Veterans of all ages are affected by PTSD. A variety of therapeutic and appreciation-focused programs aim to provide closure by connecting veterans with each other and their larger communities.
Closure, from a psychological standpoint, is defined as “any interaction, information, or practice that allows a person to feel that a traumatic event has been resolved” (GoodTherapy, 2015). Many veterans struggle with finding closure from traumatic events as they integrate back into their jobs, marriages, and day-to-day lives following military service. The PTSD Foundation of America defines post-traumatic stress disorder (PTSD) as “a psychiatric disorder that can occur following the experience or witnessing of a life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood” (2022b). Common symptoms of PTSD include feelings of irritation, anger, guardedness, emotional numbness or detachment, as well as nightmares and flashbacks, insomnia, poor concentration, and loss of interest in normal daily activities. According to the PTSD Foundation of America Executive Director, David Maulsby, up to 18% of veterans experience PTSD, with that number rising to up to 80% for combat veterans (Carey, 2022). Coping with PTSD can also be further complicated by depression, memory disorders, substance
abuse, and other physical or mental illnesses.
While PTSD is treatable, not all veterans recognize their symptoms as PTSD. Betty Baumann, RN, LCSW, has been a practicing therapist for 12 years and has worked with veterans as part of her practice. According to Baumann, “Many times veterans are referred to me because they are having issues in their marriage, relationships, and work. PTSD can be subtle, so the
veteran may not initially connect the challenges they are having in their day-to-day life with their military service” (B. Baumann, personal communication, May 31, 2022). While some veterans in need of closure may have served more recently, stigmas around talking about military service and sharing vulnerabilities may result in veterans struggling to find closure for many years after their service. Therefore, many programs, such as those discussed in this article, are available to all veterans, no matter how long ago they served in the military.
Examples of Community Programs
There are many community programs aimed at supporting and assisting veterans in finding closure. While every program has its benefits, it is important to understand the particular benefits each program offers to understand how best to assist each veteran in connecting with one or more programs that will be most helpful in achieving closure. Below are a few examples. Honor Flight is a program which provides veterans with all-expense paid trips to Washington, D.C. to visit the memorials, thus providing the veterans with opportunities to share experiences and memories with other veterans and honor other veterans who were lost during their service. Honor Flight has a network of independently operated hubs around the country. Honor Flight’s mission is “to celebrate America’s veterans by inviting them to share in a day of honor at our nation’s memorials. Our vision is a nation where all of America’s veterans experience the honor, gratitude, and community of support they deserve” (Honor Flight Network, 2022). According to a Wisconsin chapter of the organization (Never Forgotten Honor Flight, n.d.), participants stated the following benefits from their Honor Flight experience:
● Healed open wounds
● Brought peace
● Offered the opportunity to open up and share experiences and feelings
● Went from feeling like an old man to a hero
● Fostered pride in being an American veteran
● Created sense of brotherhood and a bond
While Honor Flight is not a therapeutic program by design, it clearly has therapeutic effects for those who have participated in it and allows for closure of certain aspects of their military service experiences. For more information, visit https://www.honorflight.org/.
Camp Hope is an intensive residential program of the PTSD Foundation of America, based in Houston, Texas since 2012. It provides interim housing for a minimum of six months with a two-month transition program for veterans who may need more support in coping with PTSD beyond what support groups, weekly counseling, or weekend/weeklong retreats can provide. Participants take part in group lessons and support sessions with other military combat veterans, as well as individual mentoring sessions with certified combat trauma mentors. The focus is on individual and group counseling, as well as assistance with career, income, education, housing, and transportation to give the veteran the skills and resources to reintegrate into day-to-day life successfully once the program is complete.
A key component to the program is that families can stay at Camp Hope with the veteran, so that they can work on the issues and transition together as a family. Veterans die by suicide at a rate of over 20 per day (PTSD Foundation of America, 2022a), and the focus of Camp Hope is in preventing veteran suicide. The program also offers a 24-hour crisis support line, family and veteran support groups, and a new program called The Ranch, where any veteran struggling with coping can drop in for assistance. For more information, visit https://ptsdusa.org/camp-hope/.
Support groups and individual counseling can be an option for veterans seeking closure from traumatic events of military service. Many support groups are available specifically for veterans, but some may also benefit from PTSD support groups. Some key benefits, according to Betty Baumann, RN, LCSW, for veterans participating in PTSD support groups include:
● Adjustment back into society.
● Finding people who can relate to their experiences, when prior to participation in the
support groups, participants had felt a lack of understanding.
● Validation that what they are experiencing is relatable to others.
In her practice, Baumann has found that veterans can benefit from general support groups for PTSD, not only those specifically for veterans, due to the sense of shared experiences and
symptoms with others with PTSD. While support groups and group programs can be helpful for some, others may find individual counseling to be a better option. Michelle Donald, LCSW, who has been working in individual counseling for veterans for the last 12 years, states: “It can be challenging, especially in small towns, for veterans to participate in support groups; because the veterans do not feel
they have true privacy and confidentiality. We have had support groups in our area that did not succeed, because the participation would dwindle to too few participants to continue the group. I
have seen more veterans have success with one-on-one therapy, because they have privacy and a safe place to share” (M. Donald, personal communication, June 1, 2022). For some veterans, an individual approach is more beneficial.
Make the Connection, a campaign launched in 2011 by the Department of Veterans Affairs, seeks to connect veterans and their families with individual counseling. The initiative provides information and resources to help veterans confront the challenges of transitioning from service, facing health issues, or navigating the complexities of daily life as a civilian (Office of Public and Intergovernmental Affairs, 2011). Their website states “even if you left the military decades ago, it’s never too late to get treatment or support for whatever is troubling you. Even Veterans who didn’t realize they were dealing with a mental health condition for many years have improved their lives with support” (Make the Connection, n.d.) Strengthening relationships, renewed sense of purpose, and a brighter outlook are some of the benefits of getting help, according to Make the Connection. For resources on counseling options for veterans, please visit https://www.maketheconnection.net/.
Connecting Veterans and Programs
A variety of programs are offered through the federal government and privately that are aimed at assisting veterans in finding closure as a result of traumatic experiences related to their
military service. This article has focused on examples of different types of programs, including appreciation (Honor Flight), residential (Camp Hope), and therapeutic (support groups, individual counseling) programs, all of which can help veterans achieve closure. One of the larger challenges of helping veterans to find closure appears not to be the availability of or access to programs, but rather engaging veterans with the programs. Some of the challenges to seeking help include:
● Military, generational, cultural, and societal stigmas around seeking help
● The norm of veterans avoiding talking about their military experiences
● Addiction to drugs or alcohol
● Mental illness
For healthcare and other professionals working with veterans, it seems one of the greatest challenges may be in maintaining persistence in working with veterans who need closure and staying committed to helping them to connect with a program that is right for their individual needs.
It is also important to recognize that veterans of any age may still be struggling with issues from service decades ago, and they may find great benefits and closure from participating in programs many years after their last day of service. Colonel David Hackworth said, “Bravery is being the only one who knows you are afraid.” This quote epitomizes the mindset ingrained into those who serve in our military forces. Many would argue that this mindset is part of what it takes to survive in some situations that our military encounters in their service. However, this mindset can be an obstacle to veterans finding closure, as they may still be putting on a brave face, when they truly need help. Some have done so for so long that they do not even recognize when help is needed. According to Make the Connection (2022), signs and symptoms to be aware of in veterans who may need help include:
● Anger and irritability
● Chronic pain
● Confusion, difficulty concentrating
● Dizziness, headaches
● Eating problems
● Feelings of hopelessness
● Nightmares, trouble sleeping
● Noise or light irritation
● Reckless behavior
● Social withdrawal/isolation
● Stress and anxiety
Because there can often be a lack of awareness by the veteran that what they are experiencing may be a result of military trauma, the first steps may involve helping the veteran to recognize this connection and that getting help can bring about improvement. Next, assist the Veteran in exploring the types of programs available and connecting with these programs. The VA has a search engine for programs at https://www.mentalhealth.va.gov.
Having the support of professionals, friends, and family in committing to programs and seeing the program through to the end is an important part of gaining closure. Some programs may involve a commitment of months or years, depending on the type of program. The veteran may also need support and education around the importance of committing to a long-term program when this is needed, depending on the severity of their issues.