Our Stories

We know that stories are powerful tools - they are the narratives of our lives and shape our world. In his book Redirect, psychologist Timothy D Wilson explains the importance of story telling as therapy. He explains how critical incident stress debriefing (CISD),  the main approach used in most militaries for critical incidents, may actually be harmful.

CISD was developed by Mitchell when he studied firefighters in the USA. Unfortunately the Mitchell model of debriefing has been hijacked. In Mitchell's model the firefighters debriefed themselves within their working groups - they told their stories and how they felt. Because it was successful in this context it was assumed it would be equally successful in formalised debriefing with trained councillors - but here's the rub - it actually creates harm when done in this way.

The premise of CISD is that when people have experienced a traumatic event they should air their feelings as soon as possible, so that they don’t bottle up these feelings and develop post-traumatic stress disorder. In a typical CISD session, which lasts three to four hours, participants are asked to describe the traumatic event from their own perspective, express their thoughts and feelings about the event, and relate any physical or psychological symptoms they are experiencing. A facilitator emphasises that it is normal to have stressful reactions to traumatic events, gives stress management advice, answers questions, and assesses whether participants need any additional services. Sounds plausible. Its what gets done for critical incidents for military personnel - compulsory debriefings.

Logic suggests that early interventions are better than later ones, and offering people the services of a trained professional is better than asking them look after themselves. It took research psychologists some time to study CISD, in part because it seemed so obvious that it was beneficial. When they did, they found something unexpected: not only is CISD ineffective, it may cause psychological problems. 

In one study, people who had been severely burned in a fire were randomly assigned either to receive CISD or not. Over the next several months, participants completed a battery of measures of psychological adjustment and were interviewed at home by a researcher who was unaware whether they had received CISD. Thirteen months after the intervention, people in the CISD group had a significantly higher incidence of post-traumatic stress disorder, were more anxious and depressed, and were less content with their lives. Similar results have been found in studies testing the effectiveness of CISD among emergency workers. 

It turns out that making people undergo CISD right after a trauma impedes the natural healing process and might even “freeze” memories of the event. After reviewing all tests of the effectiveness of psychological debriefing techniques, Harvard psychologist Richard McNally and his colleagues recommended that “for scientific and ethical reasons, professionals should cease compulsory debriefing of trauma-exposed people.” Yes, that's right, in 2003 it was debunked. So why are we still doing it?

The problem is two fold. The first is trauma counselling has become a bit of an industry mired in the politics of the field and the need to be seen to do something. The second problem is the alternative is not sexy. Timothy Wilson, again in his book redirect, argues that there’s a way to redirect people’s personal interpretations, one that doesn’t require one-on-one counselling sessions or group debriefs and that it can address a wide array of personal and social problems, from severe trauma to everyday distress.

This 'new' approach is based on the work of Kurt Lewin, who was one of the founders of the field of social psychology in the 1930s and 40s. It has its foundation in three specific psychological interventions:

story-editing — a set of techniques designed to reshape people’s narratives about themselves and the world in a way that results in lasting Behavioural change,

story-prompting — redirecting people down a particular narrative path with subtle prompts which changes the story over time.

"do good, be good" - an approach that dates back to Aristotle which is premised on changing people’s behaviour first, which in turn changes their self-perception of the kind of person they are.

In the approach we use we have the veteran tell their story - unedited as it is now. Then we help the veteran examine that story and edit it - so that the narrative changes and with that their self perception changes. In the end we have them write their story as it should be moving forwards.  This is story telling as therapy - which as every good therapist will tell you is all that really happens on the couch.

Mass grave, Aceh

Aceh - humanitarian aid

The call came on Boxing Day. I packed a bag, jumped in the car and drove to Wellington. We started planning the response to the largest humanitarian event we had ever encountered. A response plan was sketched out and the numbers decided - a light medical group consisting of about 30 people. I called around my medics and was immensely proud of the fact that not one person I called said no, not one had been drinking as they were waiting for the call.

The scale of what was waiting for us was biblical. The reality far outweighed what the media reported. What these young people were exposed to is outside of our usual experience, outside of what we can comfortably get our heads around. On the drive from the airhead to the hospital we passed a line of trucks. One of the team asked what they were carrying and was told that was the bodies going to the mass grave. Each truck carried 200 bodies and there was a line of trucks waiting. Each grave held thousands of bodies.

When we moved into the hospital the first job was the removal of the bodies of the staff and patients. Then the backbreaking work of cleaning out a hospital that had a tsunami wave of mud 6 feet deep pass through it. We opened the first ward in under 24 hours and had the entire facility up within the week. We were careful about who got exposed to what. We selected whom would  even get to see the childrens ward, who would clear out the other wards, who would help in the aid post, but you couldnt control everything. Even a simple task like clearing the drains would hold challenges. Being a tropical country it rained like crazy at 1600 every afternoon. The place would flood as the drains were blocked. It was disheartening works digging the thick smelly mud out of the drains just to have them refill. Eventually we had the drains cleared and the water still didnt drain away - until one of the team got down on hands and knees and fished around in the sump - and pulled out a human head.

We debriefed daily - sitting together and eating our rationpacks and talking about what had happened and what we felt. Some people really surprised us - a medic whom was on the road to an administrative release for failure to perform at home became a star player. We deployed with a section of infantry, which most medical people were sceptical of. A hurried combat lifesaver refresher and they were thrown into the deep end doing things that would test seasoned medics. We were overwhelmed with casualties, our infantry would be doing dressings on 30% burns cases because those cases were too minor for the medical staff. They shone and proved their worth. The team were sleep deprived, exhausted and yet no request was too much.

No one asked what the allowances were when we deployed. The allowances were paid as high physical and environmental threat (we lived in filth, ate expired ration packs, were in a police state, and had many large aftershocks whilst accommodated in a condemned unstable building). Then it was decided that the threat actually wasnt that high, so the allowances were downgraded and the intent was to recover the difference. The team were philosophical - being screwed was just part of the deal.

When they deployed no one had any idea how long they were going for. By 4 weeks it was clear the team was reaching its limit. Push too much harder and we would really start breaking people - fatigue is a major factor in the development of mental injury. The team rotated out shortly after and went straight into a 5 star hotel in Jakarta. It was such a contrast to what we had spent the last month in that is was jarring. In that environment we had the compulsory debrief with the industrial psychs and then it was home.

East Timor

Tim wilson tells his story of a motor vehicle accident and the effect it had on him as a 19 year old soldier.

Safety plans

Safety plans are a big part of what we do. The format is something military people understand - if this do that. What we add is the context - the bit veterans often don't have a handle on. What do I look like when I am well? What does it look like when I am slipping? What does dangerous look like? Its different for every veteran.

We use the WRAP system for creating plans - its American but you cant have everything. It works, its printed and electronic and its affordable (about $30 per veteran).

The components are;

Wellness Toolbox – A list of resources used to develop a WRAP plan. It includes things like: contacting friends and supporters, peer counselling, focusing exercises, relaxation and stress reduction techniques, journaling, affirming activities, exercise, diet, light, and getting a good night’s sleep.

Daily Plan – Describes the activities of daily living when the veteran is well, and list things they need to do every day to maintain wellness. Include here the start and end of day review - time to reflect on what worked and what needs improvement.

Stressors– External events or circumstances that, if they happen, may make the veteran feel uncomfortable. These are normal reactions, but if we don’t deal with them in some way, they may actually cause us to feel worse. we include here the triggers in those with PTSD.

Early Warning Signs – Internal, subtle signs that let you know you are beginning to feel worse - our tells for when we are getting danger close. Reviewing Early Warning Signs regularly helps us to become more aware of them and allow us to take action before they worsen. This is part of the beginning and end of day review - as well as when things start to build through the day. Actions on planning is an important part of gaining a sense of control back.

When Things are Breaking Down – We have the veteran list signs that let them know they are much worse - this is my in the shit plan. How much worse - like feeling suicidal all the time, or hearing voices. Using the Wellness Toolbox, veterans develop an action plan to help them feel better as quickly as possible and prevent an even more difficult time.

Crisis Plan – Identify signs that let others know they need to assist. Outlines a plan for who the veteran wants to take over and support them through this time. It needs to cover healthcare, staying home, things others can do to help and things they might choose to do that would not be helpful. This kind of proactive advanced planning keeps the veteran in control even when it seems like things are out of control.

Post-Crisis Plan – this part of the plan is done in advance to speed up the recovery post crisis. Its more of a template that the veteran adjusts as they are beginning to recover from the crisis, when they have a clearer picture of what they need to get well and stay well.

What this looks like in reality

A while back I was pretty messed up. I had nightmares every night, I was drinking to sleep. I was fine at work and a real prick at home. After some serious help from friends and industrial level counselling things were on an even keel. But I still had my plans in place.

Same as every actions on I had in service - if this do that. Actions on something turning to shit - do this. 

Its simple, I know this shit and can do it in my sleep. 

Except they didn't give me an action plan when I walked out that gate. 

What happens when my I am in the shit action plan doesn't work? When its that bad who do I go to? I cant go to my wife - she has already suffered enough. I let her know I am fucked in the head again and go find someone. By that stage talking is hard enough, explaining isn't realistic. I need someone who knows - is an expert and I don't have to explain — just tell me what to do.

When my in the shit plan failed I called a number of agencies that I thought could help and got told to see my Gp. I call the Gp and its 3 weeks to an urgent appointment and I freak out (turned out it was 4 weeks and I had to chase down my own health records as the Gp had no idea where to get them from).

3 weeks, seriously? (3 weeks is actually less than the average time that a veteran waits for an urgent appointment). 3 weeks  - I drink myself into a stupor but it doesn't work. I was fortunate that a friend stepped in and carried me for a while.

When the alcohol doesn't work and they don't have a mate rescue them many veterans go and see the local druggie and get something that calms it all down. Meth is the usual one with NZ vets these days - highly addictive and really shit when you are coming off it. Meth lowers your threshold for violence, in some one whom is predisposed to violence it can make you paranoid as fuck. Usual end point is violence then prison. Take someone whom has had their threshold for violence reduced, remove their social support and give them meth - what could go wrong?

I worked some time ago with a veteran whom had been dishonorably discharged from the military. He came from a good home, had no drug or alcohol problems prior to the military and was a good soldier up until he deployed. When he deployed he was involved in a cruitical incident. He was supposed to go on a patrol but he was sick so didn't go. His friend went in his place. His mate died on the patrol - in his mind it was supposed to be him. Survivor guilt. His freind died and he felt responsible for it. He had a record of minor disciplinary infractions following the death of his friend. 

He continued to act out and the military kicked him out. Every red flag that indicated he needed support, and he was kicked out at a time when that meant you lost all support and benefits, including no VANZ support.

He is a very angry young man. Scary to be in a room alone with. He became a gang enforcer. Many of our most damaged enter the gangs. That is where the mongrel mob and hells angels come from - World War 2 veterans looking to regain the security of the 'tribe'. Gangs offer food, shelter, a sense of belonging, hierarchical structure, routine, ready access to substances to numb the pain and accept the violence, in fact encourage it - sound familiar? The question then is having been rejected by his tribe, why wouldn't he go to a gang?

I will always remember his description of clearing a tinny house - his training put to good use. His comment on the gang being disturbed by his level of violence - "pussies”. Speed, surprise and overwhelming violence - maximum aggression - exactly what he had been trained to do. He became so hyper violent that the gang disowned him. 

He inevitably ended up in prison on violence offences. Prison struggled to manage him - in the words of one prison manager - "we have never seen anything like him before, we don't know what to do with him. None of the programs in the Corrections system are suitable for him. There is no ramp up, just instant instant overwhelming violence”.  

Think about that - how violent do you need to be that a gang becomes afraid of having having you around and a high security prison cant manage you? Someone whom prior to when they were injured was a good soldier.

I interviewed him when he was released from prison. We cleared the clinic, he and I were the only people in the building in case it all went sideways - the interview can be confronting and triggering. I could see the soldier and the pain behind the scary gang member. I  interviewed him and we attempted to change the outcome, to put things in place to support him. He genuinely wanted things to turn out differently - he wanted to find a way to "go dark".

In the end the government agencies were just too slow moving. We couldn't get things in place in time. We had a regional manager from Ministry of Social Development in tears on the phone to us as she explained they just couldn't help in time. It just didn't work out. 

In the interview we talked about what would happen if it all went south. He was realistic about how it was going to turn out. His plan was tactically sound, putting his infantry training to good use. He was trained for this - his chosen opponents weren't - it would be a blood bath. I didn't sleep for weeks and grieved for one of our boys. One of my biggest fears is that some day he will hit the news with his end game.

That was pretty dark; it's sad that its not the only case like that, in fact not even our worst. Our supporters and volunteers sometimes carry a heavy burden. Not unlike our veterans we teach our supporters to reach out. When it all gets too much make sure you have reached out to someone, a friend, a supervisor, anyone.

Changing the outcomes requires 3 things - the resources to put to the problem, the support workers to step up and help the veteran, and the medical expertise to build the support plan. But sometimes that is not enough. Sometimes it all goes horribly wrong.

If someone calls us we will be there. But the veteran, their family or someone has to call. Sometimes that call never comes. 

Sometimes the veteran kills themselves. Then we have to support the families, the friends whom are often veterans

 and our support people - often veterans themselves. When a veteran kills themselves its devastating for those around them. The support workers, the family, the veterans from their unit, the ripples carry out through the military community.

We wrap around and grieve together but unfortunately it often goes unnoticed. How many in service would know if a veteran ends their life - keep in mind we get one every few weeks? How many politicians would know? I could guarantee that almost every veteran from their unit would know. I am pretty sure that I get to know about every veteran from my rotations whom has died, every medic that I trained, every soldier that has died. Its the same for every commander or SNCO - its something I don't think you get to escape when you become responsible for those whom serve.

I don't expect CDF to know when each veteran commits suicide. I do not even expect the senior commanders to know - they have have a busy job to do which we all signed up for. But I would hope that as a country we can come together to mourn the loss that this represents, to support the families and communities that our our service people came from. 

Lets get serious here; there is no silver bullet, 'one size fits all' solution to veterans support. Bad shit happens, veterans really struggle and some times things are not what we want them to be. That is when we need to trust our mates and know that they will pick us up. Reach out and we will be there.

For our brothers and sisters in arms, when things get shit reach out to us, we will pick you up, walk with you and be your whanau. We will not judge you, we do not care what side of the 2 way range you fought on. Call us and we will be there - no judgement, no cost, no expectation beyond making the effort.