War and the Military Family: An Intergenerational Perspective

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War and the Military FamilyAn Intergenerational
Perspective

• Barbara Leiner, LCSW-C
• Walter Reed Army Medical Center
• Child and Adolescent Psychiatry Service

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Disclaimer

• This presentation expresses the private views of
  the presenter and do not reflect the official
  policy or position of the Walter Reed Army
  Medical Center, The Department of the Army, The
  Department of Defense or the U.S. government.

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Outline of Presentation

• Stages of Deployment
• Intergenerational theory A Historical
  Perspective
• The Holocaust
• The Vietnam War
• The Gulf War
• Trauma and relationships
• Mechanisms of transmission
• Treatment
• Walter Reed Army Medical Center

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Stages of Deployment

• Pre-deployment (varies)
• Deployment (staging, 1st month)
• Sustainment (duration of mission)
• Re-deployment (last month)
• Postdeployment (3-6 months after deployment)
• (Pincus, et.al)

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Background Information

• PTSD 18.5 of returning SM
• TBI 19.5 of returning SM
• PTSD or Major Depression 300,000
• TBI 320,000
• The figures are based on a survey of 1,965
  returning members of the military conducted from
  August 2007 through January 2008.
• (APA Psychiatric News)

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Intergenerational transmission, or secondary
traumatization

• Children of trauma survivors directly or
  indirectly affected by their parents post
  traumatic sequelae (Rosenheck, Nathan 1985)
• Children who did not experience the actual event
  who come to experience an emotional
  disequilibrium similar to that of the traumatized
  parent (Harkness 1991)

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Intergenerational Theory A Historic Perspective

• Studies on Holocaust survivor families
• Began in the 1960s, in considering the
  psychological effects of the Holocaust on
  children
• children of Holocaust survivors seemed to
  struggle silently with war derived messages
  from their parents
• (Yehuda, et.al 1996)

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The Holocaust

• Researchers questioned the methodology of early
  studies
• Studies of survivors showed exceptional coping
  and resilience, good social and family
  functioning and high socioeconomic achievement
• Similar negative response to literature on
  offspring
• (Yehuda, et.al. 1998)

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Intergenerational Theory A Historic Perspective

• Studies on Families of Vietnam Veterans
• The National Vietnam Veterans' Readjustment Study
  (NVVRS) was conducted in response to a
  congressional mandate in 1983 for an
  investigation of PTSD and other postwar
  psychological problems among Vietnam veterans
• (Kulka et al., 1990a, Kulka et al., 1990b).
• (Price, National Center for PTSD Fact Sheet)

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The Vietnam War

• Findings from the NVVRS
• Majority of Vietnam Veterans readjusted
  successfully to postwar life
• However, substantial minority of Vietnam theater
  veterans suffered a variety of psychological
  problems and life-adjustment problems (e.g.,
  marital problems, work difficulties).
• Only a small number of these veterans actually
  sought treatment from mental health providers.
• (Price, National Center for PTSD Fact Sheet)

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The Vietnam War

• Avoidance and emotional numbing exerted a
  significantly detrimental effect on the
  parent-child relationship (Samper et.al, 2004)
• Children of Vietnam Veterans who participated in
  abusive violence (atrocities) showed more
  behavioral disturbances than children of other
  Vietnam Veterans (Rosenheck, Fontana, 1998)

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The Gulf War 1990 - 1991

• Expected to be brief, sanctioned by public
  opinion
• initially viewed as analogous to peacetime
  deployments, a normative stressor, unlikely to
  cause large scale stress reactions for troops and
  families.
• Found instead to be catastrophic stressor,
  bringing anxieties beyond peacetime deployments
  due to anticipation of physical and
  psychological trauma
• (Piebles-Kleiger, Kleiger, 1994)

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The Gulf War

• Moderate increase in emotional and behavioral
  symptoms of deployed service members children
• Parental reports more than half children ages 3
  - 12 experiencing increased sadness, anxiety
  depression, and discipline problems during
  deployment
• Boys and young children at higher risk for
  complications
• Increase in symptoms rarely required treatment,
  those who did had prior histories
• (Cozza,Chun,Polo 2005)

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Intergenerational Studies Conclusions. ?

• The good news of intergenerational studies is
  that in most cases, the horrors of the parents
  experiences are not visited upon the children, at
  least, as long as there is not further exposure
  to trauma (Rosenheck, Fontana 1998)
• Despite a plethora of descriptive information,
  intergenerational transmission of trauma is a
  poorly defined empirical construct, and one that
  is not well understood within the professional
  community (Ancharoff, Munroe, Fisher 1998).

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Trauma and Relationships

• Numbing, social withdrawl, irritability, and
  episodic outbursts of rage impact interpersonal
  relationships
• Veterans with PTSD are more likely to report
  overall marital and family adjustment problems
  than veterans without PTSD.
• (Ancharoff, Munroe, Fisher 1998)

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Trauma and Relationships

• Traumatic events impact along a continuum of
  emotional functioning traumatic related
  messages and beliefs can be communicated by a
  parent who does not have PTSD
• Trauma related communications from parent to
  child can result in overt, or subtle disruptions
  in psychosocial functioning and adjustment.
• (Danieli, Ancharoff et.al 1998)

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Trauma and Relationships

• How are trauma related messages being
  communicated to the child?
• Overtly, covertly
• How is the family conceptualizing the parents
  experience
• Family problem
• Identification of parent as damaged
• What are the social, cultural, socioeconomic
  issues, strengths and sources of support?
• (Anacharoff, et.al, 1998)

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Trauma and Relationships

• Cannot predict or specifically measure the impact
  of parental trauma on a child.
• A thorough evaluation is needed to assess childs
  affect, behavior, and overall functioning in the
  home, the community, and in school.

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Mechanisms of Transmission

• Overdisclosure
• Identification
• Reenactment
• Silence
• Partial Disclosure
• (Ancharoff et.al 1998)

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Treatment

• Informative
• Psychoeducational material on PTSD as well as
  effect on loved ones
• Interactive
• Active therapeutic involvement to identify and
  decipher complex messages,
• So as to assess for current relevance
• To distinguish between reactions to the past and
  responses to the present
• And to assist family members with worldview that
  allows for more flexible range of responses.
• (Ancharoff, et.al 1998)

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Walter Reed Army Medical Center Caring for
Generations of Warriors

• Child and Adolescent Psychiatry Service
• Psychiatric Consultation Liaison Service
• Operation BRAVE Families

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• To Soldiers, Sailors and Airmen
• who bear the hopes
• and the burdens
• of freedom
• And to the generations that follow