Warriors and Healers: Preparing for ReturningVeterans

IRENE RODRIGUEZ MARTIN

Smith College School for Social Work, Northampton, Massachusetts, USA

Despite its ideological differences, social work has had a longhistory of affiliation with the military. In 1918, the Smith CollegeSchool for Social Work was established to respond to the mentalhealth needs of ‘‘shell-shocked veterans.’’ In 2008, the Schoolrenewed this commitment by sponsoring a three-day conferenceaimed at preparing social workers to respond to the new andcomplex needs of veterans returning from the Iraq andAfghanistan wars. A joint planning process effectively developeda program that helped military and civilian social workers gaininsight into the impact of multiple deployments, traumatic braindisorder, post-traumatic stress disorder and other factors present intoday’s new military culture.

KEYWORDS social work, military, shell shocked veterans,civilian social workers in the military, history, new militaryculture, mental health needs of vets

More than 90 years ago, moved by reports of devastation in World War I(WWI), women in a small New England college rolled bandages andurgently prepared care packages for U.S. troops. The college’s sole graduateprogram, a school of social work, adopted as its primary mission the trainingof social work clinicians prepared to ease the minds of what was then called‘‘shell-shocked’’ veterans. Today that school, the Smith College School forSocial Work, continues to train clinical social work interns to work withtraumatized citizens in communities around the country. Although theschool’s mission has expanded over its history to include the after-effects oftrauma occurring not only from war, but also from multiple sources of

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Address correspondence to Irene Rodrı́guez Martin, Smith College School for SocialWork, Lilly Hall, Northampton, MA 01063, USA. E-mail: imartin@smith.edu

Smith College Studies In Social Work, 79:464–470, 2009Copyright # Taylor & Francis Group, LLCISSN: 0037-7317 print / 1553-0426 onlineDOI: 10.1080/00377310903130266

community and family violence, its commitment to working with trauma andveterans has never flagged.

It was not surprising, then, when Carolyn Jacobs, the Smith CollegeSchool for Social Work’s 12th Dean, drew on this historic mission to renewpriorities for the School. In 2004 she challenged the social work faculty tothink creatively about how Smith could take leadership in developing asocial work response to the Iraq and Afghanistan wars. She felt Smith’shistory made it uniquely positioned to educate social workers to respond tothe emotional and psychological conflicts of these latest conflicts.Additionally, she believed that service members brought a singularperspective and dedication to working with veterans, and so for the firsttime in the School’s history, Smith began to actively recruit service membersand veterans as social work students and advisors to its curriculum. In 2005she also established the School’s first scholarship for military personnel toencourage the enrollment of service members. Concurrent to theseinitiatives, Dr. Kathryn Basham, a member of the resident faculty, wasappointed to a congressionally mandated committee sponsored through theInstitute of Medicine, of the National Academies of Science, to participate asthe only clinical social workers on a committee titled Gulf War: Physiologic,Psychological and Psychosocial Effects of Deployment Stress between 2004and 2007. During this time period, the committee published two books onthe effects of deployment and combat stress on the mental health of soldiersand their families. Results were conveyed at a congressional hearing that ledto policy changes affecting the mental health services extended to returningtroops from Iraq and Afghanistan, as well as those Veterans of the Gulf War.In particular, specific ways were recommended to improve clinicalpsychosocial assessments and interventions. During the spring of 2008,Dean Jacobs asked Dr. Kathryn Basham and me to join her in envisioningadditional ways to highlight this reemerging role of responding to the mentalhealth needs of today’s Veterans, especially those returning from OperationIraqi Freedom (OIF) and Operation Enduring Freedom (OEF).

Our first conversations set as our goal the need to increase generalclinical social work knowledge to better assess issues specifically confrontedby Veterans and to provide leading-edge information on effective treatmentmodalities for them. Dr. Basham honed the focus of the discussion based onher work with the congressionally mandated committee sponsored by theInstitute of Medicine noted earlier. Dr. Charles Figley became an early andessential advisor to our planning who was then working as faculty at theFlorida State University Traumatology Institute and more recently as Chair ofDisaster Mental Health at the Tulane College School of Social Work. Dr.Figley brought not only his extraordinary expertise in working with trauma,but also a vast network of colleagues dedicated to the new challenges oftoday’s Veterans. Of particular interest to Dr. Figley was the impact ofrepeated redeployments on today’s soldiers and the impact this had on their

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ability to process and recover from trauma. His orientation toward disastermental health moved us to think in terms of primary and secondary trauma.For the military, the soldier is the primary unit of concern, but traumaextends well beyond the soldier to parents, partners, children, survivors, attimes even communities who are affected. We began to consider otherconstituents at times marginalized in major programming to support themilitary, such as guardsmen, reservists, women, families, and loved oneswho lost a service member to the war.

As the focus expanded to include additional groups influenced by war,it also became more narrowly focused, as the discipline represented wassingularly psychological. As we considered our primary audiences (i.e.,mental health professionals, civilian and military; social work and othermental health educators; allied health professionals such as physicaltherapists, occupational therapists, rehabilitation, disability specialists;deployed and returning soldiers and veterans; policy makers; and thegeneral population affected by the war), we recognized the importance ofensuring diversity among the presenters. Not only did we invite speakerswho represented each of these population groups, we also recognized theneed to represent the voices of clinical social workers while also attending toissues of gender, ethnicity, and race. To include greater representation froma range of constituents, we invited three strategic players to collaborate inour planning: Maj. Gen. (ret.) Marianne Mathewson-Chapman, Ph.D., ARNP,Jonathan Shay, M.D., Ph.D., and Barbara Romberg, Ph.D.

Maj. Gen. Mathewson-Chapman serves as the Veterans HealthAdministration Outreach Liaison to Guard/Reserve and Families and broughtto the planning a career of expertise working in the military. She spokepassionately about the importance of careful training and support of soldiersbefore deployment and the urgency of returning to one’s mission healthyand strong. She offered a particular focus on the deployment cycle and theimpact of battle-mind preparation for deployment, and redeployment. Shealso raised issues of particular concern specific to the OIF/OEF servicemembers such as traumatic brain injury (TBI) and polytrauma. AWashington, D.C. psychologist Dr. Barbara Romberg was inspired by thestories of veterans struggling with psychological issues resulting from thewar, who were unable to secure sufficient mental health services. Shefounded Give an Hour, a national network of civilian clinicians, willing toexpand the military’s capacity to serve service members in treatment bycontributing at least one free hour of treatment each week. Her networkincluded thousands of mental health clinicians across the country whoshared a desire to help, and lack of training specific to working with themilitary. In a related way, her work connected her to multiple groups thatsupport family members who had lost a loved one through war. Finally, Dr.Jonathan Shay joined the group and brought wisdom gained from hisextensive clinical experience, writing, and research with war veterans. He

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also brought a deeply compassionate and empathic orientation based on hisyears of work with veterans through the Department of Veterans Affairs inBoston. His perspectives were not only medical, psychiatric, and psycho-logical, but also political.

Although joined by a shared commitment to support the well-being ofreturning soldiers, the inherent tensions of a broad mandate coupled with anintentionally multidisciplinary planning group were in some ways unavoid-able. These underlying tensions primarily emanated from the different coreidentities of the two central disciplines involved: the military (warriors) andsocial work (healers). Historically, many social workers are politically liberal,peace activists and war protesters. Professional values include acceptanceand inclusion. Clinical social workers acknowledge, explore, and seek tounderstand psychological pain and the effects of trauma to help individualsto move beyond their pain and to resume a fuller way of living. Soldiers areproud of their role as protectors of freedom, while also deeply loyal to Godand country. They are trained to obey authority and trust their leadership.They are willing to deny or repress psychological and physical pain to staystrong and keep others safe. They value being strong and proud, adedication to duty and service to one’s country, the sense of honor thatcomes with fighting a war, and the willingness to deny one’s self for thegreater good. There were beliefs and worldviews grounding each disciplinethat traditionally conflicted.

These tensions became apparent as the group worked to prioritizeissues and select presenters. Our discussions investigated questions such asshould we emphasize presentations about troop support and preparation fordeployment/redeployment or should we focus on content that educatesclinicians for better diagnosis (i.e., accurately diagnosing TBI so that asoldier can receive permanent disability)? If we ask for family members tospeak, do we damage our purpose if someone speaks against the war? If weask for presentations from veterans, should the experiences of Vietnamveterans be included with OIF/OEF veterans; what would we gain, whatwould we lose? What about women’s issues in the military: which issuesshould be addressed, how should they be addressed, and by whom? Shouldthe conference primarily focus on civilians working with service members orthe military working with service members? Even decisions about whatlanguage presenters would use colored our conversations; that is, should weassume attendees have a working knowledge of military protocols orinclude deliberate translations about military culture for civilian attendees? Inaddition to the diverse and occasional conflicting perspectives within thegroup, there were obvious differences in the style and functions of militaryorganizations compared with institutions of higher education.

Negotiating the planning for this conference meant finding commonground between military and civilian cultures and across governmental andeducational domains. It was essential to foreground unifying values and

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background individual disciplinary priorities. All planning committeemembers shared a deep respect for the work of service members and adesire to ensure that they returned to full and healthy lives whether backhome with their families or returning back to active duty. There was also ashared deep compassion for the collateral victims of war: children, spouses,marriages, family, and community. Committee members reached aconsensus that providing support and treatment to family members wasessential, yet requiring an expansion of the supports ultimately available tothe soldier. The resulting program balanced presentations about mentalhealth for optimum functioning in deployment and redeploymentsgrounded in empirical research (e.g., Col. Castro’s lecture ‘‘TheDeployment Cycle: Expectations and Implications’’ featured in this issue)and presentations that gave voice to veterans’ experiences (e.g., ‘‘Living withPostcombat Stress: The Voices of Veterans from OIF and Vietnam’’sponsored by the Amherst Veteran’s Education Project featured in thisissue). In our discussions, the committee members aimed to strike abalanced chord in topics and avoid partisan language or values.

Yet, despite our capacity to find common ground, we worried about ourability to convey this unified position to the community. Would soldierscome to an elite private Northeastern college campus with a reputation forfeminism, lesbianism, and ultraliberalism? Would the local ultraliberalcommunity protest the School’s association with the military around war,regardless of the focus? We braced ourselves for unexpected responses fromeither camp.

In the end, the desire to demonstrate respect and support for returningVeterans proved to be a value that transcended the spectrum of diversepolitical perspectives, conservative, moderate or liberal. Fully one third ofthe registered participants were service members. In fact, more than 100uniformed and khaki-clad men and women on the grounds of this privatecollege campus created a remarkable and unusual sight. Many others werecivilians working in Veterans Administration Medical Center settings.Participants included social work and other mental health clinicians, healthprofessionals, chaplains and pastors, family members, educators, civilians,soldiers, and Veterans. Among those in attendance were two WWII veterans,whose unique messages represented the range of political opinions. OneWWII veteran stood and proudly introduced himself as he posed a questionto presenters. The audience stood in ovation as he introduced himself byrank and brigade; the shared pride and admiration in the auditorium waspalpable. The other WWII Veteran arrived by wheelchair and carried asimple sign: ‘‘No More War.’’ Her presence was equally received with respectand care; participants took turns helping her negotiate hallways andelevators to attend lectures. Her voice was heard and welcomed. These twoindividuals represented distinct spoken voices reflecting different politicalviewpoints.

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Although the lectures over the 3 days were powerful and moving,perhaps one of the most poignant moments occurred during the veterans’presentation. In unrehearsed statements, veterans of OIF/OEF and Vietnamspoke of the internal conflict of the being a proud soldier and the hellishimpact of serving in war, their love of the military and military colleagues,and the pain at the loss of a loved one or at times one’s self. Capt. MariaKimble, L.C.S.W., choked back tears as she discussed what she felt was herweakness in not being present enough for her command when she wasunable to objectively process the death of a young soldier: a son, brother,husband, and soon-to-be father. Her commitment to the military wasapparent, but in that presentation, the burden of being human and stayingstrong seemed almost unbearable. As a military social worker, her struggle tosimultaneously maintain her role as a warrior and a healer erased what hadfelt like a dichotomy in our planning. She spoke passionately about theimportance of being present for the remaining troops, as well as her need forpersonal support in order to continue to be strong and present, and tocontinue to be, in her words, always ‘‘a soldier first.’’

An important bridge was forged not only through the collaboration ofthe planning committee, but also through the conference and theconnections made between the audience members. Social work affirmedits role as a partner in responding to the emotional and psychological impactof war. The military recognized an important role for social work in helpingwarriors resume full and healthy lives.

The conference laid out a path for multiple future and mutuallybeneficial collaborations not only within Smith College, but also within thesocial work profession. Recently, the Council on Social Work Educationconvened a committee of deans and directors of schools for social work todiscuss curricular development in support of training for work with veterans.For its part, the Smith College School for Social Work has instituted ongoingtraining through its continuing education program to provide resources tomilitary and civilians working with soldiers and their families. We have alsodesigned innovated curricula in course work and a field-based telephonicseminar for all MSW students placed at the Walter Reed Army Medical Centerand Veteran Administration Medical Center settings. Dr. Marsha Pruett, of theSmith College School for Social Work faculty, has partnered with SesameStreet Workshop to evaluate a film pilot to help children understand andprepare for parents returning from war with physical or emotionalimpairments. Dr. Kathryn Basham has been invited to participate with acongressionally mandated committee, sponsored by the Institute ofMedicine, that is charged with exploring the expected educationalcredentials and experiences required for clinicians to assess and treatreturning service members and their families. She, along with Dean Jacobs,are also designing an Institute for Clinical Social Work with service membersand their families that involves research, education, and consultation to a

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range of military organizations, colleges and universities, and communityagencies.

In an ideal world without war, we would not need to prepare graduatesto work with returning Veterans. Until then, we will continue, as a School, tosustain our enduring commitment to educate M.S.W and Ph.D. interns andlicensed mental health professionals to engage with service members andtheir families in exemplary clinical social work practice and research.

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