Michael Miovic, MD

I am a civilian psychiatrist who recently finished 20 months of work as a contractor for the US Army. Going into the job, I expected the degree of combat-related stress I saw in our troops. I was not prepared, however, for the scope of the impact our 2 long wars have had on military children.

Like most civilians with no military background, I didn’t realize how many children there are in the Army. During the Vietnam War, the United States used the draft to maintain a large fighting force of single soldiers, most of whom did only one tour of duty. Today, we have an all-volunteer force full of families. About 55% of the military is married, 1.9 million children have a parent in the military, and over 1 million children have had a parent deploy.

 In fact, in 2010 the active-duty sector of the Army actually had more children (570,000) than soldiers (562,000).

The consequences of this shift in military structure are major. As the wars in Iraq and Afghanistan dragged on, the Army had to recycle soldiers through multiple deployments, because our total force is relatively small. Some military families are resilient and cope well with the stress of deployments, but some do not-and for most it gets harder with each cycle. I met too many young parents in the infantry who were justifiably overwhelmed with the competing demands of going to war and raising kids, two pursuits that do not fit naturally together. Fights over finances, video game addiction, and infidelity were rampant, and too often this escalated into substance abuse, domestic violence, child maltreatment, and/or divorce. And, of course, some parents return with devastating injuries, or die in battle.

What do we know about the impact of our current military structure on children? Recent reviews of the research find that “most” military families are resilient, but that a significant number of children-about one third-show anxiety symptoms and behavioral disorders during and following a parent’s deployment. Multiple deployments and parents returning with PTSD are risk factors for increased distress.

 Also, a recent Pew study of post-9/11 veterans found that almost 50% feel that deployment negatively affected their relationships with spouses and children.

Based on my experience, I would say the veterans’ perceptions are right, and the other research underestimates the rates of adverse impact on children (perhaps because it misses the real but more subtle dimensions of children’s emotional experience, such as the grim atmosphere and restriction of joy one feels on military bases). So, do the math: 50% of 1 million makes 500,000 military children who have suffered negative mental health effects of parental deployment-and combat isn’t over yet. That’s a lot of children. As a nation, what should we do about this?

We have three broad options: 
. Increase mental health services to military children.
. Decrease their exposure to parental deployment.
. Look the other way.

Most people’s first reaction is to say increase services and research into effective interventions. That is good. As a psychiatrist, I can only praise our armed forces’ huge investment in mental health services in the last decade. No fighting force in the history of the world has tried harder to support its soldiers and families than this one, and we can all be proud of that accomplishment.

However, research and services cost money. Thus, it seems unlikely that services will grow now as the budget shrinks. Also, there are natural limits to what services and research can achieve. Soldiers at war will be stressed no matter how much therapy or resiliency training they get, and stressed parents make for stressed children. Developmental psychology has already shown that young adults cannot master the tasks of intimacy, career, and parenting simultaneously in their 20s. And if people cannot do this during peace time, how are they supposed to do it during war?

This leads us to the second option. For both practical and moral reasons, I think it’s time for the United States to decrease children’s exposure to the emotional wounds of war. Our current military structure is a social experiment, and there is evidence the experiment is in trouble. Whatever later generations decide is the ultimate political effect of our wars in Iraq and Afghanistan, I think one of the lessons learned at home will be the negative impact that long ground wars have on military children.

A lot-but all options involve change. We can keep our current military structure, but end combat in Afghanistan and limit future conflicts to shorter or less dangerous interventions (as in Bosnia and the first Gulf War). Or we can modify military structure in a number of ways: shorten deployments, lengthen rest periods between deployments, limit combat roles for parents, or change recruitment and retention standards to reduce the number of children in the military. And finally, if we really believe in long wars, we can bring back the draft.

Which brings us to the last choice: look away. Because all of the options above could be either expensive and/or politically unpopular, there will be a strong temptation to look away. This is where mental healthcare professionals, as part of our mandate to protect children, must speak out. We have to put a spotlight on the issue of military children, and remind the public that war is a national commitment, not a lifestyle choice for a small percent of American families. Where children are involved, silence and looking away are not acceptable responses. The military has done its part to fight for the country-now American civilians have to do their part to take care of the military. The first step is to admit our military children are hurting, the second is to start a serious discussion about how best to help them.

References
1. Department of Defense. “Strengthening Our Military Families,” January 2011. 


2. Lester P, Bursch B. The long war comes home: mitigating risk and promoting resilience in military children and families. Psychiatric Times. 2011;28(7):1-3.
3. U. S. Army. Demographics. 

http://www.armyg1.army.mil/hr/demographics.asp


4. White CJ, de Burgh HT, Fear NT, Iversen AC. The impact of deployment to Iraq or Afghanistan on military children: a review of the literature. Int Rev Psychiatry. 2011;23:210-217.
5. de Burgh HT, White CJ, Fear NT, Iversen AC. The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel. Int Rev Psychiatry. 2011;23:192-200.
6. Park N. Military children and families: strengths and challenges during peace and war. Am Psychol. 2011;66:65-72. 
7. War and sacrifice in the post-9/11 era: the military-civilian gap. October 5, 2011. 

http://pewresearch.org/pubs/2111/veterans-post-911-wars-iraq-afghanistan-civilian-military-veterans

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An Army of Children

I am a civilian psychiatrist who recently finished 20 months working as a contractor for the United States Army. Going into the job, I expected the degree of combat-related stress I saw in our troops. However, I was not prepared for the scope of impact our 2 long wars have had on military children.

Like most civilians with no military background, I didn’t realize how many children there are in the Army. During the Vietnam War, the United States used the draft to maintain a large fighting force of single soldiers, most of whom did only one tour of duty. Today, we have an all-volunteer force full of families. About 55% of the military is married, 1.9 million children have a parent in the military, and up to 1 million children have had a parent deploy.

The consequences of this shift in military structure are major. As the wars in Iraq and Afghanistan dragged on, the Army has had to recycle soldiers through multiple deployments, because our total force is relatively small. Some military families are resilient and cope well with the stress of deployments, but some do not-and for most it gets harder with each cycle. I met too many young parents in the infantry who were justifiably overwhelmed with the competing demands of going to war and raising kids, two pursuits that do not fit naturally together. Fights over finances, video game addiction, and infidelity were common, and too often this escalated into substance abuse, domestic violence, child maltreatment, and/or divorce. And, of course, some parents return with devastating injuries, or die in battle, both of which are hard on children.

What do we know about the impact of our current military structure on children? Recent reviews of the research find that “most” military families are resilient, but that a significant number of children-about one third-show anxiety symptoms and behavioral disorders during and following a parent’s deployment. Multiple deployments and parents 

 are risk factors for increased distress.

 Also, a new Pew study of post-9/11 veterans

 found that almost 50% feel that deployment negatively affected their relationships with spouses and children.

Based on my experience with enlisted soldiers, I would say the veterans’ perceptions are right, and the other research underestimates the rates of adverse impact on children (perhaps because it misses the real but more subtle dimensions of children’s emotional experience, such as the grim atmosphere and restriction of joy one feels on military bases). So, do the math: 50% of 1 million makes 500,000 

 who have suffered negative mental health effects of parental deployment-and combat isn’t over yet. That’s a lot of children. As a nation, what should we do about this?

We have three broad options: increase mental health services to military children, decrease their exposure to parental deployment, or look the other way. Most people’s first reaction is to say increase services and research into effective interventions. That is good. I was impressed with the Army’s clinical programs and have only praise for our armed forces’ huge investment in mental health services in the last decade. No fighting force in the history of the world has tried harder to support its soldiers and families than this one, and we can all be proud of that accomplishment.

However, research and services cost money, and the American public is growing increasingly disengaged in the war(s). Thus, it seems unlikely that services will grow now as the budget shrinks. Also, there are natural limits to what services and research can achieve. Soldiers at war will be stressed no matter how much therapy or resiliency training they get, and stressed parents make for stressed children. Developmental psychology has already shown that young adults cannot master the tasks of intimacy, career, and parenting simultaneously in their 20s. And if people cannot do this during peacetime, how are they supposed to do it during war?

So what can we do? A lot-but all options involve change. We can keep our current military structure, but end combat in Afghanistan and limit future conflicts to shorter or less dangerous interventions (as in Bosnia and the first 

). Or we can modify military structure in a number of ways: shorten deployments, lengthen rest periods between deployments, limit combat roles for parents, or change recruitment and retention standards to reduce the number of children in the military. And finally, if we really believe in long wars, we can bring back the draft.

Which brings us to the last choice: look away. Because all of the options above could be either expensive and/or politically unpopular, there will be a strong temptation to look away. This is where mental healthcare professionals, as part of our mandate to protect children, must speak out. We have to put a spotlight on the issue of military children, and remind the public that war is a 

 commitment, not a lifestyle choice for a small percent of American families. Where children are involved, silence and looking away are not acceptable responses. The military has done its part to fight for the country-now American civilians have to do their part to take care of the military. The first step is to admit our military children are hurting, the second is to start a serious discussion about how best to help them.

[Editor's Note: For further information, see Psychiatric Times' 

 U.S. Department of Defense. Strengthening Our Military Families: Meeting America’s Commitment. 

http://www.defense.gov/home/features/2011/0111_initiative/

 Lester P, Bursch B. The long war comes home: mitigating risk and promoting resilience in military children and families. 

 White CJ, de Burgh HT, Fear NT, Iversen AC. The impact of deployment to Iraq or Afghanistan on military children: a review of the literature. 

 de Burgh HT, White CJ, Fear NT, Iversen AC. The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel. 

 Park N. Military children and families: strengths and challenges during peace and war. 

 Pew Research Center. War and sacrifice in the post-9/11 era: the military-civilian gap. October 5, 2011. 

This psychiatrist was not prepared for the scope of impact our two long wars have had on military children.

Author | Michael Miovic, MD

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