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ILLUSTRATION: FRED SEBASTIAN

Sitting in a dentist’s chair, Susan Binnie asks if she can stay after the dentist is through—just so she can soak up the peace. She lives near St. Albert, northwest of Edmonton with her two daughters, aged nine and 14, and her husband, a veteran who has struggled with post-traumatic stress disorder (PTSD) for 15 years. Binnie has discovered if one person in the family has PTSD, the whole family suffers.

And so she takes her peace where she finds it.

Angelle Peacock, a mother of two small boys, lives in Morinville, Alta. She is also coping with post traumatic stress disorder (PTSD). Her husband Ted, a serving member of the military, is in treatment, and at times it has been like she has three small children, especially when her husband has had to be reminded to eat or to shower.

Both women describe other instances when typical childhood behaviour has triggered angry outbursts or flashbacks from their husbands. Both are juggling full-time jobs and family issues that demand full-time attention.

These women—and hundreds more across Canada—cannot turn to colleagues at work or chums for support because those who don’t live under the umbra of Operational Stress Injury just won’t understand. “They say, ‘Why don’t you leave?’” says Binnie. Peacock adds: “I’ve woken in the night to find my husband has taken out a window and is in the backyard ‘fighting bad guys.’ How do you go to work the next day, and over coffee say, ‘You know what’s going on at my house?’”

“We never get, ‘Oh, how do you do it or Oh, you’ve got to leave him,’” in regular group meetings of the area Operational Stress Injury Social Support (OSISS) Family Support Network, adds Binnie.

“You don’t get pity,” says Peacock. And these women don’t want pity; they want help and they get it from others who’ve walked in their shoes. “What they’re saying is, ‘Help, has somebody else lived this?’ And then stories come out, and the suggestions come out and the strategies come out,” adds Elizabeth Atkins, the Western Region OSISS family peer support co-ordinator in Edmonton. Meetings are places to get information about other community resources, Veterans Affairs Canada (VAC) and Canadian Forces (CF) programs, The Royal Canadian Legion and its service bureau. And members exchange phone numbers so if someone is having a bad day, there’s someone available to listen.

“Military wives are the caregivers; their job description is to be supportive, no matter what,” she says. When their husbands come home injured, “they remember the good guy; they remember who they married and they still love him. So it’s their job to fix them.” Such understanding is worlds apart from what Atkins was given after her own husband was injured in Bosnia in 1993, in the days when no one talked about OSIs. “We still have a long way to go, but there is information, and the isolation is not as severe.” More importantly, OSIs are now out in the open, and people are talking about them.

The national OSISS family program was created in 2005 following a CF needs analysis that recognized the impact of OSIs on military families and the importance of providing support. It’s based on the model of the OSISS peer support program for military members and veterans created in 2001. Peer support coordinators in both programs have personal experience with OSIs, either coping themselves with an injury or living with someone who has one. “They have ‘street cred[ibility],’” says Lieutenant-Colonel Stéphane Grenier, an OSI sufferer himself, who helped design the program.

“They just get it,” adds Binnie.

Families must cope with personality changes and unusual behaviours, including out-of-proportion anger, drinking problems, sleeping problems, mood swings, inability to concentrate, hyper-vigilance, shame and grief, lack of energy or appetite, thoughts of suicide. Each family has its own cocktail of grief and stress. “There is no cookie-cutter solution,” adds Atkins, who has helped about 130 families in the past five years, doing needs assessments, meeting clients for coffee, arranging and facilitating evening groups, providing support. She hopes the CF’s new Integrated Personnel Support Centres (IPSC) will absorb some of the load. The military is “trying to make it more user friendly for families” who can also benefit from the “one-stop support” philosophy in which all support services for their spouses are located in one place.

Angelle Peacock hopes dealing with the new support centres will be an improvement over the older system and its frustrations. “They sure didn’t make it user-friendly,” she said, describing going office to office, picking up and filling in forms, collecting records, enough in two years to fill a double-wide kitchen drawer. Then there was “dealing with a lot of people in uniform who didn’t want to deal with the wife.” Coping with Ted’s symptoms and wading through red tape to get him the help he needs has been very stressful on the whole family, even though her husband’s commanding officer and unit were tremendously supportive.

“Families have to be the advocate,” says Senator Roméo Dallaire, a retired general and OSI advocate who suffered an injury himself in Rwanda in the 1990s. “The injured guy can’t take care of himself, let alone figure out what papers are due when, and who he’s got to talk to” and it all has to be done within a short period of time.

“Families need the confidence that they can advocate,” adds Atkins, who helps them learn when it’s a good time to step in, and how to go about it effectively.

As well, OSISS doesn’t need to wait for a diagnosis before offering help, and services are confidential. If necessary, spouses can get help without their partners’ knowledge. “You don’t need to have a diagnosis to have symptoms. Life is still messed up. They’re not sleeping well, still reacting to things the kids are doing, still driving like an idiot…if it’s causing family problems, we can help,” explains Atkins, noting OSISS doesn’t turn anyone away.

But support isn’t therapy. The Department of National Defence/VAC crisis line can help families through a crisis, but for long-term help, many services to families “are contingent on the serving member or veteran accessing services themselves,” says Atkins. Problem is, many OSI sufferers don’t know they need help, or stubbornly try to cope on their own or are incapable of processing their paperwork while acutely ill. “Families dissolve in front of our eyes because we don’t get to them, because of red tape.”

In an interview with Legion Magazine earlier this year, Chief of Defence Staff General Walter Natynczyk stated he was acutely aware of the challenges the military faces on the home front, and must do more to support service personnel and their families (On The Move With The CDS, July/August). The support services put in place over the last year are seen as a step in that direction.

Those damaged in the line of duty deserve no less, says Dallaire, whose own family needed therapy to cope. “We do not have a system to re-stabilize the families and individuals when they come back.” He believes the CF should develop ‘best practices’ for caring for families of OSI sufferers and the government should “be prepared to pay for those practices to be delivered to the individuals and their families.”

Such help wasn’t available for previous generations of veterans and their families. “Many of the young men and women I grew up with grew up in families where the hurt and pain was handed down,” Veterans Affairs Minister Greg Thompson said at an OSI symposium in 2007. “It never left.”

Back then, veterans and their families simply had to cope on their own, and the Legion had a role in helping them, adds Dallaire. “I think the Legion saved my father, and saved my family from being physically abused far more than we were.” Veterans would go to branches where they’d find others who’d had similar experiences. “It was self-generated therapy,” says Dallaire. They’d talk about problems, and “unfortunately, drink and medicate themselves.”

“We called it the BS table,” a place where veterans could swap stories and have a drink, says Doug Lawrence, a former Legion branch service officer who spent 13 months in Korea in 1951 and 1952. In that comradeship “you realized you’re not the only one. We didn’t know what it was at the time.” But many knew what to do about it. “I turned to drink; we all did.”

Korean War and Second World War veterans suffered for decades with symptoms of OSIs, not knowing what was wrong, let alone whether they could get help. Lawrence, and George Mann, who served in Northwest Europe with the Sherbrooke Fusiliers during the Second World War, experienced a range of PTSD symptoms. For 65 years Mann has had nightmares. He and Lawrence talk about unexpected angry outbursts, mood swings and their effect on family. “I’d wake up screaming,” says Mann. “Sometimes my wife had to practically cave in my ribs to wake me up.” Lawrence says he lashed out during nightmares, forcing his wife to sleep in another room.

Mann was diagnosed with PTSD after breaking down during a tour to France in 2002. It happened during commemoration services for Canadian soldiers murdered at the Abbaye d’Ardenne in 1944. He’d known six of the soldiers, and he finally got help five years ago after a suicide attempt. Both veterans receive VAC pensions for their injuries.

The Canadian Forces’ 19 new Integrated Personnel Support Centres (IPSCs) offer the Legion a new opportunity to be of service to serving military members, veterans and their families. “It will certainly give us more visibility with younger soldiers and their families,” notes Gerry Finlay, service officer with Alberta–Northwest Territories Command, who has set up an office at the IPSC in the garrison in Edmonton.

Conceived as “one-stop service” for ill and injured CF personnel, IPSCs are meant to help CF personnel recovering from serious illness or injury in the transition either back to work or civilian life. Regular forces, reservists, retiring members and their families have access at IPCSs to a range of benefits and services from CF, VAC and organizations such as the Legion. The Legion can move quickly to provide emergency support for serving members’ families, guide members through VAC benefits claims and provide support to new veterans returning to civilian life in small communities, Finlay adds.

Often when a member is being treated for OSIs, family routines and structure break down. While the serving member uses the support and services of DND, “the family can sometimes suffer quietly on the sidelines.” But the Legion can help by providing emergency funds for shelter, food and transportation and connecting the family with a local Legion branch for community support. “We try to stabilize the situation,” says Finlay.

“The Legion is a perfect partner,” says Lt.-Col. Joe Pollock, regional commanding officer for the Joint Personnel Support Unit in Alberta/Northern Canada. “It’s reciprocal.” CF members can count on Legion help and support and in return, the Legion has access to serving members about to become veterans.

The Legion’s British Columbia/Yukon Command has also developed a more direct way of helping veterans and their families cope with OSIs. In the mid-1980s, Dr. Marvin Westwood brought together groups of veterans, in a program partly funded by the Legion, to talk about how military experience shaped their lives. “In the process, they recognized the impact war had on them in other ways,” says the University of British Columbia psychologist. “They said ‘this should have happened 60 years ago,’ when they first got out of the service.”

Westwood and the Legion ran with the idea, developing the Canadian Military and veteran Transition Program, which has helped about 170 serving members and veterans ‘drop the baggage’ from military service and get on with their lives. The program offers free, confidential group counselling programs delivered through UBC and the University of Victoria in Vancouver, Victoria and Kelowna. “The reason we initially got into it was to help Second World War veterans still suffering, and that kind of help was unheard of (back then),” says British Columbia/Yukon Command President Dave Sinclair. “Then we realized a lot of the peacekeepers needed help.”

“The focus is on transition,” says Westwood. Groups of six to eight, plus leaders, meet for intensive weekend sessions to talk about how trauma has affected their lives. They develop coping skills, identify resources for support, and are referred to complementary services where warranted. Their spouses or partners are brought in to learn how trauma affects the lives of everyone in the family. Couples learn new communication skills.

The program was expected to wane, especially with the increase of OSI programs offered by VAC and the CF. But demand has continued. “I think one reason is we include spouses,” says Sinclair. The format is also attractive, says Westwood. “It’s not advertised as a therapy program (so) there’s no stigma attached.” Group workshops are comfortable because military personnel are used to working in and being supported by a group. And they leave with a ready-made support network. “The change in these people is dramatic.”

Sinclair has seen families—on the brink of breakdown—strengthened. He’s seen those who were once broken-down drunks, unable to hold down a job, go on to have productive careers. “They’ve turned their lives around.”

It’s an investment the Legion is proud to make. “Financial support for this program has come solely from the RCL,” says Westwood. Sinclair points out the psychologists involved in the sessions donate time, keeping costs down. The $90,000 for program funding is raised from branches in the geographical area where the programs run.

There are many more options for OSI sufferers and their families today, and it’s important that they use them, and the sooner, the better, says psychologist Curt Hillier of St. John’s, Nfld., whose clientele includes many veterans and serving soldiers, some who waited years before getting help. In 30 to 50 per cent of cases “we can expect complete remission at some point down the road.” On the other hand, U.S. data shows about 30 per cent of those with PTSD “remain symptomatic for six years or more…indefinitely, in some cases.”

He hopes those statistics will change for the better with the new CF programs aimed at preparing troops prior to trauma on tours of duty, treating OSIs at the battlefront and intervening more quickly when symptoms appear.

Sometimes, OSI sufferers just don’t recognize the symptoms. Often they get help only after a spouse makes an ultimatum. For veterans who don’t get help, the road to recovery can be longer and littered with the bones of a broken family.

Invisible Wounds

Operational stress is a given in the job description for military personnel. In fighting wars, enforcing peace or responding to emergencies, they can witness horrible events, be terrified, feel helpless, lose people they care for. Sometimes they are forced to behave in a way contrary to their personal moral values.

Most suffer only temporary effects; in a few days or weeks they come to terms with what they’ve experienced and return to normal. But for a few, these experiences leave lasting problems—depression, anxiety, post-traumatic stress disorder.

Researchers are finding such operational stress disorders (OSIs) cause physical changes in the brain, invisible wounds—injuries caused by their own bodies in reaction to overwhelming stress.

The body’s stress response—sometimes called the flight or fight response—gives us the best possible chance of survival in life-threatening situations. When danger is perceived, it’s like an emergency switch is thrown, flooding the body with adrenalin to increase blood sugar, raise blood pressure and pump up the heart rate, and cortisol, to provide quick bursts of energy, heighten senses and lower sensitivity to pain.

When danger passes, different biochemicals are released to bring the body back into balance, but with an OSI, it’s like the body has forgotten how to use the off switch.

Prolonged exposure to cortisol kills cells in the hippocampus, the brain area responsible for memory and learning. PTSD and depression diminish metabolism in the prefrontal and frontal cortex, which regulate emotions and fear responses. It’s this damage that is thought to cause fear after the threat no longer exists, nightmares and flashbacks, uncontrollable outbursts of anger or sadness, intrusive memories, hypervigilence.

Brain scans of military PTSD sufferers have shown differences in brain activity compared to unaffected soldiers, leading to speculation it may one day be possible to screen out those more likely to be injured, or use brain scans for diagnosis.

But “you don’t actually have to reach a diagnostic level to say there’s been an impact and you require help,” says Norman Shields, research consultant at the National Centre for OSIs in Montreal. It’s one reason why DND and VAC prefer the umbrella term Operational Stress Injury rather than PTSD. The focus should be on helping patients rather than categorizing them. “For us, it’s more an issue of can you sleep at night, are you preoccupied about it…so long as it’s related to military experience, they’re entitled to come here and get help.”

And it is important to get help, for OSIs can have unexpected long-term consequences.

“Stress in general has a huge impact on our immune system,” says Shields. Research is showing people with OSIs have a greater risk for developing metabolic syndrome, the precursor to Type 2 diabetes; high blood pressure, heart disease and Alzheimer’s.

Aside from medication to relieve symptoms, treatments include cognitive behaviour therapy, which helps people identify distorted thoughts and negative reactions and replace them with rational thought and more benign behaviour; EMDR (Eye Movement Desensitization and Reprocessing) which is believed to re-set the brain’s information processing system allowing troubling experiences to be integrated into memory and emotionally processed; propranolol therapy, which uses a blood pressure drug to block reconsolidation of the traumatic memory; and group and family therapy, which offer support and teach new skills for coping with symptoms.

Soldiering On

Dave Fitzpatrick will never forget the day he signed up to serve his country. He lights up as he talks about joining the Royal Canadian Regiment and becoming a master sniper. “I was a good sniper; I could certainly handle myself.” He served at Oka near Montreal in 1990, Cyprus in 1991, then on back-to-back tours in Bosnia in the early 1990s.

The day he sacrificed himself for his country is also seared into his memory.

As he talks about it, he breaks into a sweat and his body becomes a tense spring. He vibrates and struggles to control himself, and he carpet bombs his conversation with the F-word.

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ILLUSTRATION: FRED SEBASTIAN

His scariest duty in Bosnia was escorting a food convoy to Sarajevo, roughly 28 kilometres southeast of the Canadian camp near Kiseljak. During one trip the convoy was stopped at a roadblock surrounded by buildings. Armed Bosnians were positioned at the windows in the buildings and in roadside trenches. The Bosnian commander demanded half the food. “Our major said no,” creating a standoff. “We heard every single weapon cock and could feel every single scope pointed at us.”

For 31⁄2 hours the Canadians were the centre of a bull’s eye as the commanders’ exchanges grew more threatening. “It would have been a bloodbath if even one guy had pulled a trigger.” Finally, the other side backed down and waved the convoy through, but not to safety. Instead, it moved through a firefight between Bosnian and Croat troops. “You don’t know if you’re going to be living from one second to the next. There were that many rounds,” he remembers. In Sarajevo there was no relief within the sandbag walls meant to protect incoming vehicles. Within minutes they were under mortar fire, hell raining down for half an hour; afterwards, they counted about 80 shell holes, and their vehicles were peppered with shrapnel. Luckily, no one was wounded.

The convoy headed to offload, leaving one vehicle—Fitzpatrick’s—to secure the route. “You go from a peacekeeping soldier to suddenly being in the middle of a war. Your defence skills kick in.” A round whistled overhead, he turned around and another sped by his left ear, knocking him out. Fitzpatrick realized later that if the sniper had compensated even a touch for wind “he would have caught me right between the eyes.”

When the other vehicles returned to where he was, “I couldn’t absorb any more. I was literally vibrating by this time. It was a blur, like a dream…that day was definitely the start. It put a shot of adrenalin in my nervous system that has never been able to leave….”

Later, while on observation duty he saw snipers firing from a hillside into a nearby village, hemming in the villagers until advancing troops arrived and killed them all. Under strict orders not to interfere and to fire only when fired upon, Fitzpatrick could only observe and report to headquarters. “I didn’t know who was in the village; I didn’t really care. I felt it was wrong…. The things that happened, no man should witness.”

When the tour ended and new units arrived, Fitzpatrick wished them luck, thinking they were in for a bagful of horrors. Little did he realize he was packing his own horrors for back home; he had suffered all four causes of operational stress injury—trauma from terrifying or horrifying events; helplessness; accumulation of stress over time, grief over loss of friends, and a “moral injury.”

While back in Canada a car backfired at a local mall and Fitzpatrick found himself on the “ground with my head covered and I’m yelling ‘Incoming! Incoming!’” Problems multiplied. He was unable to sleep, argued constantly with his wife, yelled at his kids. He felt guilty about coming home from Bosnia alive. He took anger management courses; five years of marriage counselling didn’t save him from divorce. From time to time he’d ask for help. “I was basically told to relax, to forget it and soldier on.” And he did, but he would lock himself in a bathroom stall, and “be there for hours, crying. I couldn’t control the crying.”

He’d changed from one of the fittest soldiers he knew into a guy hardly fit for company by the time his 18-year military career ended. In 1999, Fitzpatrick was diagnosed with post-traumatic stress disorder (PTSD). “That’s when my world fell apart.” It was made clear to him that his career was ending. His view was that PTSD “was an embarrassment to the unit, and I think, the forces.” On March 14, 2002, he left the service.

He’d remarried, started a family, moved to Newfoundland. In 2005, he was interviewed by a local newspaper about his experiences in Bosnia—bringing him to the attention of the Operational Stress Injury Social Support (OSISS) Peer Support Network, a joint program of the Department of National Defence and Veterans Affairs Canada. He was referred to a psychiatrist who had been in the military and then started attending a peer support group. He says it has made all the difference. “It’s been 15 years since that tour in Bosnia and I cannot stop thinking about death. The pressure, the stress of doing convoys, roadblocks, standoffs, mortar rounds, getting shot at all the time. It never leaves you.” Without OSISS, “I’d be in a straitjacket, maybe committed suicide.” He seems flabbergasted to have a wife and second family—three girls and a new baby boy in October—and feels guilty that his condition deprives them of ‘normal’ family life.

He still sees a psychologist every other week and regularly attends OSISS peer support group meetings. “There are stories you share with these guys that you can’t share with anybody else. They don’t question what you did and why you did it; because they get it.

“I’m a lot better now,” he says, adding he is proud to have served. “Pro patria, for one’s country…that was my greatest motivation.”

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