Chapter 1: Operational Stress Injury

Introduction

Military personnel returning from combat, deployment or other stressful du­ties, can find themselves changed and not always in a good way. They can feel distant from their surroundings and may have trouble relating to friends, family and even fellow military members. They often feel alienated from soci­ety – no longer able to fit in. But they push on, sure that things will eventually return to the way they were before deployment – except this doesn’t always happen.

Some can’t put their finger on what’s wrong. Others have the deep wor­ry that they might have emotional problems but, being strong people, they are committed to powering through. To ease their pain, they might turn to alcohol and drugs for temporary relief. While these tactics may numb their fears for a while, they could have worrisome consequences like damaging the relationships they once valued or getting in trouble at work or with the law. Some might feel they are becoming people they don’t recognize: angry, combative, anti-social, and – sad and alone. Above all for many, is the numb­ness – they just can’t seem to feel anymore.

OSIs don’t just result from combat-related service. They may also result from difficulties that may occur during peacekeeping missions, after serving in a war zone, or following other traumatic events not related to combat.² It is estimated that 30% of people who serve in combat zones will develop Oper­ational Stress injuries (OSIs).³ There are a range of OSI symptoms including overall numbness, hyper-vigilance, overwhelming anger, explosive temper, nightmares, inability to sleep, interrupted relationships, and suicidal thoughts which may result in suicide attempts.

The risk of developing post-traumatic stress disorder (PTSD), one of the most common OSIs, is about three times higher in the military and law en­forcement than the general population, although this could be low because of under-reporting.⁴

Common OSIs include the following psychiatric diagnoses:

• PTSD,
• depression,
• anxiety, and
• substance use disorders.

Operational Stress Injuries need to be taken very seriously. It is never too late to seek treatment. Evidence suggests that recovery is possible even for those with chronic symptoms.⁵

Brief history of OSIs

The term Operational Stress Injury was first coined by a Canadian Lieutenant Colonel in 2001.⁶ It was designed to describe – not medicalize – service members’ and Veterans’ experiences. Another motivation was to give the same legitimacy to their injuries as is given to physical injuries.

For a fuller overview on Operational Stress Injuries (combat-related stress) go to:

• www.cafconnection.ca/getmedia/4aee355d-6b62-4bc8-a9ef-e099cdc743b9/Guide-BSO-EN.aspx
• www.veterans.gc.ca/eng/health-support/mental-health-and-wellness/under­standing-mental-health/ptsd-warstress

Resources

Operational Stress Injury Clinics are what are called a ‘tertiary’ service, meaning that they provide highly focused and specialized care to peo­ple with Operational Stress Injuries. You must have a referral from Vet­eran Affairs Canada to access these clinics. Serving Canadian Armed Forces (CAF) members can also be referred under certain circumstanc­es, through CAF Health Services. There are 10 outpatient clinics (some with additional satellites) around the country: Vancouver, BC; Calgary, AB; Edmonton, AB; Winnipeg, MB; Ottawa, ON; London, ON; Mon­treal, QC; Quebec City, QC (French only); Fredericton, NB; and Dart­mouth, NS. As well as one inpatient clinic at St Anne de Bellevue, QC.

Visit: www.veterans.gc.ca/eng/health-support/mental-health-and-wellness/assessment-treatment/osi-clinics

Operational Stress Injury Social Support (OSISS) is a na­tional peer support network for CAF members, Veterans, and their families experiencing an Operational Stress Injury.

Visit: https://cfmws.ca/support-services/health-wellness/mental-health/operational-stress-injury-social-support-(osiss)

Veteran Affairs Canada also has a VAC Assistance Service Line available. This help line is available whenever needed.

Call: 1 800 268 7708 or TDD/TTY 1 800 567 5803

Other sources of OSIs

In recent years, the Canadian Armed Forces has recognized other experiences that can re­sult in an OSI.

1. Military sexual trauma

Military sexual trauma⁷, includes sexual ha­rassment; sexual assault; and/or discrim­ination on the grounds of sex, gender, gen­der identity, or sexual orientation during the course of military service.⁸ Sixteen to 27% of female-identifying CAF members have expe­rienced sexual assault or harassment while 1 to 4% of men have had these experiences.⁹

Military sexual trauma does not always result in an Operational Stress Injury but it can and it does. It can also exacerbate an already existing OSI.

With the best of intentions, the sexual misconduct policies within the Canadian Armed Forces included a mandatory reporting requirement, meaning that any member of the Forces who receives a complaint must report it to the hierarchy. An unintended consequence has been that some survivors are now afraid to report.

Those who report sexual assaults are guaranteed anonymity but it is important to note, that even with these assurances, some survivors simply do not trust that their information will not, somehow, get out, placing themselves and their careers at risk. As a self-help alternative, some establish private Facebook pages for communication and support.

Resources

Sexual Misconduct Response Centre is an entity that oper­ates outside of the Canadian Armed Forces chain of com­mand. It provides 24/7 counselling and/or support. It also helps survivors navigate their workplace or make a complaint.

See: https://www.canada.ca/en/department-national-defence/services/benefits-military/health-support/sexual-misconduct-response.html

Information on sexual trauma during service.

Visit: www.veterans.gc.ca/eng/health-support/mental-health-and-wellness/understanding-mental-health/military-sexual-trauma

2. Discrimination and oppression

The Canadian Armed Forces is a voluntary force with diverse people within its membership. However, discrimination, including systemic racism, contin­ues to exist and is considered to be under-reported.¹⁰ The military is working on new policies to address systemic racism and discrimination, particularly hateful conduct. This is important work because racism, discrimination, bul­lying and microaggressions in any form are harmful.¹¹

Experiencing various forms of oppression, such as sexism, racism, ho­mophobia, and transphobia, among others, can have negative consequenc­es for mental health. In fact, research suggests that oppression is a form of trauma.¹² People who are part of multiple equity-seeking groups may experience the cumulative stress of intersectional discrimination which may increase the risk of developing PTSD and other mental and physical health problems.

Help is available. Whether you choose to seek professional treatment or not, there are also self-help strategies to protect your mental health. Chapter 7 offers some suggestions, as a start.

Resources

Veterans Affairs Canada, Building Communities. Information about research and other initiatives related to diverse Veteran communities.

Visit: www.veterans.gc.ca/eng/about-vac/what-we-do/women-LGBTQ2/build­ing-communities

3. Moral Injury

Veterans can have both physical and Operational Stress Injuries and into that mix may come what is called a moral injury. A moral injury refers to “the psychological, social, and spiritual impact of events involving betrayal or transgressions of one’s own deeply held beliefs and values occurring in high stakes situations.”¹³

There are two general types of moral transgression events: moral transgressions that involve people doing or failing to do things themselves (deliberately or unwittingly); and being exposed directly or indirectly to transgressions on the part of someone else (betrayal, bearing witness to grave inhumanity). These events are called potentially morally injurious events. Recognizing that not everyone will respond in the same way to these types of events, just like in the trauma field, where it is understood that individual responses to potentially traumatic events that involve a threat to one’s life or person will differ according to the individual.¹⁴

When a moral injury does occur, the outcomes are wide-ranging and can include:

• • feelings of guilt, shame, anger, sadness, anxiety and disgust;
  • intrapersonal outcomes including decreased self-esteem, high self-criticism, beliefs about being bad, damaged, unworthy or weak, and self-impeding behaviours;
  • interpersonal outcomes including loss of faith in others, avoidance of intimacy and lack of trust in authority figures; and
  • existential and spiritual outcomes including loss of faith in previous religious beliefs, and no longer believing in a just world.

People who struggle with a moral injury can say that the things they have seen and done will haunt them for the rest of their lives. While moral injury, like OSI, is not an official diagnosis, it can interfere with people fully em­bracing health and recovery because of the belief that they don’t deserve a better life.

Operational stress and moral injuries need to be taken very seriously.