Introduction

Statement of Purpose

He purpose of this research was to explore the intrapsychic and interpersonal experiences that contribute to the combat soldier's self-perception as "broken." His researcher first heard the term while working in an Adult Behavioral Health Clinic at Fort Campbell, Kentucky. Returning combat soldiers created and used the term "broken" to characterize their psychological condition as a result of combat experiences. It is necessary for clinicians to discover the vast psychological meanings within this term in order to appropriately serve this population.

Significance of the Study for Clinical Social Work

He researcher first heard the descriptor of being "broken" when it was used by a patient treated in her clinical practice. With this patient, therapeutic work focused on the meaning of feeling "broken" and was essential to understanding the constructs that comprised this term. He patient presented underlying thoughts of suicide, which led to the patient's hospitalization for approximately six weeks. As a result of this work, a class project was conducted to further investigate the therapeutic experience with soldiers who reported being "broken." He results of the class project, which consisted of interviewing three therapists working with soldiers who identified as "broken," indicated that the therapists were familiar with the term and proceeded to delineate a wide range of emotional phenomena as well as social, familial, and command interactions that were associated with the term. It is possible that the term "broken" has been in colloquial use in military circles for many years. Remarque (1928) used the term to describe the experience of soldiers in World War I: "We will be weary, broken, burned out, ruthless and without hope. We will not be able to find our way anymore ..." (p. 254).

According to a Department of Defense (DOD) report from August 2012, there were 131 potential suicides of active duty soldiers. Eighty of these have been confirmed as suicides and 51 still remain under investigation (DOD, 2012). In 2011, the DOD also reported that 165 suicides had been confirmed, with none under investigation. Suicide has helped focus public concern for the mental health needs of returning soldiers. The researcher has observed a wide range of distress among this group. Some soldiers report feeling broken along with suicidal ideation while others do not; however, these individuals can be suffering from significant psychological symptoms.

A systematic study of the experiences of soldiers who report feeling broken provided an in-depth exploration of war-related distress and how it is experienced intrapsychically, interpersonally, and in the context of Army life. It also offered a phenomenological context for the relationship between suicidal ideation and war-related trauma or distress.

Statement of the Problem to Be Studied and Specific Objectives to Be Achieved

This researcher's interest in the topic centers around the population she worked with at the Army post on Fort Campbell, Kentucky. Many soldiers there have been through multiple deployments since joining the Army and since the war began in Afghanistan, moving into Iraq and continuing in Afghanistan. Some of them have deployed as many as eight times since the onset of the war. Many of these soldiers have endured injuries during these deployments, which present as physical, psychological, or coexisting in nature.

According to the RAND Study (Williamson & Mulhal, 2009), 68% of 33,000 soldiers experienced blast-related injuries (p. 1). Fourteen percent of the soldiers return from combat with symptoms of Posttraumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), or Major Depressive Disorder (p. 5). It was reported that 30% of soldiers that return screen positive for PTSD and TBI symptoms (p. 6). The report was broken down to define the ranges of the three most prevalent psychological conditions: 14% PTSD, 14% Depression, and 19% TBI of the 30% returning with mental health symptoms (p. 6). Since September 11, 2011, more than 638,000 soldiers have deployed more than once (p. 6). According to the Army Mental Health Advisory Team, soldiers that deploy longer than six months or more than once are more likely to be diagnosed with a psychological injury (p. 6). It was stated that multiple deployments increase combat stress by 30% or more (p. 7). Overall, 17.2% of 80,000 soldiers screened positive for mental health immediately after returning from combat (p. 9).

This researcher's experience indicates that soldiers returning with either a physical condition or mental health condition use the term "broken" to describe their presenting issues and psychological state in general. This term is one that the soldiers have created and is commonly used among the soldiers at Fort Campbell, Kentucky. Although this term is used frequently, there is no consistent understanding of what meanings lay beneath the term. This research is aimed at an in-depth understanding of the descriptor "broken" as a summary statement regarding a grossly altered sense of self.

Emotional consequences of combat and life in a time of war are well documented in the literature (Fairbairn, 1952; Freud, 1920; Kardiner, 1941; Ornstein, 1994; Stolorow, 2002, 2007; Wolf, 1995). Combat often includes losses of fellow soldiers and commanders. It is important to note that psychological distress is experienced in the context of the soldier's unit, command structure, and family relationships. In addition to individual distress, the responses of command, fellow soldiers, and often family members to perceived emotional difficulties are all potentially linked to feeling "broken" (Mezei, 2012).

The objectives of this research were as follows: (a) to explore in depth the complex intrapsychic and interpersonal experiences that contribute to feeling "broken," (b) to generate a substantive theory about combat-related stress and its relationship to feeling "broken," (c) to compare and contrast the findings of this research with the trauma theories of Wolfe (1995) and Ornstein (1994), and (d) to provide a framework for clinicians working with war-related stress in active duty or veterans mental health facilities.

Trauma "Locations"

If it is assumed that "feeling broken" is an existential or a phenomenological expression of combat-related PTSD, or war-related distress, we must also be free to question our...