Loneliness Kills: Lessons From a Combat Hospital

Kate Hendricks (center)

I used to think I understood health. I worked in fitness and told people about it for a living. I WAS WRONG. Focusing only on movement and nutrition, I was missing the bedrock concept upon which real health is built. We are wired to connect and social health is the foundation of human well-being. (Check out the science behind this in my just-released TEDx talk).

This is what I study today, but in a life quite different than my current as a suburban mom and public health professor, I was a Marine Corps Military Police Officer. I have a little brother who also joined the Marines and we’ve always been very close, probably because we had to be! When we were young we moved over 20 times – there was many a summer where my siblings were my only friends because we were the new kids.

I was already deployed to Iraq when he e-mailed me to share his grand romantic plans to propose to his girlfriend before he headed over. She was a civilian schoolteacher that I had yet to meet. I was in my cynical deployment mode and I was surrounded by Marines receiving what we call “Dear John” letters. They often read the same, “the grind of deployment is too much, our relationship is over, I already have a new significant other, the end.” I didn’t think his proposal would wind up any differently because he was headed to Iraq right behind me, but I wanted to be supportive so I told him I didn’t have a problem with the proposal but admonished him to buy her a ring made out of cubic zirconia. No sense in buying a diamond he might never get back.

As younger brothers often do, he ignored my advice and bought her a beautiful ring.

Well, that is some cash he will never see again! Should have listened to me!

When he was coming in I had convoyed south and I was able to be there at the hangar in the middle of the night when he flew in. Even armed and incredibly well-trained my brother will always look like a little kid to me. He was walking towards me with a huge pack on his back, a Kevlar on his head, and a rifle in his hands. All I could see were his big, blue eyes peeking out like a turtle under all that gear and I thought, “who let a ten year old on the plane with a rifle???”

As I stood watching his C-130 unload on the tarmac I forgot to feel invincible for a moment and my heart sunk – I knew where he was heading and I knew what was happening there. I had some big sister notions of telling him what he needed to know to stay safe during his deployment and for the first time it occurred to me that may not be enough.

Soon after I was headed home to the states and I didn’t know it at the time, but he was as well. Except that an improvised explosive device made sure that his trip home was wounded and on a stretcher.

When a service member is medically evacuated and they make it to the stateside hospital, there are no guarantees and a lot of unknowns.

When my brother arrived at Bethesda, we didn’t know what he might be facing. Our family came together to be there for him, but even with our support system gathered, Bethesda was a dark place some days.

Into this world walked my brother’s civilian schoolteacher.

Frankly, I didn’t yet know if she was part of our close-knit family. I had stereotyped her on sight—mostly because she was a pretty girl who often wore makeup and always had on matching accessories. I was waiting for her to fall apart.

She never did.

When her leave ran out at work she went back to teaching all day long in nearby Virginia, but made the drive every night to sleep in a chair at my brother’s bedside. I was terrible in that hospital room always dropping things – just graceless. She kept him smiling and focusing on their future together. She kept him connected to their community of friends when he left the hospital and had to spend his days in a reclining chair. She kept him looking forward to new plans to build a family, even when they had to install bars over his bed at home and he needed help with the most basic tasks.

That makeup had fooled me; she was more than serious. She showed up, and she was a foundation for my little brother when he really needed one.

They got married and she gained three sisters that would help her hide a body today if she asked.

She has a really good memory though. Every now and again, I hear about that cubic zirconia comment.

The Science of Social Cohesion

Here’s the truth about human health – nothing will kill you faster than loneliness.

We know all of this because scientists have studied social cohesion from a variety of angles and proven that disconnection is dangerous! We’ve studied partner relationships, friendships, and civic involvement – it is all important and comprises our social health. In one study, medical students without many friends had depressed immune systems. A 30 year study out of Roseto, PA found that support protected against heart disease even when the diet wasn’t ideal. My own research has demonstrated convincingly that people without partnerships are at greater risk for depression.

We talk in public health about behaviors that offer something called protective effect and upping your social support has more protective effect than quitting smoking. Don’t hear me wrong – smoking is still bad!

The reason for that can be found in our physiology. Stress hormones surge when you’re feeling lonely or rejected, and if this happens too often or for too long, you start seeing problems.

Cortisol and adrenaline are useful when facing a real threat – they fire us up to respond, but they also shut down everything non-essential. Our heart rate and our breathing rate jump up and blood flows to our biggest muscles. Energy to the logical brain, digestive system, and even blood flow to our extremities is diverted.

If hormone levels stay up, you can imagine the problems your body starts to face. At first, diminished blood flow to the extremities is just cold fingers and toes. Over time it might become neuropathy. Then, you stop feeling and have trouble picking things up or even balancing – in this way our body is trying to signal us – loudly, in the only way that it can – social numbing becomes physical numbing.

Our brain activity being interrupted may mean initially only that it becomes tough to find our car keys. Soon enough, we begin to have difficulty communicating, displaying empathy, or engaging in high-level thinking. This makes connecting with others even more challenging, and our isolation can easily become self-perpetuating.

I work in military public health today, and for a long time, all we talked about was the correlation between post-traumatic stress and combat deployments. That’s not the whole story, though – it’s far too simple. The riskiest time for veterans is the first six months of coming out into the civilian world. We face that complex mix of losing identity, our purposeful, all-consuming work, and the biggest loss – our tightly-bound community.

Conclusion: So-What Factor

When social support is happening the way we want it to, you get a veteran reintegration story like my brother’s.  In our family, he is still everyone’s favorite. He’s now a dad and a slightly-intense High School English teacher.  His wife is hilarious and keeps us all on our toes.

When it’s not, you get one like mine, and like too many of our service members leaving active duty today.

I struggled with pulling the right people around me after deployment and that time at the hospital. I was angry, guilty, then angry some more. I drew inward and sought to surround myself with people who had similar experiences to my own.

The results for me weren’t pretty. I worked too hard, drank too much, and communicated not at all. I found a relationship that was as volatile and crazy as I was feeling on the inside. I didn’t know the meaning of the word “introspection” or the phrase – ‘I need help.’” There was a time I could’ve wound up an isolated, angry statistic.

The social health issues I’m talking about aren’t strictly veteran problems. The angry veteran, the elderly shut-in, and the person in an emotionally abusive relationship all deal with the same physical effects.

All of us have to prioritize it.

I was never lonely exactly, I certainly had people around me, but I had too many of the wrong people, and I had no one who ever challenged the way I was doing things.

We all need the strength that an uplifting group of different – and thus complementary – personalities brings us. So I had to ask myself, as I encourage you to ask yourself – how are my people?

Do they support you? We need affirming, yes.

Do they challenge you? We also need different.

Connect. Be willing to get a little uncomfortable – It can completely change your health.

Military-Civilian Drift: Leaders Work to Bridge the Gap at S2C Summit

I spent last week at the University of Alabama’s second Service Member to Civilian Summit. S2C was full of amazing speakers from realms academic, government, and grassroots. It was a truly humble space where thought leaders strove to collaborate rather than “talk at” one another. A key theme kept emerging, and it is one that data support as relevant to veterans’ reintegration strongly, as do my own experiences. Social support. Tribe. Community. Military-civilian drift. We used a lot of words for the same problem and shared success exemplars to bridge gaps. We have military personnel falling into risk and illness because of issues related to alienation and we can change that together.

I came away thinking about that rallying cry – both for veterans to be resilient leaders who contribute and connect in their home communities and for civilian members of those communities to care, notice, and commit to change.

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Warrior Culture

My community is a military one, and we in the military social work and health communities know that we’ve lost too many this year. Not all veterans lose their social support systems upon returning home, though many of us do. It can be tough to stay close to people when we aren’t sure that we speak the same language any longer. Some veterans are blessed with the ability to keep communication lines open, even in hard times and with loved ones able to weather the storm alongside. These are the cases that highlight even more powerfully the importance of connection, and I will always be grateful that this was my brother’s experience.

I was already deployed to Iraq when my brother e-mailed me to share that he was probably going to propose to his girlfriend before he headed over. She was a civilian schoolteacher from Philadelphia that I had yet to meet, and I just rolled my eyes when he shared his romantic plans with me. I was surrounded by guys losing their girlfriends to the grind of deployment, and I expected that his schoolteacher would be mailing him the same “Dear John” letter after a few months. I told him I didn’t have a problem with the proposal but admonished him to buy her a ring made out of cubic zirconia. No sense in buying a diamond he might never get back.

As younger brothers often do, he ignored my advice and bought her a beautiful ring.

Well, that is some cash he will never see again! Should have listened to me!

He didn’t listen, but he did come home around the same time I did, sent back by a pressure-detonated IED that tore apart metal and bodies and all of our hearts.

When my brother arrived at Bethesda, we didn’t know what he might be facing. There was so much damage. On his third surgery, the physicians in the operating room took a vote about whether or not to amputate his leg at the hip; he had infection setting in and they were worried it could get worse. Two voted to amputate, and three voted to give him a couple of days.

Ward 5 was a dark place. We were surrounded by morphine drips, pain, injury, and struggling families who weren’t sure what to make of it all.

Into this world walked my brother’s civilian schoolteacher.

She won’t be able to handle this.

We Can All Be Warriors

When a wounded service member is medically evacuated, he or she often has a long period in a hospital ward and in lots of different outpatient treatment facilities ahead. There are no guarantees and it is painful for both the patient and those standing alongside. I watched the prospect of a long, uncertain recovery level some people. In others, I watched uncertainty and trauma bring out their diamond-hard character.

Throughout this period I watched his young fiancé with a cynical eye. I stereotyped her on sight—she was a pretty girl who often wore makeup and always had on matching accessories. I assumed she lacked gravitas and would fall apart any minute.

She never did.

When her leave ran out at work she went back to teaching all day long in nearby Virginia, but made the drive every night to sleep in a chair at my brother’s bedside. I would find her sitting by his side laughing about some silly thing or another, always keeping him smiling. She never complained and never gave up, never confessed fears about marrying a man with so many new health issues.

While I fumbled gracelessly in his hospital room, once even dropping a portable DVD player on his gaping wounds, she was all kindness and poise. She kept him looking toward their future on a daily basis. Even when he left the hospital and had to spend long days in a reclining chair. Even when he needed help with any and all of the most basic tasks.

The makeup had fooled me; she was more than serious. Only in her twenties, she helped him make it to the bathroom, shower, move, and get through hard physical therapy appointments without complaint. There were guys on the ward whose wives filed for divorce when they saw what they were going to have to struggle through together. I don’t think the thought ever crossed her mind. She helped him through medical retirement, a search for a new career and a civilian identity, and they became parents with that joyous excitement reserved for newbies who don’t yet know how much sleep they will soon go without.

She married a Marine with three sisters, all of whom would gladly hide a body for her today—no questions asked. She has a good memory though. Every now and again, I hear about that cubic zirconia comment.

Invisible Wounds

For me personally, this was the start of a very confusing time. I spent some nights in the hospital lounge, some with my parents at the Fisher House, and many others with friends in the local area. I began to struggle with leaving the hospital and interacting in the real world – it was a world I no longer recognized. Everyone was so casual and happy, oblivious to the pain and sorrow facing everyone I’d just left. I lost the ability to speak to civilians and my resentment seethed under the surface. I was simply angry with no way to articulate why.

And then, I got self-destructive.

Not all wounds are visible, and you can join us in working to navigate this space at the next S2C Summit. Look for dates next year! Until then, how can you connect? Where can you help?

Older People Living Alone With Dementia

Dementia-Signs-and-Symptoms-Include-Alzheimers

We are having a conversation, social worker to social worker, about the older constituents and clients who we each try to help. She works in a small senior center, and I work in the district office of a New York State Senator. I believe it is those of us on the front line of senior issues in our city who see first-hand the breadth and depth of the ever-growing population of older adults who are left to their own resources to navigate the complexities of life in this large urban city. So many are suffering from some form of mental illness, most often dementia. They are only one step away from winding up in a shelter system where they do not belong. To most people, they are invisible.

Sounding frustrated, she says,”They just keep coming”. I reply, “And they are all mentally ill or in some phase of dementia, right?” “Absolutely, she replies, “either that or they are broke…or, more likely, both.”

And yet, over the past several years, with a very heavy heart, I have had to refer elderly people to our city’s shelter system.This comes only after exhausting my own resources to find them even just a bed for the night. Programs that once offered temporary emergency shelter are full. One program director told me, “Clients used to come in and stay for a few weeks or a few months until they could find permanent accommodations. Now they seem to stay forever, and we very rarely have even a single bed available.”

Add to this the fact that these are people who have no social support network. They have no children or are estranged from their children, their friends have all died; and in some cases they have physical and/or mental limitations, that keep them isolated. These constituents are not anomalies, they are part of a cohort of seniors and elderly community members who come into or call our office every day. One day a young staffer said to me, “Wow, all seniors are mentally ill”. My answer was “No, not all seniors are mentally ill, only the ones that come to see us.”

The older adult that seeks our assistance comes with a legitimate presenting problem; i.e. my landlord is harassing me, someone is coming into my apartment when I’m not home, I’m not getting my food stamps or SSI credits. It is only when I sit down to talk with the constituent, whether in person or by phone, that I very soon realize that the presenting issue is just one piece of a much larger problem. When I make the decision that the constituent’s issues are not appropriate for a legislative office, I then refer the constituent to a senior service agency. It is my hope that the agency will be able to assign her to a case worker who can holistically see the entire picture and assist her in getting the help she needs.

While we need the many extraordinary social workers who are dedicated to helping these constituents with direct service, I can’t help wondering why we are having such an influx of older adults with mental health issues. It is only when we can answer that question that an effective solution can be found…or perhaps legislation can be written…to ameliorate the situation. As a macro social worker, this is my job.

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