In 2009, veterans comprised approx. 25 percent of U.S. deaths that year. Veterans: An Underserved Population, Deborah Grassman, ARNP
Veteran Population in Michigan As of 9/30/2013 Wartime Vets483,963 Peacetime Vets176,810 Female Vets 50,121 Male Vets610,652 WWII 39,574 Korean Conflict 72,421 Viet Nam Era247,859 Gulf War134,004 Total660,773 U.S. Dept. Veteran Affairs NCVAS
Two major potential Psychosocial problems can develop for Vets in a Hospice setting : 1.Difficulty accepting the terminal prognosis, possibly resulting in Clinical Depression. 2.Triggering of invasive and emotionally painful traumatic memories.
Defense Mechanisms protect us from unacceptable information about ourselves and our world. Our reactions can Be intense and the defenses difficult to penetrate, especially when our indoctrination to a specific perception of reality has been intense and our belief complete.
Two Essential Types of Defense Mechanisms: Repression [Unconscious] Suppression [Conscious] Forms of Denial: Reaction Formation RationalizationProjection
Recognize the Power of Military Indoctrination: Tearing down individualism in boot camp. Build up with “Group Mind”. Stoicism is valued: prevents defeat and surrender. Death is the ultimate enemy; live to fight again. Death is a sacrifice made for a greater good. “It is a good day to die!” (Controlled sacrifice) Your body is your best weapon.
An emotional state will cause one’s consciousness to bridge back to other times when a similar emotional state was being experienced. These memories, or fragments of them, will then be pulled in to consciousness and must then be re-integrated back in to one’s core narrative. This is as true in grief as it is in the experiencing of any trauma and is known as the “affective bridge”.
Experiential Elements (how the event sounded, smelled, looked) The meaning assigned to the memory Emotions connected to the memory How a Healthy Memory is Encoded and Stored
Experiential Elements (how the event sounded, smelled, looked) The meaning assigned to the memory Emotions connected to the memory Conscious Mind Trauma Trigger UnconsciousMind Unconscious Mind Mind
Frequent Causes of Depression and Increased Suicide Risk in Vets Facing Death When they prepare themselves for it, it doesn’t come fast enough. (lack of control) Feeling betrayed by their bodies for housing “the enemy”. The inability to re-define the meaning of death (not “surrender”, not weakness, not defeat or failure, not sacrifice for a greater good; just the end of life.) Wanting the unrelenting guilt and pain of unresolved traumatic memory to end. *Please recognize Depression is a form of pain that may be treated. It is not an inevitable by-product of dying.
So how do you help your patient re-integrate their military experiences without ripping apart their defense mechanisms and re-traumatizing them?
How to Assist: Take a Military History: Begin with the straight-forward questions. However, keep in mind that you’ll only glean fully conscious and well-rehearsed material with this method.. Augment the Military History with the opportunity for them to tell you stories that may lie at the edge of conscious memory by using generally themed pictures. This will access memories of importance to the individual in accordance with their readiness to remember specific details of their experiences. It helps to let them choose which images they wish to tell you about. Be careful to select images that are not overly graphic or violent.