Operational Stress Injuries and Post-Traumatic Stress Disorder (PTSD) are among the possible consequences facing members of the Canadian military. Unlike the potential physical consequences of dangerous deployments, psychological injuries are not always apparent. Military members are taught a mental skillset to help them manage their internal emotional worlds allowing them to do extraordinary things. Unfortunately, while ingrained military training prepares our men and women for action as capable soldiers, this same training may also require them to trade aspects of their humanness—sowing the seeds for lingering mental distress. As a result, those most affected are left in a limbo, disconnected from their military roles and yet unable to relate to their former civilian lives. They become ghosts of their former selves, haunting the ranks until, more often than not, they find themselves on the outside looking in, with unacknowledged scars, anger, and regret. We ask a great deal of our men and women in uniform; if a shift in culture can help members of our military with mental distress, we owe it to them to make that shift possible.
I have worked in the area of addiction as a clinician and researcher for the past 30 years and I am still amazed at how it continues to be portrayed as somehow separate from other ‘legitimate’ mental health diagnoses like depression or PTSD. When it comes to alcohol in particular, even though it is the most widely used drug in Canada it is also linked with violence, suicide, and accidental death. So, it enters a sort of legal-medical category which is generally not the case for issues like depression, anxiety, or PTSD. This despite numerous studies showing high levels of overlap between substance misuse and most other mental health issues. We are not sure where to position addiction – as a behavioural problem stemming from flawed character or as a self-management strategy to cope with other mental health struggles.
Most commentators will agree publicly that addiction is a kind of self-medication (people use various substances to manage emotional control) but when it comes to traditional treatments the reality is quite different. Within nearly all organizations, there are two competing views – addiction is seen as a sort of disease on the one hand but on the other it is also viewed as a performance or discipline problem similar to a self-inflicted wound – the person brought it on themselves. Again, this is decidedly not how we view depression or PTSD which are considered to be legitimate operational injuries affecting members. Instead, these patients are seen as victims of specific external events.
When it comes to offering help, clinicians will state that they treat addiction and other co-occurring mental health problems at the same time under a unified approach. However, the fact is that most institutions seem to treat issues sequentially – do this first and do that next. Often, this requires people to stop drinking, have a period of abstinence, and then deal with other issues. A common view in addiction treatment is that in order to get, well patients have to become honest, face their denials, and stop their rationalizations and manipulations – they are viewed skeptically. If these same patients are also diagnosed officially as experiencing workplace or operational mental injuries, however, they are usually seen as victim sufferers. Efforts are made to support them and to treat them carefully and incrementally to help them resolve their problems. How can an employee make sense out of these polar opposite reactions to their problems?
We know that problems with emotional management and trauma of all types drive nearly all mental health issues, including addiction. Instead of compartmentalizing problems, we really need to develop coherent interventions for all mental health issues as shared problems of social disconnection and emotional dysregulation. We need to answer the fundamental question of ‘why’ when it comes to helping people come to terms with their over-reliance on substances and medications.
Do events cause operational stress injuries, including chronic depression and PTSD or something else, hidden from view? This is a central focus of ongoing research into military mental health. Be strong, follow orders, show no fear, banish one’s private thoughts and reactions and use anger to succeed. Military men and women are trained to manage adrenaline and their private reactions, through an essential skillset – compartmentalization, depersonalization, and even dissociation – to help them face routine and exceptional circumstances without a second thought. But what if this very skillset - an essential requirement – is the very thing that keeps people caged up emotionally without acceptable outlets. The premium placed on pride and specialness usually over-rides humility or the truth of vulnerability and there is not much room, either for things like compassion, empathy, tenderness, or kindness without fears of being weak. When personal ego is no longer fed by others or by the rewards of heroic acts, the result is often a crushing sense of emptiness - useless, without purpose, and an indifference to life.
‘Ghost in the Ranks: Forgotten Voices and Military Mental Health’ (Upcoming Release) addresses these issues head-on through the stories of serving and retired members of the military.
“… an open and straightforward message to the men and women who serve and Canadian society about the lingering effects of an acquired military identity on mental health struggles... [he] has captured the very fabric of the men and women who serve. A must read!” — Michael Hobson, Veteran and R2MR Mental Health Educator
John J. Whelan
John J. Whelan, Ph.D., is the author of Going Crazy in the Green Machine, available now on FriesenPress.