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The first few weeks of class for Combat Veteran Certificate students didn’t involve running out and buying textbooks. It involved writing a farewell letter to family, receiving a pair of green dog tags and several packets of ready-to-eat military rations.
This is part of MSU’s new immersion style course on how to treat combat veterans for PTSD and combat trauma. Last year, the U.S. Department of Veterans Affairs released a study of veteran suicides from 2005 to 2016. It found that on average approximately 6,132 veterans and 1,387 service members die each year from this cause. That’s nearly 20 lives lost per day.
This means veteran suicides surpass the total 6,951 military combat deaths in the wars in Iraq and Afghanistan from 2001 to 2018 in one year.
Tina Blaschke-Thompson, a senior clinical instructor of the MSU Combat Veteran Certificate courses, speaks from experience. Her husband Kevin Thompson, a former marine who served for seven years, struggled with PTSD and depression after returning home from the Iraq War.
She noticed that nothing in her over 10 years of experience working in social work prepared her for this.
“By not digging deep into that combat trauma to develop a thorough understanding of what that looks like, social workers won’t be prepared to help a veteran ever work through it,” Blaschke-Thompson said. “That’s what we experienced through my husband meeting helpers who had no idea what he went through.”
Right off the bat was one faux pas after another with Thompson’s social workers, Blaschke-Thompson recalls. One called Thompson a “soldier,” a designation from the Army instead of the Marines.
A slip such as this shows a cultural gap between the people treating these service people and the service people themselves, Blaschke-Thompson said.
The Department of Veteran Affairs is the largest single employer of social workers in the U.S., but many of them do not specialize in combat trauma, Blaschke-Thompson said.
“Military social work is very broad. The combat piece is just a really small piece of what they cover,” she said. “Through my experience with my husband, his combat experience is what was especially traumatic.”
Seeing a void in treatment, she contacted Glenn Stutzky, a fellow senior clinical instructor of social work at MSU. The pair looked into the topic and found there were little to no dedicated courses or programs on combat trauma for social workers in the U.S.
Another disconnect the instructors found was between service people and medical providers.
“The predominant diagnosis for people coming back from war who are having difficulties, especially if it looks like it has an emotional element, is PTSD,” Stutzky said.
PTSD is predominantly a stress and anxiety disorder well researched with treatment methods since the Vietnam War, he added.
“Tina and I were looking at this wondering, ‘Why are suicide rates still so stable?’ Seven thousand people a year is not a small amount when you are talking about how less than 1 % of the population are those actually serving in the military.”
They came across developing research on the concept of treating "moral injury," making it a prime focus in the fight against veteran depression.
Psychiatrist Jonathan Shay coined the term working with Vietnam veterans, defining it as “betrayal of what is right by someone who holds legitimate authority in a high stakes situation.”
Stutzky said, “They have seen, smelled and heard things where it violates their deepest identity as who they are in their moral heart. It is a wound and an injury just as real as anything else.”
Part of the confusion on behalf of social work is a Venn diagram effect, where PTSD and a "moral injury" — the injury done to one's conscious, or moral, compass — see some overlapping symptoms.
“What we are doing by more clearly defining moral injury is to tease it out because it needs a different approach for healing,” Stutzky said.
In summer 2018, SW 491: Embracing the Stories of War, the first of a series of three veteran-focused social work classes were offered. Stutzky and Blaschke-Thompson decided to teach it through immersion and narrative, bringing in real combat veterans and artifacts to tell their stories.
Stutzky looks at this similar to a trainee entering the medical world testing on cadavers. “You need a certain amount of exposure to develop what you need to handle a specific situation,” he said.
There are many accounts of social workers recoiling to stories of war from their clients, which has a chilling effect on the effectiveness of therapy, he added.
Part of the solution is Stutzky and Blaschke-Thompson opening up a no-credit version of the class for human service professionals desiring to earn the newfound certification. It is $500 a class plus the cost of learning materials. All three courses are required for full certification.
The most intensive part of the immersive course came from the two days students had to spend in “combat.”
In simulated combat, students had to seclude themselves from friends, family, the Internet and all meals, except military rations, for two days. One student even carried a baseball bat with her at all times to mimic the weight of a rifle.
Joel Evers, an inaugural graduate of the certification, hiked five miles into the woods with a 90 lb. rucksack, slept outside for two days and listened to a veteran-approved playlist of music that servicemen listened to while at war.
“It was more than walking in their shoes, it was building empathy. I can’t imagine doing what they had to do in that setting. It gave us only a glimpse of what it could’ve been like for them,” Evers said.
The first group of eight students graduated with a Combat Veterans Certificate last May. Each one plans to work with veterans directly in the field post-graduation, according to Blaschke-Thompson.
In 2018, Blaschke-Thompson and Stutzky received a Council of Social Work Education Award for Innovative Teaching in Social Work for SW491: Embracing the Stories of War
“As civilians, we hold some responsibility for what goes on. We elected the officials who sent them to war,” Evers said. “With that being said, we are responsible for who they are, what they did and the consequences when they get home.”