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THE UNDEFEATABLE FOE:VETERANS FACING THE END OF LIFE
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In 2009, veterans comprised approx. 25 percent of U.S. deaths
that year. Veterans: An Underserved Population, Deborah
Grassman, ARNP
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Veteran Population in MichiganAs of 9/30/2013
Wartime Vets 483,963Peacetime Vets 176,810Female Vets 50,121Male Vets 610,652WWII 39,574Korean Conflict 72,421Viet Nam Era 247,859Gulf War 134,004Total 660,773U.S. Dept. Veteran Affairs NCVAS
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Two major potential Psychosocial problems can develop for Vets in a
Hospice setting :
1. Difficulty accepting the terminal prognosis, possibly resulting in Clinical Depression.
2. Triggering of invasive and emotionally painful traumatic memories.
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Conscious Mind
Subconscious
Mind
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Defense Mechanisms protect usfrom unacceptable information
about ourselves and our world. Our
reactions canBe intense and the defenses
difficult topenetrate, especially when our
indoctrinationto a specific perception of reality has been intense and our belief
complete.
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Two Essential Types of Defense
Mechanisms:Repression [Unconscious]Suppression [Conscious]Forms of Denial:Reaction Formation RationalizationProjection
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Recognize the Power of Military Indoctrination:Tearing down individualism in boot camp.Build up with “Group Mind”.Stoicism is valued: prevents defeat and surrender.Death is the ultimate enemy; live to fight again.Death is a sacrifice made for a greater good.“It is a good day to die!” (Controlled sacrifice)Your body is your best weapon.
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An emotional state will cause one’s consciousness to bridge back to other times
when a similaremotional state was being experienced.
These memories, or fragments of them, will then be pulled in to consciousness and must then be re-integrated back in to one’s core narrative. This is as true in grief as it is in
the experiencing of any trauma and is known as the “affective bridge”.
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ExperientialElements (how the
event sounded, smelled, looked)
The meaning assigned to the memory
Emotions connected to the memory
How a Healthy Memory is Encoded and Stored
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ExperientialElements (how the
event sounded, smelled, looked)
The meaning assigned to the memory
Emotions connected to the memory
Conscious Mind
Trauma Trigger
Unconscious
Mind
Unconscious Mind
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Frequent Causes of Depression and Increased Suicide Risk
in Vets Facing Death• When they prepare themselves for it, it
doesn’t come fast enough. (lack of control)
• Feeling betrayed by their bodies for housing “the enemy”.
• The inability to re-define the meaning of death (not “surrender”, not weakness, not defeat or failure, not sacrifice for a greater good; just the end of life.)
• Wanting the unrelenting guilt and pain of unresolved traumatic memory to end.
*Please recognize Depression is a form of pain that may be treated. It is not an inevitable by-product of dying.
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So how do you help your patient re-integrate their military experiences without ripping apart theirdefense mechanisms and re-traumatizing them?
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How to Assist:Take a Military History:Begin with the straight-forward questions.However, keep in mind that you’ll only glean fullyconscious and well-rehearsed material with this method..
Augment the Military History with the opportunity for them to tell you stories that may lie at the edge of conscious memory by using generally themed pictures. This will access memories of importance to the individual in accordance with their readiness to remember specific details of their experiences. It helps to let them choose which images they wish to tell you about.Be careful to select images that are not overly graphicor violent.
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