Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 16 The Experience of Vulnerability in Geriatric Combat Veterans 333
attachments. It is critical to understand how and why attachments are
formed during combat in order to fully comprehend and effectively treat
survivors’ guilt and their impairments to interpersonal relating and social
and familial functioning.
When the ego is encouraged to identify with larger archetypal categories,
it is a short step to living out the self in an archetypal drama of war—
identifying the self as hero. When this happens, the boundaries of real and
perceived power blur, moral judgment is impaired, and personal feelings
become marginally or completely inaccessible.
Martha Nussbaum (2007) suggests, in her work Upheavals of Thought,
that the affective component is so critical to informed thinking and decision
making that its absence impairs the individual capacity for moral/ethical
right judgment and decision making.
When the combat veteran returns home, he or she does not easily or
frequently shed the thought distortions acquired in the combative experience.
Similarly, the combat veteran is unconscious of changes in his or her
personality; these changes are not self-apparent, although they might be
apparent to others. Many are disinclined to express emotion and demonstrate
a tendency to repress tender and sensitive feelings as well as feelings
associated with vulnerability and anxiety. Combat veterans identify their
postwar life as one of survival but not living. Countless veterans with chronic
and severe PTSD shun the feelings that accompany many nonthreatening
and pleasant activities of living. For many, their families become the new
squad; the veterans’ role is to keep everyone safe. Even their health and
mental health providers may be viewed as members of a squad from whom
they expect safety and protection and for whom they will provide safety and
protection if needed.
There are four typical behaviors of combat veterans with severe PTSD:
avoidance, withdrawal, protection, and reaction. All these behaviors are designed
to ward off anxious feelings and thoughts. These behaviors correlate
to the five basic problematic areas identified in cognitive processing
therapy, or CPT (Resick, Monson, Price, & Chard, 2007), as beliefs that are
evident in many areas of life. These cognitive distortions manifest in relation
to safety, trust, power and control, self-esteem, and intimacy.
The Avoidance of as Many Stressors
in Daily Life as Possible
The avoidance of remembering events from war, as well as the avoidance
of as many stressors in daily life as possible, consumes a large portion of