Spring 2003, Vol. 11, No. 1

Military Deployments are HARD:

The Four P'S of Helping Patients Cope with Deployment Stress

By Major Steven Pflanz, MD
Cheyenne, WY

In the coming days and months, as our nation is at war, psychiatrists and other mental health professionals are encountering patients who are military personnel deploying overseas or the family members of military personnel stationed in harm's way. These patients will, appropriately, be experiencing a considerable level of anxiety. Even when deploying to regions of the world well away from the war itself, the separation from family and regular life remains very difficult.

Deployments are HARD: Harsh, Ambiguous, Risky, and Distant. Deploying personnel live with austere conditions in the field. These environments can be uncomfortable, harsh, and severe. They have limited toilet, bathing, and laundry facilities. Recreational options can be limited. The temperature and climate can range from the very cold to the very hot. Deployment situations involve a great deal of ambiguity and uncertainty. Deploying personnel often don't know when they are deploying, where they are going, or when they are returning. The variability and unpredictability of deployments adds to the stress of the experience. Deployments are risky. Especially today, deploying military personnel are heading out to war. They are deploying to dangerous environments where they will be exposed to the threat of enemy fire and terrorist attacks. These hazardous conditions create anxiety. Lastly, deployments are distant. Military personnel are far away from friends, family, and home. They are disconnected and removed from their family life. When problems occur at home, deployed personnel have little ability to help solve these difficulties. They must sit idle while their spouse or other family members deal with the problems that occur. This can include school problems with children, medical problems in the family, or financial concerns.

Since deployments are HARD, how can psychiatrists help their patients deal with deployment stress? In addition to the routine tools of psychotherapy, psychiatrists can offer their patients the four P's of dealing with deployment stress: Preparation, Prevention, Purpose, and Pride. These four words will help both family members and deploying military personnel to deal with the stress of the months to come.

Preparation involves exploring with patients the benefits of taking care of business before they leave, so that they don't have to worry about loose ends while they're gone. They should do this as soon as possible. The sooner plans are finalized, the sooner they can relax and enjoy the remaining time before they go. They need to look at their finances and determine who will pay the bills while they are gone. They need to make sure that their spouse has all of their financial information and access to their accounts. This includes having the account numbers and phone numbers of the various financial institutions. Is their will completed? Do they have life insurance? Have they thought about who will take care of the routine maintenance of their car and their home? Who will their spouse call if maintenance is needed on these items? Who will provide support for their family? Does their family know the name and number of their unit commander and their first sergeant? Do they have close friends who can look in on their family? Will their parents or in-laws support their spouse while they are gone? With medical care, which doctor will take care of the medical needs of their family while they are gone? In particular, spouses who suffer from psychiatric illness often decompensate in the setting of deployments. Spouses with psychiatric illness need to have an established appointment schedule with their therapist and psychiatrist before the active duty spouse departs.

Prevention involves teaching patients the principles of healthy self-care, both for themselves while they are away and for their family here at home. Self-care involves a healthy diet, plenty of sleep, regular recreation, and daily exercise. Communication to and from the deployed setting can be critical, including phone conversations, e-mail, and letters. Talking about their stress out loud with a friend, family member, or co-worker can help blow off steam. Time off can be an important part of managing deployment stress. While deployed, military personnel should use their off-duty time to rest and relax. At home, family can use vacation time to get away from their worries for a while.

Purpose involves helping patients understand and focus on their reasons for choosing to serve in the military. They are serving their country and defending freedom, democracy, and the American way of life. This is true both for those deploying to fight the battle and for the family members tending the home fires and providing emotional support. They are all serving their country and making sacrifices that matter. A strong sense of purpose about what they are doing can comfort them during the difficult times ahead.

Lastly, therapists can assist patients in developing a sense of pride in what they are doing. They can be proud that they have volunteered to make these sacrifices. Not all Americans chose to live the military way of life. Those that do can take a certain satisfaction in service to their country and take pride that they wear the uniform or that their family members wear the uniform.

Deployments are HARD. Through discussion of the four P's of dealing with deployment stress (Preparation, Prevention, Purpose, and Pride), psychiatrists and other mental health professionals can help their patients (both military personnel and their families) navigate the months to come. Exploration of these four issues can be a valuable part of the psychotherapeutic process.

 
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