After serving two tours overseas as part of the initial invasion of Iraq, U.S. Marine Cameron White came home and no longer felt a part of the society he left behind. Prior to leaving the military, White started drinking heavily to mask the psychological damage he carried home from the war.

White hit rock bottom one year post-deployment before eventually seeking help for Post-Traumatic Stress Disorder (PTSD).

White’s experience is not uncommon. In fact, thousands of U.S. troops returning from Iraq in December may face similar challenges when trying to reintegrate into civilian life, with many bearing invisible wounds from the war.

Every veteran goes through a mandatory structured reintegration process called a post-deployment briefing in an effort to ease this transition. The goal is to help soldiers deal with combat stress reaction, job displacement, adjustment with familial relationships, education and other issues they may face when returning to mainstream society.

Although mandatory, the post-deployment briefings are not standardized, which makes its effectiveness uneven. The meetings, issued by a fellow commander or health care provider, go on for about a week and cover how to deal with members of the opposite sex, communication, alcohol and substance abuse, dating rituals and PTSD.

“(The briefing) really depends on the engagement skills of the presenter. If they make it interactive and give a question and answer period, it makes it more effective because it gets the soldier who has just been going through it more engaged and active in the participant process,” said Valvincent Reyes, a military social worker.

Reyes, who helped establish the first combat stress control unit in Afghanistan, said some people will sleep through it and “most of the comments that you’ll get will be that its perfunctory, we sit there and just let it happen, then it’s over with and then we can be released to go with our families.”

White had his first debrief upon his return from Kuwait and Iraq, calling the experience “laughable.”  The military is “very good at creating the warrior but there’s no boot camp to go back to being a civilian. The expectation is to act normal. And that’s almost verbatim what we were told at a brief,” said White.  “One of our first sergeants pulled everyone into a room and said ‘OK, we’re going back to the civilian world.  You can’t yell and curse at your kids, you can’t beat your wife, you can’t road rage and go off on this guy.’”

In addition to the reintegration debriefings, the military administers a Post-Deployment Health Assessment (PDHA) to help identify and address health concerns, such as depression, substance abuse, and family relationship problems.    

The PDHA is an expansive survey that appraises the mental and physical health of each soldier. It asks them to compare their health since pre-deployment and rate how difficult emotional problems make it for them to do their work, take care of things at home, or get along with other people. The assessment further asks soldiers to detail combat experiences and whether or not they’ve encountered dead bodies—enemy or civilian—during the deployment. 

“The problem with that health assessment is that is is self-reported,” said Reyes. “Everyone wants to be home when they come back and they don’t want to be kept at the medical station for a couple of days because they say, ‘Yeah, I’m having alcohol or drug problems’ so they put no on the responses. So after they’re evaluated and attending briefings, which go on for about a week, then they’re given leave and they can go ahead and spend time with their families.”

As a result, a number of veterans under-report symptoms they have or the problems they’re experiencing. Newer standards issued in 2008 now command a Post Deployment Health Reassessment (PDHRA) to be conducted 90 to 180 days post-deployment in order to catch more latent symptoms of health issues.

Despite reintegration debriefings, PDHAs, and a number of veteran service organizations to help with the transition, reintegrating back into civilian life can introduce an entirely new set of challenges.

Since mid-September, nearly 45,000 troops have started withdrawing from Iraq. The War in Iraq formally ended Thursday when the U.S. performed a low-key ceremony in Baghdad to mark the end of the nine-year war effort.

“We are ending a war not with a final battle, but with a final march toward home,” said President Obama during a speech at Fort Bragg in North Carolina. “This is an extraordinary achievement, nearly nine years in the making.  And today, we remember everything that you did to make it possible…Hard work and sacrifice.  Those words only begin to describe the costs of this war, and the courage of the men and women who fought it.  We know too well the heavy cost of this war.”

Obama called for an increased attention to support for veterans and their families once they return home.  “Part of ending a war responsibly is standing by those who fought it. It’s not enough to honor you with words—words are cheap—we must do it with deeds.”

These deeds include assuring veterans receive the care, benefits and opportunities veterans earned.  The president said as a country we will help our “wounded warriors” heal and stand by those who suffered the unseen wounds of war.

The remaining 4,000 troops in Iraq are expected to depart for the U.S. and Kuwait by next week. As the troops pack up their gear and journey home, many will still be on high alert from combat stress reaction.
 
In combat veterans are exposed to trauma, forcing their bodies to psychologically adapt by exhibiting stress reactions, said Reyes. “They have sleeplessness, they have intrusive memories, replaying the traumatic event over and over in their minds. They are edgy, anxious, because they’ve had to be hyper vigilant to protect themselves from anything unseen. They come back feeling that edge, which is a natural state,” said Reyes.

Reintegration with mainstream society poses a problem when veterans realize people maintain their own pace and you don’t control your own life anymore, said Reyes. “You have to deal with the every day experiences of people wanting to prioritize life on what you now think is fairly insignificant when you’re used to helping people who deal with life and death situations,” said Reyes.

White, who served two tours in Iraq, found the second transition more difficult. On his first tour he came back by ship, allowing him more time to decompress. On White’s second tour he flew out of Baghdad and landed in the U.S. the following day.

“You’ve been in what they call a combat mindset for such a long time and a lot of those methods you use in those mindsets aren’t applicable to most situations you’re in when you’re back stateside. Part of the difficulty is recognizing what’s acceptable and what’s not and what’s useful and what’s not,” said White.

Multiple deployments pose an even bigger challenge for veterans because there is a lack of adequate dwell time.  The purpose of dwell time is to help veterans deal with combat stress reaction in a safe, comfortable environment at home, and allow them to access more care for PTSD or anxiety if needed. 

The problem, Reyes said, is when a unit receives deployment papers before dwell time is complete, putting veterans at risk for unresolved trauma.  When soldiers are shipped back into the combat zone, a secondary level of trauma builds, called complex PTSD. This exacerbates the feelings of distress and causes problems in the field.

Short tours in the Marine Corps make transitioning back more difficult. As part of the initial invasion into Iraq in 2003, White said such fast movements provide little time to process anything overseas, leaving veterans to process everything stateside.

As he continued the reintegration process, the difficulty in transitioning put pressure on his relationship with his family. White said family members started noticing he was emotionally numb.

“I’ve had people close to me almost get mad at me for it saying, ‘How can you be so cold?’ or ‘Why are you not crying right now?’” said White. “You kind of become dead because that’s what you have to do when you’re in a volatile situation. You can’t let every little thing set you off.  You’re not going to survive.…I don’t know that that process is so easy to switch it back once it’s done.  And that’s really an unfortunate byproduct of military service. Because sometimes it’s just like, let me feel again, you know?”

The feeling of desensitization is a common issue among veterans during the transition process. Monica Valencia, a veteran of the U.S. Air Force, served in Korea and Germany as a military police officer and received desensitization training as a first responder.

Valencia said the training continues to stick with her back in civilian life. “At first I felt like I couldn’t have feelings for anyone or anything. You don’t really cry or feel because you’re expected to respond to an emergency situation and not break down.”

She believes her military occupation specialty helped make her more resilient to certain things and made it more difficult to transition. Valencia said she’s constantly in a military mindset, continuously aware of her surroundings and checking for exits. 

The effects of transitioning extend to even the simplest actions of civilian life. Multiple deployments created an added challenge for Valencia, requiring her to retrain for different jobs and reestablish herself whenever she moved around. “General things like getting an apartment, getting a car, settling in, getting my medical done…the little things are some of the most difficult.”

The adjustments get easier the more time that passes since her return stateside, said Valencia.  Although she’s become desensitized, Valencia believes her compassionate nature will help balance out that feeling.

Despite the challenges posed by veterans as they transition, many skills learned in the military aid in the transition process. Skills like leadership, integrity, responsibility, and seeking excellence are still relevant stateside. “You take what you like and what helps you and you press on,” said Valencia.

Added skills like being goal-oriented and working collaboratively also serve veterans stateside, said Reyes.

In order to aid veterans in the transition process, Reyes thinks society needs to politicize the need for counseling services as veterans return home. “They need to acknowledge that veterans have adjustment problems because we’ve been through the longest war with the most devastating instruments of destruction—the Improvised Explosive Device (IED)—we are multiple deployers and we have to deal with an unseen enemy. The new dynamics of the war create new adjustment problems and they’re mostly psychological at first.”

Services that could impact veterans the most could be those that address the largest issues affecting veteran transitions: combat stress reaction and PTSD, job displacement, adjustment with familial relationships, and education.

“Businesses need to do a better job at recruiting highly qualified veterans. There’s a whole generation that have great skills but need to be solidly employed and have an opportunity to show that they are goal oriented and team players. Those military skills have a place in the civilian work place,” said Reyes.

Veteran service organizations that give easy access to veterans with PTSD and anxiety, as well as their families, are of high priority said Reyes.  At a college level, he said more effective and comprehensive veterans programs are needed to address the growing issue of veterans and education.