SAN ANTONIO—If there’s one thing that Sandra Morissette, PhD, wants people to understand about veterans is that, when it comes to the need for social support in order to heave a healthy, functional life, they are no different than their civilian counterparts. And the barriers to achieving that support are the same for both.
Veterans just arrive at those barriers with a few more challenges to scaling them, as well as a few more benefits, she suggests.
A clinical psychologist and professor at the University of Texas, San Antonio (UTSD), Morissette has spent her career researching how veterans recover and function after they return from a war zone. Starting out as an anxiety disorders researcher, she quickly expanded into post-traumatic stress disorder and co-occurring mental health conditions, as well as suicide prevention. Her goal is not just to understand these conditions in isolation but how they affect how a veteran goes about their day-to-day life.
She is especially interested in risk and resilience factors that can be modified—factors that the veteran, their caregivers and the people in their life can actually impact.
“We have to understand what puts people at risk, so we can prevent suffering,” Morissette explained. “We also need to know what makes veterans resilient, so we can armor veterans with those resilience factors.”
One factor that has shown a strong signal in affecting a veteran’s functioning following deployment is their perceived social support.
“Social support helps people thrive. It’s no different for veterans than anyone else,” Morissette explained. “Do you have someone you can talk to when stressed? To catch a ride to a medical appointment? Do you feel like somebody has your back?”
Being on the other side of that relationship can be beneficial as well, especially for mission-oriented individuals.
“It’s the social support that we give that is important for everyone but especially for veterans who are people who have served their country and are focused on contributing to the greater good,” Morissette said. “When we provide social support to other people, it makes us feel valuable.”
But how people view what is or isn’t support can vary from person to person, which is why researchers use the term “perceived social support.”
“You can be in a room full of people and not feel social support,” Morissette noted. “It’s whether you perceive those people around you as being socially supportive.”
These days, Morissette focuses much of her attention on the question of what barriers exist between veterans and achieving robust social support, as well as what can be done to assist them. After 18 years at VA, which culminated as the Treatment Core Chief at the VISN 17 Center of Excellence for Research on Returning War Veterans, she’s now continuing her research at UTSD, while teaching military health psychology to doctoral students.
“A lot of veterans never get to VA. This is a way for me to reach out to veterans in the community,” she explained. “Universities are in this pivotal position to help student veterans reset their mission after their military service. What is the next step?”
In these students she witnesses a microcosm of the difficulties faced by many veterans and by people in general.
“The barriers to developing social support vary a lot depending on the person,” Morissette elaborated. “One of the things I often hear are stories from veterans who have a hard time recreating that sense of bonding and belonging from when they were in the military. I think sometimes when they return they have trouble connecting with civilians and family members who haven’t had those experiences, and they feel less connected. And when they feel less connected, it’s more difficult to garner social support. Sometimes that support is there, and sometimes we have to ask for it.”
This hurdle exists for veterans and nonveterans alike—understanding that something is lacking and then reaching out and asking for it. But for veterans this can be especially challenging, having been trained to be self-reliant and to eschew asking for help.
Some find social support within veterans groups that are made up of people who have had similar experiences. Others join outward-bound clubs, enjoying the physical component that echoes their time in the service. Some join bands; others participate in arts groups.
“You can’t really recreate things, but the connection they felt as part of their communal service together they may find through another form of commonality like music or art or being outdoors,” Morissette said.
This feeling of belonging can be incredibly important when it comes to having a healthy, functioning life. Lack of it can lead to isolation, depression and potentially suicide.
“We have solid evidence that perceived social support is a robust protective area against suicide, and that the lack of it increases risk,” Morissette explained. “But there’s so much to learn about this phenomenon.”
For example, what type of social support is most useful? What is the balance between that feeling of belonging and the feeling of burdensomeness that comes from connection? How do you give people meaning in their lives so that they want to keep living?
“We need to connect them in meaningful ways,” Morissette declared. “Because people can be surrounded by other people and still feel the pain of loneliness.”
The enforced physical distancing caused by COVID-19 has made this work much more challenging. Morissette is currently engaged in a VA-funded study looking at how veterans’ social networks have been impacted during the pandemic.
“A number of veterans are really struggling, but veterans are also trained perhaps better than your average civilian to cope and manage stressful situations,” Morissette said. “In some ways, some veterans are probably doing better than your average civilian there.”
At the same time, these veterans are facing the same challenges as people everywhere—keeping social connection while maintaining physical distance.
Videoconferencing has helped many bridge this gap, especially in the healthcare arena. “Our mental health providers and physicians are a form of social support. People feel like somebody is taking care of them, so the pivot to telehealth has been really important,” Morissette noted.
However, lack of access or comfort with technology can be an additional barrier, especially older veterans. For those veterans, a telephone call might remain the best solution.
And waiting for that veteran to reach out might not be enough.
“We have a lot of people who are very lonely. And I worry about that loneliness,” Morissette said. “Reaching out is important, because it’s harder for people to ask for social support as opposed to being offered social support. Just having somebody call because they care can mean a world of difference to somebody because they don’t want to burden people by asking for social support. It’s hard for people to ask help.”