A Look Inside A Combat Veteran’s Transition To Civilian Life

A Look Inside A Combat Veteran’s Transition To Civilian Life

Veterans are not getting the health care—including the mental health care—they need to thrive and survive after their service.
Jonathan McConnell
By

Two weeks after returning from Iraq in 2009, I was sitting in school, opting to use the GI Bill to earn my law degree. There I sat, alongside 23-year-olds who spent the last four years partying, sometimes studying, and going to football games. I spent the last four years of my life as a Marine Infantry officer.

At the end of the first week, one of the professors asked how my first week of law school was. “I like Iraq better, I told her. “There, I got to shoot people I didn’t like…”  Of course, I was kidding—mostly.

Too many veterans face the same situation. They come home from fighting a war that has been all but forgotten. Twenty-two-year-old veterans return stateside from war with the life experience of a 42-year-old. Then they go to college and sit next to an 18-year-old drama queen they can’t relate to. They haven’t seen the last X number of seasons of whatever is popular on TV. They are probably wearing the same clothes they wore in high school, and could relate better with an 80-year-old Korean War veteran than that college freshman.

But this only scratches the surface of veteran struggles after they are thrust from the battlefield back into the home front. What is often unknown, or unrecognized, is the physiological effect of running at 110 percent for months at a time.

Dealing With Overproduction Of Cortisol

In a combat zone, your body is constantly in fight or flight mode. Combat veterans will go days without sleeping. Days without having a bowel movement. Days without relaxing or sleeping deeply. All of this is because the body must divert all its energy into surviving—into being able to run, or fight.

One result of all that physical and psychological stress is the overproduction of cortisol, a hormone the body produces when under duress. According to the Mayo Clinic, cortisol

“increases sugars (glucose) in the bloodstream, enhances your brain’s use of glucose and increases the availability of substances that repair tissues. Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with regions of your brain that control mood, motivation and fear.”

Cortisol is a natural and necessary response to life-or-death situations. But when it remains present in the body for too long, it can cause adverse outcomes such as anxiety, depression, weight gain, sleep problems, and memory and concentration impairment.

How Veterans Struggle After Returning Home

When vets get off the front lines or stop patrolling, they “go to the rear,” where an amazing set of anatomical changes begin to happen. Upon entering friendly lines, the body immediately starts to relax, bowel movements come on with a vengeance, appetites return, and sleep is deep—almost comatose.

The first few months I was back in the US, my body was in a state of extreme relaxation. Serotonin—a neurotransmitter that can contribute to feelings of wellbeing and happiness—was coursing through my veins. I slept deeply, but still only required 3 to 4 hours of sleep each night. I couldn’t get off the porcelain throne, going a dozen or more times a day.

But the excess cortisol that had been flooding my body for the previous months had killed my short-term memory. It wasn’t uncommon for me to be unable to tell you what I had done the day before, or where I had been just hours ago. One of the questions I dreaded the most was “What did you do today?” or “What did you do last weekend?”

My inability to concentrate had ramifications in some unexpected areas of my life. My habit of a daily quiet time became next to impossible. In order to get quality time with God, I literally began to put away all electronics, and copy the Bible. Starting with Psalms made life better than trying to get through the historical books of the Old Testament.

Compounded by new technologies like social media and texting, getting through law school wasn’t going to be easy. To cope, I embraced some tactics from my Marine Corps days and re-learned the art of checklists. Deleting social media helped, as well.

Struggling With Hyper-vigilance And Crowded Rooms

Despite my struggles concentrating, and as strange as it sounds, law school was underwhelming. Hell, life was underwhelming. I never felt stressed. Nothing could compare to the previous two deployments. It wasn’t until years later when I went skydiving that I finally felt excited again.

But that doesn’t mean my mind and body became ambivalent to my surroundings or situation. The amazing thing was that I never lost my hyper-vigilance. I could walk into a room and tell you who was the most threatening. I couldn’t sit with my back to a doorway and I couldn’t maintain a conversation in a restaurant. It still takes extreme concentration to pay attention to a conversation when where there are many people around: there are too many triggers that can cause my mind to race through scenario after scenario.

Even today, eight years after my last deployment, I don’t listen to the radio or watch TV. I rarely go see a movie.

Dealing With Tinnitus And Insomnia

Perhaps one of the loneliest experiences I have personally had is in dealing with Tinnitus. Another all-too-common byproduct of military life, and today’s number one disability for veterans, tinnitus creates a perception of sound when none is actually present. A ringing in the ears on steroids. When it gets loud, sufferers know no one else can hear it, and it only adds to their own anxiety.

For me, it is like it’s pushing the pissed-off button and then having a gremlin jump up and down on it. Click-click-boom. The inability to find this quiet may contribute to so many veterans’ desire to isolate themselves once they return home.

And let’s not forget the power of insomnia. When I returned home, I hated sleep, but more than that, I hated that my body was so weak that it required sleep. I slept three to four hours a night. Usually one night a week, I would stay up all night just to prove I still could. Even then, I went years before having dreams, because the increased cortisol in my bloodstream denied my ability to dream. Of all the side effects of cortisol, I would likely say the inability to dream is the best. Remembering things that are better left forgotten is the worst in dreams—particularly of atrocities like war.

Those Four Letters—PTSD

Probably the most known—and least understood—condition afflicting many veterans is Posttraumatic Stress Disorder, or PTSD.

Like the release of cortisol, PTSD is our bodies’ natural response to being under episodes or sustained periods of danger. Hypervigilance, overreaction to stimuli, flashbacks, and the inability to sleep for long periods of time are exactly what you want when on the battlefield. They protect us, keep us alive, sustain us when being pushed to our limits.

But when these same symptoms hit off the battlefield, things get dicier.

Maybe one of the least known facts about PTSD, at least by civilians, is that it is highly treatable. But too often, returning service men and women don’t know where they can find help.

Veterans With PTSD Don’t Get The Support They Need

According to the RAND Corporation, Only 34 percent of patients newly diagnosed with PTSD received minimally appropriate care in the eight weeks following their diagnosis. Success rates are high for those who get the help they need.

According to Terri Tenielian, a senior behavioral scientist at RAND, “At present, too few of the veterans who experience the invisible wounds of war get the help they need and even fewer get the right care. Closing these gaps will require raising awareness about the problems and barriers to care, and changing the way the mental health care system is organized and delivers services.”

Today there are more treatment options available to sufferers of PTSD than ever before, extending from cognitive behavioral therapy to service and emotional support dogs. But addressing the problem is the first step on the road to recovery.

Processing Grief And Survivor’s Guilt

When veterans return home, they are often not only surrounded with people who can’t or won’t relate to their experiences—they are constantly bombarded by an overwhelming sense of survivor’s guilt.

To put it bluntly, we hate the fact that we came home and our brothers didn’t—or if we decided to leave active service, as I did, that our brothers and sisters still deploy.

For quite a while after my final deployment, I refused to do things that were frivolously fun or enjoyable. A product of the south, college football had been one of my favorite pastimes. But survivor’s guilt kept me from watching a game for years. The things I used to love seemed grey, and sparks of fun and interest were kept at an arm’s length. I was effectively hazing myself for getting out of the Marines. For two years, I slept on my office floor because I knew my friends didn’t have it any better overseas.

It’s Difficult To Empathize With Civilians

But while I was working hard to empathize with those still in the service, I developed a distinct lack of empathy for civilians. A friend’s family member would die and I would have a difficult time feeling their pain. I began to view pain and emotion as a weakness, something to flee from at the first sign of their presence.

This unwillingness or inability to empathize, or appropriately process emotions, may explain the twisted sense of humor servicemen, particularly Marines, tend to have.

All these defenses are ways servicemen and women work to cope after being thrust back into a world where they can’t trust their co-worker with their life, where their blood and bravado jokes are scorned, not celebrated. It is not uncommon for people who endured trying, dangerous times with another group of people to miss the camaraderie and support found only with other people who have been through the same experience.

As Sabastian Junger wrote for The Atlantic, as a communal species, this reaction of missing those times of trial is completely natural, if not understood by most civilians.

“What all these people seem to miss isn’t danger or loss, per se, but the closeness and cooperation that danger and loss often engender. Humans evolved to survive in extremely harsh environments, and our capacity for cooperation and sharing clearly helped us do that. Structurally, a band of hunter-gatherers and a platoon in combat are almost exactly the same: in each case, the group numbers between 30 and 50 individuals, they sleep in a common area, they conduct patrols, they are completely reliant on one another for support, comfort, and defense, and they share a group identity that most would risk their lives for. Personal interest is subsumed into group interest because personal survival is not possible without group survival. From an evolutionary perspective, it’s not at all surprising that many soldiers respond to combat in positive ways and miss it when it’s gone.”

Suicide: Is It The Inevitable End?

Eighteen marines from my battalion were Killed In Action in Iraq.  Suicide has prematurely claimed almost half that number since returning home. When that number reaches equilibrium, do we consider it a tragedy? At what point do we stand on street corners screaming, march on Washington, or make a concerted effort to fix our VA Health care system? It is estimated that 22 veterans a day commit suicide. Once again, 22 veterans a day kill themselves.

When there is evidence of wrongdoing at the VA, our congressional delegations yell and scream like petulant children. They make speeches and send out press releases. But words do little to address the problem head-on, and what good is a press release if all it really does is buy time for politicians?

Veterans are often used as a token during campaign season, quickly forgotten as soon as the ballots have been cast and reelection has been secured. It’s about more than accountability—it has to be about action. Waiting until the next time it becomes politically convenient to roll out the love for veterans will be too late for hundreds of my brothers and sisters.

What Policy Prescriptions Could Help?

I don’t think there’s a person in this country familiar with these issues who would say our veterans are getting the healthcare—including the mental healthcare—they need to thrive and survive.

A good first step is expanding and strengthening the Choice system, which allows veterans who live more than 40 miles away from a VA facility or can’t get an appointment within 30 days to see doctors outside the VA system. Opening Choice up to all veterans by instituting a voucher system would not only drastically increase the number of doctors we are able to see, it would also introduce an element of competition into what has been a poorly-run government monopoly.

A survey by Concerned Veterans for America found that 90 percent of veterans favor reforming veterans’ health care, and that 89 percent believe it is “very important” that these reforms include “increasing health care choices for veterans.” Eighty-six percent believe that eligible veterans should be able to choose a private physician, and 77 percent believe veterans should be given this choice, even if it costs them a little more out of pocket. “Bottom line,” the survey concludes, “veterans want choices.”

Members of Congress have historically scrambled to show everyone how pro-veteran they are. But then they paradoxically drag their feet in actually voting on substantive changes. Speeches and press releases didn’t help the veterans who died while on illegal waiting lists, and it won’t help those still needing care now.

Should we regret joining the military or serving our country? Absolutely not. The bond formed while serving remains one of the highlights of my life. Seeing such things performed by men greater than me remains one of the highest honors I have ever experienced. The tinnitus, PTSD, insomnia, anger, and general pissed-off-ness don’t disappear. But they do get better. A whole lot better.

We Can Get Better—But It Takes Help

But the only way we get better is by talking about our issues, both with each other and with the men and women in power in our nation. Though some find them intimidating because of the absence of veterans from one’s unit or age group, Veteran Service Organizations (VSO) like the Marine Corps League or the Veterans of Foreign War can help. Maybe support comes in the form of a get-together with other war veterans from your town. It can be as informal as watching a football game together, or as formal as a Gulf War Veterans Association meeting.

In the end, what’s important is talking about it. Talk about it with your fellow veterans, with the men and women you served with, with your friends, with your family, with medical professionals, with politicians. The answer isn’t silence, or hunkering down and bearing it by yourself.

To the families and friends of veterans, my advice is to shut up and listen. Importantly, don’t ask questions you can’t accept an answer to. If you ask what the worst experience a veteran had was (which is not a question I advise asking), don’t gasp and look at us like we just kicked a puppy.  It’s war. It’s Hell. It happens. Don’t damn us to live it in perpetuity.

Jonathan McConnell is President of Meridian.us, a private security firm that primarily defends merchant ships off the coast of Somalia. He's a graduate of Auburn University, with a law degree from the University of Alabama. He served in the Marines as an Infantry Officer, and was deployed to Iraq in July 2006, and to the Syrian border in October 2007. He's been awarded the Navy and Marine Corps Achievement Medal with Combat “V” and the Combat Action Ribbon, as well as the Navy and Marine Corps Commendation Medal.
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