ELEVEN

Mothers in War

AMY CANUSO

The purpose of this chapter is to introduce clinicians to topics that may be the focus of clinical attention and to highlight the unique issues that women with children face when they deploy in the United States military. The military is becoming more inclusive to women in leadership and combat operations; thus the number of women with children who deploy in the operational setting continues to increase. This chapter will educate clinicians on the resources available to military mothers. It will discuss the ways that clinicians can advocate for Servicewomen with infants by educating commands on the various military instructions which ensure that women have adequate bonding time and opportunity to breastfeed. Mental health clinicians and medical providers alike will be able to discuss with mothers who are about to deploy, and their children, how cognitive preparations can help them to maintain a sense of family stability and proficiency in their work while they are deployed. This chapter will explore the ways that mental health providers and other clinicians can stress to military Servicewomen that the deployment experience can be strengthening to their family, and to themselves, offering many resiliency-building attributes. Clinicians with this knowledge can assist women in their personal and family readiness, and can begin to set the stage for healthy processing of the deployment experience.

The changes in the way that women and mothers have deployed with the military may be attributed to the changing structure of the military itself. The military continues to integrate women in non-medical military occupations, no longer limiting them to the “male supporting roles” (Defense Manpower Data Center via Military OneSource, 2012). Similarly, the traditional family structure is changing. There are a growing number of female primary breadwinners, single breadwinner income with stay-at-home fathers, families in the military who are dual active duty (both mother and father being active duty), and single mothers in military service (Defense Manpower Data Center via Military OneSource, 2012). With these changes in the demographics of family structure, there will continue to be more women who have children in deployable positions.

The majority of “Generation X” women who entered military service (as well as those who are younger) do not view women who deploy in service of their country as a novel phenomenon. Women in the military often see their deployments with generational pride—a period in history when more women are actively integrated into military roles (other than as nurses) (Patten & Parker, 2011). There is very little research that has exclusively tracked the attitudes and expectations of military mothers in this age group; however, it is the experience of this author and other professional women interviewed for this writing that most women who entered the military post–9/11, for the most part, fully understood that they would deploy.

The majority of women who joined the post–Persian Gulf War military entered their service commitment without children. Most women interviewed for this chapter did not initially appreciate that they had to choose between motherhood and career, or motherhood and service to country. The current cohort of women in military service grew up in the era that followed the women’s movement of the 1960s and 1970s; for the most part, they believed that women could (and should) “bring home the bacon” as well as “fry it up in a pan” (as most of that generation saw on an Enjoli cologne commercial, which became iconic). This faction of women grew up after Title IX; thus they were more apt to participate in school athletics, and to feel that they could perform physically in rigorous military training, which led to a desire to pursue the military lifestyle of activity and physical readiness. While women with children were becoming more successful in the civilian sector, as police officers, pilots, managers, and scientists, it seemed logical that there would be similar trend in the military sector (US Department of Commerce, US Census Bureau, 2013).

“I was a single mom. I found out I was pregnant after I signed up and finished my training. I didn’t have a choice but I really felt it was a situation that was not only possible, but also could be beneficial.”

Women in the military are less likely to marry then their male counterparts. Women who do get married frequently marry an active duty partner after basic training and military educational training (specialty schools or specialty training) (Defense Manpower Data Center via Military OneSource, 2012).

For new families and single mothers, the resources of the military social support Services, the steady paycheck and housing, the free healthcare and generous maternity leave can be favorable.

“I was married when I joined; however, I did not think I would have children. I thought I would serve my time and get out of the military but I just never did.”

“I knew I would deploy so I timed it to when I could go early after the baby was born. I don’t think I’ll stay in though, I would not want to do another deployment with my kids older.”

For many military women with children, deployment orders can be a conflicting situation. They may want to deploy because the mission is the result of months, sometimes years, of training and preparation. Women whom I interviewed explained that they were honored to be able to be among the fighting forces serving their country. However, the reality is that when they leave their children, there may be significant cognitive dissonance.

Unfortunately, most women don’t fully appreciate the ambivalence until they have both a child and deployment orders in hand at the same time. Reactions may range from sadness and denial to anger.

“I didn’t think that I would be sad when I deployed away from my kid and I wasn’t, but I did end up angry. Angry all the time.”

“You always know there is a chance you might deploy with kids, but we just decided to do it [have children]. I had wanted to deploy, but now I began to sort of dread it.”

There are women with children who enjoy deployment time as much as any person without a child. Many women find the deployment very satisfying, both professionally and personally (Patten & Parker, 2011). It is an opportunity to serve the United States. It is an opportunity to provide for their family monetarily. It is an opportunity to gain precious job experience.

“I thought it was almost easier being deployed in Afghanistan then trying to balance between work and home-life Stateside. When deployed, I could work around the clock and focus entirely on the mission without worrying about the needs of my children or husband.”

“My view of deployment didn’t change when I had my son, but my husband’s did. Now it became more family involvement and child care time for him.”

“I got paid two and half times as much on deployment so it really helped us out.”

For the mental health provider, it is important to appreciate the diverse presentations and experiences that a woman with children may have before and during deployment. The ability to focus on inherent healthy defenses and positive cognitive framing of the situation can be used therapeutically to strengthen baseline resiliency.

Family therapists and family readiness specialists agree that it is necessary to designate a period of family preparation when any family member is deploying. This is beneficial for the family and also for the active duty parent. While it may be tempting for parents to not want to distress their children, it is imperative to recognize that the motive for not telling children may be unconscious avoidance of the parent. When a mother understands that her child is mentally prepared and that all caregiving needs are secure, she can better focus on the needs of the mission.

There are multiple resources to assist a mother in explaining the separation of deployment to their children in a developmentally appropriate manner. There are numerous children’s books that feature stories of children whose parent is deployed and that discuss the feelings that children and parents feel in the pre- and post-deployment stages. In these books, characters find ways of resolving their conflict when a parent is away in military service. Many books are even specific to children whose mothers are deploying. For example, Sesame Street has produced a DVD that has been helpful to many families (Sesame Street Workshop, 2006). Other tools for families include journals, “mommy dolls” videos, and numerous cognitive tokens (such as filling a jar with small candies to number the days Mommy will be deployed and then eating one a day until the return).

It is a commonly understood phenomenon that at times Service Members can be overwhelmed with the amount of social services that are available and may not know which would be the most beneficial.

“I became so obsessed with learning about every resource book, video and craft possible that I nearly collapsed. I needed to be sure that my kids did not miss THE book/video/class/toy that was going to ensure that my kids did not forget about me and did not suffer an emotional scar.”

“I must say that when Elmo spoke about this topic I was really starting to feel a bit comforted.”

Resources are widely available through military social service programs, such as Fleet and Family Services, and family support programs, and they are often free. Clinicians should be aware that such resources could be helpful to women with children who deploy, and they should be familiar with resources so that clinically relevant and therapeutically sound resources can be recommended. The following is a list of helpful materials that clinicians can keep on hand. All are readily available through Military One Source (www.militaryonesource.mil) and are free of charge.

• Home Again by Dorinda Silver Williams: This is a lovely illustrated book for children ages 0–3 years that helps children and parents with some of the issues of reunification after deployment.

• Over There by Dorinda Silver Williams: This is a book for children ages 0–3 years that introduces the concept of a parent deploying. There is a Mommy version and a Daddy version.

• Over There: This is a downloadable MP3 recording of Dr. Heidi Kraft discussing some of the challenges and the benefits of mothers who have deployed. It is also available for order in CD form.

• Military Youth Coping With Separation: When a Family Member Deploys: This is a video that can be downloaded or ordered on DVD. It is designed specifically for older children and adolescents to help them understand and prepare for the social and emotional changes in the household when a parent deploys. It was designed by military pediatricians.

• Mr. Poe and Friend Discuss Family Reunion After Deployment: An animated carton designed for young children and school-aged children to discuss the return of parents and reunification. It also features real children and their active duty parents who discuss how they got through deployment and reunification in their families. This video focuses on positive family strengthening aspects of deployment.

• Sesame Street Talk Listen Connect: Deployment Homecoming Change: From the writers and directors of Sesame Street, this video features familiar Sesame Street characters as they talk about the changes and feelings they have when their parents deploy. This is a bilingual DVD, which also has some supplemental materials for parents to act as “a conversation starters” to discuss deployment with their kids. This is appropriate for children ages 1–5 years.

• Coming Together Around Families: This is a comprehensive “toolkit” designed for “families and providers.” It has leaflet style handouts that are promotional for Military OneSource’s other programs and articles, which are found the Military OneSource website (http://www.militaryonesource.mil). It includes the Over There books and the Sesame Street DVD. It is not age specific.

While OneSource has very useful tools, they limit the amount that one person can order. A clinician may want to have multiple resources on hand, however. OneSource representatives report that they would rather clinicians refer to the website so that military members can log in themselves to order. Clinicians can log in with families while in session to ensure that the resource can be utilized.

There are a number of children’s books specifically about mothers deploying that can be bought at bookstores or procured from city or military base libraries. The following is a list of some readily available titles that are exclusive to the subject of military mothers who deploy:

• Mamma’s Boots by Sandra Miller Linhart, illustrated by Tahana Marie Desmond

• Love, Lizzie: Letters to a Military Mom by Lisa Tucker McElroy, illustrated by Diane Paterson

• My Mommy Wears Combat Boots by Sharron G McBride

• Mommy, You’re My Hero by Michelle Ferguson-Cohen.

Not exclusive to a mother being the parent deploying but still worthwhile and gender neutral:

• We Serve Too! A Child’s Deployment Book by Kathleen Edick

• Love Spots by Karen Panier

• You and Your Military Hero: Building Positive Thinking Skills During Your Hero’s Deployment by Sara Jensen-Fritz, Paula Jones-Johnson, and Thea L. Zitzow.

The military healthcare provider is in a key position to assist women in preparing their families and themselves for an upcoming deployment and separation. Mental health providers, women’s health practitioners, pediatricians, and general medical providers can use pre-deployment health visits, well women visits, and well child visits to explore the level of preparedness with women who are in deployable positions. This should be part of an ongoing wellness screen because it is not unheard of to have spontaneous deployments or “hot fills,” which can mean as little time as two weeks to prepare for deployment. Clinicians may consider the following questions to discuss with patients and clients in preparation for deployment:

• Is there a chance you will deploy in the next year?

• How do you intend to discuss the deployment with your child?

• Have you allowed sufficient time for your child to process fears and questions? (an opportunity to discuss the importance of not waiting to tell children about the deployment)

• What resources have you utilized to help your child understand why you must leave?

• Have you planned for sufficient time to spend with your child (without interruptions) before deployment (like a family trip)?

• Have you investigated the ways you will be able to communicate with your children? (Skype is often unavailable)

• How do you hope that this deployment will help you and your family? (an opportunity to put focus on the value of deployment and how the family may benefit).

Such questions are meant to begin the discussion and facilitate the opportunity to assist the mother in the arduous and sometimes overwhelming preparations for deployment and separation. Questions should be discussed, with answers derived by the clinician and the mother in a therapeutic manner, again with resources readily available.

It may be that the mother about to deploy needs a meaningful act to sublimate her anxiety and fear of separation. Clinicians can suggest the following activities that families can do together to facilitate discussion and bonding.

• Consider a memory box with some special items, pictures, meaningful tokens, and a special letter that the child can look at when he or she misses mommy. This box can be made together, or a mother could make one for her child and the child could make one for the mother; then they could share the experience of giving a gift to each other.

• Create a jelly bean jar: a jar is filled with jelly beans (or other candy) that has enough pieces in the bowl for each day that mommy is gone. One piece gets eaten every day until mommy returns.

• Consider a mommy doll (https://www.daddydolls.com/); this can act as a transitional object for a child while the mother is deployed.

• Suggest that books are read and recorded in front of the laptop (in photo booth type application or similar program). This allows children to see their mother read them a story, thus maintaining a part of the nighttime routine.

• Encourage women to write often to their children in developmentally appropriate ways. A child might really enjoy just a drawing from their mother if he or she doesn’t read, and it makes children feel special to get a piece of mail.

• USO offers a reading program for kids through the chaplain services at most overseas bases (http://www.uso.org/united-through-reading.aspx). This, again, is an opportunity for the child to have a special connection, a special gift, that comes just for them from their mother.

• Caregivers can keep a journal in the kitchen and write down the date and just a line about something humorous or significant the child did or said that day. After a few pages are filled out, the pages can be sent to the parent as a letter.

It is not uncommon for women in the military to deploy when their children are very young, given that 65.7% of military members are less than 30 years of age and 44.0% of the members of the Armed Forces who have deployed have children (Department of Defense, 2010; Defense Manpower Data Center via Military OneSource, 2012). Each branch has a slightly different direction regarding the deferment period before a postpartum active duty member must return to her deployable status. Each branch—Army, Navy, Air Force, US Coast Guard, and US Marine Corps (USMC)—has some provision to allow women in the deferment period to continue military service and training while breastfeeding their children.

The Air Force, the US Army, the Coast Guard, and the USMC prohibit deployment for 6 months following childbirth. The US Navy has a 12-month deferment from deployment after childbirth. The Air Force also supplies a recommendation to commands to wait a full 12 months after birth before the active duty member deploys; however, there is no guarantee that the command will follow the recommendation, especially when resources and manpower are limited. The US Coast Guard has a one-time opportunity for men and women, Officer and enlisted, to be separated without pay from their service obligation for child-care needs. After two years there is a return to previous pay grade and benefits are restored.

The respective directions are as follows:

• Army AR 614-30 Deployment, Table 3-1 #33

Available on Internet at http://www.apd.army.mil/pdffiles/r614_30.pdf

• Marine Corps Order 5000.12E (Revised by MARADMIN 358/07)

Available on the Internet at http://www.marines.mil/Portals/59/Publications/MCO%205000.12E%20W%20CH%201-2.pdf

• Navy OPNAVINST 6000.1C

Available on the Internet at http://doni.daps.dla.mil/Directives/06000%20Medical%20and%20Dental%20Services/06-00%20General%20Medical%20and%20Dental%20Support%20Services/6000.1C.PDF

• Air Force Instruction 44-102

Available on the Internet at http://www.unitedstatesairman.com/AFI44-102_20_medical%20care%20management-1.pdf

• Coast Guard COMDTINST M1000.6A

Available on the Internet at http://isddc.dot.gov/OLPFiles/USCG/010564.pdf.

Most branches also have a provision in place for returning to service and being able to sustain breastfeeding. The US Army is the only branch with no clear guidelines; however, there is a formatted template letter that women can give to commands asking accommodations for breast-pumping needs, which is available with CAC access on Army Knowledge Online. In the readiness manual for female Soldiers there is a section on supporting breastfeeding after return to work. An excellent resource that clinicians can provide to women is the website www.breastfeedingincombatboots.com, which has a link to all military policies, military manuals, and sample letters provided in a very concise and user-friendly format (forgoing the need for CAC cards and time-consuming Internet searches) (Roche-Paul, 2014).

The US Air Force and the Coast Guard have in their written directions the specific requirement of a private space for breast pumping when mothers return from maternity leave. The US Air Force written direction requires specific time allotments (15–30 minutes per 3–4 hours) to allow women time away from their duties. The Navy and the USMC written directions even state that the room provided for mothers who use breast pumps must be private, and with running water (the Navy even requires refrigeration). Times allotted are not specified in the Navy direction or the USMC direction. This “unspecified” time allotment for breastfeeding can be extremely problematic. Most women find out soon after delivery that breast milk is produced in response to demand, so minimal breaks that are relatively short through the day result in a dwindling supply of breast milk.

“With my first baby I was so worried about being away from my job and I only produced milk for about 4 months. If I my breasts felt full, like I needed to pump, I just waited until it was 4 hours from my last pump. With my second baby I stopped worrying about what my command thought and pumped often for at least 40 minutes. My supervisor never complained. I sustained feeding for nearly 10 months.”

The ability to be away from the needs of the job varies, depending on the job and the command. Furthermore, there is the unspoken future ramification of how promotion and advancement will be affected for a female who spends up to two hours a day away from her post, pumping milk.

While the ability to breastfeed is no doubt better for baby and for mother, the limitations to time spent breastfeeding and the conditions under which a mother is pumping (such as unclean spaces, or no running water) can affect the mother’s ability to sustain milk (Foster & Alviar, 2013). Plugged ducts, poor hydration, engorgement, or contaminated milk product due to lack of cleaning and refrigeration are some of the unfavorable outcomes that may result from limitations to pumping and inappropriate accommodations (Bell & Ritchie, 2003).

“I was in the field for two weeks when my child was 9 months. I pumped three times a day but at the end of that workup my milk really dropped to only a few ounces a day. I had no way of getting the milk to my child so I ‘pumped and dumped.’ I hated to waste it.”

Neither the Army, Navy, USMC, US Coast Guard, or US Air Force allot for the deferment of training exercises, special trainings (TAD), special schools, or field training. It is plausible that 6 months postpartum, an active duty women may be expected to go to operational, pre-deployment workups, possibly being in the field training for days or weeks. As illustrated above, in addition to compromising the amount of milk produced and its usability, this interrupts the bonding process that is known to occur during breastfeeding, and may result in the child switching preference for bottle feeding over breastfeeding.

Clinicians can assist new mothers in the military by providing education and information from the above military directions.

A family care plan is a mandatory document that all Service Members with children must submit to their commands. This document is considered an essential part of operational readiness. It is devised to pre-plan for child-care arrangements when a parent deploys or could be deployable. There are roughly 20,000 couples in which both husband and wife are in military service, and 30,000 single military mothers. Forty-eight percent of married women in the military are married to a man who is also in the military, but only 7% of men are married to an active duty female (Defense Manpower Data Center via Military OneSource, 2012).

It is important to understand that the family care plan is not choosing a babysitter or a preschool. The mother will be deployed for months, conceivably even over a year. Child-care arrangement vary from the husbands of military mothers, their children’s fathers with whom the mother is not married, grandparents, aunts and uncles, and, in some cases, family friends. The family care plan can be especially stressful for single mothers (Ritchie, 2001 December). Women may find that they have problems with the consistency and reliability of family care plans before and during deployment. It is impossible to predict unforeseen complications in care, such as when a grandparent becomes sick, a caretaker has legal problems, or a father relocates for a job.

For example, I interviewed one woman whose family care plan stated that her child would stay with the child’s biological father, whom she had divorced two years earlier. This father developed a drug habit and became increasingly unreliable and difficult to contact. She asked to return from deployment to ensure the safety of her child and was legally charged by her command for not having a proper family care plan.

Women with children have much more to prepare for when they are about to deploy or go underway than merely having their backpacks or sea bags fully “squared away.” Clinicians can assist mothers in the military by being supportive as they navigate mother-specific challenges in deployment preparation. Clinicians may consider the following questions to discuss with patients and clients in preparation for deployment:

• Is there a chance you will deploy in the next year?

• Do you have a family readiness plan?

• Do you have a power of attorney?

• Who would act as your child’s guardian if you deploy?

• Will your child need to move to a different location to be with the guardian? Would this move entail that the family will be outside travel to a military base?

• Does your guardian have reliable transportation? Reliable income?

• Does your guardian have legal problems? Substance abuse problems?

• Have you discussed how your guardian will discipline your child and set boundaries with your child?

• Have you discussed school or day-care provisions with the guardian?

• How will your guardian have access to emergency monetary funds?

• Who will be the temporary guardian if your assigned guardian becomes ill?

Many military women who are mothers find that they can, somewhat, acclimate to the separation from their children during deployment. Once a unit is “boots on the ground,” the emotions of missing and longing for children, or even the feelings of guilt because a mother has left a child during deployment, are often replaced by the urgency of the mission.

“For the first time since before being married and before children, it felt like I was in control and independent. I felt like what I did mattered in a different way then when I am mom at home. I felt like the primary focus was my skill and I felt like my work was important.”

It may only be during phone conversations, letters, or Skype sessions that women really begin to experience the full emotional weight of missing their children. There are some very helpful tools, such as cognitive reframing or simple behavioral planning, that can assist to ensure that the duty member remains effective occupationally if she begins to have mood or anxiety symptoms.

“I tried to avoid thinking of [my child] most of the time. I had this system where I had something to do right after every phone call so that I would not retreat to my tent and start crying.”

Besides the positive feelings of competence that mothers have when they are deployed, they may find to their surprise that their families also are experiencing a sort of satisfaction that comes with mastery of task: “Mommy is doing her part for the country and so am I. I am being brave and I know Mommy will come back soon.” This can be an opportunity to allow children to build self-confidence in a shared, family endeavor, and even start to develop healthy autonomy.

Mothers describe that upon their return from deployment, children recall with pride their mother’s service to their country: “Veterans day is special because Mommy is a Veteran.” Some describe that their child connects seeing people in need on the news with the work that their mother did when she was away.

“My girl sometimes still brings it up. She sometimes will refer to the year that I wasn’t there as ‘the year you were helping to keep America and us safe.’ ”

The unique perspective of motherhood can be both helpful and also a challenge. Deployed mothers, whether in healthcare support, supply support, or directly in the line or wing units, report improved patience with the younger active duty population with whom they interact. Being a mother inherently has a way of helping a woman recognize that every person has a mother somewhere, and there becomes almost a surrogate nature to interactions with younger Service Members. Mothers describe having an ability to mitigate the needs and demands of their mission with an ability to also be supportive and sometimes even diplomatic. This ultimately can be beneficial for the mission. Women describe being able to keep peace in the military unit by using the skills of keeping peace in a family unit.

“Once I had children I noticed I didn’t want to strangle my young guys when they did something foolish. Before I may have really laid into them.”

“I always took the time to talk to the young Service members, just ask them how they were doing. I explained that I had two kids, and if one of my kids was serving in Afghanistan I would want someone to check in with them and make sure they were doing okay, tell them their mom was proud of them. Even the biggest toughest Soldier seemed to soften up a little.”

A specific challenge to many mothers who deploy can be when their mission requires that they come in contact with local children. This was the case for many women deployed in the Middle East during OIF and OEF, and for women who deploy on humanitarian missions, such as Haiti and Tsunami relief missions. Healthcare workers in military treatment centers, as well as women integrated into line or support units who travel beyond the wire in operations, can often be in contact with local children. It is not uncommon to see sick or injured children. Women in healthcare positions often treat children injured from military operations. In places like Afghanistan, injured children brought to US or NATO treatment facilities for medical care are not accompanied by women; they are escorted by a male family member or the village elder. This contributes to the level of emotional distress the child may experience when injured. While the sight of severely harmed, frightened, sometimes badly burned, or even deceased children can be traumatizing for anyone, many mothers who deploy say it is particularly difficult.

“It was not that we were reduced to ineffective puddles on the floor, however it did color our interactions with the patients and the families. It was almost as though there was an extra sensitivity or a commonality we had with this child. This was another woman’s child. That could be my child.”

In the area of operations, there are profound differences in the male and female ratio. One source reports states that there were nearly 300,000 women deployed in support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) between September 2001 and February 28, 2013, making up approximately 11% of the fighting and supportive force (Burrelli, 2012).

Mental health workers interacting with women who deploy are in a unique position of not only helping to build resiliency in the mother and her family in the pre-deployment stage, but also, in theory, focusing and highlighting inherent resiliency traits in the active duty member to help her potentiate her leadership capabilities. Many mental health experts have examined how the experience of deployment and exposure to trauma may be defined in psychodynamic theory as a “disconnect from self or shattering of the “self” (or ego). When active duty members, men and women alike, are separated from the familiarity of their homes, families, and normal environment and social structure, it is not uncommon to have a regression to more primitive defense mechanisms (Figley & Nash, 2007; Litz, 1992; Arreed et al., 2011). For example, when an active duty member is in the United States, doing his or her job, that person may suppress anxiety and anger over everyday stressors while at work for social appropriateness. When that active duty member goes home at night, he or she releases frustration in the safety of the home (with distance from the given stressor). During deployment, that same active duty member now finds that there is no acceptable place to discharge emotion and no way to gain distance from the stressor. Thus the secure “self” becomes compromised, and the active duty member may experience frustration, anger, and/or anxiety.

The conceptualization of “self” that many active duty members have in military service is that they are strong, untouchable, and able to withstand. This is a fundamental teaching to every military recruit. It is embraced by all branches in the military in all Corps and Services. A fractured self-concept is more vulnerable to doubt, insecurity, and fear. Such “chinks in the armor” of the self (ego) may become more pronounced with exposure to trauma.

Women who return from deployments with positive and healthy experiences describe that using the lessons they have learned as mothers can be helpful in navigating the stressors of a tour of duty. Denial, suppression, depression, and anxiety are common when challenged with separation from their children while deployed. One therapeutic approach for women is to embrace the “mother” in them and to pursue sublimation. Women who describe the ability to take the fear and sadness they feel from being separated from family and refocus the frustration in a positive way in their work (such as maintaining focus on the greater good of the unit, and accepting that separation is temporary) describe less emotional conflict. It is possible that supportive interactions by mothers (and even women who in any way identify with the representative human archetype “Mother” or “Sage”) have therapeutic potential to enhance ego strength (Young-Eisendrath, 2000; Wilson, 2007). As anecdotally reported above, a woman who is a mother may have a conscious or unconscious desire to sublimate the energy of longing for her child. This surrogate capacity may shape psychological processing of the trauma associated with combat. Trauma exposure and the development of a psychological stress reaction may be mitigated or lessened when the innate resiliency (balanced sense of self) is strengthened. The representational “mother figure” assists with the processing of fear, sense of loss, lack of trust, and the fundamental feeling of helplessness and separation. This is in no way to suggest that the area of operations benefits from the presence of women to “soften the trauma of war.” However, figures that are reminiscent of the inherent unconscious representations of safety and security and trust may act to balance the idea of “self” and may foster pre-existing resiliency.

Likewise, for mothers who are deployed and who are enduring their own grief and guilt of not being with their own children, the interactions may have a reciprocal therapeutic capacity, through the sublimation of the mothers’ desire. This technique in reciprocal therapeutic interaction is a positive alternative for women who may feel the need to suppress their natural drive to nurture, or to comfort, because they fear them to be inappropriate or unfavorable in the environment of military service. This theory is based on anecdotal observations of women who verbalized successful and favorable experiences during OEF. There is no known research to support the theory, and so it remains a much needed area for continued research and the development of appropriate metrics.

It would be naïve to deny that there are negative aspects of the military deployment of women with children. A mother’s separation from her children for extended periods can be particularly critical during specific early child developmental periods and can impair the relational connection or bond between mother and child. There is always the chance that the marriage may be strained and that there may be unsettled damage to the family unit’s cohesion. For single mothers who implement the family care plan, there is a potential for abuse or neglect of children while the mother is deployed. No mother would willingly want to leave a child in an unsafe or unprotected situation, but unforeseen circumstances have resulted in tragic outcomes.

Thus there is a risk of post-combat symptomatology that may affect parenting ability (Nguyen, et al., 2013; Bonanno et al., 2012). However, this potential exists for fathers who deploy as well, not only mothers. This continues to be an area that lacks data. There is a need for a long-term, evidence-based evaluation of how families fare after a parent deploys, examining both the negative and positive aspects.

I suggest that there is also a therapeutic benefit that likely cannot be quantified to having women with children in deployment areas. Women who deploy in service to their country are able to significantly contribute to the family household income. Most Service members know the financial incentive of service and deployment, not only in building savings, but also later in utilizing the GI bill. For a single mother, this economic advantage could potentially outweigh the costs of separation from a child, particularly if there is stable family or community support to ensure the safety of her child in her absence. There can be a therapeutic advantage to stressing pride in the family member, the family sacrifice, growth in autonomy, and the effort that all in the family put forth. Though separations can be difficult, there is also a potential for the strengthening of family bonds.

“I have a special place for the letters my family and I wrote to each other. I cherish them as part of our family’s story and don’t take for granted the time I now spend with my kids.”

Every active duty military member who deploys will face challenges, as well as gaining some rewards, when she serves her country overseas. This is true for all parents, whether mother or father. Clinicians who provide care for the military population can assist active duty mothers by including deployment planning and family preparation as part of the ongoing treatment plan and treatment goals. Clinicians should be educated regarding the resources and military instructions pertaining to mothers who deploy and serve with the United States military. They should have tools and materials readily available in their clinic or should be able to offer in-office demonstrations of navigation to online sites, because it is a common clinical complaint that military social and family support networks are resource rich but utilization poor (Department of Defense, 2010). Clinicians can include positive cognitive framing techniques as a therapeutic tool to build a strong, stable mindset, and to encourage that the entire family, together, work toward viewing the deployment as an opportunity to grow. Clinicians for active duty mothers have a unique position of working with military leadership to challenge the flawed notion that mothers cannot be productive workers in the military or effective members of the unit, and they can champion for the accessions needed so that a mother can do her duty without compromising her ability to provide for her child.

The numbers of women, and also women who are mothers, in military operations are rising. This chapter reflects some experiences of the women interviewed in preparation for this writing; however, at this time there is very little evidence-based data to support conclusive statements. Future research should focus on family outcomes to examine the challenges that both mothers and children face and the benefits that the family gains.

It is known that women Veterans experience many of the same challenges that male Veterans do (Patten & Parker, 2011). It would be helpful to evaluate if the children of women who deploy experience more health concerns. A review of medical documentation from specific families and of women who deployed may be a way to gauge overall family well-being as the OEF mission is slowing. A simple questionnaire could be used to measure resiliency and family satisfaction and would not require review of medical documentation. In the next 10 years there will be a cohort of children who have had mothers deployed and are now reaching their own adulthood. This prospective approach may invalidate entrenched views of the way our society regards mothers who deploy in service to their country.

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