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Authors: Charles W. Hoge M.D.

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Sometimes victory is achieved in loss. Sometimes we must invest in losing
in order to gain. Sometimes we must move right to go left or down to go
up. Sometimes we must yield to overcome. Softness overcomes hardness,
like water gradually etching away stone, or the tears of a child bringing us
back to our purpose. As long as we're alive, we're victorious. As long as we
give to others and strive to create a better world, we're whole. This is grace. First Sergeant Mike Schindler:

There is not much in life that equals the camaraderie, courage, sacrifice,
love, and devotion shared between brothers and sisters in arms. Your combat buddies "go all the way everyday "for you as you do for them, and the
most difficult part of the transition home is the sense of disconnect and loss
because you are not with them.

The good news is that you can find a way to fill the void through
veterans groups and clubs, team sports, community volunteering, or any
activity that gets you engaged with people and life. The world is loaded
with wonderful people and lots of challenges that allow you to use your
combat talents in a positive manner.

In 2006 I was introduced to the sport of Hawaiian outrigger canoeing, involving one- to six-man crews. In paddling I have found a sense of
camaraderie, community involvement, and competitive excitement that I
missed when I was no longer with my combat brothers. Paddling is a way
of life for me and all involved.

The best aspect of six-man Hawaiian outrigger canoeing for fun or
racing is the brotherhood of paddling. Some of the main paddling rules are:
shut up and paddle, paddles in together-out together, maximum power
with every stroke.

In essence, we must depend on each other to get an 1,100- to 1,500-
pound canoe and paddlers up and running smooth. This task must be
done with a 100 percent positive attitude. All negative energy must be kept
out of the canoe at all times. The crew must paddle hard, trust each other,
and depend on each other for survival. Sometimes we paddle in ten- to
twenty foot swells over long distances in the deep blue Hawaiian ocean.
Talk about a tiger on the loose, get-down, kick-ass experience! This is it for
me, brothers and sisters.

My suggestion is to find a positive physical activity with people who all
have a common goal. You will find this type of activity to be a great experience-not to mention that it will keep you in high physical conditioning.

Outrigger canoeing, which involves open-ocean, long-distance racing
or voyaging, allows me to use my quick reflexes, physical and mental train ing, and stamina. The sound of crashing waves, the feel of ocean spray,
enduring the physical demands over long distances, plus the dependency
on your fellow crewmates in challenging situations, is truly outstanding.

Outrigger canoe paddling saved me from doom and gloom. Paddling
is part of my blueprint to live life. Sometimes you need to be the lone paddler whose quiet power and purpose leads the way for others. Most times
life takes a crew, working as one, to reach out as far as you can, digging
in and pushing for glory.

Laughter is another design feature in my blueprint. Live life with a
smile; laugh at yourself. Give yourself a break and turn your brain off
sometimes. Humor and calmness are a must-have tool.

Learn, all there is to know about your reflexes and reactions and why
you act and feel the way you do after combat. Use your combat skills, loyalty, honor, quickness, physical strength, mental awareness, etc., to accentuate the positive. Just imagine the good energy we combat veterans can
give to each other, our families, communities, and ourselves. Combat skills
are life. Life is good. Live, love, and laugh.

 

The following is a partial list of the books, medical journal articles, and
reports considered in preparing this book.

MENTAL HEALTH IMPACT OF DEPLOYMENT, COMBAT,
AND MILITARY SERVICE (INCLUDING PTSD, BARRIERS TO
CARE, STIGMA)

Adler, A. B., P. B. Bliese, D. McGurk, C. W. Hoge, and C. A. Castro.
"Battlemind debriefing and battlemind training as early
interventions with soldiers returning from combat: randomized
by platoon." Journal of Consulting and Clinical Psychology 2009; 77:
928-40. 2009.

Brandi, Sgt. PTSD. The warrior's guide to insanity: traumatic stress and life.
Self-published. www.warriorsguidetoinsanity.com.

Britt, T. W., T. M. Greene-Shortridge, S. Brink, Q. B. Nguyen, J. Rath,
A. J. Cox, C. W. Hoge, and C. A. Castro. "Perceived stigma and
barriers to care for psychological treatment: implications for
reactions to stressors in different contexts."Journal of Social and
Clinical Psychology 2008; 27: 317-35.

Dohrenwend, B. P, J. B. Turner, N. A. Turse, B. G. Adams, K C. Koenen,
and R. Marshall. "The psychological risks of Vietnam for U.S. veterans:
A revisit with new data and methods." Science 2006; 313: 979-82.

Friedman, M.J. "Post-traumatic stress disorder among military returnees
from Afghanistan and Iraq." The American Journal of Psychiatry 2006;
163: 586-93.

Grieger, T. A., S.J. Cozza, R.J. Ursano, C. Hoge, P. E. Martinez, C. C. Engel,
and H.J. Wain. "Post-traumatic stress disorder and depression in battleinjured soldiers." The American Journal of Psychiatry 2006; 163: 1777-83.

Hoge, C. W. "Deployment to the Iraq war and neuropsychological
sequelae [Letter]." jAMA 2006; 296: 519-29.

Hoge, C. W., J. L. Auchterlonie, and C. S. Milliken. "Mental health
problems, use of mental health services, and attrition from military
service after returning from deployment to Iraq or Afghanistan." The
Journal of the American Medical Association ([AMA) 2006; 295: 1023-32.

Hoge, C. W., and C. A. Castro. "Post-traumatic stress disorder in UK and
U.S. forces deployed to Iraq [Letter]." Lancet 2006; 368: 837.

Hoge, C. W., C. A. Castro, S. C. Messer, D. McGurk, D. I. Cotting, and
R. L. Koffman. "Combat duty in Iraq and Afghanistan, mental health
problems, and barriers to care." New England Journal of Medicine 2004;
351: 13-22.

Hoge, C. W., J. C. Clark, and C. A. Castro. "Commentary: Women
in combat and the risk of post-traumatic stress disorder and
depression." InternationalJournal of Epidemiology 2007; 36: 327-29.

Hoge, C. W., H. E. Toboni, S. C. Messer, N. Bell, P. Amoroso, and
D. Orman. "The occupational burden of mental disorders in the U.S.
military: Psychiatric hospitalizations, involuntary separations, and
disability." The American Journal of Psychiatry 2005; 162: 585-91.

Iversen, A. C., N. T. Fear, A. Ehlers, J. Hacker Hughes, L. Hull,
M. Earnshaw, N. Greenberg, R. Rona, S. Wessely, and M. Hotopf.
"Risk factors for post-traumatic stress disorder among UK Armed
Forces personnel." Psychol Med. 2008; 38:-511-22.

Jacobson, I. G., M. A. K. Ryan, T. I. Hooper, T. C. Smith, P. J. Amoroso,
E.J. Boyko, G. D. Gackstetter, T. S. Wells, and N. S. Bell. "Alcohol
use and alcohol related problems before and after military combat
deployment." JAMA 2008; 300: 663-75.

Kang, H. K., B. H. Natelson, C. M. Mahan, K. Y. Lee, and F. M. Murphy.
"Post-traumatic stress disorder and chronic fatigue syndrome-like
illness among Gulf War veterans: A population-based survey of 30,000
veterans." American Journal of Epidemiology 2003; 157: 141-48.

Killgore, W. D. S., D. I. Cotting, J. L. Thomas, A. L. Cox, D. McGurk,
A. H. Vo, C. A. Castro, and C. W. Hoge. "Post-combat invincibility:
Violent combat experiences are associated with increased risk-taking
propensity following deployment." Journal of Psychiatric Research 2008;
42: 1112-21.

Killgore, W. D. S., M. C. Stetz, C. A. Castro, and C. W. Hoge. "The effects
of combat experience on the expression of somatic and affective
symptoms in deploying soldiers." Journal of Psychosomatic Research
2006;60:379-85.

Milliken, C. S., J. L. Auchterlonie, and C. W. Hoge. "Longitudinal
assessment of mental health problems among Active and Reserve
Component soldiers returning from the Iraq war." JAMA 2007; 298:
2141-48.

Prigerson, H. G., J. G. Johnson, and R. A. Rosenheck. "Combat trauma:
Trauma with highest risk of delayed onset and unresolved posttraumatic stress disorder symptoms, unemployment, and abuse
among men." The Journal of Nervous and Mental Disease 2001; 189:
99-108.

Seal, K H., D. Bertenthal, C. R. Miner, S. Sen, and C. Marmar. "Bringing
the war back home: Mental health disorders among 103,788 U.S.
veterans returning from Iraq and Afghanistan seen at Department of
Veterans Affairs facilities." Archives of Internal Medicine 2007; 167: 476-82.

Self, Nate. Two Wars: One Hero's Fight on Two Fronts-Abroad and Within.
Carol Stream, IL: Tyndale House, 2009.

Shay, Jonathan. Achilles in Vietnam: Combat Trauma and the Undoing of
Character. New York: Scribner, 1994.

Smith, T. C., M. A. K Ryan, D. L. Wingard, D.J. Slymen, J. F. Sallis,
D. Kritz-Silverstein, and Millenium Cohort Study Team. "New
onset and persistent symptoms of post-traumatic stress disorder
self reported after deployment and combat exposures: Prospective
population-based U.S. military cohort study." BMJ2008; 336: 366-71.

Tanielian, T. and L. H. Jaycox, eds. Invisible Wounds of War: Psychological
and Cognitive Injuries, Their Consequences, and Services to Assist Recovery.
Santa Monica, CA: RAND Corp., 2008.

Thomas, J. L., J. E. Wilk, L. A. Riviere, D. McGurk, C. A. Castro, and
C. W. Hoge. "The prevalance of mental health problems and
functional impairment among active component and National
Guard soldiers 3 and 12 months following combat in Iraq." Archives
General Psychiatry, 2010.

Vasterling, J. L., S. P. Proctor, P. Amoroso, R. Kane, T. Heeren, and
R. F. White. "Neuropsychological outcomes of Army personnel
following deployment to the Iraq war." JAMA 2006; 296: 519-29.

Warner, C. H., J. E. Brietbach, G. N. Appenzeller, V. Yates, T. Grieger, and
W. G. Webster. "Division mental health in the new brigade combat
team structure: Part II. Redeployment and postdeployment." Military
Medicine 2007; 172: 912-17.

Workman, Jeremiah. Shadow of the Sword: A Marine's Journey of War,
Heroism, and Redemption. New York: Presidio, 2009.

Wright, K. M., O. A. Cabrera, A. B. Adler, P. D. Bliese, C. W. Hoge, and
C. A. Castro. "Stigma and barriers to care in soldiers postcombat."
Psychological Services 2009; 6: 108-16.

IMPACT OF DEPLOYMENTS ON FAMILIES

Eaton, K. M., C. W. Hoge, S. C. Messer, A. A. Whitt, O. A. Cabrera, D.
McGurk, A. Cox, and C. A. Castro. "Prevalence of mental health
problems, treatment need, and barriers to care among primary
care seeking spouses of military service members involved in Iraq
and Afghanistan deployments." Military Medicine 2008; 178(11):
1051-56.

Elizabeth, Quynn. Accepting the Ashes: A Daughter's Look at Post-Traumatic
Stress Disorder, 2004. Self-published. www.acceptingtheashes.net.

Gibbs, D. A., S. L. Martin, L. L. Kupper, and R. E. Johnson. "Child
maltreatment in enlisted soldiers' families during combat-related
deployments." JAMA 2007; 298: 528-35.

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