In the Service of Science: Veteran-Led Research in the Investigation of a Theatre-Based Posttraumatic Stress Disorder Treatment

Abstract

Research data have consistently shown that military veterans are more likely than the general U.S. population to experience mental health problems, as well as homelessness and unemployment. Additionally, data show exceptionally high attrition rates from mainstream mental health treatments for veterans. While several emerging, alternative programs have great potential to support veterans in dealing with trauma and with the transition to civilian life, there is a paucity of research documenting the effectiveness of these programs. This lack of data prevails partly because of biases within the scientific community, which remains largely ignorant of the pervasive difficulties confronting veterans. Our antidote to this problem is a model of veteran-led research. In this article, we outline a set of principles of veteran-led research that we have developed through our ongoing empirical investigation of the DE-CRUIT treatment program, which uses theatre to address traumatic stress and related problems encountered by veterans. We describe the challenges involved in prioritizing the veteran perspective in conducting research within a mainstream scientific context as well as ways of meeting these challenges in order to use the tools of science to better serve our nation’s veterans.

Keywords

military veterans trauma treatment theatre arts-based programs

There is no denying that the U.S. mental health system needs to become more responsive to the needs of military veterans. Veterans are more likely than the general population to experience higher rates of homelessness, addiction, unemployment, and suicide (Institute of Medicine, 2014; Kaplan, Huguet, McFarland, & Newsom, 2007; Sher, Braquehais, & Casas, 2012; U.S. Department of Housing and Urban Development, 2014). While such problems are often construed as individual pathologies or weaknesses, they can be seen as symptoms of our society’s neglect of service members once they return home. Additionally, attrition rates from mainstream mental health treatments for veterans are disturbingly high (Garcia, Kelley, Rentz, & Lee, 2011; Gros, Yoder, Tuerk, Lozano, & Acierno, 2011) and have been shown to involve a complexity of factors (Mott, Modragon, Hundt, Beason-Smith, Grady, & Teng, 2014).

While there are several alternative, community-based programs that have great potential to support veterans in dealing with trauma and with the transition to civilian life, there is a paucity of research data documenting the effectiveness of these programs. This lack of empirical data prevails partly because of biases within the scientific community itself. As several authors have argued, mainstream research all too often fails to ask the right questions, about the right issues, and in the right way; in particular, psychiatric research remains predominantly focused on the evaluation of biomedical approaches that rely on medication and/or traditional psychotherapy, frequently discounting the effects of trauma and other social and environmental factors on mental health challenges in veterans and others (Caplan, 2011; Whitaker, 2011). In this article, we argue that these biases exist largely because of an ignorance on the part of most scientists when it comes to understanding the real, pervasive challenges confronting veterans. Our antidote to this problem is a model of veteran-led research.

In this article, we describe the underlying tenets, methodologies, and levels of veteran engagement that we believe are necessary to conduct work that is truly veteran led. We begin with a description of the underpinnings of our veteran-led paradigm and then describe the specific treatment model we derived from that paradigm. Next, we describe some of the challenges inherent in studying the effects of our treatment program, and we lead from that to a detailed outline of our team’s guiding principles of veteran-led research. We conclude with some of our future aims that we hope will help veteran-led research proliferate and ideally influence models of empirical work and practice in populations of traumatized individuals even beyond veteran populations.

Our approach to conducting veteran-led research has emerged from our ongoing empirical examination of the DE-CRUIT program. This program uses theatre—and specifically Shakespeare—to address traumatic stress and associated problems encountered by veterans as they navigate the transition from military life to civilian life. The program uses the verses and characters from Shakespeare’s plays to allow veterans to better understand the timelessness of soldiers’ suffering, which dates back to Shakespeare’s time and earlier. By using the Shakespearian monologue form, veterans in the program construct their own personal trauma narratives, which they share with other veterans in the group through a systematic, manualized process of communalization. The components of DE-CRUIT reflect our philosophy of a veteran-led model at every stage of the intervention design, implementation, and scientific evaluation. As such, the program reflects principles of mission-oriented therapeutic practice, which emphasizes unit cohesion within the treatment group, with veterans supporting one another toward a shared goal of healing and recovery.

Constructing a Model of Veteran-Led Research

From its inception, the DE-CRUIT project has been veteran led. The treatment program itself was initiated by team member and Army veteran, Stephan Wolfert. Stephan left a career in the military after experiencing debilitating traumatic stress, addiction, and suicidal thoughts that persisted until he unexpectedly came upon a live performance of Richard III that saved his life and altered his career trajectory. Seeing the character of Richard live in front of him, a veteran like himself who was unable to function in the civilian world, Stephan came to understand the healing power of theatre and went on not only to develop the DE-CRUIT program but also to become a renowned playwright and performer whose award-winning show Cry Havoc recounts his experience of trauma and recovery. Stephan connected with our New York University (NYU)–based research team (led by Alisha Ali) through a think tank titled the “Project for the Advancement of our Common Humanity,” which brings together scholars, artists, activists, and practitioners who want to use the tools of science to demonstrate the role of the arts, community, and human connection in addressing social, physical, and mental health problems.

In developing the science behind the DE-CRUIT program, all phases of work have been veteran led. Stephan has spent decades listening to veterans who are struggling with the transition back to civilian life, through his outreach theatre programs and other related initiatives. This work parallels Alisha’s work over the past decades listening to trauma survivors describe their frustration with medical interventions that pathologize the sufferer and do not recognize sources of strength and resilience that already exist in communities. One such community is the community of military veterans, all of whom—regardless of their specific service experience and the eras or wars in which they served—share a bond simply from being veterans. That ready community, along with the bond that forms through engagement with theatre, became the basis of our ongoing collaborative DE-CRUIT project. While all aspects of the project are informed by the lives and stories of the veterans we have worked with over the years, there are three overarching needs that have been voiced across groups of veterans that have become the basis not only for the treatment program itself but also for the goals of our program of research examining the effects of DE-CRUIT. These are described in the following sections.

“I Need to Get a Job”

Given the high rates of economic insecurity and joblessness among veterans in the United States (U.S. Department of Housing and Urban Development, 2014), it is not surprising that so many of the veterans who come to our program report job seeking to be their main challenge. Because of effects related to traumatic stress and social isolation, these veterans lack the sense of confidence and self-efficacy necessary to go on a job interview or even apply for certain jobs. This is one of the areas addressed by the use of theatre. The vocalization, posture, and embodiment necessary for the recitation of the verse that is learned in DE-CRUIT builds not only awareness of body and voice but also the self-assurance to look at an audience, a group, or an interviewer in the eyes and speak confidently. Following the lead of our participating veterans who have described these benefits, we have included a measure of self-efficacy in our scientific evaluation of the DE-CRUIT program.

Our research also examines the ways in which varying types of injury have compromised veterans’ attempts at job seeking. These include not only physical challenges from combat-related injuries but also additional psychological challenges resulting from traumatic brain injury, as well as the damaging effects of a wide range of psychiatric medications and prescription painkillers. The impact of these effects can be so pervasive that any steps toward planning around educational or job-related goals can seem overwhelming. Therefore, a core element of the DE-CRUIT program involves developing ritualized habits that build mental focus through the repeated practice of rehearsing scripted verse and the routinized techniques of physical and mental grounding in preparing for the spoken delivery of lines. In accordance with building these important skills in our participating veterans, our ongoing research on DE-CRUIT includes neurophysiological measures, including EEG measures, to assess improvements in this domain.

“I Need to Relate to People Around Me”

This need has been mentioned by nearly every one of the hundreds of veterans who have been involved in the DE-CRUIT program. Because of the same challenges around speaking and communication mentioned above, even holding a conversation with another person can be difficult. This process can be particularly challenging if the other person is a nonveteran who does not have an understanding of the deep impact that serving in the military can have on one’s life. We find that these difficulties often relate to a different kind of injury, moral injury. The concept of moral injury was developed by the psychiatrist Jonathan Shay (1995) and refers to the process by which a betrayal of one’s sense of morals (as often happens in war) leads to emotional and social consequences that include a general lack of faith in humanity and a lack of trust in others.

Through our work with the Project for the Advancement of our Common Humanity, our team has been able to consult with Jonathan Shay as an expert in military psychiatry. That consultation, along with the expertise of our participating veterans, has helped us develop our integrative model of research and practice. Specifically, we have seen the importance of sharing veterans’ stories of healing, and we have learned that veterans can come to understand their mistrust of nonveterans when they begin to better understand where that mistrust originates. To begin to rebuild this trust and connection, the final session of the DE-CRUIT program has the participating veterans present their personal trauma monologues to an audience that includes family members and community members who are nonveterans. In concert with that key element of treatment, we now include qualitative measures aimed at capturing veterans’ firsthand accounts of their psychological, social, and interpersonal growth along with the more standard quantitative measures in our research endeavors.

“I Need Community”

The lack of community that our veterans report consists of two components. The first component is the feeling of no longer being part of a unit as they were on a daily basis during their military service. The second component is a lack of integration into the civilian community that they left behind on entering military service. To help build a sense of community within the DE-CRUIT program, we draw on the feelings of loyalty to one another that military life cultivates in service members, a characteristic that persists in veterans even after they leave the military. We see this loyalty in our participating veterans in part through their insistence on a “no man left behind” mentality, which translates into a reluctance to cover new content in a program session if any of the treatment group members is unable to attend that session. Because the scientific component of our project requires adherence to a weekly schedule of sessions, we have accommodated this need by using the advanced technology available to us through the CREATE Lab at NYU (where our project is based). This technology, which we additionally use for the collection and storage of our research data, allows veterans to connect into program sessions in real time and to participate in the sessions remotely.

Across all these needs are common themes of human connection and a desire to move forward with one’s life. Those themes are at the heart of the DE-CRUIT program and are essential elements that we aim to better understand through our research. We are currently conducting a randomized controlled trial of DE-CRUIT, with the goal of disseminating our findings to other scientists and to practitioners working with veterans and other traumatized populations. Specifically, our veteran-led scientific team is using a mixed-methods evaluation approach in the study of the DE-CRUIT program, combining quantitative and qualitative measures as well as physiological readings of brain activity, to demonstrate the effectiveness of the program in addressing posttraumatic stress and other outcomes of relevance to veterans’ lives (Ali, Wolfert, & Homer, 2018).

From this ongoing work have emerged principles that we believe can together become a guiding model for veteran-led research. Before we describe those principles, we will first describe and explore the DE-CRUIT treatment program itself in greater detail. Evident in our description are the ways in which the three overarching needs we have outlined are integrated across all stages of the program.

A Veteran-Led Treatment Model

The DE-CRUIT program is a fully manualized 8-week treatment based on a systematic therapeutic model that begins with the articulation of the trauma experience and culminates in an open performance in which veterans perform their personal trauma narratives for an invited audience. The treatment model consists of the following five stages.

Stage 1: Formation

The DE-CRUIT program begins with the veterans joining together in entering the world of Shakespeare’s verse. The formation of group bonds is designed to mimic the veterans’ experience of unit cohesion, the bond that is formed among members of a military unit, which Freud (1921) described as a key psychological mechanism in driving soldiers to succeed together on a joint mission. Because this sense of cohesion becomes so engrained in soldiers, returning veterans often feel untethered on reentering civilian life when their unit members are no longer alongside them (Greene, Emslie, O’Neill, Hunt, & Walker, 2010). The sense of isolation and vulnerability that accompany this untethering have been identified as psychological markers for traumatic stress response (Caddick, Smith, & Phoenix, 2015; Mowatt & Bennett, 2011). DE-CRUIT uses unit cohesion in bonding treatment group members as they learn to recite military-relevant verses from Shakespeare and embark together on the process of healing from the effects of trauma.

Stage 2: Narration

The second stage of treatment has each participating veteran write his or her own personal trauma monologue, based in part on the structure of the Shakespearian monologue. This treatment stage integrates components of narrative therapy in its story-telling approach (White, 2005; Schweitzer, Vromans, Ranke, & Griffin, 2014) along with components of cognitive processing therapy in the identification of a traumatic trigger or “stuck point” (Monson et al., 2006; Resick, Monson, & Chard, 2007) for each veteran. Identifying this stuck point is central to the selection of the specific Shakespearian monologue that will be given to the veteran to learn, rehearse, and ultimately perform; that monologue is chosen using an algorithm that our team has designed to parallel the trauma experience each individual veteran describes as affecting him or her the most. The algorithm follows the method developed by Brown and Harris (1978) for the measurement of life stress and uses written descriptions of stressors and traumas typically reported by veterans (e.g., the experience of insomnia and traumatic nightmares is paralleled in Lady Macbeth’s “out, damn spot” speech describing her haunted sleep).

Stage 3: Simulation

In the third stage of the program, each veteran “hands off” their personal trauma monologue to a fellow group member who will rehearse and ultimately perform that monologue. Each veteran will thus witness a fellow veteran practicing and reciting the monologue during the treatment sessions. This step is the evocation of the aesthetic distance element of the DE-CRUIT model in that a veteran who may not be able to forgive himself or herself for a traumatic incident (e.g., the death of a comrade or the death of innocent civilians) may be able to empathize with the fellow veteran reciting that trauma and thereby begin to forgive himself or herself. This form of simulation is also designed to capture the therapeutic effect described by Oatley (2001) of imagining oneself in an emotionally-charged scenario that is removed enough (e.g., through the distance of witnessing a performed narrative) to invoke a gradual self-awareness around one’s reactions to traumatic triggers.

Stage 4: Routinization

The fourth stage of treatment involves the daily routines of grounding and breathing that are necessary for the delivery of Shakespearian verse (Ali & Wolfert, 2016; Wolfert, 2015). This process involves a routinization that is regimented in a way that allows it to the replace the structure of military life that becomes a relied-upon habit for service members—a habit that the participating veterans need as they transition into civilian life. This therapeutic element captures a key embodied processing component of the DE-CRUIT model wherein group members work together on fully inhabiting the spoken verse in passages and monologues, progressively immersing themselves in the requisite patterns of breath and rhythm. In particular, the iambic pentameter that is prevalent in Shakespeare’s speeches echoes the human heart beat and thus aids the veterans in reducing their heart rate variability, a clinical variable that has been identified as key in addressing physiological components of traumatic response (Tan, Dao, Farmer, Sutherland, & Gevirtz, 2011).

Stage 5: Communalization

The final stage of the DE-CRUIT program involves the veterans performing their own personal trauma monologue and their selected Shakespearian monologue for an invited audience of veterans, family members, friends, and community members (Figures 1 -3) . This culminating performance emphasizes the communalization of trauma—a process that Shay (1995) has described as essential in helping veterans overcome the effects of moral injury and in fostering veterans’ reintegration into civilian life. These performances also require the veterans to master the recitation of dramatic verse. That skill is foreign and often intimidating to most of the veterans and thus reflects the therapeutic notion of feeling “safe, but not too safe”—a technique in trauma therapy that fosters support but also challenges clients to take measured risks (Bromberg, 2006). Also in keeping with trauma therapy, the sense of safety and cohesion in the group during the performance allows for the creation of a “holding environment” (Herman, 1992; Lemma, 2003; Winnicott, 1965) in which the veterans feel supported while taking the risk of performing. Greene et al. (2010) have identified communal healing through the use of camaraderie with groups of traumatized veterans as a crucial therapeutic element, stating that the key to working therapeutically with veterans is to create “a caring ethos in which some admissions of weakness may be permissible” (p. 1480). The culminating performance fulfills this need while also providing the opportunity for a feeling of accomplishment and risk taking that many veterans miss after the end of their military service.

Figure 1.

A veteran preparing to rehearse for the performance of her monologue.

Figure 2.

A veteran rehearsing for the performance of his monologue.

Figure 3.

A veteran performs her monologue for an invited audience.

The performative component of the experience of communalization is therapeutic partly because the act of performing takes the performer-veteran outside of themselves while simultaneously allowing them to delve into their inner suffering and share their pain with others who have similarly suffered. The performance of the assigned Shakespearian monologue extends this communalization by providing the veterans with a common language that is at once new to them but also familiar to them collectively as they have studied Shakespearian verse together as a group. As an example, we can look at the experience of “Joe”, a White, middle-aged veteran who served in Vietnam. Joe experienced military sexual trauma at the hands of other servicemen, and he has spent decades since that experience trying to forget the experience, which still haunts him unexpectedly from time to time. In his first-person monologue, he described his reaction to this trauma: “I set off to be someone else so I would not hurt any more.” As an accompaniment to that sentiment, Joe performed his assigned Shakespearian monologue (Lady Macbeth’s “sleepwalking” monologue), which reflected his attempts to forget the trauma: “Out, damned spot! Out, I say! One, two. Why, then, ‘tis time to do it. Hell is murky!” By using both his own words and the words of Shakespeare, Joe is able to connect with other veterans and to a broader audience in order to communalize his inner suffering, which, until now, had been a solitary experience.

Lessons Learned: Challenges and Solutions

Although we have seen several successes as we enact our veteran-led research model, we have encountered a number of challenges in this work as well. For instance, we have begun using segments of the participating veterans’ self-composed trauma monologues in the scientific writing about DE-CRUIT, including extensive quotations, and accompanying personal details as part of case study reports. This has become a challenge as we struggle to accurately depict the veterans’ experiences while still respecting their anonymity. Another challenge involves meeting the requirements of funding agencies that privilege grant applications from traditional teams of investigators, rather than from scientific teams that include military veterans. Other challenges involve engaging veterans as participants in scientific research, especially in terms of the time demands on veterans for taking part in research, as well as the openness required to disclose and describe in a research context the deep suffering they have experienced. Such sharing is difficult for so many veterans because that disclosure can feel at first like a violation of the culture of nonemotion they had found themselves in during their military service (Greene et al., 2010).

A related set of challenges arises from the nature of the treatment itself. Getting a group of veterans to believe that Shakespeare can be a bona fide treatment for their suffering and traumatic stress can be daunting. Also, once they begin to participate in the program, they realize that there are components that they may not have expected; for instance, many of the veterans come to understand the role that early-life trauma may have played in their decision to join the military as well as in the difficulties they are experiencing now in working through the effects of trauma (Ali, Wolfert, McGovern, Aharoni, & Nguyen, 2018). They are often unprepared to examine these early-life experiences. Many veterans are also surprised that there is a physical element to the grounding and breathing exercises that are part of the DE-CRUIT treatment method and that are to be practiced every day while in the program—and even after they have completed their participation in the program. The commitment required for this component of the program eventually becomes something that many of the veterans rely on in their daily life, but at first it can be a challenge.

Despite such challenges, we consistently have an attrition rate below 10% in our studies. In reflecting on this success, we have identified a set of elements that tend to predict timely study completion while also suitably capturing and honoring the experiences of the participating veterans across our studies. Primary among these is the evocation of the sense of camaraderie that the veterans share as they go through the studies together. Without exception, the veterans are united in their knowledge that their study participation will yield data in the advancement of intervention science that will make programs like DE-CRUIT available to larger and larger numbers of veterans. Additionally, the veterans are motivated by knowing that the research itself is veteran led and that the scientific team is invested in documenting not only the sequelae of trauma in veterans’ lives but also the role that arts-based, nonmedicalized interventions can play in supporting veterans’ psychological health. We have also found that veterans who have gone through the DE-CRUIT program are very willing to help us spread the word about the program to other veterans and they are thus partners in working to expand the program and the accompanying research.

Principles of Veteran-Led Research

From our work in building and studying the DE-CRUIT program, we have developed a set of principles that continue to guide us and ensure that our treatment program and our scientific examination remain veteran led. Our hope is that these principles can be informative for other scientists who want to engage more fully in conducting research on topics that relate to the lives of veterans. Additionally, we hope that these principles can help create mechanisms whereby more veterans can assume roles as full members of research teams. This vision is in keeping with existing best-practice guidelines outlined through resources such as the VA’s Toolkit for Veteran Engaged Research (Hyde et al., 2018) and through models of veteran involvement, including the use of veteran patient advisory councils to ensure multileveled veteran engagement. Our principles of veteran-led research are as follows.

Veterans must be Acknowledged for their Expertise and Knowledge

This guiding principle is crucial in helping us not only honor the wisdom that each of our veterans brings to our project but also in reminding us that scientific knowledge is always bounded by the point of reference of the scientist (Ali, 2002; Ali & Sichel, 2018; Harding, 1991; Riger, 1992). The limits of understanding of the veteran experience on the part of nonveteran scientists are problematic in numerous ways. For instance, intervention science is generally geared toward achieving the most dramatic change in the outcome variable as quickly as possible. However, there are nuances in working with veterans that at times necessitate a “one step forward, two steps back” approach. In fulfilling this need, we find it useful to have veterans as facilitators of our treatment program, especially since veterans will be able to best read one another’s subtle signals of not being ready to tackle the next task immediately.

This principle also keeps us aware of the risks of co-opting the participating veterans’ experiences in the dissemination of our research. There is always the temptation on the part of researchers to share the most dramatic or sensational stories when presenting research findings at conferences or in research reports. However, when working in equal collaboration with veterans, a mutual respect emerges that can help scientists circumvent that need. Similarly, on the part of the veterans, we have seen an increasing appreciation of the function and purpose of scientific endeavors. The result of these processes is a reciprocity that serves to expand and democratize the mechanisms of scientific knowledge production and ultimately builds a base of shared understanding between veterans and nonveteran scientists.

Veterans must be Paid for their Contributions to Scientific Endeavors

This principle has been part of the DE-CRUIT research model from the beginning. The DE-CRUIT program itself is always delivered to veterans free of charge, whether or not a veteran takes part in the research component. Additionally, our research grants include a budget line for payment to the veterans in the project. This includes not only paying the veterans for participating in the data collection but also employing veterans as facilitators in the delivery of the treatment program. Our treatment model is grounded in the philosophy that veteran-led work must maintain an ongoing respect for the realities of veterans’ lives. In accordance with that philosophy, this form of employment builds key skills of group facilitation, public outreach, and interpersonal communication that participating veterans can add to their resumes and draw on in entering the job market and on job interviews.

More broadly, we have seen the importance of research grants in helping us pay veterans in various capacities. Veterans who have “graduated” from the DE-CRUIT program are not only presented with the possibility of being trained as DE-CRUIT co-facilitators, but they also often go on to further develop their acting skills and abilities through open weekly veterans acting classes that are offered to them for free as part of our DE-CRUIT outreach efforts. Being able to pay them as co-facilitators through our grants can give the veterans the time and space they need to examine their life goals and envision possible career trajectories while retaining contact with other veterans who have gone through DE-CRUIT. Also central to our model is paying veteran researchers as consultants and co-researchers on research grants, thereby acknowledging the value of their contributions and demonstrating a commitment to the ongoing collaborative partnership.

Veterans must Shape the Dissemination of Research Findings

This principle relates to both the content and the form of dissemination of findings from scientific studies of treatments for veterans. An overriding goal of the dissemination of our DE-CRUIT study findings includes active outreach to veterans, especially veterans in isolated areas who are in need of the connection and related benefits of the program. In that work, we rely on veterans who have taken part in DE-CRUIT to tell us about their own immediate communities and other areas where there might be veterans or veteran organizations where DE-CRUIT can be delivered. We also actively work with veterans who have participated in DE-CRUIT when we present research findings at academic conferences and at university-based symposia and colloquia. Audience members—including scientists, students, and practitioners—benefit from the participation of veterans in these presentations because the veterans can respond to audience questions with details, information, and firsthand knowledge that the nonveteran scientist presenters do not have. Given these benefits to the overall DE-CRUIT project, we build into our research funding structure dedicated funds to cover veterans’ honoraria and travel costs associated with these presentations.

The Veteran Community must Benefit from the Research

We have integrated this final principle into our work over the years in several ways. In addition to supporting veterans by paying them for their participation in the DE-CRUIT project, we have partnered with veterans groups and veterans organizations in the New York City area and nationally to carry out our extensive outreach initiatives. These initiatives include the presentation of Shakespeare plays at professional venues with entire casts and crew comprised of veterans. Our outreach also includes performances at colleges and universities in which veterans who have taken part in DE-CRUIT present their monologues and perform their Shakespeare monologues for academic and professional audiences. The benefits of these presentations involve not only the participating veterans gaining experience and exposure but also the education of audience members around ways to better understand and support the veteran community.

We are also working to influence policies and practices related to veterans at various levels. For instance, we participated in the 2017 Creative Forces Summit in Washington, D.C., which brought together scientists and practitioners working with the arts to help veterans and service members deal with the physical and mental health effects of trauma. We are also working with the New York City Department of Veterans Services in conjunction with the New York City Department of Correction to use the DE-CRUIT program in the training of corrections officers working on the new veterans-only inmate unit at the correction facility on Rikers Island. Through these initiatives, we are expanding the reach of the DE-CRUIT program and—equally importantly—build our capacity for research that prioritizes the needs of veterans, their family members, and their communities.

Conclusion

Initiating, developing, and expanding the DE-CRUIT program has helped us understand the challenges and rewards of using the tools of science to support veterans in moving forward with their lives in the civilian world. Cutting across the various challenges we have encountered is the theme of the divide between the realm of science and the realm of lived experience—in this case, military experience. We have become more and more convinced that there is a tremendous amount that the scientific community can learn from the veteran community. Key among the lessons that veterans can teach nonveteran academics is the need to be vigilant about the ways that scientific endeavors tend to use the experiences of veterans in the collection of data without attempting to understand or acknowledge the veterans behind the data.

Our hope as we continue to build the DE-CRUIT project is that veterans can begin to lead their own research teams in increasing numbers. To this end, we are encouraging the advancement of veterans as scientists-in-training in undergraduate and graduate programs and as key members of our research team. Specifically, we are reaching out to enrollment offices on our college campus to ask them to assist with outreach to veteran students. Additionally, we are conducting outreach to the NYU Prison Education Program to develop ways of partnering with inmate veterans to incorporate them into our research teams after their release.

Including military veterans in the scientific enterprise is absolutely essential if empirical inquiry into effective treatments for trauma in veterans is to gain any kind of legitimate traction in terms of policy, implementation, and scalability. Our research into the DE-CRUIT program has followed the lead of the veterans involved in the delivery of the program. While we have achieved that aim primarily through the role of military veteran, Stephan Wolfert, as an author, scholar, and key member of the research team, there are numerous ways of conducting research that is veteran led. By adopting principles such as those we have laid out here, researchers can begin to bridge the scientist–veteran divide and thereby advance empirical research not only in the service of science but also in the service of our veterans.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Alisha Ali

Author Biographies

Alisha Ali PhD is an associate professor of Applied Psychology at New York University. She specializes in studying community-based and arts-based treatments for the effects of trauma and violence.

Stephan Wolfert (MFA, Army Veteran) is the founder of the DE-CRUIT program which uses Shakespeare to treat the effects of trauma in military veterans.

Bruce Homer PhD is the chair of Educational Psychology at the Graduate Center of City University of New York. His research examines socio-cognitive factors in learning and development.

References

Ali

(2002). The convergence of Foucault and feminist psychiatry: Exploring emancipatory knowledge-building. Journal of Gender Studies, 11, 233-242.

Ali

Sichel

C. E.

(2018). Humanizing the scientific method. In Way

Ali

Gilligan

Noguera

(Eds.), The crisis of connection: Its roots, strategies, and solutions (pp. 211-230). New York: New York University Press.

Ali

Wolfert

(2016). Theatre as a treatment for posttraumatic stress in military veterans: Exploring the psychotherapeutic potential of mimetic induction. The Arts in Psychotherapy, 50, 58-65.

Ali.

Wolfert

Homer

B. D

. (2018, March). From victimization to empowerment: Using communalized narration to address military sexual trauma. Paper presented at the Annual Meeting of the Association for Women in Psychology, Philadelphia, PA.

Ali

Wolfert

McGovern

Aharoni

Nguyen

(2018). A trauma-informed analysis of monologues constructed by military veterans in a theatre-based treatment program. Qualitative Research in Psychology. Advance online publication. doi:10.1080/14780887.2018.1442704

Bromberg

P. M.

(2006). Awakening the dreamer: Clinical journeys. Mahwah, NJ: The Analytic Press.

Brown

G. W.

Harris

(1978). The social origins of depression. New York, NY: Macmillan.

Caddick

Smith

Phoenix

(2015). Male combat veterans’ narratives of PTSD, masculinity, and health. Sociology of Health & Illness, 37, 97-111.

Caplan

(2011). When Johnny and Jane come marching home: How all of us can help veterans. Cambridge: MIT Press.

10.

Freud

(1921). Group psychology and the analysis of the ego. London, England: Norton.

11.

Garcia

H. A.

Kelley

L. P.

Rentz

T. O.

Lee

(2011). Pretreatment predictors of drop-out from cognitive behavioral therapy for PTSD in Iraq and Afghanistan war veterans. Psychological Services, 8, 1-11.

12.

Greene

Emslie

O’Neill

Hunt

Walker

(2010). Exploring the ambiguities of masculinity in accounts of emotional distress in the military among young ex-servicemen. Social Science & Medicine, 71, 1480-1488.

13.

Gros

D. F.

Yoder

Tuerk

P. W.

Lozano

B. E.

Acierno

(2011). Exposure therapy for PTSD delivered to veterans via telehealth: Predictors of treatment completion and comparison to treatment delivered in person. Behavior Therapy, 42, 276-283.

14.

Harding

S. G.

(1991). Whose science? Whose knowledge? Ithaca, NY: Cornell University Press.

15.

Herman

J. L.

(1992). Trauma and recovery. New York, NY: Basic Books.

16.

Hyde

Wendleton

Fehling

Whittle

True

Hamilton

. . . Ono

S. S.

(2018). Strengthening Excellence in Research through Veteran Engagement (SERVE): Toolkit for veteran engagement in research (Version 1). Washington DC: U. S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development. Retrieved from https://www.hsrd.research.va.gov/for_researchers/serve/

17.

Institute of Medicine. (2014). Treatment for posttraumatic stress disorder in military and veteran populations. Washington, DC: National Academies Press.

18.

Kaplan

M. M.

Huguet

McFarland

B. H.

Newsom

J. T.

(2007). Suicide among male veterans: A prospective population-based study. Journal of Epidemiology & Community Health, 61, 619-624.

19.

Lemma

(2003). Introduction to the practice of psychoanalytic psychotherapy. Chichester, England: Wiley.

20.

Monson

C. M.

Shmurr

P. P.

Resick

P. A.

Friedman

M. J.

Young-Xu

Stevens

S. P.

(2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74, 898-907.

21.

Mott

J. M.

Modragon

Hundt

N. E.

Beason-Smith

Grady

R. H.

Teng

E. J.

(2014). Characteristics of US veterans who begin and complete prolonged exposure and cognitive processing therapy for PTSD. Journal of Traumatic Stress, 27, 265-73

22.

Mowatt

R. A.

Bennett

(2011). War narratives: Veteran stories, PTSD effects, and therapeutic fly-fishing. Therapeutic Recreation Journal, 45, 286-308.

23.

Oatley

(2001). Shakespeare’s invention of theatre as simulation that runs on minds. Empirical Studies of the Arts, 19, 27-45.

24.

Resick

P. A.

Monson

C. M.

Chard

K. M.

(2007). Cognitive processing therapy treatment manual: Veteran/military version. Boston, MA: Veterans Administration.

25.

Riger

(1992). Epistemological debates, feminist voices: Science, social values, and the study of women. American Psychologist, 47, 730-740.

26.

Schweitzer

R. D.

Vromans

Ranke

G. R.

Griffin

(2014). Narratives of healing: A case of a young Liberian refugee settled in Australia. The Arts in Psychotherapy, 41, 98-106.

27.

Shay

(1995). Achilles in Vietnam. New York, NY: Simon & Schuster.

28.

Sher

Braquehais

M. D.

Casas

(2012). Posttraumatic stress disorder, depression, and suicide in veterans. Cleveland Clinic Journal of Medicine, 79, 92-97.

29.

Tan

Dao

T. K.

Farmer

Sutherland

R. J.

Gevirtz

(2011). Heart rate variability and posttraumatic stress disorder (PTSD): A pilot. Applied Psychophysiology and Neurofeedback, 36, 27-35.

30.

U.S. Department of Housing and Urban Development. (2014). Veteran homelessness since 2010 (HUDNo_14-103). Washington, DC: Author.

31.

Whitaker

(2011). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York, NY: Broadway Books.

32.

White

(2005). Re-authoring lives: Interviews and essays. Adelaide, Australia: Dulwich Center.

33.

Winnicott

D. W.

(1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. London, England: Hogarth Press.

34.

Wolfert

(2015, March). Theatre as medicine: Exploring healing through our common humanity. Paper presented at the 1st Annual Conference of the Project for the Advancement of our Common Humanity, New York, NY.