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Aftershocks of War

November 28, 2004

Dan is a true hero of the war in Iraq, and he has the Bronze Star to prove it. A staff sergeant in the Army Reserve, Dan is part of a psychological operations unit that helped lead_ the way to places most of us know only as exotic names from the evening news: Nasiriyah, Baghdad, Tikrit.

It was near Nasiriyah that Dan earned the Bronze Star for meritorious service. He and his team were shepherding about 30 Iraqi civilians to safety while U.S. Marines were setting off explosives nearby. Suddenly, Dan’s group came under enemy fire. Refusing to leave the civilians defenseless, Dan climbed onto the hood of a slow- moving Humvee and started firing back, shielding the civilians as they moved up the road to the safe area controlled by the Marines.

It was only after Dan returned home to Maryland that things began to fall apart. The company where he had worked as director of sales and marketing was gone, so he had to find a new job. He also had to adjust to married life because, in the long tradition of soldiers shipping out, he had married his girlfriend just four days before leaving for Iraq.

On top of that, there was the emotional residue of war. One of his unit’s missions had involved broadcasting surrender appeals over loudspeakers, which led to many harrowing moments. “As soon as we cranked that thing up, we were immediately a target,” Dan recalls. In a place where the days were punctuated by gunfire and grenades, a constant state of vigilance served him well. Back home, though, it was hard to let his guard down again. Something as innocuous as the banging noise of a trash truck was enough to set off alarm bells in his brain.

Dan went through a series of jobs in his first months back. He had trouble concentrating, and he showed up late for work. To make matters worse, he was plagued by back pain from an injury he sustained in a Humvee accident. Fortunately, Dan has since found a half-day sales job with an understanding employer. But he has yet to seek counseling, and he still seems to be struggling to grasp how his life could have changed so dramatically in such a short time.

To Iraq and Back

Dan’s struggle is far from unique, and stories such as his are apt to be repeated many times over as the military completes a massive rotation of troops into and out of Iraq. Of course, not everyone goes through a difficult readjustment period when they return. Dan himself had an easier time after coming home from an earlier deployment to Bosnia. For some, though, the stress of wartime service continues to exact a harsh toll long after the last shot has been fired.

For human resource professionals, this presents a twofold challenge: first, to understand what returning war veterans have been through-and may still be experiencing-and second, to be alert for signs that a little outside help might ease their transition back into their civilian jobs. Fortunately, we now know more than we ever did about how to spot war-related problems early and how to provide people with the emotional and practical support they need to heal.

Making use of that information will be particularly important in the coming months because many experts expect the war in Iraq to lead to more postwar psychological fallout than other recent conflicts. For one thing, there is the magnitude and duration of the war. “To put it in perspective, this has been the largest and longest-lasting mobilization [of the Reserve and National Guard] since the Korean War,” says COL John O’Shea, USA (Ret.), consultant to ROA’s Defense Education Forum.

Then there is the high-anxiety nature of the combat. “This has been a much more difficult operation than the first Gulf War,” notes John Thompson Jr., a former military psychiatrist who now teaches at Tulane University School of Medicine in New Orleans. This time around, our forces have had to contend with more exposure to traditional warfare as well as the injuries and fatalities that go with it. Add to that the everpresent threat of terrorist attacks and the unpredictable risk of conducting door-to-door searches, factor in difficult living conditions, and you have a recipe for fatigue, stress and possible trauma.

Among troops still in the field, this stress has manifested itself in a suicide rate that appears to be higher than peacetime military rates. (As of February 2004, there were at least 18 suicides among service members in Operation Iraqi Freedom, according to the Department of Defense. The actual number may be higher and is a source of some controversy. As of this writing, additional information from the Defense Department is expected shortly.) In veterans who have returned home, such stress may lead to a host of adjustment problems.

At times, it may turn into full-blown post-traumatic stress disorder (PTSD)-an anxiety disorder that can develop in survivors of any terrifying ordeal in which there was a threat of serious bodily harm. In general, about 30 percent of individuals who spend time in a war zone go on to develop PTSD, according to data from the National Institute of Mental Health. Among those who spend extended periods of time in a high-risk situation, however, the odds of developing at least a few PTSD-like symptoms may rise to between 50 percent and 70 percent, says Thompson.

Explosive Mind-Fields

They called it shell shock after World War I and combat fatigue after World War II. Since Vietnam, PTSD has been the term du jour. Whatever you call it, people have long recognized that soldiers returning from battle frequently have lingering emotional and behavioral reactions to the trauma they have endured. Sometimes, the reactions are limited and go away on their own.

“The only problem I had after I came back was trouble sleeping,” says Derrick Smith, a senior supervisor at New York utility company KeySpan, who was deployed to Iraq with his Marine Corps Reserve communications unit. “After a couple of weeks, though, slowly but surely, I got back to normal.”

For other people, however, problems persist, interfering with their lives at home and at work and often causing considerable distress and confusion.

Some veterans with war-related stress reactions are bothered by unwanted memories, flashbacks or nightmares. Others are troubled by emotional numbness, depression or self-blame for something they did or failed to do in combat. Still others are unable to let their defenses back down, even though the threat of imminent attack has now passed. Instead, they live in a continuing state of high alertness. This may show up as insomnia, irritability, angry outbursts, difficulty concentrating, anxiety, panic attacks, being easily startled or being constantly on the lookout for danger.

Injured But Not Broken

Thanks to modern advances in body armor and medical science, more soldiers are surviving injuries that would have been fatal in the past. That’s undeniably good news, but it also means that some employees may be battling pain and disability long after they’ve returned home. Soldiers who have been injured in battle also are at high risk for developing post-traumatic stress disorder (PTSD).

“The military medical centers are already treating a lot of orthopedic injuries, and they’re seeing that almost half of those people have PTSD,” says Patrick Calhoun, a staff psychologist at the Durham VA Medical Center in North Carolina.

Health-care coverage for injuries incurred while serving in the military is provided by the government. Nevertheless, the return of these soldiers raises some issues for employers.

“Developing work opportunities for those who have been injured will be a challenge,” says Robert Ursano, director of the Center for the Study of Traumatic Stress in Bethesda, Md. “These individuals need to be given an opportunity to succeed. Feeling that they are contributing at work is critical to their self-esteem, and that may require some job accommodation.

Such symptoms usually appear within the first three months after a traumatic event, although occasionally they may lie dormant for years. About half the time, the symptoms go away within a few months. The rest of the time, they stick around for longer. Even after the symptoms seem to have vanished, however, a recurrence may be triggered by reminders of the traumatic event or by new sources of stress in the person’s life.

If you have employees returning from Iraq, a little sensitivity to the stress they may be experiencing can go a long way. Joseph Mancusi, a psychologist, speaker and consultant who formerly was national director of the U.S. Department of Veterans Affairs (VA) psychology program, suggests that you watch for the following warning flags:

An Army National Guard soldier from North Carolina’s 30th Brigade Combat Team checks out a vacant vehicle parked on a quiet road during a late night presence patrol in eastern Iraq.

* Personality changes such as irritability, anger, anxiety or withdrawal

* Tardiness or absenteeism

* Trouble completing work on time

* Conflict with co-workers

* Increase in accidents or close calls

* Drop in motivation or performance

* Evidence of alcohol or drug abuse

There’s nothing unique about such signs, of course. They’re similar to the signs of many other psychological and behavioral problems. PTSD is not exclusively an issue for veterans, either. It can affect anyone who has been through a traumatic ordeal. Nevertheless, t\he horrible events that are the everyday stuff of war-such as firing a weapon at another person, being fired on, sustaining a serious injury, witnessing the maiming or death of others, or living in constant fear of attack-are powerful risk factors. It’s little wonder that some vets take a while to heal.

Reaching out to these individuals is, first and foremost, an act of caring. However, it also makes sound financial sense. PTSD affects a number of physiological systems that are involved in the body’s stress response, which can give rise to a host of physical symptoms. It also increases the risk of depression and hostility, both of which have been linked to poor health. In addition, people with untreated PTSD tend to abuse alcohol and other drugs at high rates. The bottom line is that PTSD raises the risk for a broad range of medical conditions.

“There is an increase in circulatory, digestive, musculoskeletal, nervous and respiratory diseases,” says Patrick Calhoun, a staff psychologist at the Durham VA Medical Center in North Carolina. Although hard data are not available yet, it seems logical that the cost of employee reintegration and assistance services might be more than offset by future health-care savings, says Calhoun.

Defusing the Stress

Two keys to helping your returning employees cope are common sense and compassion, says Elaine Weinstein, PHR, senior vice president of human resources at KeySpan. The company has had 28 employees, including Smith, mobilized since September 11. Twenty have since returned.

“I try to anticipate what they might need to help them come back and readjust well,” says Weinstein. If supervisors see that an employee is not 100 percent yet, “we might work out a gradual re- entry process or a flexible work arrangement. We’ll do whatever it takes to make sure the Reservist is integrated back in a sympathetic way.”

She offers this advice to other HR professionals: “Although your policies and practices may not explicitly state what you should do, treat them as you would wish to be treated after leaving your family and supporting your country.”

Bruce Blythe, CEO of Atlanta-based Crisis Management International-which provides consulting and mental health services to companies whose employees have been affected by crises such as September 11, the Oklahoma City bombing and Hurricane Andrew- seconds the need for an individualized approach. “We suggest that the person who is returning have some say-so in how the workplace responds to him or her,” he says. “Have a meeting with the person before he or she comes back to work. Say, ‘Let’s talk about your reentry-what you can expect, what you’d like from us, how’d you like it to be handled, and what you want communicated to others.’ “

Some people are eager to move full-speed ahead. “I jumped right back in,” says Steve LaBarbera, a supervisor in the retirement services group at Merrill Lynch in New York, whose Marine Corps Reserve unit patrolled cities in Iraq.

Others, however, need a more gradual transition. In that case, it may help to brainstorm with the supervisor about possible ways to ease the person back into his or her job, says Blythe.

Robert Ursano, director of the Center for the Study of Traumatic Stress in Bethesda, Md., adds that a training course is often a good way to bring employees back up to speed gradually without expecting them to assume a full workload immediately.

Managing the reception from co-workers is another sensitive issue. “Co-workers often feel unsure about how they’re supposed to behave,” says Blythe. “They think, ‘There’s no telling what this person has been through. Should I ask about it or not? Can I still joke around, or do I have to watch everything I say?’” The veteran, meanwhile, may have no idea why everyone is acting so awkward and stilted. All the vet knows is that people aren’t treating him or her the same as before.

You can help the returning employee understand what’s going on and suggest possible strategies for handling the situation. Because everyone is different, though, let that individual guide you in what feels comfortable for him or her.

“The No. 1 rule is, when a person wants to talk, he will,” says Mancusi. Until then, respect the person’s silence. Trying to force disclosures too soon can do much more harm than good.

If the person is ready, however, one option might be to call a meeting of the workgroup where the veteran can share stories and photos. Some may want to say, “I’m going to tell this once, and then I don’t want to discuss it again.” Others may say, “If you have any questions, feel free to ask at any time.” The only rule is that the veteran should help define how other people interact with him or her.

“People are naturally resilient,” says Blythe. Many are able to fully resume their old jobs in a matter of weeks. If a returning employee seems to be struggling, however, a prompt referral to the employee assistance program (EAP) can help smooth out a bumpy re- entry and possibly avert future problems. War veterans who seem to have PTSD-like symptoms may also benefit from a reminder about the specialized counseling provided by the U.S. Department of Veterans Affairs through its VA medical centers and Readjustment Counseling Service vet centers.

The Rest of the Vets

Of course, not everyone who is called up for military service winds up on the front lines. Thankfully, many mobilized members of the National Guard or Reserve have not had to face great danger to life and limb. Still, virtually all have had to contend with the substantial stress of leaving their ordinary lives behind on short notice.

Take Angee Linsey, a senior consultant in the Walnut Creek, Calif., office of career services firm Lee Hecht Harrison. Linsey, who is also a lieutenant commander in the Naval Reserve, was deployed to a post in Italy in the aftermath of September 11. Although she had been told the deployment would last a year, she was sent home after only five months.

“With four days’ notice, I was literally plucked out of my life and all that was familiar to me,” she says. “Then, with four days notice on the other side, I was dropped back into my life here.”

Although she felt fortunate in her military assignment and grateful to be sent home earlier than expected, it was disorienting. Her work team had assumed she would be gone longer, and someone else was temporarily doing her job. “I felt a bit disconnected,” Linsey says.

Although returning employees such as Linsey aren’t at risk for PTSD, they can still experience plenty of garden-variety stress caused by the disruption in their lives. They, too, may need time to take care of personal business and get reacquainted with their loved ones before returning full time to work. When back on the job, many may require a gradual reorientation period as well.

“It’s like time stopped for them in terms of their organizational history,” says Cynthia McCabe, a managing consultant in the Cleveland office of DBM, a global human resource firm. Meanwhile, back at the office, tasks that the person used to do have been redistributed, and changes in co-workers, clients, hardware, software, products and services have all continued apace. It is easy to see why a little catch-up time is often necessary.

For any returning members of the National Guard or Reserve, whether they were stationed across the country or across the globe, simply taking time to say, “welcome back” and “thank you for the sacrifices you’ve made” can make a world of difference.

“If somebody is coming back, let the company or work team know,” says Ursano. “You might have a small gift, a cake or ribbons on the person’s chair and desk. The boss could make a special point of reaching out to say, ‘We’re glad you’re back.’ “

Once again, though, the exact form this takes needs to be tailored to the culture of the workplace and the personality of the returning individual. Some may be embarrassed by a lot of hoopla, others may appreciate the attention.

If you have several mobilized employees, it might be a good idea to create standard information packets to give them on their return. The packet could include information about their rights and responsibilities under the Uniformed Services Employment and Reemployment Rights Act. The packet could also describe services provided through the EAP for veterans who are experiencing trouble readjusting. In addition, it could offer guidance on which health- care services are covered by the employer’s plan and which by the government’s.

In general, “if they come back after serving and report within the approved time, they go right back into the employer’s health plan just as if they had never left,” says John Wirtshafter, an employee benefits attorney at the law firm McDonald Hopkins in Cleveland. “But if they were injured while serving, that injury would be covered under the government’s plan, not the employer’s.”

The Few, the Proud, the Employees

Of course, Blythe points out, no packet can ever take the place of simply sitting down with returning employees and discussing their personal needs and concerns. It’s a scene human resource professionals will play out many times in the years to come if, as some experts say, our military continues to rely ever more heavily on the National Guard and Reserve. The payoff, says Ursano, is the retention of mature, dedicated employees who have received valuable leadership and job skills training courtesy of Uncle Sam.

For most, the transition back to everyday life will probably be relatively painless after the first few hectic weeks have passed. For some, however, the stress of wartime service may last longer. Early recognition of trouble signs and prompt referral to appropriate counseling or other resources may mean the difference between continued distress and fast recovery for many of these individuals.

“If there’s one thing we’ve learned from research,” says Blythe, “it’s that a strong support system is hi\ghly correlated with resiliency and recovery.”

Soldiers returning from Iraq are likely to need their human resource department’s help in coping with delayed emotional trauma.

Ms. Andrews is a freelance writer in Albuquerque, who has specialized in health and psychology issues for two decades.

Reprinted from HR Magazine, April 2004, Vol. 49, No. 4. Reprint permission granted through the Copyright Clearance Center.

Copyright Reserve Officers Association Nov 2004




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