Running Head: VETERAN MINDFULNESS 1

Using Mindfulness with Veterans

Dennis Higgins

Adelphi University
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Using Mindfulness With Veterans

In two years of working in the New York VA Health Care system, I found that in

almost all of my cases, I was teaching veterans elements of mindfulness. Many of the

veterans who came into my office found themselves unable to identify or express emotions

in a direct or healthy manner. This was often the product of their upbringing, reinforced by

the military. This required some training in order to become aware of their bodies and

minds in order to facilitate further treatment.

The Veteran Mind

The transformation from civilian into service member requires a comprehensive

indoctrination program. Social support systems (intimate relationships, family units,

friends) are interrupted during the basic training process, where trainees are sequestered

at a base, often far from home, and unable to see friends or families until the training

process is completed (Hayden, 2000). This expands the trainee’s interactional experiences

by including new people and new places and creating a greater tolerance for diversity

(Elder, 1987). The structure of tasks in basic training, in addition to teaching the

fundamental skills service members require (Hayden, 2000), force unit cohesion, which is

predictive of higher psychological mediators and lower negative mental health measures in

recruits, as well as higher levels of resilience (Williams et. al, 2016). The indoctrination into

the military provides a level of institutional support as well. In knowing that their basic

needs will be met, service members gain a level of security and investment into the military

culture (Kelty, et. al, 2010). Resilience to adversity is built through hardiness training on an

individual and organizational level, in addition to the aforementioned social buffers

(Lovering, et. al, 2015; Maddi et. al, 2017). The military environment, then, is experienced
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as a family who takes care of the service members and creates a structured set of

expectations. Finally, the physical setting is important. The sequestration of trainees is

total—with uniform haircuts, clothing, and prohibitions on contact with outside world, the

recruits are completely immersed in this martial culture (Hayden, 2000).

The transition into the military focuses as much on changing internal cultural views

as it does on specific task and physical fitness training. This warrior ethos is crucial for

maintaining an effective force and behave in ways that show perseverance, responsibility

for others, motivation by a higher calling, and an ability to set priorities, adapt, and work in

a team environment (Redmond et. al 2015). The identity created by military indoctrination

is infused with values of duty, honor, loyalty, and commitment to comrades, unit, and

nation (Demers, 2011; Redmond et. al, 2015). In addition, that identity emphasizes

personal responsibility, health, training, and self-improvement (Kelty et. al, 2010). The

indoctrination and subsequent military culture is sufficiently strong enough to influence

the expression of members’ personality characteristics and how veterans view their service

is largely an intersection of these personality characteristics as well as the reason they

enlisted (DeVries & Wijnans, 2013). That said, while there are no doubt characteristics that

lead certain citizens to enlist compared to others, civilians who were given hypothetical

moral challenges similar to those that exist in current military operations answered

similarly to military respondents indicating that there are no fundamentally moral

differences between the two populations (Blais & Thompson, 2013).

Bessel van der Kolk (2014) discussed how traumatized people are afraid of feeling.

The anxiety that comes with the constant feeling of threat creates constant physical

sensations that prepare the body to defend itself. In combat, this is a wonderful trait.
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Hyperarousal, while a criteria for PTSD in the civilian sector, is necessary to survive

combat. The military culture is one of hypermasculinity. As such, there is a focus on doing,

not feeling. Grossman and Christiensen (2008) discussed the nature of military

indoctrination is such that service members look forward to combat, honing their

behaviors and instincts to gain mastery in their martial arts. These behaviors and instincts

become habituated and internalized, making it impossibly difficult to reintegrate into

civilian society without refocusing. As these behaviors are often unconscious reflexes, the

cultivation of mindfulness practice is important to first draw attention to the behaviors and

emotions, and then learn to experience them all in real time, without judgment.

Morgan and colleagues (2016) discuss cultivating mindfulness in two different

ways—attention and compassion. These are both vital for veterans to understand and I will

attempt to discuss the concepts in the context of the veteran mind.

When using mindfulness as attention training (Morgan, et. al, 2016), there are

generally three goals that come from mindfulness mediation: focused attention, open

monitoring, and loving-kindness and compassion. The first is actually very easy to develop.

Many veterans will have learned to focus their attention on a task. In some ways, being on a

rifle range, focusing your breathing, monitoring your trigger pull, ensuring you are in the

proper position, and aiming at a target is a very specific form of focused attention

meditation. It cultivates an awareness of the body in relation to your rifle and the target

and regulates your physiological responses to enhance your accuracy.

Open monitoring is a little more difficult and loving kindness and compassionate

mindfulness is the most difficult. Compassion for one’s self is not part of the military

mindset. In fact, it is actively suppressed in service of the other. Your teammates and the
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mission are more important than you are. This is something instilled during the

indoctrination process and, as there is no process of reintegrating back into civilian society,

stays with many veterans upon discharge. The level of self-criticism that veterans place

upon themselves is high—military culture places responsibility for personal readiness

squarely on the service member’s shoulders and mental health problems are seen as a

personal weakness, not as an injury. The loving-kindness meditations that Morgan and

colleagues (2016) suggest would be a very tough sell on a veteran without preparation. In

some ways, it is first necessary to bring the veteran’s attention to how his mindset was

both useful in combat but troublesome back home. In many ways, there must be

considerable psychoeducation done before the veteran is ready to undo his self-critical

mode of thinking. What needs to happen is an understanding that safety will be ensured

with this new way of thinking. The military mind is a survival mind, tied to the deepest

regions of the reptile brain. These skills, this mindset, is explicitly designed to enhance

survivability on the battlefield and that is the main focus of military indoctrination. Once

safety is established, then we can start undoing that self-criticism and replacing it with

loving kindness and self-compassion. It is vital for the clinician to be attentive to the

veteran in this stage, as the veteran will be moving into a new, vulnerable emotional

territory that could require support from the therapist.

I can discuss this in practice by using a patient at the Brooklyn VA I will call The

Dreamer. Throughout all of our treatment I cultivated mindfulness through direct inquiry,

compared to a more meditative style (which I believed he would be resistant to). The

Dreamer entered treatment in order to treat his nightmares, which reflect his vulnerability

and aggression. Getting him to be more comfortable with his vulnerability required
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exposing him to aspects of it in a safe, controlled manner and showing him that he can

survive being vulnerable. The aggression he feared would also have to be explored in full.

He usually began every session discussing a dream he had over the previous week before

moving into other topics.

After hearing his dream, I would ask the Dreamer how he felt discussing the dream

in the present time as well as how he felt when he woke up from it. Comparing the

reactions between then and now can be useful for showing the patient that negative affect

is transient. Then I would ask him what he thought the dream meant. This would give me

an idea of how self-aware he was about the symbolism inherent in his dreams.

Since many of his dreams have ambivalent relationships with medical personnel, I

would ask him how he feels about coming to mental health treatment. I’d ask him his

opinions of the medial personnel that he has encountered at the VA and, in particular, his

opinions of myself and other mental health staff he has worked with. His dream

relationship with medical personnel is often contentious based upon the personnel doing

something that puts the Dreamer at risk. I would discuss with him the risks he feels about

discussing his history with me, as I felt his reluctance to share his emotions is based upon

that fear.

Utilizing a more interpersonally focused approach to the Dreamer’s therapy was

slow but had positive results. After he detailed one of his dreams where he was being

chased by an unusually persistent and intelligent snake, I asked the Dreamer what he

thought might be chasing him. To this, he responded, “I’m chasing myself,” which I thought

was a very insightful response. This encouraged me to ask him about many of the more

prominent features of his dreams. In one, where a taxicab driver who was supposed to take
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him to see me, the taxicab driver frequently misunderstood the Dreamer’s directions

(which were to a different hospital than we see each other at). When I asked him why he

thought the taxicab driver had trouble understanding him, the Dreamer replied, “people

don’t understand where I’m coming from most of the time, anyway.”

We terminated after about a year of therapy, when I left the hospital. While The

Dreamer acknowledged he could probably benefit from more therapy, he said he didn’t

want to start over with a new therapist and that he felt he was much more in touch with his

feelings and was able to understand his anger and he reported no nightmares for the last

two months we were in treatment together. By creating a more mindful veteran, I was able

to create a more peaceful veteran.

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Response to Military Dilemmas. Ethics & Behavior, 23(3), 237-249.

Doi:10.1080/10508422.2012.748634

Demers, A. (2011). When Veterans Return: The Role of Community in Reintegration.

Journal of Loss and Trauma, 16(2), 160-179. Doi:10.1080/15325024.2010.519281

DeVries, M. R., & Wijnans, E. K. (2013). Personality and military service. In Military

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Elder, G. H. (1987). War mobilization and the life course: A cohort of World War II

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