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10 Things To Know Lists

VA Chaplaincy LogoIntroduction:

CareForTheTroops was fortunate and grateful to receive from the Chaplains Office at the San Diego VA Hospital a number of documents and pieces of information. This information has been quite useful in our Guidebook for Leaders of Military Ministry Congregation Programs as well as other content on our website. In the lists below, we have maintained the original references to the San Diego VA Hospital even though you (the reader) may be located near a different VA Hospital.

It is anticipated that these quick reference lists will be helpful to clinicians in their work with military family members; to caregivers as they work with vets in their care; clergy and lay leaders as they lead and inform members of their congregations.

The following statement applies to all the list displayed...“10 Things You Should Know" is produced by the VA San Diego Healthcare System, where caring for Veterans is our top priority, in partnership with Chaplains Caring for Veterans and Families, an informal organization committed to helping faith communities identify and attend to the spiritual distress experienced at times by those in military service. For more information on this program call the VA San Diego Healthcare System Chaplain Service at 858-642-3496.”

10 Things You Should Know About…Post-Traumatic Stress Disorder (PTSD)

  1. VA PTSD AppPTSD is an anxiety disorder that involves the over-activation of the fight and flight response.
  2. PTSD symptoms include re-experiencing the trauma through flashbacks or nightmares, feeling constantly on edge, and avoiding people and places that may remind one of the trauma.  It involves both the body and the mind and the spirit.
  3. Some signs and symptoms include: anger, anxiety, grief, feeling lonely or abandoned, sleep disturbances, feeling out of control, or physical signs of tension such as racing heart beat or muscle tension.  People with PTSD may feel disconnected from their spiritual connection, lose their sense or meaning and purpose for living and ask “Why” they experience such suffering.
  4. Potential triggers could be: an argument, media stories, loud noises, life stressors, anniversaries/holidays, or insensitive questions about combat or other traumatic experiences.
  5. PTSD results from innate biological and physiological mechanisms. It is not the result of moral failing or weakness in character.
  6. Not everyone who experiences trauma develops PTSD. Some of the symptoms are very normal responses to an extreme stressor and for most people; the symptoms naturally decrease over time and eventually disappear.
  7. If a person has PTSD, he or she is at greater risk for developing another illness such as depression or alcohol abuse.
  8. Research shows that certain psychotherapies (both individual and group) as well as psychiatric medications are very effective in decreasing symptoms of PTSD.  The San Diego VA offers multiple state-of-the-art treatment for PTSD, including spiritual care, and tailors treatment to the individual needs of each veteran.
  9. There is also increasing evidence that many people experience personal growth after experiencing a trauma. People often emerge with a greater appreciation of life, an increased sense of personal strength, and/or a deepened spiritual life.
  10. The VA San Diego Healthcare System is growing and updating its services constantly. Call the Mission Valley front desk (619-400-5170), for more information if you have any concerns about PTSD and a veteran in your life.

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10 Things You Should Know About…Spiritual Injury in Military Service

  1. Soldier depicting spiritual injuryMilitary service may involve separation from home, multiple deployments, exposure to different cultures, different morals, different religions and may require acts of violence that have specifically been prohibited in one’s religious tradition, resulting in spiritual injury.
  2. Military personnel and their families rank religious organizations second only to family when it comes to providing helpful nonmilitary support.
  3. Persons suffering from PTSD from recent conflicts are twice as likely as the general public to believe that God is punishing them for their sins or lack of spirituality.
  4. Persons suffering from PTSD from recent conflicts are four times as likely as the general public to believe that God has abandoned them.
  5. Moral and spiritual injury are often invisible injuries which go undetected because Veterans carry so much guilt and shame that it makes it difficult to discuss these injuries.
  6. Families and military personnel may often feel forgotten or invisible in faith communities because members are simply unaware of the trials of families separated from their loved ones.
  7. Families and military personnel may often feel forgotten or invisible in faith communities because members are opposed to war and believe that attending to the spiritual needs of military personnel or their families is to support war.
  8. The pain of spiritual injury and moral distress in military personnel or Veterans can be so severe that it leads to use of alcohol or drugs use to cover the suffering.  Suicide attempts may be efforts to escape the spiritual suffering all together.
  9. Local faith communities can become healing agents for families and military personnel through intentional efforts to reach out during each stage of the deployment cycle.  It only takes one person or a small group to make this happen.
  10. The VA San Diego has outpatient spiritual care counseling and groups specifically designed to help Veterans deal with guilt, shame, forgiveness and other spiritual issues.

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10 Things You Should Know About…Mental Health Stigma

  1. Mental Health Stigma pixStigma is defined as "a mark, blemish, or defect; a symbol of disgrace, shame or reproach and often involves fear of that which is different.”
  2. Stigma has been identified as a major reason that only about half of all Americans with a serious mental illness seek treatment.
  3. In one survey, many people reported they would rather tell employers they committed a petty crime and served time in jail, than admit to having been in a psychiatric hospital.
  4. Stigma is perpetuated in the media, which often portrays individuals with mental illness as violent and unable to contribute to society. However, research consistently shows that mental illness—by itself—is not significantly linked to violence. In fact, those with serious mental illnesses are much more likely to be a victim of violence than a perpetrator.
  5. Language is closely related to stigma. Using negative labels such as calling someone "crazy" or "a schizophrenic" (not "a person with schizophrenia") or language that emphasizes limitations, not abilities, strongly influences our and others' perceptions.
  6. Science tells us that mental illness is caused by a combination of genetic and life experiences, much of which a person has little or no control over.
  7. Organizations such as the National Alliance for Mental Illness (NAMI), the Depression and Bipolar Support Alliance (DBSA), and the San Diego "It's Up 2 Us" campaign, serve as advocates and educators to reduce the impact of stigma.
  8. The VA has an interactive website "Make the Connection" to reduce stigma of Veterans obtaining mental health services at the VA. Visit
  9. What can you do to fight stigma? Communication is key. Seek knowledge, and don't be afraid to talk to trusted others about your mental health concerns.
  10. The VA San Diego Healthcare System is growing and updating its services constantly. Call 858-552-8585 for more information if you have any concerns about a Veteran in your life.

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10 Basic Things You Should Know About…Suicide, Treatment,and Prevention

  1. Suicide PreventionEvery 16.2 minutes someone in the U.S. commits Suicide; and, every 17 minutes someone is left to make sense of it.
  2. There are 18 Veteran suicide deaths per day. Male Vets are more likely to use firearms as means.
  3. Substance abuse/misuse is a key risk factor for suicide.
  4. Suicide rates are highest in the older (50+), single, male, Caucasian population who have a mood disorder and/or are abusing alcohol.
  5. Individuals with certain non-cancer pain-related conditions are at greater risk for suicide than those without these diagnoses.
  6. OEF/OIF/OND Veterans who have mental health conditions are at increased risk for suicide. The increased risk is associated with diagnoses of depression, bipolar disorder, substance use disorders, anxiety disorders, and schizophrenia.
  7. Individuals with a diagnosis of Traumatic Brain Injury (TBI) are at greater risk for suicide than those without this diagnosis.
  8. A suicide crisis is time-limited and, with appropriate intervention, the risk for harm can be thwarted.
  9. If you think someone is at risk: Open up a dialogue, listen; Don't judge, try to understand the problem driving the crisis; Convey a message of hope that the crisis will pass; Offer to contact a chaplain or mental health provider; Provide a safe environment by removing the means; and, Escort the person to a behavioral health facility ASAP.
  10. Immediate help and/or treatment is readily available to Veteran’s via
        The Veterans Crisis Line 1-800-273-8255
        The Veteran’s Chat Line
                   The VA Hospital walk-in Psychiatric Emergency Clinic (PEC) 2-North M-F 8a-4p
                   The VA Hospital Emergency Department located on the Main floor
                   Contact with one’s Primary Care Physician, Principal MH Provider, Pharmacist, Chaplain

For Georgia, see the Crisis Intervention webpage on this website - Blue Button, Left Side of every page

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10 Basic Things You Should Know About…Caregiver Support

  1. VA Caregiver SupportA caregiver is someone who provides personal care services for a Veteran. Caregivers may   assistant with activities of daily living like personal hygiene and transferring from bed to chair and back again, and/or provide supervision to ensure the safety of the Veterans.
  2. A caregiver may also provide transportation, prepare meals, do household chores, manage appointments, help with medication management, provide support and companionship, help pay bills and manage finances, and/or make important decisions on behalf of your Veteran.
  3. A caregiver could be a spouse, significant other, adult child, parent, family member, or a friend.
  4. A caregiver may experience mixed emotions. It is common to feel overwhelmed, burned-out, hopeful, scared, not in control, isolated, unprepared, loved, lucky, and/or frustrated.
  5. The VA Caregiver Support Program provides a wide range of services to caregivers of eligible Veterans of all eras at every VA across the country.
  6. Caregivers of eligible Veterans may qualify for: skilled nursing, home health aide, Home Based Primary Care, medical equipment, home and/or vehicle modification, Adult Day Health Care, Aid and Attendance, support groups, education and training on caregiving, and respite care.
  7. Caregivers of seriously injured, post 09/11/2001 Veterans may be eligible for supplemental services. In addition to the services previously mentioned, these caregivers may also qualify for: a monthly stipend, ChampVA health care coverage, counseling, and respite care.
  8. At the VA provides information and resource access for caregivers.
  9. Call 1-855-260-3274 toll free to reach the VA's Caregiver Support Line and find out what the VA can do to help a caregiver stay strong while caring for a Veteran.
  10. Every VA Medical Center has Caregiver Support Coordinators, who are nurses and social workers that specialize in helping caregivers navigate the VA system and/or assist with referrals to VA and community resources. Go to or call the VA Caregiver Support Line 1-877-260-3274 for your VA Caregiver Support Coordinators.

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Top 10 Things Your Combat Vet Wants You To Know

July 21, 2012, in Deployment by Guest Bloggers  172

I’m a psychiatrist. Every day I listen to my combat veterans as they struggle to return to the “normal” world after having a deeply life-changing experience. I do everything I can to help them. Sometimes that can involve medications, but listening is key. Sometimes a combat veteran tells me things that they wish their families knew. They have asked me to write something for their families, from my unique position as soldier, wife, and physician. These are generalizations; not all veterans have these reactions, but they are the concerns most commonly shared with me.
 (Author’s note: obviously warriors can be female — like me — and family can be male, but for clarity’s sake I will write assuming a male soldier and female family.)

  1. Soldier Greeting Wife After DeploymentHe is addicted to war, although he loves you. War is horrible, but there is nothing like a life-and-death fight to make you feel truly alive. The adrenaline rush is tremendous, and can never be replaced. Succeeding in combat defines a warrior, places him in a brotherhood where he is always welcome and understood. The civilian world has its adrenaline junkies as well; just ask any retired firefighter, police officer, or emergency room staff if they miss it.
  2. Living for you is harder. It would be easy for him to die for you because he loves you. Living for you, which is what you actually want, is harder for him. It is even harder for him if you are smart and do not need him to rescue you, since rescuing is something he does really well.
  3. “The training kicks in” means something very different to him. It is direct battle doctrine that when ambushed by a superior force, the correct response is “Apply maximum firepower and break contact.” Unfortunately, your tears are unbearable to him; they create explosive emotions in him that are difficult for him to control. Unfortunately, warriors frequently respond to strong waves of guilt by applying more “maximum firepower” on friends, family, or unfortunate strangers.
  4. He is afraid to get attached to anyone because he has learned that the people you love get killed, and he cannot face that pain again. He may make an exception for his children (because they cannot divorce him), but that will be instinctual and he will probably not be able to explain his actions.
  5. He knows the military exists for a reason.  The sad fact is that a military exists ultimately to kill people and break things. This was true of our beloved “Greatest Generation” warriors of WWII, and it remains true to this day. Technically, your warrior may well be a killer, as are his friends. He may have a hard time seeing that this does not make him a murderer. He is a sheepdog, not a wolf. The emotional side of killing in combat is complex. He may not know how to feel about what he’s seen or done, and he may not expect his feelings to change over time. Warriors can experiences moments of profound guilt, shame, and self-hatred. He may have experienced a momentary elation at “scoring one for the good guys,” then been horrified that he celebrated killing a human being. He may view himself as a monster for having those emotions, or for having gotten used to killing because it happened often. One of my Marines recommended On Killingby Dave Grossman, and I would pass that recommendation on.
  6. He’s had to cultivate explosive anger in order to survive in combat. He may have grown up with explosive anger (violent alcoholic father?) as well.
  7. He may have been only nineteen when he first had to make a life and death decision for someone else. What kind of skills does a nineteen-year-old have to deal with that kind of responsibility?
  8. He may believe that he’s the only one who feels this way; eventually he may realize that at least other combat vets understand. On some level, he doesn’t want you to understand, because that would mean you had shared his most horrible experience, and he wants someone to remain innocent.
  9. He doesn’t understand that you have a mama bear inside of you, that probably any of us could kill in defense of someone if we needed to. Imagine your reaction if someone pointed a weapon at your child. Would it change your reaction if a child pointed a weapon at your child?
  10. When you don’t understand, he needs you to give him the benefit of the doubt.  He needs you also to realize that his issues really aren’t about you, although you may step in them sometimes.

Regina Bahten has been practicing medicine for the past 24 years; the first twelve were as a primary care doctor.  She then crosstrained as a psychiatrist. She has been honored with the friendships of many veterans over those years, whose influence led to her decision to accept a commission in the National Guard at the age of 48. For the past three years she has worked as an outpatient psychiatrist with the Veterans’ Administration in Las Vegas, primarily with veterans of the current conflicts.

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