Grief and guilt haunt the living. It's our responsibility to recognize when patients are struggling.
“This generation has forgotten us,” said my 72-year-old veteran patient. “I never would have gone to Vietnam if I knew this would happen. ”For a long time, he did not look at me, then softly continued with tears in his eyes, “I often go to the war memorial downtown and read the names. I knew those guys.”
Memorial Day can be a heavy day emotionally for our patients, filled with grief, guilt, and wondering if there can ever be peace for themselves and their loved ones.
On May 5, 1868, the Grand Army of the Republic, a politically powerful organization of Union veterans led by Major General John A. Logan, issued General Orders No. 11 or the "Memorial Day Act." The observation was set by the GAR for May 30, which was chosen to ensure availability of “the choicest flowers of springtime” and led to its original name, Decoration Day — the day to decorate graves with flowers. Today, 164 national cemeteries hold the remains of over 1.5 million fallen soldiers.
Soldiers are often so overwhelmed by grief that they find it difficult to articulate their experiences. On Memorial Day 1945, Lt. General Lucian Truscott turned his back to the audience to speak directly to the 20,000 American graves in Italy.
Growing up in a military family, I always understood the solemnity of this day and I had the honor of placing a wreath on the Tomb of the Unknown Soldier in Arlington National Cemetery during my eighth-grade trip to Washington D.C. I remember the Honor Guard soldier, garbed in full-dress uniform and rifle and known as a “Sentinel of the Tomb of the Unknown Soldier,” slowly pacing the 21 steps back and forth standing guard, stopping only to be relieved by another soldier. The Sentinels, who volunteer for this post and are considered the elite of the elite 3rd U.S. Infantry Regiment (The Old Guard) headquartered at nearby Fort Myer, Virginia, keep watch on the tomb 24 hours a day, every day.
Veterans and families have unique grief experiences given their military connection. It is never appropriate to say “Happy Memorial Day” or “Thank you for your service” on Memorial Day. The traditional military funeral, with the ceremonial folding of the flag, bugle playing Taps, and the 21-gun salute, is meant to convey deep honor and condolences to the fallen soldier and their family. Since World War I, families would change their Blue Star banner to gold when a soldier died, thus leading to the founding of the American Gold Star Mothers organization.
While we honor our soldiers who gave the ultimate sacrifice, it is essential to also remember that grief in the living can sometimes dramatically worsen functioning and lead to suicidal thoughts. Though there is considerable overlap between grief and major depression, normal grief should not require medical or psychiatric hospitalization. But everybody grieves differently, in their own time, and talking about death is never easy.
Anniversary reactions are very common and providers should be vigilant. Similar to post-traumatic stress, grievers will often re-experience the death, avoid triggers or reminders, have negative thoughts and emotions, and likely will be on guard through the holiday. The VA recommends visiting a grave, practicing self-care, spending time with family, and being open to growth.
Coping with grief requires courage and looking to the future. Pondering the death of a loved one will often prompt us to ponder our own mortality and how we want to live the rest of our lives. “If it is a son or brother or a husband who has died in the battle for freedom,” Rabbi Joshua Liebman wrote in 1946, “then our grief must be transmuted into the work for the unfinished cause which he has left behind.”
On May 22, 1950, President Truman and Congress transformed the nature of Memorial Day by connecting remembrance of fallen soldiers with the Prayer for Peace and shifting the emphasis away from war. The modern proclamation calls on Americans "to observe Memorial Day by praying, according to their individual religious faith, for permanent peace.” Every president since has dedicated this holiday to be a “day for Nation-wide prayer for permanent peace.”
Religion and traditional faiths have many examples of peace prayers that are readily available. Jewish congregants frequently pray, “May the One who makes peace in the heavens, make peace for us, for Israel, and for all inhabitants of the earth,” and Christians pray, “Lord, make me an instrument of Your peace,” as well as “Blessed are the Peacemakers, for they shall be called Children of God.” In the Hindu tradition: “May there be peace in celestial regions. May there be peace on earth. May the waters be appeasing.”
A moving symbol of peace on Memorial Day for me is the large Japanese Peace Garden in Fredricksburg, Texas. It was built by the Japanese government in 1976 next to the National Museum of the Pacific War to signify the friendship between American Fleet Admiral Chester W. Nimitz and Japanese Admiral Togo Heihachiro. The garden includes water symbolizing loyalty, white pebbles signifying the Pacific Ocean that binds Japan and the United States, as well as a traditional Japanese meditation house built without nails.
My heart breaks when reflecting on what my patient said that day. As William Faulkner, a profound interpreter of war memory, wrote in Absolam, Absolam!, “That is the substance of remembering — sense, sight, smell... same figment-stuff warped out of all experience. Ay, grief goes, fades; we know that — but ask the tear ducts if they have forgotten how to weep.”
We as providers should be sensitive to how Memorial Day can affect veterans and families. It is imperative for mental health professionals and primary care providers to recognize when our patients are grieving, connect with them, and hopefully bring some peace into their lives. And on this day, let us all pray for peace.
