Supplementary Q&A by Dr. Lewis-Clark and Dr. Pomerantz
Q:	To what extent does the military culture affect family members?
A:	Family members are affected in many ways. You will often hear people say “I was an army brat” or something similar. For active duty military, families may be affected by frequent moves or frequent deployments. Guard and reserves do not live on military bases and are often caught between the two worlds, particularly during deployments.
Q:	To what extent do Veterans seem to retain the military culture?
A:	This is variable. Many retain it as a core feature of who they are and how the interact with the world. A sense of order, discipline, respect for authority, dependability and responsibility is common. Others may dissociate themselves from the military and its culture.
Q:	Is the Guard and Reserve different with regards to military culture?
A:	The primary difference is the different environments in which they live. Guard and Reserve live in civilian communities while active duty generally live on military bases. Thus they have differing levels of community understanding and support.
Q:	Dr. Pomerantz, you mentioned taking a full military history, can you say what is included in taking a military history versus taking a normal medical history?
A:	I believe this was covered in Dr. Kudler’s presentation in detail but the short answer is that it goes beyond “served in Navy 1989-1991,” and into more details about duties and duty station, combat experience, type of discharge, etc.
Q:	How much do I have to know about the military culture before I can work effectively with military members or Veterans?
A:	Basically one needs to know the same we need to know about anyone in any particular culture. We’ve summarized a lot of the necessary information in the presentations, but it is also important to understand whether the individual has maintained that culture after discharge. Pretending to understand or toss around military terms does not help.
Q:	Is there a place where I could learn more about military culture?
A:	One of the most comprehensive guides to working with Veterans and active duty military can be found in the Community Provider’s Toolkit on the VA website (http://www.mentalhealth.va.gov/communityproviders/military_culture.asp#sthash.dFXmdS2Z.dpbs). You can also go to the VA website (www.va.gov) and search “Military Culture” and will find a number of other sources of information. Many of these have been developed jointly between VA and DoD
Q:	You mentioned reintegration challenges, have the reintegration challenges changed for from those experienced in previous conflicts and is our response better today than after previous conflicts?
A:	It has been gratifying to watch the 180 degree shift in this country over the past few decades. Veterans were frequently treated as second class citizens in the past. Often they were blamed for the wars in which they participated. The wars of the past 20 years have brought war home to many civilians and as their friends, family members and neighbors have been deployed, attitudes have changed dramatically. This has helped set a more supportive context for reintegration but it is still difficult for many.
Q:	Is there a way to tell the difference between PTSD and normal adjustment from reintegration from war?
A:	Often this can be a difficult distinction. I think a good analogy is how we distinguish between bereavement and depressive disorders. A key feature of any disorder is impairment in an important area of functioning –such as work, social relationships or normal responsibilities. It is also important to sort out effects of frequently associated conditions such as substance abuse. PTSD also requires a duration of 1 month. With uncomplicated readjustment, symptoms should gradually improve as time goes on. When improvement is not taking place or the individual is backsliding, it is cause for concern. The “PTSD coach” smartphone app is a very helpful resource for many returnees and families. It has proven immensely popular around the world (http://www.ptsd.va.gov/public/materials/apps/PTSDCoach.asp) . www.afterdeployment.org is a very helpful website as well
Q:	Since Veterans may not come in on their own are there any clues I might get from a family member regarding the issues facing a veteran?
A:	“He/she isn’t the same” is very common. Social withdrawal or functional problems as noted above frequently concern family members. The Veterans Readjustment Counseling Centers (AKA Vet Centers) are often an important resource for returnees and their families, especially since many Veterans do not want to go to a VA medical center. The National Guard has family programs readily available in many locations in all states.