Compassion In Combat

A Navy psychologist shares lessons of two Iraq deployments

A framed photo atop a cabinet in the office of Cmdr. Shannon Johnson captures a heartbreaking memory for the Navy psychologist. It is a reproduction of a newspaper front page honoring 48 soldiers of the 3rd Stryker Brigade Combat Team, 2nd Infantry Division who were killed during the Iraq surge of 2007. The young men in the memorial photo and others who served with them were, says Johnson, "like my sons."

Johnson was embedded as an Individual Augmentee with the Army from January through September 2007 in Al Anbar province. She and two Army sergeants, both mental health specialists, traveled as a combat stresscontrol unit to assist troops dealing with mounting numbers of fatalities and causalities that Johnson says occurred in "the most grotesque and awful ways."

"It was one constant critical incident," Johnson recalls. "Many of the soldiers had been in Iraq for 15 months, some on their second or third deployment. They often had anger and rage toward their leaders that they just couldn't describe." Maintaining unit cohesion was a top priority, she adds.

"What they experienced in losses was horrible, and you try not to delude them that these events were not awful," Johnson says. The psychologist knew it was her job to give hope to troops needing help and create a foundation for them to seek psychological treatment when they returned home.

The psychologist knew it was her job to give hope to troops needing help and create a foundation for them to seek psychological treatment when they returned home.

But Johnson began to feel that she should be doing more. Looking back, she believes she had too much empathy for the soldiers she treated. She wanted to "fix" as many as she could, as fast as she could.

She approached her work as a sprint, rather than a marathon, and Johnson says she learned an important lesson.

"There are some things you can't make okay. You have to be able to forgive yourself for not being able to undo all the bad."

Johnson was one week away from extending her deployment when she recognized the signs of compassion fatigue setting in. "Everything had been so full-force, so much adrenalin and then I hit a wall. I stopped being able to process the trauma, and this was my cue that I should go home as scheduled."

Compassion fatigue, experienced by individuals helping others in great distress, is a state of high tension and preoccupation with those being helped. It can involve depression, poor self-care and extreme self-sacrifice. Research suggests caregivers may be especially vulnerable to it if they are going through an event at the same time as the people they are treating.

Johnson again deployed to Iraq in 2008, this time with the Marines, and she realized she needed to incorporate emotional lessons learned from her first tour. "I knew I had to put more effort into staying aware of how I was doing on a day-to-day basis. That was my responsibility so it did not affect my clinical duties."

The second deployment was, however, more stressful for her than the first. "There was so much change and chaos, with the mission always changing," she says. Physical conditions — especially harsh weather, filth and mice infestations — also impacted her.

"I was anxious and agitated," Johnson says. "My feelings were muted, which was foreign to me. I didn’t have a feeling of 'sons.' These Marines were my patients."

Johnson says her best strategy for stress management was exercise.

"I'm a distance runner and no matter what, I was always up at the crack of dawn to run. It saved me and provided balance. That was the time I could take to really process all that was going on."

When she returned home, Johnson recognized that she needed time to grieve — something she had not been able to do during her deployments. After a period of numbness, she says that finally came.

She had a strong support network of family and friends. "I was very direct and honest with them," she says. "I knew I was in a process, and I knew it was important for me to articulate it."

Johnson says her deployments have increased her emotional resilience and will guide her on what she expects to be a third deployment — to Afghanistan. Her best advice to herself and other caregivers?

Have realistic expectations. Come to terms with the fact that there are limits to what any type of doctor can do in combat to heal physical and emotional injuries.

"We can't prevent people from suffering. We can do a lot to mitigate the suffering and ensure that a person doesn't go through it alone, but we can’t make it all go away."

(First published in 2010)