Stories - Blogs

By Allison Hannah, MSW, LCSW    

For more than 20 years, my life has been defined by change.
 

As a service member, I transitioned from the Reserves to active duty and back again. I went
from serving as an enlisted soldier to commissioning as an officer. I readjusted to life in the
United States after both a 12-month combat deployment and later a two-year assignment in
South Korea, not to mention the endless moves for new assignments and training. Eventually, I
hung up my uniform and transitioned into veteran status.

But my experience with military transitions did not end when my own service did.

I went from being the service member to supporting one. Our family moved from duty station to
duty station as we PCS’d around the country. I moved from job to job, repeatedly searching for
meaningful employment wherever the military sent us. Along the way, I helped our children
adjust to new homes, schools, communities, friendships, and routines.

Sometimes, it feels like the only constant throughout the past two decades has been knowing that
another change was coming in one form or another.
 

At the end of 2025, my husband retired from the military, and our family made what we believed
would be our final transition. We moved into our forever home, settled into a community, and
enrolled our children in what we hoped would be their last new school district.

There was a great deal of excitement at first. We had anticipated this chapter for years. We
imagined the relief of no longer planning our lives around orders, report dates, school transfers,
and temporary homes.
 

But after years of becoming skilled at leaving, we’ve suddenly had to learn how to stay.
The quiet that was supposed to feel like relief suddenly felt unnerving. Without another
assignment on the horizon, quiet questions started to creep in:

• Will we be content here?
• What does it mean to build a life when no one else is determining where we go next?
• How do we create a sense of permanence after years of knowing that every home, job,
  school, and community might be temporary?

This experience has also reminded me that the “final” move is not one transition shared equally
by the entire family. The retiring service member, spouse, and children may each experience it
differently. One person may feel relieved while another feels restless. One may be ready to put
down roots while another is grieving the loss of military life, familiar resources, friendships, or a
community that understood their experience.

There is still a great deal for us to discover in the years ahead. For now, though, I want to share
five reminders that have helped me through the first part of learning how to stay.

1. Give yourself a full year before deciding how settled you feel.
You do not have to feel completely settled after the moving truck leaves or even after the first
few months.
 

Retirement, separation, and relocation involve much more than changing an address. You may
also be adjusting your routines, relationships, finances, identity, expectations, and sense of
purpose. Even familiar tasks may feel different when they are no longer connected to an
installation, unit, or military community.
 

Give yourself permission to live through all four seasons before deciding if this place is right for
you.
 

A year allows time for the initial excitement to fade, new routines to develop, relationships to
grow, and the reality of the transition to become clearer. It also gives everyone in the family time
to adjust at their own pace.
 

2. You do not have to unpack your new life all at once.
This applies to both the boxes in your home and the emotions you carried with you.
There is no prize for having every room decorated within the first week. Take your time deciding
how you want your new home (and your new life) to feel.

After years of setting up temporary spaces, it may take time to believe that you are finally
allowed to settle in. You may also find that making a house feel permanent brings up more
emotions than expected. Some boxes may contain reminders of past duty stations, friendships,
deployments, accomplishments, losses, and earlier versions of your family.
 

There is no rush. Unpack what you are ready for, both physically and emotionally.
 

3. Do not let the word “forever” become a source of pressure.
 Military families often place enormous pressure on the final move.

This is supposed to be the forever home, the forever community, the last school district, and the
place where everything finally falls into place. After years of uncertainty, it is understandable to
want the next decision to feel permanent.

But “forever” can also feel intimidating.
 

Choosing a destination today doesn't trap you into a cage tomorrow. You can give your new
home and community an honest chance without treating every decision as irreversible.

Being open to future change does not mean you are failing to settle down. It simply means you
are allowing yourself the same flexibility that helped you navigate every transition that came
before this one.
 

4. Expect everyone to experience the transition differently.
Even if your family has moved many times before, this move may bring up entirely new
emotions.

The retiring service member may be adjusting to the loss of rank, structure, responsibility,
identity, and a built-in professional community. The spouse may feel excited about new
possibilities while also recognizing how much of their own life has been shaped by the military.

Children may welcome the stability of remaining in one school while grieving friendships,
traditions, and the sense of belonging that came with being part of a military community.
 

One person may feel relieved while another feels restless. Someone may feel excited one day and
deeply uncertain the next.

There is no single correct way to feel about a major transition.

Make room for everyone’s experience, including your own. Talk openly, check in with one
another, and resist the urge to assume that the family member who appears to be adjusting well is
not carrying something beneath the surface.

5. Build a new support system before you urgently need one.
Military families are often surrounded by built-in networks, even when we do not fully recognize
them at the time. There may be installation resources, military treatment facilities, family
readiness programs, unit contacts, spouse groups, schools familiar with military children, and
neighbors who understand the realities of military life.

After retirement or separation, those supports may no longer be nearby.
 

That can make it especially important to intentionally build a new network. Reach out to friends,
family members, Veterans, military spouses, neighbors, community organizations, and others
who have already navigated the process.

Sometimes their support will come through a meaningful conversation. Other times, it may be
something practical, such as reminding you to enroll in new health coverage, transfer medical
records, update important documents, or locate services in your community.

Professional mental health support may also be an important part of that network.
 

Major transitions can bring up grief, anxiety, relationship stress, changes in identity, loneliness,
or emotions that were difficult to anticipate. Seeking counseling does not mean you are handling
the transition poorly. It may simply mean that you recognize the significance of what you and
your family are experiencing.

Finding professional support can feel more difficult when you are no longer surrounded by
military resources or living near a local installation. However, military-culturally aware care may
still be available in your community.

Wherever you have landed, you can visit the Star Behavioral Health Providers Directory at
starproviders.org to search for a mental health professional who is trained in military culture and
the experiences of service members, veterans, and military families.

You do not have to wait until the transition becomes overwhelming before reaching out.

Learning to Stay
Perhaps the greatest lesson I have learned is that settling down is still a transition.

It deserves the same patience, flexibility, support, and grace as every deployment, homecoming,
PCS, career change, school transfer, and military milestone that came before it.
 

For years, we mastered the art of leaving well. We learned to pack up a life in boxes, adapt on the
fly, rebuild routines, and bloom wherever we were planted.
 

This next chapter may be about learning something entirely different.
 

It may be about learning how to stay.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Allison Hannah, MSW, LCSW, is a Military Behavioral Health Social Worker for the Consortium for Defense Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. She assists in the implementation and expansion of Star Behavioral Health Providers (SBHP). SBHP trains civilian behavioral health providers to work with service members, veterans, and their families. The mission is to expand the availability of high-quality behavioral health services, especially for those in the reserve components.

1/5     

The proportion of "US adolescents and young adults aged 12 to 21" who "used artificial intelligence (AI) chatbots for mental health advice," according to a study published in JAMA Pediatrics -- AI Chatbot Use and Disclosure for Mental Health Among US Adolescents and Young Adults.

This national survey including more than 42 million US youth (population-weighted) found that almost a fifth of adolescents and young adults reported using AI chatbots for mental health advice, representing an increase by almost half from 1 year prior. Most users told no one that they used AI chatbots for this purpose.

By Mitch Duque   

Remote-piloted drone technology has quickly become one of the most prominent staples in the modern landscape of large-scale combat operations. Given the prominence of this technology to current and future warfighters, members of the Research Special Interest Group (SIG) at the Consortium for Defense Psychology (CDP) decided to focus its monthly journal club on the mental health implications of drone warfare for remotely piloted aircraft (RPA) personnel. The article selected for review was a narrative review titled "Remote Warfare with Intimate Consequences: Psychological Stress in Service Member and Veteran Remotely-Piloted Aircraft (RPA) Personnel" by Norrholm and colleagues (2023). SIG members read the article and discussed the possible mental health implications of drone warfare for RPA crew members using this technology in their day-to-day lives.

The RPA career field has a variety of unique qualities that can potentially lead to adverse psychological effects. One of the most notable is the cognitive dissonance crew members can experience as a result of their geographical distance from their targets when conducting military operations. Despite being physically distant from their area of operation, RPA crew members experience disproportionate levels of intimacy with their targets based on the immersive nature of their weapon systems. This juxtaposition of physical distance and emotional proximity can lead warfighters serving in RPA crews to experience emotional turmoil regarding their role in conflict, particularly when executing lethal strikes on individuals that they’ve formed a remote bond with through days, months, or even years of surveillance. There can also be ‘psychological whiplash’ that occurs, with operations moving quickly from surveillance activities to kinetic action to after action-assessment, all in the span of minutes. This rapid shift is one of the central psychological challenges of RPA work.

Another dynamic worth noting in this population is the domestic nature of their work. Individuals working on RPA crews frequently execute their missions in garrison, meaning that they work in shifts and maintain personal lives when not on duty. This makes it uniquely possible for RPA crew members to play pivotal roles in potentially lethal operations akin to “mini-deployments,” mere hours before driving home from work to participate in their personal, family, and social lives. Per the article, it can be beneficial for conventionally deployed service members to have a period of decompression prior to returning home following combat operations. However, crews are not likely given adequate opportunities to decompress following this harrowing work. In other words, RPA personnel may be required to transition almost immediately from combat-related activities back to their everyday lives.

Additionally, the article identifies stigma surrounding RPA crews in the military, with crew members frequently viewed as “less than” or “inferior” for being assigned to remote aircraft instead of serving in a manned fighter or bomber aircraft. Coupled with long hours and shift work schedules that disrupt natural sleeping patterns, service members operating RPA are at a disproportionately high risk for adverse mental health outcomes and can experience symptoms of post-traumatic stress disorder and moral injury.

After learning about RPA crews and the unique challenges associated with their career field, the CDP research team discussed several important considerations for working with this population. The team was particularly interested in understanding the emotional dynamics within RPA units, especially those related to moral injury. Of particular interest was how traditional concepts of honor and military service may be difficult to reconcile for personnel who conduct remote warfare. Discussions surrounding responsibility for the deaths of enemy combatants were especially noteworthy, as many RPA crew members frequently report feeling guilt or shame for the way in which they conduct military operations, per the article.

The team discussed a handful of clinical considerations when treating these individuals. A clinical member of the team raised the possibility that psychotherapy could focus largely on stigma reduction and validation, given the isolating and invalidating nature of the environment surrounding this career field. The team also raised that cognitive-focused, evidence-based psychotherapy for PTSD, such as Cognitive Processing Therapy, may be effective in addressing experiences of guilt. Clinicians can assess and treat standard PTSD symptoms, but may also consider working with the client to target interventions toward acceptance and understanding given possible experiences of guilt, shame, stigma, and moral conflict unique to RPA service.

The unique operational environment of RPA personnel presents significant psychological challenges, characterized by a difficult juxtaposition of physical distance and emotional intimacy, compounded by the domestic setting of their work, irregular schedules, and persistent stigma. Future clinical approaches can address the prevalence of traumatic stress, moral injury, guilt, and shame in this population by prioritizing stigma reduction and employing therapies that aim to address guilt while promoting acceptance and self-understanding.

Ultimately, remote warfare may be physically distant, but it is not necessarily psychologically distant. RPA personnel may benefit from clinical approaches that recognize both the traumatic and moral dimensions of their work.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Mitch Duque is a previous Research Assistant and HJF employee collaborating with the Consortium for Deployment Psychology, DoW and Uniformed Service Contractor

12.9%

The percentage "of adults age 18 and older used sleep aids most days or every day in the past 30 days to help them fall or stay asleep," according to a statistical brief published by the National Center for Health Statistics -- Use of Sleep Aids Among Adults Age 18 and Older: United States, 2024.

Women were more likely than men to use any sleep aids (14.8% compared with 10.8%), prescription medications (6.4% compared with 3.9%), or OTC medications or supplements (7.0% compared with 4.3%) most days or every day in the past 30 days to help them fall or stay asleep (Table). No significant difference was seen between the percentage of men and women who used marijuana or CBD products as sleep aids.

The percentage of adults using any sleep aids most days or every day in the past 30 days increased with age, from 10.5% of adults ages 18–34 to 15.8% of adults 65 and older (Table). Use of prescription medications to help fall or stay asleep increased with age (from 2.2% for adults ages 18–34 to 8.8% for adults 65 and older) as did the use of OTC medications or supplements (from 3.9% for adults ages 18–34 to 7.6% for adults 65 and older). However, the percentage of adults using marijuana or CBD products as sleep aids declined with age (from 5.5% of adults ages 18–34 to 1.7% of adults 65 and older).

By Kristian Krslovic   

Most people have experienced a poor night's sleep at some point in their lives, but experiences of insomnia go beyond the occasional restless night. It involves frequently waking up, having trouble falling back asleep, and feeling unrested after a night’s sleep, which in turn can leave a person feeling tired, fatigued, and irritable during the day. 

While insomnia affects millions of people, it is especially common among veterans and active-duty service members, with as many as a quarter of service members and veterans reporting insomnia symptoms 1. Military-specific factors, including frequent deployments, irregular sleep schedules, and prolonged exposure to high-stress situations, can make healthy sleep difficult to maintain 1.

The most supported frontline treatment for insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I).2 CBT-I restores healthy sleep by shaping unhelpful thoughts surrounding sleeplessness, coupled with behavioral interventions such as stimulus control (e.g., reassociating one’s bed with sleep) to collectively improve sleep efficiency. 3 For many service members and veterans, however, insomnia does not occur on its own: it often overlaps with conditions like post-traumatic stress disorder (PTSD), depression, anxiety or nightmares. 2 Living with multiple conditions at once can be challenging for service members or veterans as they might not have the time, resources, or support to pursue separate treatments for each disorder. This raises an important question: Could CBT-I support symptoms of these co-morbid conditions in addition to improving insomnia symptoms?

A growing body of research does suggest that CBT-I may help common psychological comorbidities. In one study of veterans experiencing both insomnia and PTSD, participants who received a CBT-I intervention showed improvements in PTSD symptoms, with effect sizes ranging from medium to large. 4 The same study found that nightmare frequency decreased in participants who received a sleep-focused intervention. In another study with veterans deployed during Operation Enduring Freedom and Operation Iraqi Freedom, participants who received CBT-I treatment had reduced PTSD symptom severity compared to veteran participants who did
not receive CBT-I. 5 Lastly, CBT-I also showed significant improvements in depression and anxiety scores in a sample of U.S. Army Soldiers diagnosed with insomnia. 6

Taken together, this research suggests that CBT-I may offer benefits beyond improving sleep. It is not a replacement for treatments for PTSD, depression, or anxiety, but it may be a helpful place to start, particularly for veterans who are managing several concerns at once. Learning CBT-I skills could also give service members practical tools to use throughout their careers and after leaving the military.

Leveraging technology to increase access to CBT-I

As mentioned earlier, interventions like CBT-I can be difficult for individuals to access. Modern technology can help increase access to and engagement in insomnia-focused care. Right now there are sleep apps that create a tailored user experience by tracking sleep habits and designing customized sleep plans aimed at improving sleep and combating insomnia symptoms, such as Insomnia Coach. 7 Although Insomnia Coach is not meant to replace professional care, it is one example of how an app can provide service members and veterans with important tools, such as psychoeducation and self-care strategies, as a first step towards addressing insomnia.

Additionally, researchers at CDP led by Dr. Tim Rogers, and collaborating institutions nationwide are evaluating the effectiveness of Insomnia Coach with brief check-ins versus group CBT-I, delivered by either clinicians or behavioral health technicians, on insomnia symptoms, alongside secondary outcomes of depression, anxiety, and PTSD. By bridging the gap between innovative technology and evidence-based sleep care, service members can be equipped with tools and support to restore their sleep, build resilience, and strengthen overall mission readiness.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Kristian Krslovic joined the Consortium for Defense Psychology (CDP) as a Research Assistant in October 2025. He received a Bachelor of Arts degree in Psychology from Bard College in 2023. At Bard, Kristian was an undergraduate research assistant in the Affective Science Lab identifying factors that contribute to mood disorders.

References:
1. Hughes, J. M., Ulmer, C. S., Gierisch, J. M., Nicole Hastings, S., & Howard, M. O.
(2018a). Insomnia in United States military veterans: An integrated theoretical model.
Clinical Psychology Review, 59, 118-125. https://doi.org/10.1016/j.cpr.2017.11.005

2. Bramoweth, A. D., & Germain, A. (2013). Deployment-related insomnia in military
personnel and Veterans. Current Psychiatry Reports, 15(10).
https://doi.org/10.1007/s11920-013-0401-4

3. Walker, J., Muench, A., Perlis, M. L., & Vargas, I. (2022). Cognitive behavioral therapy
for insomnia (CBT-I): A Primer. Clinical Psychology and Special Education, 11(2),
123–137. https://doi.org/10.17759/cpse.2022110208

4. Ulmer, C. S., Edinger, J. D., & Calhoun, P. S. (2011). A multi-component
cognitive-behavioral intervention for Sleep disturbance in veterans with PTSD: A pilot
study. Journal of Clinical Sleep Medicine, 7(1), 57–68.
https://doi.org/10.5664/jcsm.28042

5. Margolies, S. O., Rybarczyk, B., Vrana, S. R., Leszczyszyn, D. J., & Lynch, J. (2013).
Efficacy of a cognitive‐behavioral treatment for insomnia and nightmares in Afghanistan
and Iraq veterans with PTSD. Journal of Clinical Psychology, 69(10), 1026–1042.
https://doi.org/10.1002/jclp.21970

6. Taylor, D. J., Peterson, A. L., Pruiksma, K. E., Hale, W. J., Young-McCaughan, S.,
Wilkerson, A., Nicholson, K., Litz, B. T., Dondanville, K. A., Roache, J. D., Borah, E. V.,
Brundige, A., & Mintz, J. (2018). Impact of cognitive behavioral therapy for insomnia
disorder on sleep and comorbid symptoms in military personnel: A randomized clinical
trial. Sleep, 41(6). https://doi.org/10.1093/sleep/zsy069

7. Insomnia coach - PTSD: National Center for PTSD. (n.d.).
https://www.ptsd.va.gov/appvid/mobile/insomnia_coach.asp

9.4 million
 

The number of beneficiaries under the care of the Department of Defense (DOD) military health system, according to a report from the Government Accountability Office (GAO) -- National Security Snapshot: DOD's Military Health System Reforms and Challenges

This care is delivered through over 700 medical facilities with more than 100,000 military, civilian, and contractor employees, and a vast network of private sector health care providers. DOD estimates that it will spend over $72.5 billion for the military health system in fiscal year 2027.

The weekly Research Update contains the latest news, journal articles, and useful links from around the web. Some of this week's topics include:

● Group-Based Suicide Safety Planning and Skills Training for Veterans With High Suicide Risk: A Randomized Clinical Trial.
● An Exploratory Assessment of Service Dog Training for the Treatment of Military Members with Posttraumatic Stress: A Pre-post Interventional Trial.
● Cognitive Decline and Household Firearm Storage Among Older Adults.
● Association between state-level kratom regulations and poison center-reported severe medical outcomes and healthcare use: A United States national analysis.
● Changes in Dietary Supplement Use Among Children and Adolescents in the United States, 2015–2016 to 2021–2023.

CLICK HERE TO READ THE 23 JULY 2026 RESEARCH UPDATE

By Dr. Andrew Devendorf

If we each had a choice, none of us would choose to develop a mental health difficulty. None of us would choose to feel the devastation of depression, the tribulations of trauma, or the suffering of being so hopeless, trapped, and alone that we want to end our own lives. We label these experiences as difficulties for good reason.

The thing is—it’s not a choice to endure these challenges. Most people in their lifetimes will experience a mental health difficulty. For some, these experiences can be easily managed; for others, they can dramatically alter their lives. Zooming out, almost everyone knows, or will know, a loved one affected by a mental health condition. Although these experiences are normal, many people with lived experience of depression, posttraumatic stress disorder (PTSD), and suicidal thoughts continue to feel immense stigma.

I have seen this stigma play out in my clinical work, my research, and my own life. As a former psychologist at the Department of Veteran Affairs, I worked with many Veterans who expressed shame about seeking therapy. I’d hear things like, “My PTSD has made me a shell of my former self,” and, “I’m weak...I can’t believe I need to seek help.” Even after a person improves or recovers, they may feel reluctant to share their experience for fears of being negatively judged or mischaracterized. These fears are not without foundation. Research shows that acceptance of mental health treatment has improved over the years, yet the public continues to have negative attitudes about mental illness. Some members of the public still see depression as “laziness,” PTSD as “dangerousness,” or suicidal thoughts as a “weakness.”

What perpetuates this stigma? And how can we reduce it?

The Deficits-view
There are many drivers of stigma. In this post, I want to focus on a systemic factor: that our American society takes a predominantly deficits-view of mental health difficulties—we see them only as something wrong with the person. This deficits-view, in my perspective, stems from how we define mental illness.

In the United States, we use the Diagnostic and Statistical Manual (DSM) of Mental Disorders to diagnosis mental health conditions. There is much utility of the DSM. It was developed to establish a consensus for diagnoses and help patients receive insurance reimbursement via diagnostic codes. It has thus helped legitimize psychopathology that may otherwise be considered “invisible” or “just in someone’s head.” It does this through giving clinicians a common language to identify and treat patterns of mental, behavioral, and emotional “symptoms.”

But an unintended design flaw of the DSM is that it takes a purely deficits-view of mental health experiences. In other words, the DSM is designed to characterize disorders without consideration of the potential value in specific mental health experiences. For instance, although sadness can be a sign that something is wrong in someone’s life (as a way to motivate making a change), the DSM does not—and was not designed to—list the potential value in this emotional experience.

This deficits-view is likely a big reason why clinicians, patients, and the public at-large will, by default, have only negative associations with depression, PTSD, and other diagnoses. Diagnostic labels have helped patients receive compassion, yes. But also, these labels carry the weight of being primarily defined by dysfunction, impairment, and distress. Thus, it makes sense why there is public acceptance about the treatment of mental illness but continued stigma toward people with lived experience.

A Strengths-based View
While we do not need to dismantle the DSM, I believe we can reduce stigma by being open- minded to the strengths, value, and assets that accompany mental health difficulties. I want to be clear—we should not discount the distress that comes with psychopathology. But, among people with these experiences, we can extract the “silver linings” of the experience to improve coping and self-acceptance.

There is a quote by Dr. Victor Frankl, a psychiatrist who documented his experiences in a concentration camp, that comes to mind. In his memoir, A Man’s Search for Meaning, Frankl advocates that we seek to find meaning in our suffering:

“We must never forget that we may also find meaning in life even when confronted with a hopeless situation, when facing a fate that cannot be changed. For what then matters is to bear witness to the uniquely human potential at its best, which is to transform a personal tragedy into triumph, to turn one's predicament into a human achievement.” (Frankl, 1985, p. 112).

Here, Frankl is presenting a strengths-based view of tragedy, which we can apply to mental health difficulties. In my own practice, I’ve heard many patients reflect on how their depression, PTSD, or suicidal thoughts have helped them grow.

I list some strengths-based themes below and give an example.

• Leveraging emotions as a signal: “My depression helps me determine if something is going wrong in my life.”
• Self-awareness and insight: “Battling suicidal thoughts, it’s made me grapple with what’s really important, and how I want to spend my time.”
• Compassion for others: “My trauma has given me perspective about what it’s like to go through hell.”
• Resilience and self-confidence: “Overcoming my dark times taught me that I can overcome just about anything.”
• Meaning and purpose: “Having gone through this, my new mission is to get other people the help they need.”

Enhancing Clinical Practice
As clinicians, we can embed this strengths-based view into our practice to help reduce feelings of shame, brokenness, and worthlessness. Of course, we should not enforce a strengths-based view onto our patients. But, we can help clients explore the potential value and meaning from their suffering with focused reflections and open-ended questions.

Here are some reflections.

• Depression: “You’ve been through a lot, and it shows your resilience.”
• PTSD: “From what I’m hearing, your trauma has given you new perspective.”
• Suicide attempt: “You know what extreme pain feels like, and it’s given you compassion for others.”

And here are some questions.

• “I recognize you’ve been through a lot. And, I’m wondering, what have you learned from your experience?”
• “How has your experience made you grow?”
• “Has going through your depression changed your perspective on anything? If so, how?”

By adopting a strengths-based view of lived experience, I believe we are better positioned to empower our clients and reduce stigma.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Andrew Devendorf, Ph.D., is a Military Behavioral Health Psychologist with the Henry M. Jackson Foundation for the Advancement of Military Medicine. He serves as a subject matter expert in suicide prevention for the VA SAFEGUARD project.

References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, Text Revision (DSM-5-TRTM). American Psychiatric Pub.

Devendorf, A. R. (2022). Is “me-search” a kiss of death in mental health research?. Psychological Services, 19(1), 49..

Frankl, V. E. (1985). Man's search for meaning. Simon and Schuster. Gruber, J., Lyman, C., Plaisance, C., & Rottenberg, J. (2026). Silver linings in psychological disorders: an agenda for research and social change. Current Directions in Psychological Science, 35(1), 49-55..

McGrath, J. J., Al-Hamzawi, A., Alonso, J., Altwaijri, Y., Andrade, L. H., Bromet, E. J., ... & Zaslavsky, A. M. (2023). Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries. The Lancet Psychiatry, 10(9), 668-681..

Rüsch, N., Angermeyer, M. C., & Corrigan, P. W. (2005). Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20(8), 529-539..

Schomerus, G., Schindler, S., Sander, C., Baumann, E., & Angermeyer, M. C. (2022). Changes in mental illness stigma over 30 years–Improvement, persistence, or deterioration?. European Psychiatry, 65(1), e78..

Schroder, H. S., Devendorf, A., & Zikmund-Fisher, B. J. (2023). Framing depression as a functional signal, not a disease: rationale and initial randomized controlled trial. Social Science & Medicine, 328, 115995.

8.6%

The percentage of Ukrainians who "had probable PTSD three years into the war" following Russia's full-scale invasion, according to an article in the European Journal of Psychotraumatology -- Moral injury and PTSD among Ukrainians exposed to full-scale war.

• PTSD severity correlated moderately to strongly with moral injury (r = .47–.58).
   
• Probable PTSD predicted higher shame (η²p = .09) and trust-violation (η²p =  .13) moral injury outcomes.
   
• Trust-violation moral injury notably exceeded shame-related moral injury in this sample.
   
• Ukrainian PCL-5 and MIOS Part 2 showed strong validity and excellent reliability.

By Justin Tash, MSW

“I Must Not Fear. Fear Is The Mind Killer.”
To anyone who has even a passing interest in the genre of science fiction, these words likely ring a bell. They are the opening lines of the Litany Against Fear from American author Frank Herbert’s 1965 sci-fi masterpiece DUNE. This book is, to this day, the best-selling science fiction novel, with well over 20 million copies sold worldwide. The saga has influenced everything from Star Wars to Avatar, offering readers a sprawling universe of political intrigue, ecological philosophy, and deeply human struggle. However, beneath the sandworms, spice, and shifting dunes of Arrakis, lies something far more grounded: a remarkably accurate portrait of what trauma does to children.

I have had this fact proven to me again and again as a social worker who works with adolescents and military families. Unfortunately, many of my clients have faced difficult situations that individuals their age should never have to go through. But, the power of human storytelling teaches us about what is happening internally for all of us and our clients. Even though trauma affects everyone differently, by examining these incredible worlds and characters, we can take away important, universal lessons. 

Paul Atreides and the Burden of the Parentified Child 
When Paul Atreides, the main character in many ways of DUNE, is introduced, he is a teenager who has already begun to carry weight no adolescent should bear. The fall of his Great House and the death of his father, the Duke, strips away his childhood overnight. These events thrust him into a leadership role among the planet's indigenous population, the Fremen, molding him into a de facto father figure for an entire people. 

Clinicians can easily recognize this dynamic because they are often faced with young clients who are being subjected to a similar situation, although not usually on such a grand scale. When a family experiences a loss, or abuse that leads to absence of one parent in some way, the child can become the caretaker or the protector and thus shoulder the responsibility and expectations of holding it all together. 

Children who experience early loss or abuse frequently develop what we call "parentification." They learn to read the emotional temperature of a room, suppress their own needs, and derive their sense of worth from how well they manage the people around them. Paul believes, with complete sincerity, that he is destined for greatness and uniquely equipped to bear this burden that has been thrust on him. This is not an uncommon reaction or complex to develop for trauma victims, especially young victims. Trauma has an insidious way of convincing the victim that they are capable of handling something that will ultimately cause intense harm. The gap that is created between that perceived resilience and a person’s actual capacity is one of trauma’s most dangerous distortions. 

Alia of the Knife and Memories Out of Order 
Paul's sister Alia presents an even more striking clinical metaphor. Born later in the story with the full ancestral memory of every generation before her, she enters the world already saturated with experiences she did not live, has no context for, and cannot process in any developmentally appropriate sequence. 

This is, in an extreme and fantastical form, what trauma does to the brain. Trauma packages memories incorrectly. Traumatic events are stored as present threats rather than being filed as past experiences due to how the amygdala interrupts the regular memory processing that occurs between the frontal cortex, hippocampus, and cerebellum. These memories are often intrusive, disorganized, and stripped of context. Much of trauma-focused therapy is about carefully pulling those neural pathways apart and rebuilding them in a safer, more coherent order, in an environment where the body finally understands it is no longer in danger. It turns out fear truly is the mind killer. 

What Adolescents (and these Children of Dune) Keep Teaching Me 
One of the most important lessons I have learned from my work with adolescents is that trauma affects every child differently. After all, the adolescent brain is still actively developing, still redistributing and consolidating information across its architecture. In many cases, that neurological flexibility allows young people to process difficult experiences before they calcify into symptomatic patterns. They moved through something hard before the brain had the context to commit to storing the experience as a wound. Due to this, there is no guaranteed response to these experiences, there is not even a guarantee that PTSD will manifest. I consistently encounter young people who have experienced events that meet the clinical definition of trauma but do not develop any symptoms. 

Children and adolescents are often seemingly unbothered by experiences we assume must be devastating because they are seeing all of this for the first time. Paul nor Alia responded to their experiences as if they were traumatic, although, objectively, they very much were. Frequently, it is the fear, the alarm, and the urgency in the reactions of the adults around them that teaches a child that what happened was catastrophic. Confusion and fear are often learned responses and not inherent ones. 

Voices from an Outer World 
Paul “Muad’Dib” Atreides and his sister Alia, however fictional they may be, are excellent, microcosmic examples of childhood trauma and adverse childhood experiences. These masterful characterizations can offer an up-close-and-personal perspective on what it means to exist as a young person who has experienced trauma. Impactful clinical lessons like these can be found in unlikely places, even from outer worlds like DUNE, but if we as providers listen to these voices, we can gain access to a deeper understanding of the human condition that no textbook could ever hope to provide.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Justin Tash, MSW, is a Military Behavioral Health Social Worker at the Consortium for Defense Psychology (CDP) at the Uniformed Services University for the Health Sciences in Bethesda, Maryland and the Project Lead/Instructor and for the Prevention of Harmful Behaviors in the Military Project. Mr. Tash completed his Bachelor of Arts in Communications at Texas A&M University in 2015 and his Masters of Social Work at the University of South Florida in 2025. He is now working toward the goal of becoming a Licensed Clinical Social Worker (LCSW).