am fed-up with the lip service and hypocrisy when it comes to mental health in Canada. On the heels of tragic events in the United States, the focus has shifted to our own tragedies and arguments over the spectre of endemic racism in Canada.
In the last few days, Ottawa Police Chief Sloly provided a heartfelt commitment to 'fix his own house' even as a young Indigenous woman was shot dead by police in New Brunswick during a wellness check. The Indigenous Minister – Marc Miller – has voiced his outrage, but the question remains: How do we stop the perversion of responding to distressed people, especially marginalized people, through threats of violence? First, we must name these police interactions for what they are – public safety risk assessment and containment interventions. Stop perverting the term wellness checks! There is no universe whereby an armed team of police in paramilitary gear can be construed as agents of care.
I have treated many police officers over the years. Most of them are considerate and good people and I have also seen many others who are misogynistic, openly racist, and discriminatory, and who thrive on the prospect of knocking heads and kicking down doors. In fact, in the interests of veteran welfare, we stopped calling police because they often made matters much worse. When law enforcement members have little regard or awareness of their own mental health, they cannot be expected to respond effectively to the psychological needs of another person in distress.
Police and public safety organizations have been studied extensively in Canada over the past several years. Nearly 45 percent of them have mental health problems resulting from things like workplace intimidation, bullying, threats, micromanagement, and overwork. Officers tell me repeatedly that their organizations are toxic and that their leaders cannot be trusted. It is a fantasy to believe that the effects of these environments on members do not spill over into their interactions with the public.
I am not anti-police by any means. I believe they are placed in an untenable position as both enforcer and social worker. Canada’s longstanding ignorance and indifference towards mental health by federal and provincial politicians means that deferring to law and order mandates to control people outranks any effort to address mental health needs. We have ample research and inquiries telling us that mental distress reaches into histories of childhood abuse, poverty, addiction, family violence, racism and social inequities, and from toxic workplaces. Time to stop the empty platitudes!
Policing, and its paramilitary ethos, centers on taking control from people and reacting with force to perceived threats which is exactly the wrong thing to do in most cases. I agree, Chief Sloly, police agencies must get their own houses in order before they can ever decide they are the ones to put other houses in order. Too many people are dying needlessly!
We are inundated with messages to stay positive, keep busy, learn a new skill, and stay socially connected alongside news and images of tragedies and mounds of flowers heaped at make-shift memorials. Radio and TV ads spin on catch phrases reminding us of ‘unprecedented times’ and ‘difficult times’ as they try to sell us something. Political leaders and public health people keep telling us to stay home, to be vigilant, and to treat this as a marathon as the country slowly tries to re-awaken.
Some health advocates have begun to warn of a possible mental health crisis; that it may not be over when it is over. It can all be emotionally draining. Some people may feel more emotional and want to talk and other people may seem numb to it all. Either way, the reaction of reaching our limits to care about any more of it, is predictable and understandable. There are limits to how much anxiety and sadness we can tolerate without switching off and into a survival mode.
I was a marathoner runner for years. The toughest part of any run began when the finish line was just coming into sight. Despite the cheering, clapping, and clamouring to keep going, I often just wanted them all to go away and leave me alone. Sometimes, I slowed to a snail’s pace or just walked, placing one foot in front of the other, blocking out pain, and focusing on some point in space – usually my wife’s face just past the finish line. The reality is that we each have limits to our physical and emotional endurance and only find the limit when we are at that line. Acknowledging our limits is important.
Sometimes the experience of exhaustion and wanting it all to end can add another layer of drain and concern because it contradicts the many positivity messages from others. Focusing on the little wins of completing a task or a chore can be essential in getting through to the next minute or the next day; putting one foot in front of the other. Remembering to eat, drink, sleep as much as necessary, getting some physical exercise (might want to leave the races to the young!), or just goofing around with music, gaming, playing with the kids or pets may be all that is possible. That’s enough.
At the risk if overdoing the marathon analogy; Stay at your own pace. Too fast risks burning out while running too slow can leave regrets that you could have done better. This is a different course since nobody is sure where the actual finish line is located. Take the time to walk through the refueling stops, going out when the parks or golf courses are opened, getting a haircut (for those of you so blessed), or going out for a meal when those doors re-open.
As the glimmers of this finish line approaches, instead of feeling excited and positive, we may realize just how drained we are emotionally and physically. This is also normal. Finding places and times to recharge, with others and alone, and staying away from despair may be enough of a goal for the immediate future. Getting over the line does not have to be pretty.
We are in the midst of necessary physical distancing from other people out of fear of spreading infection. Various public health figures and politicians have corrected the earlier misnomer of calling for social distancing - an acceptable oversight given the risks posed to human lives.
When it comes to military veterans, it is assumed that those I speak with must be having a particularly stressful time. This is not the case. They tell me that while everyone around them is trying to manage all the anxiety caused by disruptions to their taken-for-granted social worlds, they are surprisingly calm. One CAF member told me that he felt 20 years younger. "All the normal people out there finally understand a bit of my world." While I don't presume to speak for all veterans, those who are used to physical and social isolation because they are alienated from the world seem to have a peculiar bond with everyday people - however briefly this may be. Others tell me that all the pressure of having to be out in public places to prove to clinicians and family members that they are normal has evaporated over night. Now, vigilance, situational awareness, remaining disciplined and focused on priorities and routines, getting sleep, remembering to eat, staying away from 24-hour news churns filled with talking heads, connecting with buddies and family, playing video games, listening to music, or watching movies, going out only when necessary, and getting some physical exercise are common priorities. For a brief moment in history, before global economic forces and the mindlessness of consumerism push us back to where we were not so long ago, we all seem to be sharing a common reality. We each have to spend time with ourselves, to contend with boredom and figure out how to use our time creatively without resorting to booze or drugs to dull our senses, to reflect, and even reminisce without slipping into rumination over past mistakes. We all share these temporary challenges.
Veterans often believe and are sometimes told that following orders and putting other priorities ahead of themselves is misplaced in the civilian world. And yet, here we are right in the midst of these exact societal needs. This irony is not missed on military or veterans but I don't believe that they gloat over this fact, either. The skills of containing and not over-reacting to emotion, staying focused on facts, being task-oriented, maintaining situational safety, and not anticipating outcomes are hard-wired among most military and veterans. I believe that these learned skills and lessons may be incredibly helpful for family members and other civilian friends to hear as they search for direction.
At the end of this temporary hiatus in 'normal', many of these same people will have lessons to teach veterans about managing the anxiety of re-entering the larger society.
The research is clear: childhood adversity and emotional deprivation can produce significant alterations in the brain's emotional processing system which often extend into adulthood. In my work with people with mental health and addiction issues, these histories are common and the thing that unites them is a belief that they are fundamentally alone. They learn to contain and manage their emotional worlds privately since everything and everyone is a potential threat to them. This self-protective stance is not intentional; it seems to be built right into the brain's hard-wiring from the earliest memories. They learned early on that showing emotional needs were either ignored or displays led to criticisms or put-downs. These things had to be stifled, hidden away and avoided at all costs. These children, turned into adults, learn the essential survival skill of becoming chameleons - blending in by looking and sounding just like everybody else.
This adaptation to survive in a threatening world by suppressing how they actually feel often works to varying degrees and during particular periods in their lives. But many of these same people develop problems with anxiety and depression and often turn to various preoccupations including substances to self-manage. While this is often called addiction (a term nobody can seem to agree on), I view substance reliance as repetitive automatic responses to emotional triggers.
A solution for those who struggle with substance overuse involves slowing down mentally (which can involve mindfulness, spending time without outside distractions) to a point where they begin to recognize the physical cues linked with particular emotional reactions (often termed introception), honestly facing these emotions (naming what they feel, allowing themselves to feel their reactions) and then doing something about them (writing them down, telling someone, engaging in some activity). These activities can literally rewire the brain over the long-run!
These skills can be difficult to practice since the people who avoid their emotional reactions often believe that this is a silly waste of time or they fear being flooded and overwhelmed. This work (and it is work) often means taking a risk to trust another person and the possibility of being hurt or disappointed. But, in terms of the opportunity to feel the full range of emotions, including things like love, joy, or tenderness, the payoff is often life altering. This process has the power to break the chain of addictive preoccupations. It is a process which has nothing to do with the misguided notion of addiction as a disease, either. People get into difficulties with substances through very human processes and they get out the same way.
Being full awake emotionally is the opposite of addiction.
Time has a way of slipping away unnoticed; it has been several months since my last post on this site. I want to thank those who regularly follow the posts and those new people who drop by to check it out. I have been busy with two separate projects aimed at military veterans. The first is an exciting project based in Ottawa, Canada - Camp Aftermath - aimed at providing groups of military veterans living with PTSD the opportunity to move beyond symptoms by offering help to other people . We are preparing for our third rotation to Costa Rica to participate in several projects in Spring 2020.
The second project is a book I began nearly 15 years ago. I put it aside to publish the books on military mental health. Given the importance of substance abuse and addiction concerns among many veterans, I am writing about the shortcomings of standard medicalized approaches to addiction treatment for military members and veterans (and many other people for that matter).
The Rise of Medicalized Public Workplaces
A soldier / first responder tells his buddy that he is not sleeping and that he is just fed up with things. The friend suggests he may be depressed and that he should come forward and talk to a professional. At first glance, a reasonable suggestion but missing from these cryptic interactions are the contexts. The soldier does not bother to mention that he is not sleeping because he was promised a low tempo posting by his supervisor for agreeing to take on a tough tasking that nobody wanted. His supervisor has reneged on the promise and instead has told him that he is needed for an upcoming deployment and if he refuses he can say good-bye to his career. The soldier’s marriage is already rocky because he has not really been home for the past several years and he does not know what to do. Career or marriage?
These types of scenarios are not unusual. What is new is that any mention of upset/distress in work settings of the 21st century is the rush to medicalize members' problems as part of institutional risk management. Anyone displaying unusual behaviour is a potential liability for organizations. This focus on individual mental health can be helpful to people for sure but we have also come to the realization that many of the ‘evidence-based treatments’ and workplace interventions like mental health first aid, and adoptions of the military’s road to mental readiness (R2MR) initiatives are not producing the expected outcomes of reduced workplace mental health problems (See Carleton et al., 2018). I believe that something fundamental is missing.
What is missing is context. According to the Standing Committee on Veterans Affairs (SCOVA, 2018), 28 percent, nearly one-third of military members, are released annually because of physical and mental health problems. We could attribute these rates to reduced stigma, better detection, and better care for soldiers and maybe even due to leftovers from the Afghanistan War. But, we also must wonder about this seeming upsurge in the numbers of injured men and women. What else has changed?
For starters, beginning in the 1990s most of organizations and public workplaces went through massive downsizing – doing more with less – because of budgetary constraints. Since that time there has been a continual scrutiny for savings and trimming needless fat. This focus on financial bottom lines has impacted personnel and human resource management fronts. In many places, among other demands, this has also meant personnel shortages requiring members to take on multiple roles, time pressures, reduced time away from work settings, and 24-hour access through telephones and social media. Members are required to over-invest to ever-demanding work settings.
A recent investigation of Canadian public safety workplaces showed that a staggering 45 percent of members reported mental health difficulties (See Carleton et al., 2017). Surprisingly, the many public reports of supervisory abuses, sexualized and harassing workplaces, and unreasonable demands are somehow forgotten in efforts to understand worker distress. Instead, there is a predictable call for better resiliency training to address these problems. In our study of resiliency among veteran families (Submitted for publication), we found that resiliency is not an individual quality like hardiness or ‘digging deep’ but a range of problem-solving responses dependent on tangible direct support from the institution and from broader social contexts.
Strikingly, none of our current explanations or interventions into workplace mental health acknowledges or addresses institutional causes of mental distress among members. We are left with the unspoken presumption that our current workforce is somehow lacking in self-management skills or fortitude to meet job demands. We have forgotten the wealth of research from the 1970s to 1990s on occupational burnout (See Maslach). We may have created pressure cooker workplaces and have ended up blaming people for not being able to maintain unreasonable expectations.
If we are intent on creating healthier workplaces, then we must get serious about tackling institutional policies and practices and enshrine employee protections for speaking out about things like supervisory and institutional practices and inconsistencies.
Those who follow veterans’ issues are aware of two overlapping explanations for difficult military-to-civilian transitions (MCT). The first is the well-advertised problem of chronic PTSD and other operational stress injuries (e.g., depression and anxiety problems) believed to affect up to one-third of those who leave the military. As others have argued, institutionalized military psychiatry defines veteran concerns as problems to be solved through medicalization (Shields et al., 2017; Howell, 2011; Caplan, 2011). This is reflected in broader research and public discourse on veterans, where the difficulties of transition have been primarily framed as health issues, and especially as mental health issues. Such a framing is problematic because it tends to not only medicalize, but also individualize and thus de-politicize the impacts of military service and military deployments. Medicalization emphasizes individual and technical solutions (i.e. all that is required are better treatments or programs) which admittedly can be helpful for many people. However, medicalized language does not acknowledge the purpose of militaries—war and training for war (military conditioning)— is largely absent from public discourse and policy on veterans’ transitions (Eichler & Bulmer, 2016).
When it comes to PTSD as a global explanation for veteran issues, there are a number of things which remain unanswered. Since its inception, observed symptoms were believed to reflect an underlying disease process. Thousands of studies conducted over nearly 40 years have attempted to identify brain anomalies to explain the wide range of seemingly unconnected mental struggles among soldiers and veterans. This ongoing research has been promising at points and contradictory and confounding at other times. But, missing from efforts to understand military trauma is context. By context, I mean mental conditioning within a value system that is necessarily rigid, perfectionistic, and demanding.
A second explanation has emerged focusing on the impacts of moral injuries arising from warzones. While the first (i.e., PTSD and OSIs) are deemed to be medical diagnoses, moral injury is considered to be a problem of compromised belief and value systems. Moral injuries are defined as reactions to perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations (Maguen & Litz, 2012). It was the subject of Jonathon Shay’s acclaimed book – Ulysses in America - focusing primarily on combat and the heat of battle which arguably are where the highest stakes are in play and where the potential to participate in or fail to stop terrible things from happening are ever-present. As noted by Nash et al. (2013), “Shay’s conception of morally injured veterans as victims of others’ wrongdoing mirrors views found elsewhere in the mental health and ethics literature regarding the central role in trauma of breaches in social moral contracts and damage to belief systems”. Our work with veterans certainly mirrors this observation. Namely, nearly every case of military PTSD is maintained by an unresolved moral dilemma; usually centering around betrayal across a broad range of operational contexts. In fact, Mobbs and Bonanno (2018) contend that moral injuries and transitional strain (e.g., loss of military identity) are the main sources of mental distress facing military veterans, not PTSD.
Loss of Relevance and Special Purpose
Soldiers don’t just espouse high moral codes – they live them, they embody them whether at home or deployed. They have to in order for these codes to become second-nature. The soldier who is tasked with protecting a convoy but refused the necessary equipment to do the job because of budgets and another who is sexually assaulted by a superior share a common reaction of betrayal. Don’t these qualify as assaults on moral codes? I think so. These types of events challenge the currently restricted notion of moral injury (as arising from warzones). In fact, the number one complaint among veterans medically released because of OSIs is a sense of betrayal by their chain of command and being thrown away by the system. Lingering reactions of helplessness, outrage, and shame certainly contribute to post-service mental health problems. Moral injury is not restricted to warzones. My point is that if soldiers are to be conditioned in high-minded moral codes, then breaching them in any context – in warzones or on home bases - can produce the same types and severity of psychological distress. I believe our current understanding of moral injury leaves out an important breeding ground for betrayal – the promise of specialness.
Embodied adaptations that make up military conditioning are accompanied by lessons in military superiority. Military conditioning is fostered within environments that hinge on pride and specialness—which soldiers must prove continually—that distinguish them from everyday people and from the people they were upon joining. Soldiers are trained to believe that they are valued members of a special group set apart from the broader society – the guardians and the protectors. This categorization of soldiers requires them to reject civilian values and their own civilian pre-service identities. This distinction between soldiers and their civilian counterparts cements a status of the military over civilian society (Whelan, 2017). To be relegated back to the status of being a ‘mere civvie’ often results in a lingering separation between veterans and their families and communities.
We need to move beyond platitudes and stop telling soldiers they are special if we don’t mean it!
I recently had the opportunity to speak with Dan Drew about the real life of soldiers-warriors and their disconnect with the civilian world. He sent me a story he had written in 2004; reading this intimate experience of facing the end of his career as a solider is nothing short of masterful. With his permission, I have agreed to make it public for the many military personnel and veterans grappling with careers coming to an end. Please cite Dan in any reproduction.
Dan Drew, 6 April, 2004
“UNDER THE TUSCAN SUN”
A Soldier’s Response
Our earth orbits a star we call the sun, which is the center of our universe, once every 365 ¼ days, a period that is known to us as a year. As the earth follows its elliptical path around the sun the axis remains tilted at 24 ½ degrees and so it is that the seasons are created, spring, summer, autumn and winter. These seasons are often used as metaphors when we consider stages of life, spring representing birth and renewal, summer, fecund virility and passion of youth, autumn, harvest and life accomplishment, and finally we think of the long winter as the end of that period that is known to us as a life. The ancients worshiped the sun as the source of all life, the God that banished the cold of winter and the dark of night and replaced those gloomy apparitions and chilling conditions with the enchanted promise of long, warm days when the heat waves danced on endless, fertile fields of gold and green.
As I watched the movie, “Under the Tuscan Sun” the icy hands of the long Alberta winter imperceptibly lifted from my shoulders, and that movie became the center of my universe. I was unexpectedly infused and enthused with a rather confusing emotion, a nearly uncontrollable, exuberant desire to drop everything and move to that same old Tuscan villa and begin life anew. It was as if the movie screen was a window that I could climb through to land in the garden in that far off country. Where, I might sit, feeling the soft caress of the sun’s rays and the gentle fingers of the breeze in my hair and overlook the centuries old olive trees and the stone fence walls, all the while sipping the dusky, earthy life blood of the local vineyards.
Why did this Hollywood movie motivate me to do something as rash as what I was contemplating?
I have been in the Army for 28 years, nearly two thirds of my life, and I am coming to the autumn of my life as a soldier. At 46 I am becoming an old man in a young man’s game, slowly being relegated to the sidelines, a staff officer who deals with peripheral issues so that the young and hardy can be freed up and go forth and do the job and experience the adventures that I have relished and lived for these past years. Perhaps it is the feeling created by the onset of irrelevance, once a warrior and leader, now a bystander betrayed by a body succumbing to the effects of the soldier’s load and that old enemy, time. My mind, still spry, full of yesterday’s glories is able to learn but unwilling to embrace much of the new, corrupt doctrine of the politically adroit, Ottawa careerists. I know the consequences of inertia, yet am reluctant, no, unable to give up the old ways, continuing to march slowly, inexorably to retirement and eternity. I am reminded that time is being shaved away in the same way that the oceans irresistibly erode the beaches, dragging those grains of sand, seconds and minutes, away from the light of the day, to the eternity of the ocean’s depths. Having been at the edge of that precipice on more than one occasion, I have no desire to be dragged into that eternal darkness.
My culture is an exclusionary one. There is only a single way of life, that of the soldier; discipline, fitness and proficiency at arms. It is a tribal culture of men where irreplaceable emotional bonds are the product of pain and shared suffering, joy and celebration, youthful excess and victory. Soldiers belong to a sub culture; really a cloistered segment of society that exists on the periphery of what most people would call a normal life. It is a dichotomous way of life where the necessarily brutal, bloody-minded and ruthless facets of a man’s personality co-exist with profound compassion and respect for the lives of all living beings, particularly those of the weak and defenseless. Who else would, or could, do the terrible close-in work of the infantry with deadly, single-minded determination and then spend their spare time organizing winter clothing for the wretched, hesitant inhabitants with whom they are unable to verbally communicate, in a miserable country shrouded in hatred and fear? And, it is a culture that reluctantly, in the same way that one would put down a favorite dog, releases the sick, and the wounded and the old so that they do not slow down or impede those that carry on to the next battle or the next war. I have put down my share of favorite dogs, old friends and comrades fallen by the wayside, farewell and a quick wave and then fearfully, thankfully, eyes hard squinted, refocus on that road leading to the edges of the empire, marching to the rhythmic, hypnotic, crunch, crunch, crunch of the soldier’s distance-eating cadence. And now I can see that my turn is coming, soldier’s pride and a forged, never-say-die determination keeps me in the ranks but I know that my step is not as true as it once was or will need to be. The leaves of the trees beside my Roman road are beginning to turn, and in the distant hills there is snow.
As the rivulets of dust darkened sweat flow from the corners of those hard squinted eyes of mine, I return to the vision of that steadfast, solid, ancient casa. Stonewalls surround and defend the place while olive trees stand comforting sentinel, providers and protectors. “Drop out of the column, now. No one will miss you, at least not until it is too late. Get off of the road, nip into the field and lay up til dark. Then it’s a quick dash, and you’re home free bucko!” Free to start again, to feel the heart hammering, breath burning desire and the alluring promise of life giving breasts, to spend the summer sipping that dusky, earthy red wine from a lover’s succulent mouth.
Inside there is a young, vigorous woman, supple firm flesh, raven hair, sun kissed cheeks glowing under eyes a mile deep. The kitchen is brightly lit; the ceramic and iron stove warming the body and the soul as only wood heat can. It smells of the bounty of the earth; onions and garlic and tomatoes, baking bread and a faint hint of wood smoke; odors that define comfort and contentment. Outside, the first blades of new green grass are summoned forth from the earth, magical apparitions that signal rebirth and a new season, hope, light. In this place I am young again, and I will close my eyes at night and wake without the fatigue of aching bones and broken sleep night terrors.
Yes, I could trade the frostbite and shivers, the sunburn and sweat, long fearful nights and numbing physical exhaustion that is the soldier’s environment, and the odors of gun oil and diesel, wet leather and canvas, cigarette smoke and black rum, and, boot polish for that Tuscan kitchen. But, in all fairness, these soul testing, character building, body breaking challenges, and their familiar sounds and sensual smells were the narcotic attractants that brought me to the soldier’s world in the first place. And was I not coming to the end of my own long march, I would most likely dismiss Tuscany in favor of adventure that I know is just out of view, and the solid company of old comrades. At another time, this mirage would be a dream to chase another day. And, what if I did slip out of the ranks and make my way to that oasis? Would I be content to watch the trailing tendrils of marching dust settle in the last rays of the setting sun? Or would I bolt for that distant column, where the moon-silver bayonets shimmer, and the soldiers marching
sway, hypnotized by that crunch, crunch, crunch, of their distance-eating cadence, that was my true place?
“Under the Tuscan Sun”, casually dismissed by many as a “chick flick”, was a movie that struck deep into my soul, and the effect was an unexpected sense of elation and euphoria. Examining the roots of this reaction, I discovered that I was responding unconsciously to the reality that is the end of life as I know it, and euphoria suddenly became sadness. Soon, there will be a time when I no longer shoulder the soldier’s load and step off with a century’s worth of men marching in that customary, efficient cadence. The comradeship earned in the warrior’s currency of sweat and blood will fade in the distance with the sound of those familiar footfalls. No more crashing of cannons and gunfire, no more fear in anticipation or mind-blowing relief, no more finely dressed ranks with gleaming medals and razor sharp creases, just an old man and his memories of glories past looking into the setting sun to see if he can see the telltale tendrils of marching dust.
My legs say that I still have a bit of campaigning left in me, more importantly my heart tells me that although the end is near, it isn’t just the right time to be calling it quits. So, I know that over the next hill will be another challenge, and I can look forward to giving it everything I have because there will be no need to save anything for another day. When that day is done, I will be ready to slip out of the ranks and disappear into the field, saving my comrades and me from that awkward scene along our road. It will be hard not to look back, but I will be focused on the kitchen in that villa, a place where I might spend the winter savoring those enchanted, earthy Tuscan delights, and anticipate the arrival of the first blades of new green grass.
"The mental building blocks for an operational mental injury may be set in motion long before critical events ever happen. These ingredients can be rooted in early development and amplified through military conditioning but they are also present among those soldiers who come from stable, nurturing families. Essentially, most soldiers develop adaptations (i.e., emotional suppression, compartmentalization, and a detached persona) to help them succeed in training and to do their jobs. Unfortunately, these same adaptations that served them wonderfully in carrying out their military duties can interfere with the normal processing of routine and unusual events. Furthermore, the same embodied adaptations and the over-investment in military specialness seems to underpin the problem of maladjustment to civilian life. We need to move beyond our clichés if we are to understand post-service maladjustment."
John J. Whelan
John J. Whelan, Ph.D., is the author of Going Crazy in the Green Machine, available now on FriesenPress.