Keywords

When discussing military deployments, the term “deployment” typically describes the physical movement of military personnel to an area of operations in support of various duties—e.g., contingency missions, humanitarian assistance, disaster relief. Areas of operations may include combat zones. Whatever technical term may be used to describe movement of military personnel to away sites, be it “show of force,” “carrier cruise” and so forth, the intent of this chapter is to describe inherent commonalities of these diverse experiences and help the reader better understand and serve their veteran patient population.

Following the tragic events of September 11th, 2001, the average deployment experience changed significantly and became more unpredictable in terms of frequency, length and mission sets across the United States Armed Forces. In the new century, America has conducted military operations in the Middle East, Southwest Asia and other hotspots, continuing its global projection of forward presence and force in regions with vacillating degrees of politico-social stability. In turn, deployments became more dynamic to meet evolving mission needs as America shifted its overall military strategy from Cold War operations to Operations Other Than War (OOTW) and the Global War on Terror (GWOT). Major Combat Operations have given way in part to Stability Operations but American doctrine and policies remain poised for future engagement in Major Combat Operations with emerging global superpowers. The military continuously plans, trains and prepares for future large-scale action whilst actively engaging in OOTW and Stability Operations and consequently, the scale and scope of modern military deployments are progressively diversified.

In today’s military, the majority of active-duty members will participate in at least one deployment during the course of their career; certain military occupational specialties and career length affect the likelihood of multiple deployments. Although each branch of the armed forces and the total military population have traditionally been made up mostly of young single males, much of the deployed population in today’s military is comprised of young families with children [1]. To clarify, the term “deployed population” refers to those military members who have participated in at least one deployment. The deployed population includes all genders and ethnic backgrounds as well as social and service circumstances such as single parents and members of part-time components such as the National Guard and Reserve forces. Women represent the fastest growing group of veterans and the number of women deploying has steadily increased. Military family members currently outnumber active-duty service members [2]. Any effort to understand and describe the deployment experience in toto must include consideration of how family members may affect, and be affected by, the member’s deployment.

To understand the potential impacts of the experience, it is important to consider the full range of deployment settings. Be it a combat mission by an Army armor regiment or an undersea patrol by a Navy fast attack submarine, a member’s experience may be unique in contrast to other military branches as well as amongst their own service community. To wit, a Sailor aboard a frigate will have a different experience to that of a Sailor deployed on an aircraft carrier, just as a Marine in a ground combat element will have a different deployment compared to serving in an aviation squadron. The U.S. Armed Forces perform operations across all domains that include ground, air, sea, undersea, space, and cyberspace. Military deployments range in mission type from combat action to regional security activities to counter-drug operations to humanitarian assistance and more.

For the purpose of this chapter, consideration should also be given to military families whose service members serve at an away location but are not technically deployed. Often referred to as a “geo-bachelor” tour, this type of assignment may require the service member to be stationed apart from their family and may last from a period of months to years; the distance apart varies depending on the circumstance. A member’s duty orders may necessitate a “geo-bachelor” tour as seen with unaccompanied duty (i.e., family members are not permitted to follow the service member to the assigned location). Reasons for the unaccompanied duty stipulation include safety and security factors, host-nation restrictions, and family members’ special needs or inability to obtain overseas clearance. In other “geo-bachelor” circumstances, a family may elect to remain in place away from the service member assigned elsewhere. The decision for such may rest on the intent to minimize disruption to spouse employment, family educational or medical needs, or may even stem from unfortunate circumstances such as marital or family discord.

It is an onerous task to create an all-encompassing description of the deployment experience—not only in terms of today’s military population and culture, but across veteran populations of prior-century military service as well. In dismissing the notion of any universal characterization, there remain common factors to acknowledge such as the stages of deployments. Deployments are routinely defined by three stages: pre-deployment, deployment, and post-deployment. How these stages are experienced vary broadly due to myriad factors. Each deployment experience, and any acute- and long-term consequences of such, may be influenced by individual, social, and occupational factors.

Individual factors include age, gender, religion, cultural identity and traditions, personality traits, resiliency, mindset, maturity, physical and mental health conditions, marital and family status, past experiences (personal and deployment-related), financial situation, and geographical location. Recent or ongoing stressors can impact an individual’s ability and capacity to handle the unique challenges encountered during any phase of deployment.

Social factors include family members’ military backgrounds (e.g., “military brats” versus “married into the military”), length of relationship/marriage, foreign spouse, age and developmental stage of children, dependent employment status (i.e., unemployed, part-time, full-time), health and special needs, available support resources and networks, dysfunctional relationships, past deployment experiences and attitudes, and pets. Broader social elements such as community support, national will, and popular opinion may also influence the deployment experience.

Examples of occupational factors include service-specific community and culture, member’s rank, role and specialty, the deploying unit’s mission and training, deployment frequency, each deployment’s length and location, and command support and communication.

Inestimable combinations of vast and varied factors ultimately determine the quality of a deployment experience. Any mental health provider privileged to work with military members and their family would be better suited in that role to realize the diverse nature of deployment experiences. The provider’s efforts and ability to appreciate the wide-ranging factors that influence each stage of deployment will foster identification of potential acute- and long-term consequences, and better guide interventions for timely definitive care. This chapter’s reflection on experiences across the three stages of deployment includes illustrative vignettes with follow-on discussions. The intent of this chapter is to help mental health providers better understand and relate to the deployed population and their family members, thereby enhancing rapport and the provision of therapeutic services.

Pre-deployment Stage

I knew that I would deploy at some point during my career but it still felt surreal when I received orders for my first tour in Iraq. I had checked in to my unit shortly after its return from the last deployment. Everyone knew it was only a matter of time before the unit would be up for its next rotation to “the sandbox.” The unit’s state-side time was really spent training for that next deployment.

I had been married to Lee for eight years and we often discussed what my first deployment would be like for the family. Our children were too young to understand any talk of a deployment so Lee and I mostly discussed that privately. After getting my orders, we occasionally mentioned to the kids I would be going away for a while like some of the other Army parents. We were careful to say I was going to help others and I’d be back before Christmas. We tried to put a positive spin on things. Lee would describe me as a hero-of-sorts to them, promising that I would come back as soon as possible.

Now and then the children would ask questions that seemed silly or sad—“Can we go with Daddy?” “Will Daddy die?” “Will you bring me back a toy?” The whole concept may have been too abstract for them. They usually got bored with our answers and would change the topic to more important matters, like their favorite cartoons and games.

As the departure date got closer, I wondered more and more how I would bear the deployment and being away from my family for so long. Part of me hoped I would handle it in stride and be excited about the opportunity to serve my country. But another part of me secretly wished I would never have to leave my family. I felt ashamed every time I indulged in that fantasy, like I was fraud to wear the uniform. It didn’t help when Lee openly yearned for the same. I really did want to prove my worth to my unit and nation. (Army Captain)

There is an Emotional Cycle of Deployment (ECOD) experienced by military families across the stages of deployment that was originally described by Kathleen Logan in her article published in the February 1987 edition of Proceedings—a monthly magazine by the U.S. Naval Institute that is one of the oldest running magazine publications in the United States [3]. While noting there exist concurrent cycles of cognitive, physical, behavioral and existential changes throughout the deployment phases which are highlighted in part throughout this chapter, the ECOD serves as a relevant means to frame understanding of the broader aspects of deployment. Originally developed for Navy spouses, the ECOD has been utilized by other military branches, governmental agencies, and several allied nations. The ECOD has demonstrated applicability not only for military spouses but deployed members as well. It is a multi-stage model defined by stage-specific emotional phenomena. Its stages include: Anticipation of Loss; Detachment and Withdrawal; Emotional Disorganization; Recovery and Stabilization; Anticipation of Homecoming; Renegotiation of the Marriage Contract; and Reintegration and Stabilization. The first couple ECOD stages—Anticipation of Loss, and Detachment and Withdrawal—occur during pre-deployment. Anticipation of Loss may begin when deployment orders arrive, which may be months in advance of the actual deployment, but is more pronounced in the 4–6 week time frame before actual departure. During this stage, the military family encounters a wide array of emotions along with denial and anxiety. The stress of the unknown may exacerbate feelings of helplessness and frustration. Tensions increase within the family and home environment as members deal with new responsibilities and projects to prepare for the deployment. Irritability, agitation, sadness and other symptoms may manifest, along with guilt that stems from either a sense of helplessness or self-attribution for the family’s current hardships.

During the pre-deployment stage, military families face an ever-growing list of tasks with ever-less time to complete them. The service member must see to preparation of Family Care Plans, legal documents (e.g., Power of Attorney), procuring necessary gear and uniforms for the deployment, taking care of pre-deployment physical examinations and vaccinations, and other needs. Training requirements entail longer work-hours and even periods of separation before the actual departure. Prepared families will anticipate what responsibilities the family members will need to assume but may have never handled before, such as filing taxes, house payments, assorted bills, car maintenance, work and school obligations.

In the final days leading up to the deployment, the family will experience the ECOD stage of Detachment and Withdrawal. There are moments during this time frame that typify the “hurry up and wait” experience which is a too-common fact of military life. Family time together becomes limited and various types of fatigue (i.e., physical, mental, emotional, spiritual) from preparation for the deployment takes a toll. Emotional distance increases between the member and family. Intimacy can be affected and couples may feel ambivalent about sexual relations. It becomes difficult for couples to maintain intimacy as they subconsciously separate on an emotional level to handle the eventual physical separation. For sensitive individuals, this may be interpreted as rejection which adds to emotional turmoil. There is also the commonly described phenomenon of “the fight before the night” the service member deploys. Such instances of functional arguments may superficially make the early separation seem more tolerable but significant discord may have lingering consequences with negative effects. In particularly vulnerable relationships, a hurtful argument on the eve of separation may foster uneasiness or suspicions of infidelity. The last days before the deployment are commonly described as the most difficult.

Compared to “deployment-naive” families, those who have experienced previous deployments or come from a military upbringing (e.g., “military brats”) may possess more resiliency and emotional readiness to handle pre-deployment stressors. Practical readiness is also a consideration. Whether noting the member’s personal preparation, family arrangements, the unit’s mission readiness (i.e., training, supplies, et cetera), or other factors critical to deployment, how well these tasks are accomplished can affect the manner in which this stage is experienced. Poor stress tolerance, financial concerns, relational discord, pregnancy, pending divorce, job dissatisfaction, special family needs, and other items can complicate the pre-deployment stage. In turn, there may be subsequent lasting effects upon the actual deployment and its aftermath.

An individual’s mindset and attitude can determine how the deployment stages are ultimately experienced. Is the deployment seen as an opportunity to embrace challenge and achieve growth? Is it something that is dreaded? A positive attitude and realistic outlook during the pre-deployment phase portends a better deployment experience.

Deployment Stage

This was my third cruise, my second aboard “Abe” (USS Abraham Lincoln). Before we left port, my wife Darlene threw a huge going away party. She got a taco truck, bouncy castle, and a bunch of other fun things. We live in enlisted housing and all the neighbors came by … probably for the free food more than to say goodbye, right? The event was fun but we could have used that money towards a second car.

Two months into my deployment, I received some emails from friends back home saying Darlene was going out to bars and clubs. Another Sailor that lived on our street was seen spending time at our house. I checked in with our babysitter and learned that the babysitter was watching our kids almost every Friday and Saturday night. The babysitter told me that she ended up staying overnight on a few occasions because Darlene didn’t make it back until the next morning. The babysitter didn’t mind though because Darlene always apologized and paid her extra.

That news was a punch to the heart. I was already trying to deal with my dumbass Chief who had it out for me. He told me I had to stand watch during our next port visit, which was going to be Singapore. I had always wanted to see Singapore but Chief screwed me out of that. I was hoping to buy some local treats to send back home to my kids. On top of that, I work in the Engineering Department. We drill all the time and work insane hours trying to keep systems up.

When I tried to confront Darlene to find out what the hell was going on, she started crying and hung up on me. After that, I wasn’t able to reach her again. I sent tons of emails and letters but … nothing. She would never answer when I called the house. I didn’t know if my kids got any of the letters I sent them. I couldn’t get anywhere with my friends back home. How was I supposed to do my job with all that crap going on? (Navy Petty Officer Second Class)

The actual deployment is overlapped by the next three stages of the ECOD: Emotional Disorganization; Recovery and Stabilization; and Anticipation of Homecoming. Emotional Disorganization may last for up to 6 weeks following the member’s departure. The military member may arrive to a new and uncertain environment fraught with stressors and experiences previously never encountered. Some of the most challenging, and dangerous, times during a deployment are the first and last months when individual and unit vulnerabilities are more salient during transitional phases. Adapting to new roles and routines in a demanding setting can be overwhelming until familiarity and confidence attenuate the natural stress. Family members face the void left in the member’s absence with a sense of uncertainty and perhaps aimlessness. Common experiences include problems with sleep, indecisiveness, feelings of resentment, confusion, and fears of infidelity. Depending on the family situation and its members, there may be difficulty moving past the Emotional Disorganization stage.

Successful mastery of Emotional Disorganization though permits advancement to Recovery and Stabilization. As new routines are established and people adapt to the responsibilities and demands of the deployment, a sense of independence is gained that is coupled with confidence in one’s ability to function amidst many challenges. Determination and morale improve with each challenge successfully handled. That sense of accomplishment increases personal pride and independence.

For the service member, the deployment is a profound experience that is challenging to prepare for sans any previous deployments. Each day brings reminders of sacrificed freedoms and comforts many civilians take for granted. Daily attire is largely limited to prescribed uniforms. Individual expression afforded by personal wardrobes, accessories, and make-up are restricted. Outside of duty hours, members may be limited to regulation physical training (“PT”) clothing for comfort attire. Amenities, conveniences, and choices are narrowed under the reality of the situation—military bases and ships do not have capacity to provide expansive choices for dining, shopping, and recreation. Food choices are limited to whatever is on the menu at the base dining facility or ship’s galley, available for purchase at the local exchange (military store), or whichever Meal Ready to Eat (MRE) was acquired. Deployed troops have relied on MREs for daily nutrition for extended periods of time. Although creative “field chefs” may find ways to make MREs more palatable when no other food options are available, to live off of MREs more than a day is a stressor in itself.

Environmental stressors include exposure to harsh weather conditions, temperature extremes, noises, smells, predatory bugs and animals, and other difficulties. Whether exposed to an oppressive desert sun or biting cold winds, suffocating sand storms or stinging winter rains, physical and mental endurance are drained. Continuous noise from weapons, machinery, vehicles, and public address system announcements, invade all aspects of living. Smells common to military sites like fuels, oil, paints, propellants, and expended ammunitions, follow a person throughout the deployment and permeate their hair, skin, and attire. There is poor escape from pungent smells on deployment, unlike back home where one can return to living spaces with more pleasant aromas from air freshener products, scented candles, fresh flowers, and home cooking. The chemical or industrial smells that fill ship spaces may sometimes seem suffocating and can drown out any smell of the saltwater outside. The recycled air in a submarine has a piquant scent of its own. Acrid smells not usually encountered back home are particularly striking, such as the fetid stench of third-world sewage, burning of waste and feces, or even the peculiar stink of death. Memories are strongly tied to the olfactory senses and certain smells may cause aversive memories and emotions to surface. Conversely, particular smells that pervade a person’s time in service may trigger pleasant nostalgia. It is not uncommon for active-duty members and veterans to happen upon a whiff of gunpowder, jet fuel, saltwater or such, and enjoy a pleasurable remembrance.

Long hours and the repetition of mundane duty schedules strain a member’s ability to maintain focus and motivation. Privacy and personal space are lost when living in cramped tents, barracks and ship berthing. There is no proper escape from work or peers (including any antagonists) after finishing a duty shift. A sense of confinement abounds when daily life and any free time are limited to only the base (i.e., living “inside the wire”) or aboard a ship at sea. Hygiene becomes a luxury when time or access to shower facilities is not readily available. When showers are not accessible or the ship’s water systems are down, “baby wipe” products may be the best alternative.

Communication and entertainment resources are limited which can add to frustration and a sense of helplessness or hopelessness. Any member who has ever had a phone call or video-chat session interrupted by communications going down will attest to the severe irritation they suffered. Periods of restricted communication are a loathed, but often necessary, fact of deployment. Many families have shared the experience of talking with the deployed member only to hear an alarm or commotion in the background, followed by an abrupt break in communication. Stranded with no understanding of what happened, the family’s stress increases as minutes, hours, or even days go by before they are able to next speak with the deployed member. The unknown is peppered with catastrophic thoughts, which leads to miserable dread until the family can ultimately confirm their loved one is okay.

On deployment, exposure to danger and trauma is a fact of life. Working in perilous conditions is a daily hazard—be it combat, carrier flight deck operations, heavy machinery and military vehicles, or other threats. Risk of infection, accidents, injury, and death are increased by fatigue from stress and difficulty maintaining optimal hygiene, nutrition, hydration and sleep. Acute and lasting consequences can stem from traumatic exposures to combat, casualties, disaster sites, and other horrors many civilians may never experience nor understand. A deployed member may witness first-hand injuries, gore and death. Seeing casualties of war and disaster that involve women, children, and animals can be especially traumatic. Of note, deployed military medical personnel may be more affected by exposure to high-magnitude medical stressors than combat stressors [4]. The habitants of other countries may demonstrate their enmity towards outside forces with protests, sabotage, and actual violence. Members may face their own mortality during deployment. They may also be confronted with unpleasant truths about the realities of life and left with a sense of institutional betrayal.

On the home front, the family deals with daily reminders of their deployed member’s absence. A partner’s bed may seem empty or too big, mail arrives with the deployed member’s name, the member’s car remains where last parked. The partner becomes a single parent-of-sorts who must not only find a way to cope with their own anxiety and sadness but also maintain an outward appearance of “happy stoicism” for the children. Partners often find themselves doing the same during communication with the military member, lest any hint of struggle add further strain upon the deployed loved one who may be overstressed and unable to help from afar. Depending on the family, the children may thrive or suffer with a parent away on deployment. Recent studies demonstrated that older children experienced a greater number of problems during a deployment, and girls reported having more challenges than boys [5]. The at-home parent must find a way to help those who are struggling without the immediate or full support of the deployed member. One of the most distressing circumstances is that of a first-time mother handling pregnancy, birth, and early motherhood without her loved one present to share the experience and provide support. Pets may be confused by the member’s absence and exhibit new behaviors. The family may encounter a sense of vulnerability without the member around for reassurance or security (e.g., unexpected nighttime noises seem more sinister). Dealing with limited information and updates from the member’s command is challenging, especially when exposed to media and rumors that convey vexing news. Coping with responsibilities that the deployed member previously managed (e.g., taxes, bills) and handling unanticipated emergencies can be overwhelming. However, each issue mastered can lead to personal accomplishment and self-growth.

The next ECOD stage—Anticipation of Return—occurs during the 6 weeks antecedent to the member’s return. This is usually a positive time in which service members and their family members look forward to the reunion. A metaphorical finish line is in sight and individuals feel invigorated with optimism for the future. Along with a sense of renewed energy and spirit, there may also be apprehension. Planning and efforts begin for families to make room for each other in their lives again. This may lead to tension and anxiety over what roles and responsibilities may be sacrificed upon the reunion. There is worry about whether others can accept certain changes that have occurred during their time apart, not only in routines and lifestyle but in the individuals themselves. As these concerns persist amongst preparations for an ideal homecoming, individuals may feel overwhelmed and restless.

The overall stage of deployment and how it is experienced emotionally may be affected by the family’s location and circumstance. National Guard or Reserve members typically have part-time commitments to military service and the members with their families may live away from regions with military communities and resources. These families may be unfamiliar with military support systems and have difficulty accessing such. This may occur with active-duty military families as well (e.g., those that reside away from military bases and communities). A family stationed in a foreign country, living off-base and apart from other military families, may feel estranged and unsupported during a deployment. Overseas families may not have the social support that extended family could provide more readily state-side. It is not uncommon for extended family to help affected relatives during a deployment; in some circumstances, relatives may even serve as “proxy parents” [6].

Communication during deployment is an important factor to consider. Although it is beneficial when there is ready communication, it is also stressful when communication is compromised. Today’s deployed population enjoys better communication resources than any other time in history; via hand-written letters, telephone calls, emails, text messages, video-chat with webcams, et cetera. Communication is an important protective factor across all stages of deployment when families are able to develop positive communication skills that are consistently applied [7]. Convenient communications may help individuals manage the challenges of deployment and separation, but communications can also have a negative impact. Aside from any disquiet due to discussion of stressful topics or sensitive matters, the frequency of communication (too little, too much) may also lead to tension or distress [8].

There are positive consequences for those able to manage deployment stressors which include increased family bonding, autonomy, self-worth, skills, maturity, and resiliency. For those unable to handle deployment in a mature and healthy manner, there may negative consequences like infidelity, personal or professional misconduct, financial troubles, family dysfunction, and other dilemmas.

Extended families, friends, and other acquaintances of the deployed population may have difficulty understanding the stressors the military family has faced. They may also have trouble discerning or accepting any changes in the military family’s members. Contrarily, the deployed population may feel annoyed when those without similar experience act as though they fully understand and can directly relate to them.

Post-deployment Stage

After Anthony went to Iraq, our seven year-old son spent the first couple weeks mostly under his bed. I remember lifting up the bed skirt to slide him snacks. I would read him stories while I lied there on the bedroom floor. Our six year-old daughter seemed to handle things better but sometimes I would find her favorite stuffed toy damp from tears she was hiding. It was hard to wear a smile around our children when I was going through a box of Kleenex almost every day and crying myself to sleep most nights. Things got a bit better once I was able to hear his voice again on the phone. Our time apart was tough but we made it through. Any time I felt overwhelmed and was ready to fall apart, I thought of how tough things probably were for Anthony. I knew I had to be strong not only for the children, but for Anthony as well.

The toughest part was the last couple months before his return. We had reached the halfway point a month or so earlier and the daily countdown to Anthony’s return was in the double-digits. It seemed like the clock was moving slower and the days were getting longer. I came up with a plan for fun activities to help us pass the time. The kids and I worked on a big banner and posters to welcome Daddy home. Our son had been through a difficult time with Daddy away and had become withdrawn and quiet. However, reunion preparations seemed to bring the boy I once knew back to us. Seeing him smile again and play with his sister made those final weeks much easier.

I can’t describe how it felt when the day finally came and we met Anthony at the airport. I tried to look my best for him but I couldn’t stop happy tears from ruining my make-up. I must have seemed such a selfish mother leaving the children standing to the side when I ran into his arms. I don’t think the kids were bothered because they were all smiles when we had our first big family hug there. That moment was simply wonderful.

Although it was great having our Anthony home again, it was also awkward in some weird ways. Not in a bad sense. We just had to get used to being a whole family again. (Marine Spouse)

After reaching the post-deployment stage when the service member has redeployed to their home duty station and reunited with family members, the family will experience the final stages of the ECOD: Renegotiation of the Marriage Contract; and Reintegration and Stabilization. Renegotiation of the Marriage Contract typically spans the first 6 weeks following the family’s reunion. Changes in the deployed individual and their family members may be welcomed or possibly lead to conflict. Although the family is reunited physically, there may linger an emotional distance until they have had adequate time and opportunity to reconnect, share their experiences, and get to know each other once more. Family members may worry that new roles and routines established during the deployment may be undone. They may also feel any independence gained could be threatened by a return to the pre-deployment family hierarchy and practices. Service members may feel less-valued as other family assumed former responsibilities during their absence. Intimacy can seem awkward until sufficient time together permits healthy renewed acquaintance. Prominent changes that occurred during deployment, such as significant trauma exposure (perhaps with medical/psychiatric sequelae), birth of a child, and other critical events, may permanently alter family roles and dynamics.

There may be a feeling of overstimulation for the member during the first week or two upon return. Coming back from a deployed daily life visually defined by particular palettes such as desert browns or ocean blues, to days again filled with a brighter and broader spectrum of colors, may be pleasant but likewise stunning at first. After living with limited selections in consumer products, clothing, entertainment and activities, the member faces an abundance of options once more. Many troops relish having access anew to ample television channels, especially after months of maybe only eight channels provided via the Armed Forces Network (AFN). Returned troops often experience initial difficulty sleeping in a more comfortable bed and without the “white noise” of the deployed setting. Some couples may struggle adjusting to a shared bed once again.

For the deployed member who was living in more primal environments, uncensored language was likely the norm and that way of life was often defined by action before words. Returning home means relearning etiquette, unwritten social norms and using words before actions as appropriate. During the initial weeks or months of the reunion, family members may see the member as surly, prone to profanity, seeming distant, and self-absorbed in pastimes like violent video games or “adrenaline activities;” possibly forfeiting time that could otherwise be spent with loved ones.

Members may experience paradigm shifts during deployment and return with broadened worldviews. Their first-hand exposure to life beyond America and any potent personal experiences may lead to existential crises, shifts in self-identity, and disillusionment with previous values and perspectives (i.e., community, religious, political, et cetera). Large-scale disasters and mass casualties are rarer occurrences in America but exist as a common fact in many other regions. Deployments often take military members to impoverished countries with little-to-nil infrastructure and resources which are exposed to frequent natural disasters, incessant conflict and other tumultuous events. The underside of global reality that was otherwise camouflaged by first-world distractions or only experienced vicariously through media then becomes a part of the deployed member’s life. The consequences of those experiences will ultimately depend upon the individual.

As the reunited family moves into the next ECOD stage—Reintegration and Stabilization—the process of readjusting to the member’s return continues for everyone. This process commonly lasts up to 6 months or more. During that time frame, a new baseline is established as the family becomes more secure and accepting of altered roles and routines. A healthy reintegration is evidenced by a shift in family language from personal to plural possessive adjectives and pronouns (i.e., from “my …” and “mine,” to “our …” and “ours”).

There are positive consequences of deployment (acute- and long-term) that include increased family closeness, improved resiliency, occupational advancement, and financial gain (associated with special duty pay/allowances). There are also potential negative consequences that include separation/divorce, inability to adjust to new roles or changes, and occupational discord. Family members may inadvertently engage in a “Who Had It Worst?” competition that can harm relationships. Also, the member and the spouse may both assert personal entitlement to respite after the deployment and inability to reach a compromise may lead to toxic discord.

Each deployment experience and the culmination of such will in kind influence how future deployments are experienced and whether the sum effects upon the family as a whole, and each member, are considered helpful or hurtful. While some service members and military families may speak negatively of deployment experiences or self-portray as victims-of-sorts, others may describe their experiences in positive terms that reflect their sense of duty, pride, and accomplishment [9]. Many experienced service members in the midst of their military careers may never fully reconnect with their families. The motive for such a schism may be consciously, or unconsciously, derived from a notion that the service member will be separated again from their family anyways. This type of behavior is a detrimental risk to the family’s overall dynamic and welfare.

In summary, this chapter was intended to enlighten the reader to the countless factors and considerations that confound offering a simple illustration of the deployment experience. In discussing pre-deployment, deployment, and post-deployment in association with the ECOD, the common phenomena encountered across the three stages were highlighted to help the reader better anticipate the stressors and process of adjustment. These discussion points may also bolster the reader’s ability to anticipate possible problems that a service member and family members may encounter. For providers working with military members and families, this information should be applied to their assessment and understanding of patient cases to afford more comprehensive and individualized care. Coupled with sincere respect, professional modesty, and a genuine interest in each individual and family’s circumstance, the provider can use the information in this chapter to optimize rapport and therapeutic services for any patients with deployment experience.