Invisible wounds of war are injuries that veterans receive that can’t be seen on the outside. They affect their mental health, their caregivers and their families.
Dr. Heidi Kraft, clinical director at San Diego-based PsychArmor Institute and a Navy veteran, addressed these issues in a special webinar about invisible wounds of war that impact veterans as they age and how their caregivers can cope with the effects.
The medical community is starting to shift and call these wounds injuries instead of reactions or disorders because they are a direct result of service in the military. Like any injury, these wounds can be treated.
A cultural phenomenon of the military community is veterans and their families will not ask for help. For them, it is a stigma in asking for help because they are the helpers. There have been many movements within the military community to reduce the stigma of mental health needs and that going for treatment is acceptable.
One common thread for all these injuries is depression. Depression is not a normal sign of aging.
Depression can be an injury that occurs because veterans live through incredibly stressful times. It is quite a common result of the external things that happen to veterans. It does not discriminate among genders, socio-economic status or rank.
Aging veterans should not be depressed because they are growing older. It is not normal and if it’s causing impairment in a veterans’ life, it should be talked about with a doctor.
Two major signs of depression include a depressed mood and loss of pleasure—the things that used to be fun aren’t and things that used to matter don’t. Other symptoms include low energy/lack of motivation, weight and/or sleep changes, guilt or difficulty concentrating.
Depression symptoms can vary between men and women when it comes to emotions. Men tend to anger and have emotional outbursts while women tend to cry easily.
These symptoms can challenge caregivers who continue to offer solutions and motivate the veteran.
Any and all of these symptoms should be discussed with the veteran’s doctor.
Depressed people can have thoughts of suicide, which requires immediate medical intervention. Do not be afraid to ask if a veteran is considering suicide, it is a vital question that can save a life.
Post-Traumatic Stress Disorder (PTSD)
PTSD is unique because it must be caused by trauma. Traumatic experiences can be cumulative, including events that happened as children which can build on the trauma of war.
Trauma can distort memories and change belief systems that cause symptoms which may include re-experiencing that traumatic event, avoiding activities, changes in reactivity to situations, mood or thinking, nightmares or sleep disturbances.
One huge impact on caregivers is sleep disturbances, which can include vivid nightmares with physical altercations. This can cause anxiety for the family members as they go through the experience of their loved ones reliving the trauma through their dreams. The caregiver might need to protect themselves to get the sleep they need to support and care for their veteran.
Caregivers also cope with the veteran’s anxiety, agitation, jumpiness and quick anger. They also deal with memory difficulties, avoidance of reminders and triggers which impacts the whole family as activities are curbed or altered.
Caregivers need to constantly remind themselves that this isn’t their veteran. Their veteran isn’t necessarily yelling at them, they are struggling with the symptoms of the disorder.
PTSD can also look like depression and anxiety. PTSD and depression can co-exist.
As veterans age, the symptoms of PTSD continue to build and embed themselves in the person’s daily life. The longer it goes on, distorts memory and changes daily life, the more it entrenches into the veteran’s life.
Traumatic Brain Injury (TBI)
Traumatic brain injury is the signature wound of the Afghanistan and Iraq wars due to the use of improvised explosive devices (IEDs), or buried bombs. Soldiers who encounter IEDs experience mild TBIs in the form of concussions or damage to the brain. Injury can be caused by falling or something hitting the head, being knocked off their feet, penetration by shrapnel or bullet, or a wave injury. A wave injury is caused by proximity to a blast that causes impact waves to move through the brain, causing it to move inside the skull.
TBI symptoms can vary and may include fatigue, headache, depression, anxiety, tinnitus, sleep issues, dizziness or balance issues, loss of concentration and attention. Isolation is also a sign of TBI because they might not be able to communicate how they want. After all, the injured brain isn’t working correctly. Isolation leads to depression.
Soldiers can have more than one TBI if they are close to more than one blast. This can have a cumulative effect that causes significant problems. Long-term effects depend on how the brain is damaged and where the injury occurs.
Caregivers deal with sleep disturbances, mood changes, confusion/disorientation, and personality changes of the veteran as the TBI heals. Caregivers can also experience upset or confusion at the personality changes the TBI brings out and struggle with coping with the changes.
Substance abuse is a quite common escape mechanism for veterans. It is culturally and socially acceptable in the military community to use substances to avoid seeking help to numb their feelings and find short-term relief.
Symptoms include withdrawal, increased tolerance, using more than intended, wanting to quit, getting into dangerous situations, or not participating in activities that mattered.
Substance abuse does not just include alcohol and illegal drugs, it can be prescription drugs, especially opioids. Opioids are highly addictive painkillers and impact veterans of all ages who are prescribed the medication to control pain from an injury or surgery.
If caregivers are worried about opioid overdose, they can discuss naloxone in the home to counteract an overdose with their veterans’ doctor.
In addition to all these worries, caregivers are impacted by substance abuse because the veteran can have feelings of anxiety or agitation, they can lie to cover up use, choose their substance over family or have personality changes.
How to Help
The best thing a caregiver can do is break the silence. Talk to the veteran about symptoms you are seeing. Accept them and do not judge. Let the veteran know it’s OK not to be OK and be willing to go on the journey to get help with them.
Knowing a little bit about military culture and the questions to ask is key to getting through to the service person. The first question to ask is which branch of service the veteran served in, which shows an understanding that each branch is different. This starts a conversation, which is usually the hardest part and develops trust.
There are evidence-based treatments and therapies for all four of these mental health issues that work, and some are without medications.
Learn what resources are available and education is key. If any of these signs and symptoms apply to your loved one, talk to their doctor.
If you suspect a veteran is in crisis, the Veteran’s Crisis Line is 800-273-8255, press 1, text 838255 or click here. It is confidential, staffed 24/7 and available for all veterans, service members, National Guard and Reserve and family members and friends.
About the Speaker
Dr. Kraft received her Ph.D. in clinical psychology from the UC San Diego/SDSU Joint Doctoral Program in Clinical Psychology in 1996. She joined the Navy during her internship at Duke University Medical Center and went on to serve as both a flight and clinical psychologist. Dr. Kraft left active duty in 2005, after nine years in the Navy.
She currently serves as Chief Clinical Officer at PsychArmor Institute, a national non-profit that provides free online education for those who live with, care for, and work with military Veterans. She is frequently invited to speak at conferences and panels on combat stress, stigma and caring for the caregiver.
Dr. Kraft is a lecturer at San Diego State University, where she teaches stress, trauma and the psychological experience of combat, as well as Health Psychology, Abnormal Psychology, and Infant and Child Development. She is also an author.
This program was co-sponsored by Artis Senior Living of Eatontown and Veteran Care Services.
Watch the full webinar below.