Abstract
The discourse on psychosocial reintegration of combat veterans in the United States has largely been confined to discussions of the best treatment for those diagnosed with psychiatric disorders. Yet analysis of the data indicates that all combat veterans are changed by their experience. It also indicates that the current medical model of treatment is insufficient. The author suggests that another model is called for; one that benefits from psychoanalytic insights on war and violence. A model that supports veterans’ experience of changed consciousness might best help them form a coherent narrative that connects their past lives and combat experience to their lives going forward. She argues that this approach may not have been taken because the same mental processes that cause combat veterans to split off their experiences also cause society as a whole to distance itself from them. Clinicians can be most effective when they create a link to the veteran by acknowledging the veteran as part of society, not a split off aberration, and recognizing the universal role of aggression within and without in creating the war that the veterans fought, and shaping the social response to their return. Literature drawn from psychoanalysis, cognitive neuroscience, and clinicians from the global south is combined with that of military psychiatry and global relief and development to support these positions.
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Notes
Each service has a distinct name for its members; i.e. soldier, sailor, marine. The terms “warrior” or “war fighter” are used by the military to include combatants of any rank, from all of the armed services. In international law the term combatant is used. Therefore, these are the terms used in this paper.
Two exceptions are the US and Iraq where such programs were not implemented to date.
Lira is a Chilean psychoanalyst who published under a pseudonym while treating patients in the midst of a period of dangerous repression, when many of her colleagues were sent to secret prisons and murdered.
These were similar to the same ones noted in Freud (Freud 1913/1974 p. 37) but attributed by him to Timorese, and other Pacific Islanders.
Shay calls this the thumus, Melanie Klein calls it reparation.
See Freud’s Dora case (1905), in which 16 year-old Dora is assaulted by a friend of her father, as part of a perverse bargain related to her father’s own affairs.
He now reports that he sustained several minor physical injuries, affecting movement in one of his arms, legs and some back pain for which he has applied for treatment.
That requires helping the veteran patient to connect to social means of doing something that is valued in society, for which he can receive acknowledgement as a person capable of doing good things. Both Jonathan Shay and the Iraq Afghanistan Veterans Association and Rolling Thunder, a Vietnam era veterans group have advocated for the kind of service component to reintegration that have been supported by the programs in Angola and Liberia described earlier in this paper.
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Bragin, M. Can Anyone Here Know Who I Am? Co-constructing Meaningful Narratives With Combat Veterans. Clin Soc Work J 38, 316–326 (2010). https://doi.org/10.1007/s10615-010-0267-4
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DOI: https://doi.org/10.1007/s10615-010-0267-4