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When strong men feel weak

Understanding when grief and guilt from the war zone go toxic

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The stories are becoming familiar and plentiful.

They are the stories of soldiers watching their buddies' lives taken away and then walking away with sorrow, remorse, and sometimes crippling guilt. 

Just how does a soldier who accidentally kills a child or other innocent bystander in the cross fire deal with that event once back from the war?  How do soldiers who lost best friends in combat return home without feeling guilt?

Grief is never a simple process. Even models as extensive as that developed by Elisabeth Kubler-Ross show grief as a cycle that includes denial, anger, bargaining, depression, and acceptance.  Kubler-Ross acknowledged that not all of these elements are always present in grieving, nor do the elements necessarily follow any set order, leaving for an emotionally complex time for any person suffering a loss.

When trauma accompanies grief, things get even more complicated.

A fact sheet put out by Ilona Pivar, Ph.D., for the Department of Veterans Affairs' National Center for Post-traumatic Stress Disorder, acknowledges the distinct difference between symptoms of grief and symptoms of depression.

"Grief symptoms can include sadness, longing, missing the deceased, non-acceptance of the death, feeling the death was unfair, anger, feeling stunned, dazed, or shocked, emptiness, preoccupation with thoughts and images of the deceased, loss of enjoyment, difficulties in trusting others, social impairments, and guilt concerning the circumstances of the death," Pivar stated.

All of this is not the same thing as depression.

Based on studies following Vietnam veterans in a residential rehabilitation unit for PTSD, unresolved grief can be seen as a distress syndrome distinct from depression and anxiety.

Pivar suggests that in the Iraq War with strengthened unit cohesiveness, trust, and respect heightened after training and long deployments, the loss of a buddy can be a strong predictor of extended grief symptoms. And this can be further emphasized by factors such as survivor guilt, feelings of powerlessness over a failed prevention of the death, and anger at perceived error resulting in the death. Compounded with combat tasks taking precedence over the grief process - as well as an increased sense of vulnerability - experiences of shock, disbelief and self-blame can increase the risk of traumatic and complicated grief reactions, according to Pivar.

"Bereavement is a universal experience," stated Pivar.  Intense emotions and sometimes physical reactions are common; also common in "universal" grieving is a gradual decline in the emotions and symptoms.

Soldiers and those who love them should be concerned when those emotions linger and become acute symptoms of distress, such as agitation, self-accusations, and high-risk behaviors. These symptoms can indicate the presence of acute traumatic grief.

"Some soldiers are inclined to mask their emotions.  Any sign of vulnerability or ‘losing it' can indicate they are not tough enough to handle combat," Pivar said. "Delaying grief may well postpone problems that can become chronic symptoms weeks, months, and years later. The returning soldier who has developed PTSD and/or depression may well be masking his or her grief symptoms."

When grief falls into the acute traumatic grief realm, a professional is generally the best person to seek help from.  This person may be a chaplain or a medical care provider, who can refer the bereaved to more specifically trained professionals.

Soldiers who prefer that medical visits aren't documented can find professional help through However, a growing number of support mechanisms that exist through efforts on Fort Lewis and at Madigan Army Medical Center have made getting help for issues such as grief a more normal process.  While seeking help in the past might have been shrouded in mystery and stigma, the process of obtaining tools to heal from trauma now feel closer to getting help for a persistent cough than the old Freudian couch model.

In this digital age, soldiers can help themselves grieve earlier in the process through different online support groups honoring the fallen. Or they may prefer conversations with others involved in the traumatic loss event as well as sharing with loved ones.

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