The Importance of Asking THE QUESTION: "Have you or someone close to you ever served in the military?"

APsaA's SVI is partnering with other organizations including the AMA, the American Association of Medical Colleges, the American Academy of Nursing, the  White House's Joining Forces initiative to ensure that all health care providers ask their patients (at all age levels) "Have you or anyone you are close to served in the military?"

Harold Kudler, chair of APsaA's Service Members and Veterans Initiative, puts the problem in perspective:

Although many in American Medicine (and in government/policy) have taken it for granted that any mental health issues stemming from deployment stress would be identified and treated somewhere in the DoD/VA continuum of care, this is not possible because only 39% of all living Veterans have ever enrolled in VA and only 28% of all living Veterans use VA services in any given year.  This is despite the outstanding success of DoD and VA in getting 54% of all OEF/OIF/OND Veterans eligible to use VA to have been seen in VA  at least once.  Even when Veterans do use VA care, an estimated 40-70% are, at the same time, receiving at least some of their care from community providers who more often than not don't even ask them if they have ever served in the military and don't know that they currently ARE receiving VA care.  All this is from VA data available from its Epidemiology website and VA's Office of Rural Health.  Finally, we know from the National Vietnam Veteran Readjustment Study that 80% of Vietnam Veterans who actually HAD PTSD at the time of that study (published 1990) had NEVER gone to VA for mental health care.  Even though VA is doing an outstanding outreach to OEF/OIF/OND Veterans, I'm afraid that Veterans have not changed all that much and that we therefore need to be thoughtful about the large non-help seeking sample of OEF/OIF/OND Veterans and of ALL Veterans.  And none of this touches on the problem of getting the right assessment care and support for family members who may be dealing with related stressors and mental health issues stemming from them.  All of this is essential in our nation's response to having deployed over 2.5 million Servicemembers since 2001.

A comprehensive article by Davis, Blaschke, and Stafford published in NeoReviews, a Journal of the American Academy of Pediatrics February 2012 gives an overview of current perspectives of the impact of parental deployment on children and the demographics, policy and health care delivery issues that follow from an awareness of this impact.  The article, Military Children, Families, and Communities: Supporting Those Who Serve, points out that up to 50% of the 2 million military children receive pediatric care outside of the military and VA system. 


Though it remains in need of a great deal more attention and awareness, the issue of transgenerational transmission of combat trauma is not new to psychoanalysts.

Kerry Novick called our attention to a classic article on transgenerational transmission of military trauma. "Secondary Traumatization in Children of Vietnam Veterans" was written by Robert Rosenheck and Pramila Nathan in 1980 (Hospital and Community Psychiatry, Vol 36, No. 5.)

Ms. Novick writes,

In the early 1980s a colleague consulted me about a number of children in her practice who were all showing similar configurations of anxiety, phobias, difficulty sleeping, school problems and withdrawal, sometimes alternating with out-of-control wild behavior. As we talked about the children and their families some common factors emerged. All their fathers had served in Vietnam, several for multiple tours, and these vets had struggled on reentry to civilian life. We heard about volatility, alcohol misuse, physical violence, nightmares, irritability and more in the grownups. It seems commonplace now to be able to characterize such difficult experiences in terms of PTSD, but it was new territory then to understand the fathers' troubles and their generational impact. Rosenheck and Kamila's article in 1985 was a clarifying and validating piece of work; it told us that we were not alone in identifying the phenomena, nor in attributing the family fallout to issues arising from combat service. With these insights, we could offer more effective and thoughtful interventions to help multiple generations.

Posted by Prudence Gourguechon, M.D.