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War can harm loved ones.

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The invisible injuries of service members resulting from our nation's war on terrorism pose complex challenges for military families, especially military children. With injuries such as post traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI), there are often dramatic changes in personality and behavior without a change in one's appearance. This "injury duality" - looking the same, but not acting the same - is troubling for family members, friends and co-workers, and can be particularly confusing for children who thrive on parental consistency, trust and safety.

This Courage to Care addresses the vulnerabilities of children whose service member parent suffers an invisible injury. This injury may include not only PTSD and mTBI, but also depression and health risk behaviors (i.e. increased use of alcohol and illegal or prescription medications, etc.) that are prevalent in many returning service men and women. Health professionals who work with military families and children should be alert to the effects of these kinds of injuries on children and on parenting, as this essential component of healthy development is often disrupted due to the family's injury experience.

Secondary Traumatization

Many children may develop symptoms that mirror those of their injured parent. An example might be a young child having nightmares because of their parent's nightmares or because they are worrying about their parent's behavior. A child may have trouble paying attention at school or exhibit new behavioral problems because he or she is thinking about her parent's problems. This impact on a child due to their worry and identification with their injured parent is sometimes referred to as "secondary traumatization." A child's symptoms can get worse if there is not a parent who can acknowledge the effects of the parental injury and communicate with their children to help them feel better.

Impact of Invisible Injuries on Children

The unique nature of PTSD, mTBI or disorders such as depression - causing changes in personality and/or behavior without altering physical appearance - is especially confusing for children of all ages. The following signs and symptoms exhibited by children may indicate distress and require professional assistance.

Increased acting out behaviors, such as disobedience, tantrums, or risk-taking behaviors

Emotional distress, such as crying, increased anxiety, or withdrawal

Feelings of loss and grief related to the change in the injured parent

Feelings of isolation

Feelings of embarrassment about the injured parents' appearance or behavior

Misinterpreting parent mTBI-related fatigue and apathy as indicators that the parent no longer loves them

Feelings of anger or resentment about new responsibilities or changes in the family such as having to care for younger children, even sharing in or taking on the care of the injured parent

Feelings of self-blame for the injured parents' irritability

Helping Children Integrate the Parental Injury Experience within the Family

Healthcare and family support professionals should encourage families to:

1. Seek out resources and instrumental support. Families may require that basic needs be met in the areas of finance, medical care, military concerns, housing, education, and child care. Children may need special services and/or supports to address any behavioral/mental health problems that develop or to connect them with community resources that provide them with social support and structured activities.

2. Support and help monitor their children's stress. As children deal with stress, they may find it difficult to express emotions, to relax, or to calm themselves. Parents can teach children to label and express their emotions giving them specific strategies (i.e., deep/belly breathing, progressive muscle relaxation, or visualizing a safe space).

3. Share information with children about the injury in a way they can comprehend it. Particularly important is information that helps children understand what the injury is, what the effects of the injury are in terms of parent functioning and/or symptoms, and what to expect over time. Children may need reassurance that the injury is not their fault and that specific symptoms/emotional changes in the parent are expected. This helps to normalize and contextualize the family's current difficulties and helps children understand what is happening in their family.

4. Develop problem solving skills and goal setting. Particularly important is helping children identify relevant problems, name their goals, brainstorm possible solutions, and pick a solution to try out. Goal setting helps families identify how they would like things to be different, and how to monitor change. Parents and children can select family goals together and practice them as they plan for future challenges, recognizing incremental improvements over time.

Resources

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The Invisible Injuries of War: Impact on Military Families and Children | BrainLine

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The invisible injuries of service members resulting from our nation's war on terrorism pose complex challenges for military families, especially military children. With injuries such as post traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI), there are often dramatic changes in personality and behavior without a change in one's appearance.

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The physical pain of war is worth the freedom for our country.

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Medical marijuana can help cure the long term mental affects of war.

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War & Military Mental Health Article (Jenna)

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War & Military Mental Health Article (Jenna)

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War can harm one mentally.

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There are many ways to contact loved ones during war.

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World War II had its "V-mail" - photographed, miniaturized letters both to and from servicemen. Today's war has e-mail.

"In Iraq, there were guys who'd been in for more than 20 years who would constantly give us young guys crap," about using technology to communicate, says Marcus Penn, a 25-year-old Marine from Beaufort, S.C. "They'd say, 'When I was in Desert Storm, we didn't have e-mail. I went for a month and a half without talking to my family.' We'd say, 'Welcome to the 21st century.' "

Aside from e-mail, and depending on access and availability, 21st century military men and women have a host of technological options to help them stay in touch with friends and family back home: cell phones, Skype voice calls using the Internet- e-cards, instant messaging, message CDs, and even social media sites like Facebook.

Penn, who spent eight months in the Al Anbar province of Iraq in 2007, didn't have access to a cell phone or Skype, but he did have e-mail capability.

"My wife still has my e-mails," he says. "I sent 1,845 from the day I left to the day I got back. That's not counting the Google chats."

Although he was fighting halfway around the world, Penn says Internet access and e-mail helped him feel much less isolated.

"Whenever we lost somebody, whenever somebody died, we'd go into communications blackout - it's part of the military procedure to protect the family until notification is made," he says. "We'd basically cut off all access to the outside world - no phones, no Internet. And you'd feel that absence. When you'd come out of it, it would be a giant relief. You realized the world was still out there."

Technology also helped him keep track of important developments back home.

"Our daughter was born two months before I left," he says. "But my wife was awesome about taking pictures and uploading them to Google's Picasa" photo-sharing site. "She would take about a week's worth of pictures and then upload them in one big batch. It definitely closed up the distance."

'On a business trip'
Tonya Gustafson, a 26-year-old Seattle marketing consultant whose husband left for Iraq five months after their 2008 wedding, says the ability to keep in constant contact made an "enormous difference" in her brand-new marriage.

"It felt like one of us was on a business trip and would be home shortly," she says. "There was enough communication that it didn't feel like he was so far away. It was still difficult and I would spend nights crying, but he told me ahead of time what technology they had. I knew we'd be able to connect daily."

Gustafon's husband, a member of the Washington State National Guard who was deployed for more than a year, primarily used Skype to stay in touch.

"He paid $3 a month to be able to call my cell phone with his Skype account," she says. "I would wake up at 4:30 a.m. to talk to him for about an hour before going to the gym. It was the highlight of my day. I would even make a 'talk list,' things I wanted to remember to tell him or funny things that happened throughout the day. Although 10 hours later, they sometimes weren't as funny."

Gustafson says she believes keeping in touch via Skype and e-mail helped make her marriage stronger.

"A year passed and we didn't skip a beat," she says. "I'd actually say it benefited our relationship because the only way we had to express ourselves was by talking. Most couples take for granted how often they get to see their spouse; they don't realize how much they communicate through non-verbal means. You can't have that when they're deployed. You have to come up with the words to express yourself at every moment. I think our relationship deepened."

Technical difficulties
Of course, not all deployed personnel have access to all the latest, greatest technology.

Whitney Izzo, a 25-year-old director of operations from Carlsbad, Calif., says her fiancée, currently stationed in Afghanistan, has only been able to use Skype once.

"Some families get to Skype all the time or have e-mail or communicate through Facebook," she says. "I'm so glad that some people have that, but it's definitely not something everybody has."

Izzo says she and her fiancée use letters, e-mail, and a cell phone to keep in touch, but that technical difficulties are often a problem.

"The Internet is slow and is not always reliable," she says. "And the same goes for the cell phones. You have to hope the cell towers are working. Or that the circuits aren't busy. Sometime, it will take maybe three hours to finally get through, then we'll talk for two minutes and get cut off. There's not always great communication."

Base telephones also have issues, she says.

"Even on the larger bases, it's basically a ton of people in one tiny room with no privacy," she says. "They're great when they have them set up," but even then, her fiancée "has to wait in a line that could be an hour long."

Allison Hester, a 40-year-old freelance graphic designer - from North Little Rock, Ark., says she usually communicates with her husband via e-mail, but has found not everything gets through the military's firewall.

"I sent my husband a couple of videos, but the military computer system wouldn't let him open them," she says. "He also couldn't do Facebook or anything like that because of security concerns."

Hester says during her husband's current deployment - he just left for a 14-month tour of duty in Afghanistan - the two will most likely rely on letters.

"Eventually he'll be able to get e-mail, but I imagine it's mostly going to be snail mail," she says. "We're the non-technology people."

Old vs. new
While today's communications choices are vast and growing each day -- a new startup, Speaksake.com, - compiles and sends CDs full of recorded messages to soldiers at war -- many agree there are still benefits to communicating the old-fashioned way.

"I certainly think the ability to communicate through e-mail and through telephone is important," says Susan Ross, associate professor of sociology at Lycoming College in Williamsport, Pa.. "But it doesn't diminish the importance of a care package or actual letter. A care package is a symbolic gesture. It says: 'I've taken the time to gather things for you, wrap it all up, go to the post office and ship it.' It's very tangible evidence that you're not forgotten."

Letters, too, require more time and thought, says Stephanie Coontz, director of research and public education for the Council on Contemporary Families.

"I do think steady communication can be a real boon for parted couples," says Coontz, also a social historian and author of "Marriage, A History."

"But the big advantage of letters is that people used to compose them, often over a few days, and think through what they wanted to say. If we did the same with e-mails, instead of just rapid-fire back and forth, it might allow couples to reach even more depth."

Whitney Izzo, whose fiancée is currently in Afghanistan, says she sees advantages in both the old and the new ways.

"Letters are something you can have forever," she says. "You can go back and reread them. It's something physical and tangible that you can keep. But it's wonderful getting something instantly. That's one thing that technology has been able to bring to people overseas. It's dangerous there and you don't know what happens on a day-to-day basis. To get something instantly means you know that two hours ago, he was OK."

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Staying in touch with loved ones during war

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World War II had its "V-mail" - photographed, miniaturized letters both to and from servicemen. Today's war has e-mail. "In Iraq, there were guys who'd been in for more than 20 years who would constantly give us young guys crap," about using technology to communicate, says Marcus Penn, a 25-year-old Marine from Beaufort, S.C.

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War can harm one physically.

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Essential Question: Does war do more harm than good?

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Essential Question: Does war do more harm than good?

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By: Laura Hillenbrand