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To help veterans, sometimes it’s best not to use the word ‘veteran’



Monitor staff
Wednesday, February 24, 2016
There may be no better example of the complexities that civilian health care providers face when dealing with patients who are military veterans than a subtle piece of terminology.

You may have seen the billboard on Interstate 293 in Manchester urging doctors, nurses, therapists and other health care providers to “ask the question” of their patients, determining whether they are veterans, because military service may provide clues to aid in a diagnosis.

Yet the question they ask isn’t what you might think.

“The question has changed from ‘Are you a veteran?’ to ‘Have you served in the military?’ ” said Dr. Nicole Sawyer, a psychologist based in Exeter who ran a recent training session in front of a packed room at Riverbend Mental Health Center in Concord.

While this may sound like a distinction without a difference, the change was made because the term “veteran” has connotations that aren’t obvious to the civilian world.

“People who served during peacetime, they may not think of themselves as veterans at all,” Sawyer said.

The same goes for those who never saw combat, or whose service was entirely in the U.S.

These veterans were subjected to dislocation from everyday life and did dangerous work, and their service information can help them deal with medical issues from the physical to behavioral, yet many are reluctant to adopt the title “veteran” because the civilian world associates it only with fighters, said Ginger Munson, a veteran and wife of a veteran.

Munson volunteers for a program called Dare Mighty Things that seeks to bridge the cultural gap between the military and the largely civilian world of health care. She also participated in the Riverbend session, one of many projects designed to make sure that the civilian health care world does everything it can for veterans.

This is important, the group was told, because New Hampshire has about 115,000 veterans, putting the state eighth on the list of states in terms of per-capita military service, yet only about 43,000 are enrolled in the Veterans Administration, the official body to oversee health care for those who served in the military.

“The rest get all their services out in the community,” Sawyer said.

Like the New Hampshire population as a whole, this group is relatively old: 48 percent of veterans in New Hampshire are over age 65, meaning they served during the wars in Vietnam or Korea, or even during World War II, and thus had very different experiences than younger veterans who served in the Middle East.

Even military personnel who have seen combat may shy away from the word “veteran” because it feels excessive, she told the group, which was made up of therapists, doctors and some administrative personnel, few of whom had any military experience.

“My husband, he will not tell anybody,” Munson said. “You know how you can get a free meal on Veterans Day, or get 10 percent off here, or who knows what? He will absolutely not avail himself of any of those things.”

That’s a not uncommon reflection of military culture, she added. “There are those who say: ‘This is my job.’ They don’t want glory. That is part of the ethos of most military, very self-sacrificing, team members. They want to get in, get the job done.”

Overcoming this reluctance so veterans can get the help they need is the idea behind four military access projects run through the state Department of Health and Human Services. Ask the Question Campaign, run by Easter Seals of New Hampshire, is the most public push, but Dare Mighty Things’s statewide military culture training, sessions of which are being held across the state, is also very active.

Complicating the situation for civilian providers is that the culture of veterans differs depending on their age and when they served.

New Hampshire has a relatively high percentage of veterans from World War II and Korea, when tours of duty were long and communication with home was sporadic, and when units tended to stay together “from boot camp to discharge,” as Sawyer put it.

In some ways, those conditions were less stressful to veterans and their families than the current situation, when cell phones and texting keep everybody in contact even when serving on the front lines.

“If you’ve heard of the sea captain’s wife, walking and waiting to see the ship come home. Now it’s email,” Munson said, mimicking somebody who doesn’t quite dare check their phone, for fear of seeing bad news.

“It’s surreal. The constant communication, it’s not always healthy. Over there, they’re supposed to completely focus on the task, which is hard to do. And it’s the same at home, if you’re checking email every minute . . . it’ll eat you up,” Munson said.



(David Brooks can be reached at 369-3313, dbrooks@cmonitor.com, or on Twitter @GraniteGeek.)