Special Operations Forces: Challenges and Solutions to Traumatic Experiences of SOF Members

U.S. Army Rangers of the 75th Ranger Regiment conduct field training for a unit TFT (Task Force Training) operation on Joint Base Lewis-McChord, Washington, Aug. 19, 2019. (Spc. Garrett Shreffler/U.S. Army)

Special Operations Forces: Challenges and Solutions to Traumatic Experiences of SOF Members

Special Operations. A seemingly small community in our US military, this elite group of fighters focuses on specific tactical missions that encompass a wide variety of skill requirements. In breaking down its very title, we know just by hearing this phrase that the men and women involved in the Special Operations community are, within their right, some of the most respected, disciplined and skilled people enlisted. Missions include but are not limited to, working in small units on dangerous, specialized missions, going on target under the cover of night, stealthily completing objectives to help bolster our intelligence on foreign activity, and serving as elite teams that military leaders call upon to conduct high-risk rescues in situations where options are limited. To put it plainly, they are the people you call when things aren’t looking good and you’re caught between a rock and a hard place.

SOF: The Line of Duty and Beyond

Training for Special Operations is vast and challenging, and the community itself exists within several different branches; Army Rangers, Green Berets, SOAR (Night Stalkers), and Civil Affairs. Each offers a unique skill set necessary to complete difficult missions, and the training is as rigorous as you can get. Special Operations Forces (also known as SOF) have been a part of our military since its conception, as many specialized positions have existed before the Revolutionary War. However, SOF was not formally recognized until WWII, when Col Aaron Banks coined the phrase Special Operations to encapsulate the duties of individual groups in the Army that were in charge of conducting specific missions, namely the capture or assassination of Hitler. While Army Rangers had existed as entities since the Revolutionary War, Green Berets were born of extremely specialized training that took place when elite Rangers were sent abroad to study with premier military leaders in Scotland. Upon realizing that a combination of specialized units and groups would be beneficial to handle foreign affairs that involved hostage situations, rescue missions and highly specific objectives, this birthed the need for Special Operations Command. A joint effort across the Navy, Air Force, Army and Marines created cohesive teams of operatives that could handle the task of organizing and performing particular duties within the military.

However, for all of this specialized training and the warrior ethos that goes hand in hand with it, there is a dilemma that exists within the community post-service. How do Special Operations members function in a civilian society when they have been trained to conduct the most lethal jobs the military has to offer? How does one successfully build a life that doesn’t involve going out on target, reacting to their environment in ways many wouldn’t understand or without having the structure that their military service provided? While this is not a new problem in the US military, it seems as though members of Special Operations in particular have a difficult journey in figuring out how to become a functioning member of society because of their specific training and way of life. Special Operations members are held to some of the highest military standards- what do you do when that structure and safety net is completely gone and you are left in a freefall that you weren’t truly prepared for? For some, the answer lies in many self destructive tendencies and behaviors. Others may have the support system and guidance they need to be pointed in the right direction after their time comes to transition back into civilian life. What we must be asking is how can we properly transition this group of finely crafted individuals back into a world that doesn’t understand the depth of their life’s work, their mission, and most importantly, the traumas they have faced.

While SOF performs in clandestine locations and many objectives are kept quiet, there is no lack of material produced by former members detailing their service and what life was like for them while enlisted and post-service. From books, to podcasts, documentaries and sensationalized films, we’ve come to know members of these communities as steadfast, trainable and dedicated to their jobs. Portrayals of these men and women paint a picture of stoic grace and infallibility in the line of duty, and it would be contrary to say that this wasn’t accurate. Indeed they do show an immense amount of fortitude, so much so that it’s easy to forget that at the very core, they are human beings. They are still wounded in combat morally, physically and psychologically and it should go without saying that they need the utmost care during their service and after their service is up.

Ray McPadden details these scenarios in several of his books. An Army Ranger in 2nd Battalion, he spent 15 months in the Korengal Valley, one of the most dangerous areas that Afghanistan had to offer soldiers of his caliber. Leading an infantry unit from 10th Mountain Division, he learned quickly as an Officer that leadership ability was key, and the objectives that he was responsible for were not for the faint of heart. He was very young- younger than some of the men in the unit he was leading. As a young man responsible for the lives of his fellow soldiers, that immense pressure he felt during missions weighed even more heavily on him when the men he led died in combat because of decisions that he made. During war, it’s not feasible to enter with the idea that everyone gets out alive. Even still, the deaths of those nearest to him in combat, including a medic that was close in age, left him feeling empty when he came home on leave.

In an interview with Coffee or Die magazine, McPadden stated: “Those few weeks off in the middle of a 12 to 16-month tour was the biggest mindfuck ever conceived. I was a Ranger officer, yet I seriously contemplated how to avoid having to go back. I even fantasized about crashing my car so I didn’t have to go but could still preserve some face. I obviously did not do that, but I seriously considered it. And that’s from someone who has been through some of the best training the Army has. I was an officer and a Ranger, so you have to think about how that midtour leave impacts 18-year-old kids who basically went right from basic to getting thrown into an infantry unit.” (Caltrider, 2022)

McPadden’s story is unfortunately not unique when it comes to Operators whose duties include but are not limited to, leading what feel like suicide missions, trying to organize multiple units from differing branches, and keeping their own fears and emotions in check when the going gets tough. Taught to put those thoughts and fears aside until the mission is accomplished, operators rarely get the chance to talk about how the missions affect them in a way that is productive and relatable. Because SOF is such an insular community, there is a gap in care that cannot be filled by just anyone. Their training coupled with the ethos that surrounds their duty make it difficult to reach out for help in ways that are impactful. “Quiet Professionalism” has created a pervasive and oftentimes unhelpful method of dealing with traumas that SOF members experience. The issue seems to be getting worse as time goes on and more people leave the military, the only community they’ve known for years.

In order to understand the depth of the issues at hand, each should be looked at separately, then as a whole to paint a bigger picture of what is going on in SOF member’s lives. These separate issues that make up the body of obstacles facing these members make reaching out for help difficult- each limb seems to function as a different problem. Despite the military’s efforts to implement counseling and other strategies to cut down on maladies within the ranks, we’ve seen suicide numbers increase over time as members suffer in silence. This is due to more than just the physical hardships that soldiers face when deployed and when they come home- moral and psychological injury are at play as well.

Physical Injuries & TBI’s in SOF

A 2022 study conducted through the VA states, “SOF personnel were more likely to have deployed to a combat zone, had more years of active duty service, and were more likely active duty at time of TBI. SOF personnel were more likely to have had mild TBI (vs moderate/severe) and their TBI caused by violent mechanisms. SOF personnel had a higher number of comorbidities, with more diagnoses of chronic pain, osteoarthritis, hyperlipidemia, hip fractures, and obstructive sleep apnea.” (Garcia et al, 2022)

SOF deploys to areas of the globe that are known for engaging in terrorism or harboring terrorists. The US has sent (and continues to send) operators to Afghanistan, Iraq, Syria, South East Asia and parts of Africa to carry out specialized tasks and missions that aid in intelligence, as well as the kill/capture of suspected and known terrorists. (Atlamazoglou, 2021) The environments in places such as these present high risks for those deployed there. Aside from the actual geographical terrain, wildlife, local opinion of US troops and the overall tension of military presence, Improvised Explosive Devices (IED’s), vehicular accidents, suicide bombings and explosions caused by gunfire add to the hurdles that SOF members face while on missions. Traumatic enough in their own right upon initial encounter, these instances have lasting effects long after the explosions are felt. TBI’s are a huge concern in the rehabilitation of SOF members upon the ending of their military career, and with them come a long list of comorbidities and health issues to follow. The previously mentioned 2022 study of TBI instances in SOF members describes the differences between conventional forces and SOF when it comes to the staggering numbers of exposure to hazards causing TBI.

“The differences between SOF and CF with regard to psychological and behavioral health and neurobehavioral symptoms are striking. They suggest that serving more years in the military within the high-exposure SOF environment, may increase allostatic load and put patients at risk for worse neurobehavioral outcomes after a TBI. While premorbid resilience seems to carry SOF personnel through longer careers and more frequent deployments, current findings are consistent with the notion that “cumulative exposure” may eventually tax resilience and result in clinically significant subjective distress. To retain these high value service members in deployable, active duty status, systems of care need to anticipate and provide means for addressing psychological symptoms throughout their careers, rather than a reactive stance that provides care past the point where these personnel might remain healthy and deployable.” (Garcia et al, 2022)

The research basically states that the longer someone is a SOF member, the higher their chances are of experiencing TBI’s. However, not every explosion is the same, thus making the outcomes of rehabilitation sometimes difficult to pin down. Different blasts come with different degrees of TBI’s, and therefore require many different options for treatment. In order to grasp the best possible way to treat SOF members whose injuries are specific to their line of duty, we have to understand what they go through. Different blasts are defined by different “levels”. According to brainline.org, “Primary blast injuries are caused by the blast’s shock wave traveling through the body. Secondary blast injuries are caused by shrapnel and other flying debris hitting the body. Tertiary blast injuries occur when the service member is accelerated into a solid object such as the ground or the interior of a vehicle. Quaternary injuries include crush injuries, burns, and inhalation of smoke or noxious gasses.” (BrainLine, 2017)

In using these four classifications for blast types, we’ve also been able to develop effective forms of treatment for TBI. However, TBI is not the only concern of those who served in SOF- for many, the physical impairment in the wake of TBI presents yet another concern when it comes to treating the physiological aspects of traumatic experience during service. Many members come home missing limbs and their ability to function the way that they once did, as elite members of highly trained fighting forces. These physical injuries tend to come with more insidious, less visible ailments; those psychological in nature.

Psychological Injury in SOF

A 2021 study looked at the differences in TBI and neurobehavioral symptoms between SOF and Conventional Forces (CF). Researchers found that “SOF personnel reported a longer military service and were more likely to have deployed to a combat zone compared to CF. In terms of TBI, SOF personnel had more TBIs in addition to their index TBI and were more likely to experience a delay between sustaining a TBI and admission into inpatient rehabilitation treatment (mean time since injury = 1,746 days for SOF and 320 days for CF). This may be explained by the higher rates of mild TBI in SOF, with predominantly falls (including hard parachute landings), violent-related, and non-specific mechanisms of injury (Table I). Finally, SOF reported greater severity of neurobehavioral symptoms as compared to CF.” (Garcia et al, 2021)

While SOF is responsible for carrying out a wide range of duties, those putting members at the most risk include missions dedicated to counterterrorism, counterinsurgency, hostage and rescue operations, and special reconnaissance. (SOCOM.mil, 2022) These missions require finely honed skill, but because of their specialized nature they put SOF members at a greater risk for substantial psychological damage. Given the nature of the jobs they are expected to carry out, specialists come face to face with some of the worst scenarios that any soldier can imagine.

“The study of chronic sequelae of TBI, including self-reported symptoms that the SM/V attributes to the TBI, is particularly important for SOF personnel given that they have both a higher level of TBI exposure and experience more rigorous and intense levels of training and deployments.4 Repeated and prolonged chronic stress from trainings and deployments can have significant effects on homeostasis, contributing to breakdown of body systems.5 Accordingly, within a sample of SM/V receiving inpatient rehabilitation for TBI, SOF SM/V reported a greater number of previous head injuries than CF, which were typically mild in severity.4 SOF also reported 1.5 times more medical comorbidities than CF, including chronic pain (54%), sleep apnea (36%), and orthopedic fractures (34%).” (Garcia et al, 2022)

Through the study of how our psychological health impacts our overall physiological health, we know that SOF members in particular have a difficult time reintegrating into our society, as their experiences amplify the diagnosis and comorbidities that entail mental health diagnoses.

Moral Injury in SOF

“Embrace the suck” is often used as a term to coin what military members experience in their training and beyond. SOF members understand this phrase better than most, as their training is incredibly taxing, but important to the mission set that they handle. However, this expression has roots in a line of thinking that leaves many members vulnerable to feelings of defeat, uselessness, that they are mere pawns in a game that they have no control over.

“SOF operators do (and probably should) utilize “embrace the suck” in various warfighting contexts, such as in the complexities of combat deployments. In those extreme operating environments, it is appropriate (and even desired) for SOF operators to embrace the suck as the best possible solution to many unique, low-intensity conflicts and their attendant covert and clandestine, low-intensity, asymmetric, irregular, or unconventional warfare-relational contexts. However, it is equally important to recognize that “embrace the suck” is rarely an appropriate solution for SOF operators after returning home and engaging in some equally complex and confusing relational contexts with family.” (Caterson et al, 2023)

Moral Injury is used to define how service members feel after completing tasks that do not align with their own moral character. Often, they feel a sense of overwhelming grief at the thought of their actions on the battlefield and having to do with how they operate within the ranks of the military. SOF has a strict way of maintaining order amidst the chaos, and this doesn’t always coincide with how members view the world or experience it first hand as they complete gregarious missions.

“Moral injury in SOF agents and operators is a multifaceted, multi-vectored, and highly individual experience, yet it also impacts the entire SOF community. It can provoke excessive shame, unresolved guilt, anger, contempt, loss of honor, loss of joy, and loss of hope. Relationships can be ravaged by loss of trust, severed ties, disconnection, contamination, and unforgiveness. A warrior’s view of self can be impacted and often heard in statements like, “I am not good,” “I can’t be trusted,” “I am a failure,” and “I am hopeless.” Even one’s concept of the world can be altered as demonstrated in phrases like: “There is no God,” “There is no goodness,” “Life has no meaning,” and “Life has no purpose.” (Caterson et al, 2023)

These moral injuries can be seen in footage and accounts of war experiences from operators who were responsible for daunting, painful, burdensome tasks that left them psychologically broken despite the warrior ethos that builds them up in their training. Operators have a unique experience with moral injury, because they are up close and personal with the mission- not to say that CF cannot or does not share these experiences, but individuals trained to go out on target under the cover of night, or tasked with kill/capture missions in which they deal with the enemy on an intimate level have witnessed extremely violent situations that they play a direct role in. It’s difficult to have that cognitive dissonance about war when you’re on specialized missions where the objective is to kill or capture a specific person and their malefactors. However, not every mission is black and white, and there are casualties that cannot always be justified in the minds of operators.

For many, the pressure to do the right thing in ambiguous circumstances when you’re constantly running these types of missions damages their ability to trust. They lose the ability to trust themselves, their peers, and anyone they may interact with outside of the military. These moral injuries leave SOF members questioning whether or not they did the right thing at the end of the day. The implications of these injuries can lead SOF members into a downward spiral of loneliness, distrust, anger and self abandonment. These invisible wounds are often the beginning of a long journey with battling mental illness in ways that are confusing and tiresome. This can lead to detrimental consequences, as toxic positivity in relation to “embracing the suck” leads many SOF members to ignore their feelings despite the never ending barrage of PTSD symptoms and moral questioning The idea that “someone elsewhere is worse off than you are,” or that “things are never going to be easy so you should learn to just deal with it” leave many operators wondering when the pain of their actions will end. Learning to switch up this way of thinking upon exiting the military or even just coming home on leave is a daunting task, and something that isn’t taught within the framework of their training.

Treatment Modalities Post Service

While there are many ways in which combat adversely affects those who have lived through it, there are also many treatment options available from those who relive what they have seen over and over. Some of these treatments have very high success rates, like Cognitive Behavior Therapy, considered the gold standard for treating PTSD. CBT allows the patient to change harmful patterns of thinking, leading to new and improved ways of behaving, in turn improving their coping abilities and overall mental health. Other modalities of treatment include Eye Movement Desensitization and Reprocessing (EMDR), which uses eye movement to initiate a “desensitization” of traumatic memories for patients. This bilateral stimulation in conjunction with the recollection of the triggering memory helps to cut down the hyperarousal caused by the reaction to the memory. This is still being studied, as many treatments are best used on an individual basis. Meaning, these therapies should be explored on a case-by-case level, as one treatment may not be right for everyone suffering from trauma related to combat exposure.

Other treatments are being studied for future use, like psychedelic-pharmacological remedies. Many veterans, exhausted by the ineffectiveness of the typical treatments found in their VA hospitals have turned to these alternative methods as a way of journeying inward to alleviate the symptoms left by their wartime experiences. An interesting path that many veterans have chosen to take is that of psychedelic treatments through the use of psilocybin, ayahuasca or ketamine. While these treatments require further study, and must go through legal processes that allow the studies to occur here in the United States, many individuals suffering from post-combat PTSD have seen great progress in treating their symptomatology in places like the UK, South America and treatment centers that are approved for K-Therapy (ketamine therapy) in the U.S. (Daby, 2022)

Reintegration for SOF Members

The VA has worked diligently to pay close attention to the successful reintegration of SOF members to civilian life post service. For a group that is highly trained in carrying out specific missions, the reintegration process requires more than just brief training on how to go back to “regular life” after all that was accomplished during their time as an operator. In developing programs like the Servicemember Transitional Advanced Rehabilitation program (STAR), the VA lays out feasible plans for service members to follow once they begin preparation for their exit from the military. Unique programs like this one help to ensure that SOF members are equipped with what they need for the first few weeks of independence from their duties.

According to the VA’s website, “The program places a unique emphasis on transition from military to civilian life, including individualized employment and educational exploration and planning, development of job search documentation, and learning about available community resources. Opportunities exist for patients to complete educational or professional certification courses while participating in the program. Additionally, STAR patients participate in therapeutic outings that are incorporated into their treatment plan. The STAR Program is housed in the Polytrauma Transitional Center on campus and allows patients the opportunity for rehabilitation and recovery away from their op-tempo environments. Program participants are provided a therapeutic setting with structured daily schedules and flexible priorities according to their individual goals. All patients receive an initial two-week evaluation after which we determine their length of stay and treatment. Most patients complete the program within 60 days. Each patient is involved in treatment planning, which may involve family member participation at the service member’s request. Both individual and group treatment sessions are offered. A full spectrum of rehabilitation services is available, following an interdisciplinary team model, which enhances the efficiency and standardization of treatments. Medical staff are accessible and located within the building.” (VA, 2022)

Housed within the VA’s Polytrauma Treatment Center in Richmond, VA, the program aims to provide a way for SOF members to gracefully transition while maintaining their mental health and overall well being. While this is a step in the right direction, this highly specialized program is not readily available across the country for returning SOF veterans, making its accessibility extremely limiting. The benefits to programs like this could be far reaching if they were implemented in a wider range of locations with dedicated staff.

Other programs exist along with STAR to help SOF members in their transition to civilian life. The Warrior Care Program details the following: “U.S. Special Operation Command (SOCOM) Warrior Care Program (Care Coalition) was established to provide Special Operations Forces (SOF) wounded, ill, or injured Service Members and their families advocacy after life changing events in order to navigate through recovery, rehabilitation, and reintegration as quickly as possible, strengthening SOF readiness. Whether you are returning operational status, moving into a different field or transitioning into Veteran status.” (WarriorCare, 2023)

Through programs such as this, operators are paired with a Career Transition Coordinator to help them create the best plan for their new lifestyle post military service. These coordinators are often veterans themselves, and understand the language of the military and are familiar with strategies meant to help veterans succeed after their transition. This is important for many reasons- namely, SOF vets can rest assured that although their military experience might differ from that of the Transition Coordinator, they understand how many facets of the military work and can help to guide them in the right direction.

Aside from programs such as these, many independent non-profit organizations work to assist SOF members with their transition and build helpful communities around them. Operation Healing Forces, Heroic Hearts, Three Rangers Foundation, and Wounded Warriors are just a few that focus on helping SOF members reintegrate and pair them with other veterans that can assist them as well. These non-profits allow SOF members to move freely through their transition as though they are speaking to their fellow soldiers- people who understand who they are down to their core, something that the VA lacks in their transition counseling. While the intentions are well meant, many SOF members hesitate to utilize what the VA offers in the way of reintegration techniques because there is a sense of disconnect with counselors, advisors and advocates. Having resources such as these, created and led by people who worked as operators on the battlefield provides a sense of comfort and familiarity often missing in the lives of SOF members when that aforementioned “safety net” of friendship and loyalty is missing from everyday life.

Challenges still arise, however. While operators live across the span of the United States, many foundations exist near military bases, VA hospitals, areas with higher veteran populations, and areas where funding for programs is readily available. For many operators who live out of reach for services they could greatly benefit from, options become limited and the sense of isolation can be crushing. Better outreach is needed to check in with former operators, but progress is slow going when it comes to providing these services to CF alone. With SOF being an insular community, priorities lie in laying down the foundation for the rest of the VA system before focusing on specialized groups. The struggle is then passed down to operators themselves to utilize the resources they have at their fingertips, even if that disconnect is still present in communicating their needs, or if the resources don’t exist at all.

This can lead to extremely risky behavior if those in need of high levels of assistance are left to figure it out on their own. According to one study that examined drug and alcohol use in veterans, “A 2017 study examining National Survey on Drug Use and Health data found that, compared to their non-veteran counterparts, veterans were more likely to use alcohol (56.6% vs 50.8% in a 1-month period), and to report heavy use of alcohol (7.5% vs 6.5% in a 1-month period). Sixty-five percent of veterans who enter a treatment program report alcohol as the substance they most frequently misuse, which is almost double that of the general population.” (NIDA, 2019) These numbers are staggering, and while few studies have examined SOF specifically, it is assumed that operators struggle with these troubles as much as their CF counterparts.

Insular Outreach in SOF

The SOF community has gained a lot of traction with presence on social media, and in doing so has reached current and former members and built a web of connection that spans not only our country, but those abroad. Members of different national forces are now connected via apps like instagram and tiktok, allowing the network of support to grow and those who want to be involved in the efforts to help veterans maintain healthy relationships with those around them, and prevent them from isolating themselves when their mental health becomes challenging. The beauty of these efforts is that because of the lack of truly relatable resources for SOF members, the community has pooled together to create an atmosphere that emulates the bonds and friendships they experienced during their time in the military, without the added threats of injury or loss of life. Creating community ties has carried over to their civilian life, and former SOF members build this good will between others as a reflection of their training and willingness to help people thrive.

As members of society, SOF veterans have contributed so much to the realms of research, health, mental health awareness and a call to action from policy makers to create effective changes in the treatment of veterans. Often referring to themselves in terms that evoke a roguish nature, they realize the importance of community when it comes to flourishing well after their years in the military, despite their monikers as “hoodlums”, “brigands”, “GWOT Goons” and the like. Their need for community and methods of becoming non-complacent post-service have become staples in the lives of many Americans through books, memoirs, fitness regiments, tactical training programs for civilians and law enforcement and even clothing companies.

While many former SOF members struggle with their own reintegration after experiencing traumas, there is hope in the fact that more focus is being placed on assisting and studying the needs of this particular group in the military. SOF has provided innumerable services to the military in general, and will continue to do so in subsequent years. It is important that government policy makers continue to develop strategies that can assist in transitioning SOF out of their military duties in positive ways instead of placing the burden on military members whose training focuses more on their active duty and less on their time post-service. The allocation of resources necessary to facilitate these programs should be explored further, as SOF members have been invaluable in their determination to accomplish challenging tasks presented by war.

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