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Moderator: Welcome to the seminar titled "Long Term Deployments: Airmen Under Stress, Families in Crisis."

Our speaker this afternoon is Professor John Moore, Chief Counseling Officer and Licensed Psychotherapist for the Second Story Counseling in Chicago. He is also a Professor of Psychology and Health Sciences at American Military University. A more detailed biography is in your program.

Ladies and gentlemen, Professor John Moore.

[Applause].

Dr. Moore: Thank you. It’s certainly an honor to be here with all of you today. I tried to introduce myself. If I missed people, I apologize for that.

Just a little bit about me, aside from being the shortest person in the room. [Laughter]. You know, when people hear psychotherapist, particularly at least in my experience sometimes with the military, I become as popular as a porcupine in a balloon factory. I prefer counselor. It’s less loaded. [Laughter].

Has anyone here been to Chicago? Is anybody here from Chicago? [Applause]. I always tell people this. There are really two parts of Chicago. There’s a north side and a south side. I was in San Diego a couple of years ago and I had a Cubs shirt on. A guy from the south side said hey, are you from the north side? I said yeah. He never talked to me again. That was it.

One of the things that I want to do before we begin this is just sort of ask some questions. What are you hoping to get out of this workshop? What are some things you’d like addressed? Whatever that might be, we’ll try to answer that. Are there any particular topics or issues that you would like to be discussed or explored?

Question/Comment: [Inaudible] on the ground versus the 12 months that the Army is doing, which direction [inaudible].

Question/Comment: I work with military families, I just want to know how to help the family best while they’re in place while the military member is deployed.

Question/Comment: I’m trying to help some of the younger Airmen that just got married and deploy and are having issues when they come back. [Inaudible].

Dr. Moore: Any other questions?

Question/Comment: [Inaudible], expectations.

Question/Comment: It was kind of along the same lines as [inaudible] comparing the shorter duration versus the longer duration of the Air Force/Army, and assimilation. The Air Force doesn’t have a lot of assimilation back time where the Army I think has [inaudible] program [inaudible]. If you see things different from one versus the other.

Question/Comment: As a spouse I think a lot of the programs are geared towards [inaudible]. I have [inaudible].

Dr. Moore: So for teens, older teens and so forth.

A couple of things here, and you’ll hear me refer to it as AMU for American Military University. It’s an on-line university. We have about 80,000 students worldwide, most of them are deployed. They want to work on their degree programs at the same time while working. You can find out about AMU on the internet at APUS.edu.

Here’s one common link that goes on with all kinds of deployments, and it can be short or long. That is there comes a point in time where chaos happens because a loved one is deployed, a family member or family members are left behind. Sometimes people are hurting. It causes chaos for financial reasons, emotional reasons, dare I say questions about fidelity that could come up, but there’s good news in that because chaos is the point in time when change is most likely. The reason for that is we don’t want to be in chaos any more. So my hope here is to try and talk a little bit about having a plan both before the deployment and then afterwards, that reintegration. So the front end and the back end of that.

There can be successful deployments, both short and long term. There is a difference between Army and Air Force, and I understand that, and I definitely want to try and address some of that.

We’re going to identify the key stressors for Airmen and affected love ones, recognize how deployment impacts relationships with spouses and significant others, examine the impact on children in the family, explore healthy ways of coping with stress, identify the signs of PTSD, and determine a path to recovery about that.

That’s just a little bit towards what we’re talking about here.

That’s the deployment wheel of stress. I created that to kind of just talk a little bit about what folks go through.

The first part of that is to talk a little bit about, I think, in terms of the person left behind. We’re going to look at the person deployed, but just the person left behind. They’re worried about the person that’s left. Routines are disrupted with family and children. There are new family rules that are adopted – suddenly mom becomes dad, or vice versa. That happens. Then also extra responsibilities. Dad used to take out the trash and wash the car. Well, not any more. Or mom used to do the grocery shopping or what have you. Not any more. Just looking at that deployment wheel of stress you’ve got one person now, one of a spouse or significant other that is now acting in the role of both parents.

Just looking at that kind of wheel, are there other responsibilities, financial, that you can think of? What else do you think goes on with the spouse that’s left behind?

Question/Comment: [Inaudible].

Dr. Moore: So that presence is no longer there. Just knowing the person is with you.

Question/Comment: Loneliness.

Question/Comment: Financial [inaudible]. [Inaudible] in charge of [inaudible].

Dr. Moore: And sometimes there’s a change in income. Well not sometimes, there is a change in income, right? That happens. So now a paycheck really has to go far, where before it was being stretched, now it really gets stretched, so you have that piece that goes into it.

One way in the beginning to lessen or minimize, and it’s not going to deplete or somehow stop those problems from taking effect, is to have a plan before the deployment.

In a perfect world we would know just when someone’s going to get deployed, right? Wouldn’t that be just fabulous? I know that in two months and two hours and two days I’m deployed. It doesn’t work like that. It’s usually TDY, you’re gone, and you get very little notice with that.

So in advance, even if you don’t think you’ll ever get deployed, if you’re in an administrative role or have never been deployed, I can’t emphasize this enough. Particularly with troop movements, Airmen being moved around, there’s just so much happening, it’s important to have a deployment plan with your family. Again, even if you don't think it will ever happen.

One of those pieces is to have an idea of healthy communication. To be able to feel comfortable sitting down with your spouse, other family members, and saying you know, it could happen, it might happen, but we need to have a plan so that people know what the roles are when someone is deployed. The role for the deployed person, and there is one; and the one for the person left behind.

The other part of that which we’re going to talk about is setting up a routine in that plan. There needs to be a routine when you are deployed and the family is left behind so that things don’t go into chaos again. There are going to be additional responsibilities that have to be picked up and the idea of just setting up some standards for different people can be very helpful.

What we’re really talking about is a family in crisis without a plan, particularly if deployments happen multiple times.

I had one Airman tell me I got deployed once. I didn’t think it would happen again. Well, it was his third deployment.

So the family in crisis affects the service member, the loved ones and the children, so every one is involved in that and each of those represents that crisis point without a plan. We’re talking about prevention plan, healthy communication, establishing a routine, and then reassessing that.

The first part of that is to anticipate ahead of time that the deployment will happen. Brainstorm as to what modes of communication might be available. What do I mean by that?

It can go anywhere from very expensive text messages, to e-mail, to snail mail. Let’s also be real here. Sometimes we’re not going to have the ability to get in front of a computer. If you’re deployed, wherever that might be, and there’s no technology available to you, or for security reasons you can’t get to it, there needs to be a plan even with that. One thing might be before leaving is to feel comfortable saying you know, I don’t know where I’m going. Or I think where I’m going there may not be the ability for me to communicate with you right away. That’s really important, just to alleviate stress for the person left behind. Then develop the other plans that are part of that. If it’s text messaging, or telephone’s great of course, or snail mail. Whatever it might be, but as long as there’s some type of bond of communication, that there’s a promise between both people or all members of the family to somehow stay in touch.

The other piece of this is to let Airmen make first contact and report best times for communications. I don’t know if this has ever happened but I’ve seen it happen, where someone’s deployed and a spouse, and understandably so, is anxious, upset, sad, crying, and is starting to call up the base to find out where this person’s been deployed, how to get a hold of them, what telephone number do I call, and can I have – You know, escalate this up to the President. We have seen this, right? And you know what? It’s so human. It’s so human and understandable because that person at that moment in time has been ripped away, and we heard a little bit about loneliness. Who wouldn’t feel vulnerable?

So be able to say okay, I’m the one being deployed, I’m going to be the one to make first contact. Trust me to do that. I’ll share with you what I can and what I can’t, I can’t. But at least that piece is in place.

Once that happens, depending on the situation and where the person has been deployed, that’s the time to set up a time and date for each communication session, and if at all possible stick to it. I know that can be very amorphous, that doesn’t always happen, but at least there’s a plan there. So we know that on Friday at 3:00 o’clock every time I’m going to try in some way to communicate, whatever that might be. Realize that schedules change for both parties and flexibility is a must.

As a side note here, in 2003 I went to the Provost at American Military and I said I want to teach a class on Love 101. He said you’re about out of your mind. Nobody in the service is going to want to join that thing at all, or you’re just going to get a few enrollments. It’s the most popular class at the school, and we have to turn students away because in those classes we talk about long term deployments, long distance relationships. What you see are spouses, someone who is deployed and someone who is still here, in the class together because it’s a way for them to communicate. An on-line discussion board. So sometimes we have to edit and take things out of those postings - [Laughter] – but that’s there. That’s a very clever way of doing it. The other idea is it gives people a chance to talk about what’s going on with them. Are other people going through the same experience?

Step two here, what we’re talking about is healthy communication. Share important information that’s relevant to the family unit.

If you’ve only got a few minutes on the phone nobody cares about Aunt Gertrude’s hemorrhoids. Just being honest here, you've got to really think like that because time is of the essence. Express what each person needs. What you need as a deployed person, but also as a family member left behind, what are your needs? Not just financial, but emotional. What do you need? What do you need to hear from that person?

Tell the truth about problems that have occurred with children and don’t sugar coat the problem. The reason I say that is because eventually the person’s going to come back and if they don’t know that a real problem’s happened, that’s going to cause some issues. If someone’s having a hard time in school, don’t say oh, everything’s fine and dandy, because it’s not. And who’s going to be upset when they come back? It’s that sharing, the communication. If the car’s broke down, be honest about it, say it. If money is an issue, say it. Share it.

Avoid falling into the trap of becoming glued to the TV. Let me explain what I mean by that.

I know there was a workshop earlier about the war with the media and the war in Iraq I saw something listed on that. You could turn on the TV any day of the week and get really depressed looking at the TV. As a therapist, I kind of like that because people call me up for counseling. [Laughter]. But the truth is, we need to be really careful what we watch on TV because if you’re someone left behind and you’re seeing all this chaos and craziness happening, what do you think’s going to happen to your anxiety level? What do you think? It’s going to shoot through the roof. And that’s going to happen through telephone calls. Oh, I just saw this happen in this place; I saw it happen over here; I know you’re not far from there. These kinds of things. Just be careful about how much we allow that to happen, how much we let ourselves. Again, that’s for the person that’s here, that’s kind of wondering what’s happening. A little bit of information is good, but too much information sometimes can be very damaging.

Avoid rehashing old arguments. If John is deployed and John bounced a check before he left there’s not much he can do about it while he’s away, so why bring that up? The old arguments is what I’m talking about. If there were issues in the past about trust, that needs to be not rehashed in that moment. There’s nothing anybody can do about it. So it’s being careful. Share what’s truthful, don’t edit, but let’s not go back into the past either and have old arguments. That’s caused a lot of problems.

Reconfirm the next communication session. So if at 3:00 o’clock, that was the time on a Friday, talk to one another. Okay, we will talk again at this time on this date. It may change. That could happen, but that’s the plan that we have.

Establish a routine, which is step three.

Stay involved with prior family commitments, worship services, et cetera. If the family used to go to mass or they used to go to church or mosque or synagogue, whatever it might be, and suddenly someone is deployed, I’ve heard people say we don’t go any more because dad or mom’s not here. Why? That’s a routine that disrupts the family unit when it’s not done, and kids, which are so much smarter than us I think, will know something’s up if you stop going. By all means continue to do those types of routines.

Celebrate the holidays. That’s a big one. How many times, I don’t know if this has happened to you. We’re not celebrating, let’s say in this example, Christmas this year, because so and so’s deployed. I’m just too depressed, I can’t do it. That’s probably the worst possible thing in the world to do, especially if there’s children involved. Now something’s been taken away from them and that causes problems for them, I might even argue developmentally. You want to continue to celebrate that and honor the person that’s deployed in that celebration. If there is a Christmas meal, set a plate for that person at the table. Honor that person. Bring memory to that person and show that you care about that person. That’s what I’m talking about with routines. Don’t cancel the holidays, don’t cancel Halloween or any of those types of things.

If possible, connect with other military families on a regular basis. If it’s a difficult time, using the holidays here, or any time really, try to have contact with other military families as much as possible that are going through the same thing.

Now if some folks have their spouses deployed and they’re in the United States and let’s say they’re in a rural area, that doesn’t mean they can’t connect. If they’ve got access to the internet, there are support groups they can join. If they’re on a base, even better. There's all sorts of options here for family members to be able to connect and share what’s going on.

Have another family member continue acting as a mentor during the soldier’s, in this case Airman, or service member’s departure. What do I mean by that? I’m not talking about Uncle Joe coming in and taking over as daddy. Some people might not want Uncle Joe around like that. What I am talking about is let’s say your son is playing baseball. Why can’t someone at least step in and help him with that? Be there for him. Continue that process and that routine. If your daughter is taking lessons in whatever that might be, the same thing. Have someone from the family come in and assist with that if at all possible. Even a close friend of the family.

What we don’t want to do is cancel that because the person’s been deployed. That’s part of that routine.

Explore the idea of creating connection activities. What I mean by that is maybe one night during the week the family gets together and puts some type of a video package together for the person deployed. Maybe they draw pictures. For teenagers, it could just be writing a letter. Whatever that might be so that the family has some type of connection with the person deployed, and then they send it, if they can get the address and send it, they send it, or at least they hold onto it until the person comes back. There's that connection that happens.

Any type of connection activities are good. It lessens the anxiety. Anxiety is really a feeling like you've lost control. That’s what we’re talking about here.

We’re going to also talk about coping mechanisms with that anxiety. One of them, the unhealthy ones, are drinking, then of course drug use and abuse.

Step four, you want to reassess this plan. Is it working? What can be changed? Any plan that one makes has to be tweaked, if you will, because it’s not going to be perfect the first time out. Think of your own budgets, all that kind of stuff you have to adjust.

What cannot be changed? What that means basically is the frequency of the communication. We would love to be able to talk to our spouses on a daily basis but that’s not going to happen.

Look for new opportunities that may appear. There could be new opportunities that come up. Maybe you know a friend of someone who’s deployed that can get a message to someone in that type of way. That’s another way of looking at it. And the opportunities do come up, but we need to really be open to that.

Before we go into PTSD, are there any questions about what I’m just now looking and talking about here, about these deployment plans?

Question/Comment: Could you maybe expand on – In my experience the conduit to the Air Force [inaudible]. The service member deploys, sometimes the family goes back and stays with mom and dad away from the base. Can you [inaudible] a little bit more on how you [inaudible] connected to [inaudible]?

Dr. Moore: That’s a great question. If your family’s moving off base, then how do you stay connected.

I’m going to answer that question, but I want to ask people here, just listening to that question, what ways have you found to do that?

Question/Comment: [Inaudible] and we deploy onesie’s and twosie’s. We usually have the commanding officer, all the reserves, I will call the individual, I’ll call the family, so we have to have a one-on-one connection with either their, whatever unit they’re from or whatever. I think one-on-one connection.

Dr. Moore: That’s one option.

Question/Comment: I just came from a Family Support Center Director. Even if you don’t stay at your sending base there are Hearts Apart Programs that can be linking them through the telephone, even through your base operator. So you can call in from wherever in the country you are and get hooked up through that.

Every commander is supposed to have a person assigned to that individual, regardless of where they move to. If they have access to a phone they have to make contact with them and that should be set up based on that person’s need. We have had some that didn’t want to be contacted. Look, I’m doing fine. Maybe they need that time apart, or whatever the case may be. You've got to go where they want to go. But there are lots of neat programs.

Most Family Support Centers, if not all, have monthly dinners and lunches. They should send out newsletters. There should be all kinds of different events. A lot of local churches – There’s a laundry list we can give you.

Another good source is Air Force One Source or the Military One Source. They will put together packets of information and mail it to you on different options and resources for every age group and every category that might deploy.

Dr. Moore: Wonderful information.

Question/Comment: There’s also a Key Spouse Program now where a spouse in the unit acts as a sort of ombudsman of sorts for the military families that are left behind so they have a way to stay in touch with the unit.

Dr. Moore: Any others in terms of just ways to kind of keep that connection going?

My own thought about that is again, beforehand if at all possible, try and work out that plan. Just kind of like what was talked about, the most essential part of that in that plan is to find out what kind of communication can be used if at all possible, and then stick to that if at all possible. Again, I know that that sometimes is changing.

What I’m going to do here is move on to Post Traumatic Stress Disorder. That just brings up all sorts of folks. What does that mean? What is this, what is that?

I think it’s important for me to say at the outset that PTSD does not mean you’re weak, it does not mean there's some deep psychological problem with you or that you’re just a problem person. It means you’re human. That is the nature of PTSD.

There are really two types here that I’m going to be talking about. The first is called Acute Stress Disorder. It’s a 25 cent saying for someone who’s been exposed to a trauma within two days to four weeks after it happening. If you see someone get hurt, if you get hurt, something explodes, within two days to four weeks after that happening you’re going to start to feel the symptoms of that. The diagnostic criteria for this in a nutshell is a person experienced, witnessed, or was confronted with an event or events that involve actual or threatened death or serious injury or threat to the physical integrity of others. That could cover everything, right?

PTSD does not occur, for example, when Visa denies a charge. I’ve heard that. People have said stuff like that to me. You know, I’ve got PTSD. They denied my TV. It happens.

Persons’ responses involve intense fear, helplessness or horror. They’re really afraid. That’s what you’re looking at. It’s horrible. Whatever was seen or experienced.

The traumatic event is persistently re-experienced in any number of ways. There are really four. There are recurrent thoughts about kind of what happened; distressing dreams; it could be feeling like the traumatic event was reoccurring.

Let me give you an example of that, and I’ve seen this happen. It’s raining outside, you’re by the window. Let’s say you were involved in gunfire. You were shot, maybe your buddy was killed, whatever that might be. You come back home after your deployment and it’s raining outside and all of a sudden it’s raining and it’s hitting the window. You hit the floor because in that moment you think you’re under fire. In that very moment you think it’s happening to you.

How scary is that? And people are around watching this and have no earthly idea what’s going on here.

I have seen people and talked to people who have mowed their lawns and heard a plane go overhead and hit the ground because in that moment they’re re-experiencing the trauma.

Let me just say this. The good news is that it does, PTSD does, generally speaking, it will allow the person to recover over time but there are things we can do as the affected person and those that are affected in the family. This is particular coming back.

What are the symptoms? I’m just going to go ahead and talk a little bit about the symptoms of this. This slide may come up again.

It’s an inability to sleep. Someone’s come home from a theater and let’s just say they’re back, they’ve been through some trauma, whatever that might be, you may see they’re having problems sleeping. They’re irritable. They have problems with focusing. Simple stuff like remembering someone’s name. Children’s names. Hypersensitive. They notice everything. If there’s been a crack in the ceiling and it was always there, now it’s suddenly noticed because they see things. They’re more focused. Easily startled. If someone slams a door, they jolt. There can be angry outbursts for no apparent reason. If there was a substance use problem occurring before the person left, it can turn into abuse and dependence.

There are three things that happen with substances. There is use, like most folks maybe have a beer, watch the Bears game, and you know where I’m coming from. Then there is abuse, that’s where using the substance in a way that it wasn’t intended, to medicate our pain, to medicate the anxiety. Then there is dependence, where we need to have that to function, that particular substance.

Just a little factoid for you, Vietnam vets with PTSD are three to six times more likely to divorce than Vietnam vets without PTSD. That’s pretty startling when you think about it, because of some of the symptoms we’ve talked about. This is also related to combat stress, and you may have heard of that.

So what can you do as a person who is left behind and now the family member has come back, that integration process? The first part of that is if you’re a family member, be supportive of the person. Understand that you do not possibly know what they’ve been through. And to say “I understand” is not really accurate because how could you?

Educate yourself on PTSD. Pull it up on the internet. The Department of Veteran Affairs has an excellent guide on their web site.

Don’t try to be the person’s therapist. Don’t set the person down and say tell me everything that’s going on in your mind and what’s happening. Let’s be honest, after you've been married for a while it ain’t going to happen anyway. You get into your routines. It’s not going to become that kind of sharing moment. But being supportive means being open to letting them have dialogue. There is a difference.

Look for signs of depression. That’s one of the big ones that happen, is a person becomes depressed. What does that mean? Loss of appetite. Sleeping more, or not sleeping at all, or having problems sleeping.

Another 25-cent word is anedonia. What that means is losing pleasure in activities that once brought joy. That could be watching a game on TV, playing with the kids, doing construction work, building cabinets, whatever that might be. That is gone or diminished.

Look for signs of any substance abuse, which is what I was talking about before. If the person maybe had a couple of beers before, now they’re coming back and they’re using that to medicate, then you know something’s up here.

Look for signs of anxiety. That’s that hyper vigilance I was talking about a little bit earlier. Just feeling kind of nervous about things in general. Worrying about things. These types of issues.

It’s contagious. There’s something in what’s called the Diagnostic Manual for Disorders, it’s called Shared Psychosis. If you’re anxious as let’s say the spouse, the other spouse eventually may start to adopt those behaviors. Now you’ve got two people that have kind of the same symptoms that are going around – both anxious, both upset, maybe both drinking, they don’t understand, these types of things. That’s at its worst that it can happen, and I’ve seen that happen.

Does anyone here ever work with someone in any way that’s been affected by PTSD? I see hands here.

Would someone be kind enough to share what it was like for them, either as a family member or perhaps just in a professional manner what it was like?

Question/Comment: [Inaudible].

Dr. Moore: So he turned into a recluse.

Question/Comment: Yes, sir.

Dr. Moore: What happened to him eventually?

Question/Comment: He [inaudible].

Dr. Moore: So eventually got the assistance and was able to get some help.

Let me just pause and say this about that. I grew up in a military family. My dad was in the Navy during Vietnam. One of the barriers I think to communication in sometimes military cultures, it’s difficult sometimes to talk about these things with people that you’re kind of working with because some people don’t want to appear weak; some people don’t want to just seem like okay, I’ve got these problems and everything. I want to encourage you to just kind of think about that. If you can find outlets as a person deployed, to be able to talk about things it’s important to be able to do that. It really, really is. It becomes bottled up and it stays locked in. And if you’re not talking about it with people you work with, what in the world’s going to happen when you get home? Think about that for a moment.

The treatment of PTSD --

Question/Comment: I think also [inaudible] the stigma of [inaudible] some kind of disorder [inaudible]. There are different degrees of it as well as different [inaudible]. Just like [inaudible] no reason [inaudible] someone can’t recover [inaudible].

Dr. Moore: Thank you. That was a great point. The point is the stigma with PTSD, just the stigma that there’s something wrong. You know what? I choose to say something’s right because the person’s a human being and they’ve seen something or experienced something. I’d be worried about people who didn’t feel and didn’t experience things. But there is that stigma that happens.

How many people do I work with in the addictions world that say you know what? I’d rather be an alcoholic than a cocaine addict because maybe alcoholism is more socially acceptable. That’s one of the key pieces here.

So in treating PTSD there are several things that can be done, but let’s first talk about that family role.

First, support the person. That could also mean in medication. There are medications that can be anti-anxiety types and depression types. The way you can support the person is don’t hound them and say did you take your meds today? But if you notice they’re not taking their meds to say hey, what’s going on? There’s a way to approach that. Don’t embed them in the turkey and put a glass of water next to it. [Laughter].

The third piece of that, because I’m a big believer if you can avoid medications, by God, do it. But the other piece of that is the support group. There are support groups for PTSD and research shows it’s very effective. That people be able to come around and talk about what they’re going through. They’re offered through veterans organizations, but some counselors specialize in working with military familires. There are churches that do that, particularly in military towns. So there are opportunities for that to happen.

It doesn’t have to be specific to one branch of service or the other. PTSD is the same for Marines, Air Force – the symptoms that is – for all of us.

For the treatment there is exposure therapy, there is medications and group therapy. Exposure therapy is kind of a cognitive behavioral approach where basically you kind of rehearse a little bit what happened in the mind. The first part of that is, mostly it happens in a way that is called implosion therapy. Implosion all occurs in the mind. It doesn’t actually subject the person to going back out in whatever they were in and watching a bomb go off. It’s just a cognitive rehearsal.

The medications and the group therapy. The therapist’s role or the counselor’s role is cognitive therapy, helping the person manage their antianxiety medications, which they are not no forever, let me just say that. You’re not on that forever and a day. And remember that the entire family is involved. So if you've got someone with PTSD, man or a woman, and you’ve got a spouse and children, every one is affected by PTSD. It’s not just the person that’s going through that particular situation.

What’s it like for a kid to get dad or mom snap at them when they’re not used to it? They think something’s wrong with them, they did something wrong. They didn’t, it’s just part of PTSD. So that means treating the whole family, talking with family members, bringing them all in and discussing it.

Also increased support systems. That means reconnecting with friends and family in any way that’s possible. It’s treatable. The process takes time. Survivors’ guilt is common, and I think all of us know what that is. So if I’m injured but my friend was killed, I’m going to wonder why it didn’t happen to me. I should have been the one to go. That is very difficult to sometimes work through because there’s guilt there. And depending on our own emotional makeup – I’m Catholic. I can feel guilty about anything. [Laughter]. I might really accentuate that.

The family is the most important thing related to recovery. That is the key support system. That family unit. Friends are great, coworkers are great, but the family is what you come home to, it’s what you love, and that’s so important to have. So build those relations and continue building them.

That was the slide presentation and I’ve got time here, so what kind of questions do you have?

Question/Comment: I had a friend who was in Khobar Towers and such, and he knew a bunch of people who got killed. He came back and he was back for a few month, he was seeing counselors and such, but his commanders wanted to send him right back to the front. He was having issues with it and they finally released him from it. But I’m curious as to what – I’m not in a command position as such, I was curious to find out what commanders are doing as far as taking this seriously when somebody actually has it, or maybe people saying they have it but they really don’t.

Dr. Moore: Can someone answer that question? I don’t want to step in a pile of you know what by giving the wrong answer.

I’ll give a little bit of an answer, as much as I can.

Question/Comment: What the commanders do that case, if there’s an individual who has some sort of [inaudible] issue, whether [inaudible] happen where they [inaudible] getting ready to go to deployment or come back from deployment. If they’re getting ready to go and as they go through the process of getting ready for deployment they decide I can’t go because I have this issue, we immediately send them over to [inaudible] area to get assessed by the doctors there [inaudible].

If there is a factor or issue, then [inaudible] at that point [inaudible] to decide what [inaudible] to do. If they say it’s a very small issue, he can handle it, it’s the commander’s decision.

Now if somebody [inaudible], if in fact the do have some sort of disorder, in a lot of cases if a doctor issues [inaudible], the commander is not aware of it. So [inaudible] some sort of disorder, [inaudible] talk to those folks, try to see them, and then [inaudible]. So [inaudible] ready to go again where [inaudible], your doctor will then go to the commander and say hey, I’ve been seeing this patient for X amount of time and [inaudible].

So in a lot of cases the commander doesn’t know. [Inaudible]. They don’t do things in a vacuum. [Inaudible]. We do consult with the medical community. But [inaudible] that person’s rotation [inaudible] for a long time [inaudible], if you feel based on [inaudible] issues that [inaudible].

Dr. Moore: That was great, thank you.

Question/Comment: - that process, you want it to be official, it needs to be [inaudible]. If you just refer somebody to life skills unless there is a [inaudible] should not necessarily [inaudible]. If you want documentation that will be decisive, there’s a whole process [inaudible] and things like that to make sure it’s supported. Because if they are determined to have something diagnosed that will [inaudible] deployed, then they may not be fit for duty. That’s kind of part of the expectation, and that could have long term consequences on their career and what they’re able to do afterwards.

Dr. Moore: Thank you. That was great.

Let me also kind of come back and say this about that. For someone who is back or let’s say they’re now out of the service, they’ve got an honorable discharge. I have heard stories that it backs up at the VA.

Here’s the good news. You are the patient. You can choose who you want to see. There are many people I counsel in my private practice who just feel more comfortable coming to a private practitioner. For legitimate or illegitimate reasons, maybe they just don’t want to go through whatever service so they see someone privately.

The good news is there are sliding scales, reduced fees.

If someone’s in the military and they come to me, it’s $10 a session instead of $100, but that’s just how I do it. If I’ve got openings, that’s what I do. There are options for you. Oftentimes places of worship can connect you to that. I’m always impressed with how many ministers, rabbi, are so well versed in some of the issues. Even that is a conduit in terms of having a safe place to talk about what’s happening. So I just want to kind of supplant that there for you so that you know. Let them know you’re a service member. Let them know you’re out or you’re in between maybe another deployment, and that is a way to have that confidentiality and a way to share. You’d be real surprised at how many people are eager to help folks, particularly in the mental health field, and want to help.

What other kinds of questions does anyone have about what we’ve kind of talked about?

Question/Comment: I think the active deployment is a key. I think one of the main issues that I’m learning is getting back in the family. I think there also needs to be a plan. You talked about the pre-deployment plan, but so that when the member comes back they don’t feel like they’re a guest in their own home.

Dr. Moore: Great point.

Question/Comment: It is really [inaudible].

Dr. Moore: That reintegration that you’re talking about is extremely important. When someone comes back, it’s really a myth to think we’re going to go back to the way things were. Children have grown, finances have changed, money is obviously a factor in that, but people change emotionally, spiritually, psychologically, and so to have that plan that you so eloquently said is so important, and part of that is to discuss on the front end of that, in terms of the deployment, what’s it going to be like when I come back? In other words, what are some things we can do to establish as much as possible some routine? That’s why I couldn’t emphasize that enough about the routine. Making sure kids go to whatever activities they were going to, celebrating the holidays, and all of that. Make sure those things are in place and expect things to be different.

I’ll say the word sex. Sometimes people come home and they want to have that. Sometimes people don’t. It is not going to be like the movies, necessarily where people run towards each other and it’s just fabulous. It’s very possible that people just don’t want to deal with that because they’re going through whatever emotional things are happening. To recognize that as well. It’s not a rejection of you per se, it’s really just kind of meeting the person where they’re at. That goes for the person deployed or the person who’s been staying back. That’s really important.

The other piece that goes along with that are fears of infidelity. Who were you with while you were deployed? Who were you with while I was away? If I had a dime for ever person that walked in, I’d be a rich man. That happens. That’s human and that’s normal. The way to work that out is in advance. In those communications, to establish what you feel. What it’s like. I miss you. Of course. Say those things. And truthfully speak those things. That can be very helpful.

Question/Comment: You talked about the chaos phase and then back to my earlier comment or question regarding the six to twelve month. Do you find that the length and duration impacts on that state of chaos that may occur? And is it both for personal stuff at home as well as the person who’s been deployed?

Dr. Moore: Great question. I’m just going to repeat that. If the deployment is longer does it affect the chaos that goes on, and what’s it like for both people, the person deployed and the person left behind.

When you’re deployed longer it just creates more anxiety about what’s happening. That’s been my experience. But in terms of chaos, here’s what really brings the chaos. Not having a plan. And thinking you’re not going to get deployed when you are. Oh, it’s not going to happen to me. It happened a while back, I was told it’s not going to happen again. It can happen. It’s not having that planning piece that causes the chaos, particularly if it happens like that. You’ve got no notice at all. It just happens. That can really exacerbate kind of what’s happening. So that’s why I encourage people to talk about it.

It’s not easy. I’m not going to say it is. Who wants to have that conversation? But think about not having it.

Question/Comment: We have a great family support program [inaudible] so before people deploy [inaudible]. But obviously you can’t make them do that. When they come back [inaudible] and families. At what point do we formally [inaudible] problems? [Inaudible] these people [inaudible]?

Dr. Moore: That’s a great question. At what point would you get involved.

My answer to that is when you see someone’s functioning becoming impaired. When they’re not able to function in the way that they should be or used to, then you know there’s something wrong. That’s how you make that kind of determination. When they’re not able to function or they’re jeopardizing their own safety and health, or other people that they’re serving with. That’s kind of the key idea for that. That can go not only with arguing with spouses, children, whatever, but it can also go with substance abuse, or dare I say substance dependence. That’s the other piece of it that we should all recognize.

Other questions?

Question/Comment: I have a question that’s administrative. I noticed a number of folks taking notes. Are there an copyright concerns you would have in terms of being accessible, or where someone could e-mail you if they’re taking notes but they maybe didn’t get all the steps down?

Dr. Moore: Yes. Certainly permission to post this on your web site, and people can go there if they want to do that, that’s fine. Also if you have follow-up questions, e-mail me. Go to JohnDMoore.net and there’s an e-mail link right there. By all means feel free to do that. There are also articles on my web site. One’s called “Love on the Battlefield.” That article is all about just kind of being a newlywed and now you’re deployed and what that whole situation is like.

If there aren’t any other questions let me just say it was my supreme honor to be here today. It means a world to me just to be in this room with every single one of you because of the work you’re doing for our country, and I can’t think of a finer group of people I’d rather be with, so thank you very much. You honor me.

Long Term Deployments – 9/25/06

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