Short stories, Travel and Health Information
This article appears in the latest issue of the Journal of Military and Veterans’ Health (JMVH Volume 2 2019) and is based on the Sir Edward ‘Weary’ Dunlop Award winning presentation delivered by me at the annual conference of the Australasian Military Medical Association, Brisbane October 2017.
Transitioning from service in the military back to civilian life can be an extremely challenging period for many ex-service personnel. This stressful period in a veteran’s life can precipitate the onset or exacerbation of mental health problems.
A pilgrimage—a journey of spiritual healing—undertaken in the company of like-minded companions is one way of helping veterans through this particularly vulnerable transition period.
In the summary report of the Department of Defence and Department of Veterans’ Affairs Mental Health and Wellbeing Transition Study, published in 2018, it was noted that the period of transition from military to civilian life is quickly becoming recognised as one of the most significant and stressful transitions in the life course of military members worldwide, owing to the potential changes in identity, community and residence, social networks and status, family roles, occupation, finances, routines, fresh responsibilities, supports and culture.1 Changes brought about by the transition process can lead to the development and/or exacerbation of existing service related mental and physical symptoms resulting in psychosocial adjustment issues.
The results of this study showed that Australian Defence Force (ADF) members transitioning from full-time military service represented a group at particular risk for mental disorders and would benefit from proactive strategies that aim to lessen the burden of mental illness. It was estimated that no less than 46% of ADF members who transitioned from full-time service within the past five years met the 12-month diagnostic criteria for a mental health disorder.
A year previously, the Australian Institute of Health and Welfare released its report Incidence of suicide among serving and ex-serving Australian Defence Force personnel 2001–2015. One of the reassuring conclusions from this report, which drew on data collected over the previous 15 years, was that serving members of the ADF are far less likely to commit suicide compared to the general population. Men serving full-time or in the reserve had age-adjusted suicide rates of 53% and 49% lower than all Australian men.
The not so good news from this report, however, was that the suicide rate of ex-serving men (there was virtually no data for ex-serving women) was more than TWICE as high as serving men and 14% higher than men in the general population.2
This is certainly a cause for concern. Suicide is indeed a complex issue encompassing philosophical, ethical, legal and practical dilemmas. It cannot be assumed that ALL suicides are due to abnormal mental health,3 but it is not unreasonable to speculate that such a high rate of suicide in Australian veterans after they discharge from the ADF indicates a high rate of mental illness in this population.
Why are so many soldiers—not just in the ADF but in armies all over the world—lost when they leave the military and start transitioning to civilian life? From my own observations as an army doctor and a family physician who has looked after many veterans, as well as from the discussions I have had with health professional colleagues who have served in the defence forces of other countries, some of the reasons that could explain this are:
There is already much research to indicate that veterans often experience a sense of vulnerability and social isolation, which can be attributed to their having been separated from systems and people they relied upon for years.4
In his book A Soldier to Santiago, US Navy Veteran Senior Chief Petty Officer Brad Genereux wrote: ‘For over 22 years and with pride I represented my country by wearing the uniform of my nation. And when my service was all over? Life had passed me by and I found that I fit in – Nowhere.’5
Genereux is the founder of Veterans on the Camino, a project designed to help suffering military veterans achieve healing by undertaking a journey along the Camino de Santiago (‘The Way’)—an ancient 800-kilometre trail to the shrine of Santiago de Compostela in northern Spain that is walked by over one hundred thousand pilgrims each year.
If one were to ask ‘What is a pilgrimage?’ the obvious definition would be ‘a journey to a place in the belief that a duty will be fulfilled, a wish will be granted or sins will be forgiven’. Pilgrimages such as these are undertaken, for example, by Jews and Christians to Jerusalem, Catholics to Lourdes, Muslims to Mecca, Hindus to the source of the Ganges and Japanese Buddhists to the various historic temples on the island of Shikoku. But one could also look on a pilgrimage as a journey away from home in search of spiritual wellbeing—to seek inner peace through physical journeying.
Unfortunately, although scholars within the disciplines of anthropology, archaeology, sociology and religious studies have explored the topic of pilgrimage, there has been very little research done to ascertain the psychological and emotional implications of pilgrimage on individuals.6
A strong motivation for many pilgrims is the desire for healing. The healing process that occurs on pilgrimage is not one that cures physical ailments but rather addresses the human experience of loss and suffering.7
As Notermans has observed, pilgrimage also provides a communal structure of similar individuals who move through rituals together.8 Therefore, the healing dynamics of a pilgrimage include not simply a physical journey with physical, social and symbolic effects, but also an act of personal empowerment and a sense of solidarity with a community of fellow pilgrims. It is this inner peace that a pilgrimage along the Camino can help someone suffering from the mental battle scars of war to achieve. Some of the ways undertaking a pilgrimage along the Camino can help veterans are as follows.
The shock of leaving behind one’s military identity can be profound. Wearing a military uniform allows one to ‘walk tall’, but when a soldier discharges from the military and gives up his uniform, he becomes just another civilian struggling to make his way in an unfamiliar world. Inherent in the pilgrimage journey are the adoption of a new identity, ‘Pilgrim’, and the sharing of the journey’s hardship with other pilgrims
While walking this ancient trail, which pilgrims have traversed for over one thousand years, one becomes aware of all those who have moved along this ancient space. Just as in the military, one wears a uniform, a beret or a slouch hat, which are badges of honour that acknowledge and respect those who have gone before.
Soldiers are all familiar with the ‘Situation, Mission, Execution’ type of action that goes with being in the military. The pilgrim journey provides a shared direction of movement towards a common end. While the side by side progress along ‘The Way’, reminiscent of soldiers doing PT, drill, weapon cleaning etc. together, engenders sharing and support as they move together to achieve the envisaged goal.
Walking in the company of others who are on a similar quest and so becoming part of a community (‘We are all in this together!’), brings about a sense of mutual RESPECT. There is a readiness along The Way to ‘help a mate’ through illness and injury, and there is always the opportunity, over a glass of beer or a copa de vino at the end of a hard day’s walk, to share stories and experiences.
A pilgrimage along the Camino can bring back the joy and camaraderie of old times, the respect and sense of purpose that was treasured and the self-esteem that was lost. Walking along this ancient trail, one experiences views of snow-capped mountains, groves of majestic leafy trees or tranquil lakes. The world and its travails seem a thousand miles away. One feels so very small, and yet one feels a part of humanity and a part of the universe.9
A pilgrimage to Santiago, admittedly, is not for everyone and is not the only way to help veterans suffering from loss, mental scars, PTSD and grief. The therapeutic value of a pilgrimage, however, has been well known over the ages and throughout many different societies.
Walking the Camino de Santiago is, I believe, a journey that will help veterans who are struggling to find themselves to achieve not only spiritual healing but also mental peace.
Major Sanjiva Wijesinha MBBS (Ceylon), MSc (Oxford), FRCS, FRACGP served as a medical officer in the Sri Lanka Army Medical Corps for 11 years and subsequently in the Royal Australian Army Medical Corps for 20 years. Currently an associate professor at the Faculty of Medicine, Monash University, Melbourne, Australia, he is the author of Strangers on the Camino and Not Our War.