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Authors: Charles W. Hoge M.D.

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The acronym "LANDNAV provides the framework for learning objectives and skills that can help you make a successful transition home from
combat, however long since your return. Each of the following chapters
corresponds to one of the letters. The chapters include objectives, information to enhance your understanding and knowledge of specific topics, exercises, and skills that you can practice and apply in your daily life as
you navigate your transition experience. Each chapter builds on the material in previous chapters, toward the ultimate goal of helping you learn to
become an enlightened warrior at peace with yourself in an insane world.

Chapters 4 through 9, corresponding to the letters L, A, N, D, N, and
A, are mostly for warriors. They're best read in order, but don't have to
be, if you're interested in a specific topic. For spouses, partners, and family members, these chapters provide an opportunity to learn a great deal
about the warrior spirit that could help in your relationship with your warrior, as well as developing your own inner strength and resilience. Although
the exercises are designed specifically for warriors and emphasize combat
examples, anyone can use them. Stress and trauma are universal, and all
of the exercises in this book can be generalized. As a spouse, partner, or
family member, you've been immersed in the warrior spirit and made your
own sacrifices. Chapter 10 is written for you. The closing chapter uses the
final letter "V" as a springboard toward the goal of discovering meaning
and purpose in your journey.

In addition to the learning content or skills, each of the LANDNAV
chapters includes a brief addition by my friend and colleague, First Sergeant Michael Schindler, a two-tour Vietnam combat veteran who retired
from the Army in 1999, but who did not begin his transition process home
until 2002, more than thirty years after his direct-combat experiences. His
experience adds depth to the learning material, along with the stories,
examples, and quotes from OIF/OEF veterans who have the opportunity
to navigate the transition much earlier than he did.

These chapters provide insights into the inner workings of mental
health care in a way that makes it readily understandable, so you know
exactly what's going on and can participate fully in directing your own
transition process. Some of the material may look like "coping strategies"
you've seen elsewhere, but on closer examination, you'll find the information to be more useful because the underlying assumptions and limitations of these strategies are explained. The chapters also contain many
new concepts that I believe need to be more widely considered in addressing war-related reactions and transition. Because this book doesn't contain the standard mental health educational material found in most self-help
books, a sense of humor and an ability to be flexible in your thinking
might prove helpful.

All questionnaires and surveys used in these LANDNAV chapters are
based on instruments available in the public domain. The primary source
for these instruments was the Walter Reed Army Institute of Research
Land Combat Study. You're free to photocopy or scan any of the surveys or
questionnaires in this book for your own purposes (for example, if you'd
like to repeat exercises over time and leave the original questionnaires in
the book unmarked).

 

There is no substitute for the experiences of combat and the excitement of a war zone. Combat is an adrenaline fed, high-speed,
whirlwind, tiger-on-the-loose, exhausting daily dose of life and
death. To think that you won't react, feel, behave, and think differently than before your tour of combat duty is, of course, incorrect. Your experiences in combat will forever be part of you. Allow
those combat experiences and knowledge to become your strength.

FIRST SERGEANT MIKE SCHINDLER

On a fundamental level, life is about survival, and the place to start the
journey of transitioning home from combat is to understand how deployment to a combat zone shapes a warrior's survival skills.

The goal in this chapter is to develop a better understanding of how your
body reacts to extreme stress, how your reflexes take over to help you survive as a warrior, and what you can do to improve your sleep. Combat
requires that you hone your survival skills and reactions so they become
ingrained reflexes. These reflexes are innate to who you are as a warrior
as a result of your training and experience in the war zone, and can cause
you to act as if you were still in the war zone after coming home. Understanding why your body reacts the way it does provides the foundation for
all future exercises in this book.

HM3 J (Hospital Corpsman 3rd Class), a navy medic who had returned
home from deployment with a marine unit in Afghanistan, kept startling
or throwing himself to the ground whenever there was a loud noise. This
embarrassed him in front of his friends and family. He became increasingly frustrated at not being able to control himself. Startling would lead
to a rush of anger, which made his jumpiness worse. He had trouble sleeping, would wake after a couple of hours, and be unable to fall back asleep.
He also experienced nightmares, and would sometimes try not to fall
asleep to avoid them. Whenever he went places where there were crowds,
he felt tense, edgy, and his heart pounded. As a result, he stopped going
out much, which affected his relationships. He started drinking more alcohol to calm down and help with sleep.

SSgt L (Staff Sergeant), back from his second tour in Iraq, found himself becoming furious every time things didn't go the way he expected.
If his fiancee, Sally, moved any of his things, he would become enraged.
During one incident, while running an errand, he came storming into her
house angry that he had been unable to reach her by cell phone. He had
mixed up the directions she gave him and had taken a wrong turn. When
she failed to pick up his calls, he lost his temper. Sally's sister, who was
visiting, was stunned by the intensity of his rage, and Sally's five- and sevenyear-old nieces cowered at the edge of the room. Sally felt humiliated at
being yelled at in front of her relatives. She also felt helpless, confused,
and angry. Finally, her sister stepped in and told SSgt L to take his anger
outside, which to his credit, he did. Sally's sister then turned to Sally and
told her that she was making a big mistake being involved with this guy.
It took about an hour for SSgt L to calm down, after which he was apologetic; however, Sally's family continued to feel uncomfortable around him.

If either of these stories sounds familiar, then this chapter will provide
context and offer some useful advice. Both of these warriors were continuing to feel physically revved up and hyperalert after returning home. They
were reacting to situations back home as if in the war zone, and these reactions had become reflexes that they were unable to control. Both of these
men were experiencing high levels of anger-for HM3 J, toward himself;
and for SSgt L, toward his fiancee. Both were having problems with con trol. HM3 J was angry at being unable to control his own reactions; SSgt
L was angry at his fiancee if she moved his things or if she wasn't available for him when he thought she should be. The reactions for both of
these warriors were affecting their relationships. In SSgt L's case, his anger
didn't make a good impression on his fiancee's family. It embarrassed his
fiancee, scared her nieces, and resulted in her sister advising her to call off
the engagement.

To understand the experience of these warriors, the most important
thing to realize is that their reactions were products of their combat survival skills-protective reflexes that were not well controlled after coming
home. For HM3 J, the speed with which he reacted to dangerous situations during deployment saved him many times and was ingrained in his
reflexes. After returning home his body remained on high alert to threats
and reacted instantly to loud noises. It sent him danger signals, such as his
heart pounding, whenever he entered a crowded mall. He found it difficult to relax and sleep. His sleep pattern was similar to what it had been
in Afghanistan, where he would catch two to three hours of sleep before
going out on a night patrol. Nightmares, often involving combat, also kept
him revved up. He was frustrated because his conscious mind could do
nothing to control his reactions. He expected to have better control over
himself since he had performed extremely well under fire. His anger at
himself made everything worse. He also didn't realize that his increased
use of alcohol was contributing to the heightened reactivity of his reflexes.

For SSgt L, getting angry at his fiancee was also a result of his combat
survival skills. If she moved any of his things, he reacted in almost the same
way he would if he couldn't find an important piece of gear before going
on patrol. Not answering her cell phone triggered a reaction similar to
being lost and "out of communication" on the battlefield. SSgt L's navigation skills failed him on one of his errands, and his inability to make contact with her after finding himself in an unfamiliar location caused him to
feel revved up, as if he were back on the streets of Iraq. Finding his way and
dealing with traffic back home seemed more stressful than driving in Iraq.
His body had not yet decompressed. He also had very little sleep during
his deployment, was still not sleeping well, and his temper was short-fused. He expected Sally to be available, and he reacted to her failure to pick up
her phone like he would react to one of his subordinates who failed to follow proper communication procedures.

For both HM3 J and SSgt L, their bodies were reacting as if they were
back in the war zone. In PTSD terminology, these kinds of reactions are
called "hyperarousal" and "flashbacks," and are very normal after combat.
For both of these warriors, their bodies took over to protect them. They
did exactly what they had been trained to do and had done for months
during deployment, and would need to do again if they returned to the
combat zone, or if they faced other types of danger.

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