The FAMCare Blog

PSTD, Invisible Wounds and the Alarming Veteran Suicide Rate

Posted by George Ritacco on Nov 8, 2016 11:55:19 AM


Every Day - 20 U.S. Veterans Commit Suicide

In 2014, the latest year statistics are available, 7,400 veterans took their own lives.


Social workers who work with veterans often feel helpless or unprepared to deal with the burgeoning psychic and spiritual crisis that is overwhelming combat veterans from the Vietnam war to the war in Afghanistan.

“Most social workers are not quite comfortable as to how to help their clients work through these dilemmas. They may refer clients to spiritual advisers (e.g. ministers), but I wonder if there is something more that we can do. I think that it is essential that we keep in mind that we are treating the whole person,” one social worker told me recently.


In 1980, the American Psychiatric Association added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III). The key to this new diagnosis was the stipulation that the cause agent was outside the individual (i.e., a traumatic event) rather than an inherent individual weakness. The framers of the original PTSD diagnosis considered traumatic events (war, torture, rape, the Holocaust) to be clearly different from the very painful stressors that constitute the normal vicissitudes of life such as divorce, failure, or rejection.

With the PTSD diagnosis established as the insight into the troubling behavior of veterans who had returned home from war, social workers were expected to notice the signs and send affected veterans to a psychiatrist for diagnosis and treatment. Many, many veterans, however, fell through the crack and were never diagnosed or treated because the classic signs of PTSD were not, at first, apparent.


Social workers and psychiatrists are gradually coming to grips with the fact that many veterans are loath to talk about their experiences and often remain in denial for many years as their troubling behaviors only gradually emerge. Social workers now understand that:

“These veterans have incurred ‘invisible wounds’ that occur when a soldier perpetrates, fails to prevent, or bears witness to acts that transgress deeply held moral beliefs and expectations.” (Litz et al., 2009, p. 695)

These invisible wounds occur when overwhelming conflicts arise between the ideals of being raised by the “Golden Rule” and the sanctions of killing during combat.

“War itself, no matter how just or good, will leave many of the men who fight it feeling like they’ve dirtied their souls…there is just something about killing that bites the conscience and doesn’t let go.” (Dokoupil and Snyder 2012, p. 42)

So, even when a veteran doesn’t remember the trauma of battle, or refuses to talk about it, social workers are beginning to look for the “invisible wounds” that trouble all combat veterans whether they are aware of it or not.  


They say that there is one essential skill that all social workers must cultivate in order to bring these “invisible wounds” to light – EMPATHY. All the social workers we have talked to about this agree that “empathy” is a professional “must have”, even if they can’t tell you exactly what it means.

The Social Work Dictionary defines empathy as “the act of perceiving, understanding, experiencing, and responding to the emotional state and ideas of another person”.

Most of the social workers we have talked to say that this definition will do. They add, however, that in order to “perceive and understand”, social workers must strive to become less judgmental and learn to separate their own beliefs from those of their clients. They say:

“Suspending all judgment is the beginning of active listening and empathetic understanding.”

Topics: Government, Veterans Issues

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