Narrative Medicine Project

I had the privilege to interview a long-term employee at Impact Services. The interviewee, who identifies as a she, worked for Impact under supportive veteran services in many capacities. She had recently returned to the organization at the time of interview. I wanted to ask her about their connection to this work because I have observed their care and concern for the veterans. Since I have previously worked with men who were experiencing homelessness and substance misuse, I have some relevant experience with this population. Therefore, this background informed the questions I asked.

I wanted to learn more about her experiences and gain more insight into the humanity of veterans’ experiences. I began our conversation by asking about her previous work history with Impact Services and then her insights as an employee. First, we talked about what is critical to know about veterans without any previous personal or professional experience. She expressed how trauma has impacted their experiences during their time in the military. She shared clients often discuss trauma. This begins with boot camp and continues until they are officially discharged about three years later. This has a real impact on all veterans even if they are doing well. She mentions that she knows veterans outsides of her clients who are thriving but are still affected by it. They still talk about it as well.

Next, we discussed some important aspects of working with this population. She mentioned a remarkable part of working with veterans is the camaraderie they express toward each other. They intentionally help each other even though they may be generally defensive towards people. I asked about a specific work experience with a veteran that continues to impact her. In 2014, She met a veteran and helped him obtain housing on the same day. He did not have any belongings like clothes or toiletries. She arranged for a check to buy some items and the apartment manager provided sheets and blankets. He was genuinely shocked and said she saved his life. He eventually got an apartment through Housing and Urban Development (HUD) and now has a housing subsidy where he pays 30% of the rent. He has a history of substance use and has stayed sober since. She points out there are numerous veterans who did not make it since this experience.

I asked her about how the current state of Philadelphia impacts her work since her return. In the past month, she says violence and drug use in the community have directly impacted the veterans’ mental health. She mentions specifically they are vulnerable and knows Philadelphia and Kensington are not easy places to live in. We then turned our discussion to how COVID affects her current work. COVID has negatively impacted her ability to be effective in her job. She is unable to be as hands-on and does not get enough in-person interaction. She believes this is important for her clients to talk with her and see her body language including her facial expression. This allows them to see she is showing concern.

Finally, we discussed her suggestions for professionals who work with veterans. She emphasized significant patience because they come with complex health needs due to trauma, mental health, and substance use. She points out they may act entitled and come from different walks of life including different skin colors. She says the male veterans are not used to female staff members being in positions of authority. Also, She shared female veterans face additional barriers due to fewer resources and support. Impact Services has a women’s shelter with 12 beds compared to 56 for men. In the Philadelphia area, women with children cannot find a program that includes their children which may prevent the mother from receiving services. Female veterans may have health care through the VA which does not apply to their children.

My conversation with She brought up several relevant aspects of working with this population that parallels my professional experiences with men and women who are homeless and have a history of substance use. Both have complex needs which can make it emotionally intensive to assist them. Women have additional barriers in comparison to men when seeking support and behavioral health services. The pandemic further complicates this vulnerable population from being empowered and getting the help they need when they are in crisis. Her most insightful point references how multiple traumas fundamentally alter the veterans she works with. These experiences can fundamentally alter their well-being.

This interview demonstrates the impact of multiple events of trauma on an individual’s life trajectory. I am passionate about changing how society and clinicians treat individuals like veterans with complex post-traumatic stress disorder (CPTSD). A new wave of CPTSD research began after the International Classification of Diseases 11th revision (ICD-11) included CPTSD as a unique diagnosis in 2019. There are no evidence-based practices developed for CPTSD that are peer-reviewed. Professionals using treatments for PTSD increasingly realize this is not adequate. These factors motivate my passion to change policy on CPTSD through a research career