Psychological Stress inMortuary Affairs Operations
Brian W. Flynn, EdD, RADM, USPHS (Ret.)James E. McCarroll, PhD, COL, USA (Ret.)
Quinn M. Biggs, PhD, MPH
Center for the Study of Traumatic Stress
Uniformed Services University of the Health Sciences
Bethesda, MD 20814

brian.flynn@usuhs.edu
james.mccarroll.ctr@usuhs.edu
quinn.biggs.ctr@usuhs.edu

Disclaimer
Ideas, attitudes, and opinions expressed herein
are ours and do not necessarily reflect those of
the USUHS, the DOD, or other branches of theUS government.

Be AwareSome descriptions by mortuary affairs workers may
evoke strong emotions.

History of Mortuary Affairs in War(Often spotty and undocumented)

American War Burials
Revolutionary War – People buried where they died or in
private cemeteries

Civil War – 1862 – National Cemeteries Act – Beginning ofrepatriation

Spanish-American War – 1899 Quartermaster Burial Corps Remains could be returned to US if family so desired

World War I – Graves Registration Service established in 1917
Korean War – Concurrent return policy established. All remains
brought home pending family decision upon site of burial

1991 Army Mortuary Affairs (new terminology replaces
Graves Registration Service)How Many US War Dead?
Wars ranked by total number of US military deaths- Civil War
625,000- World War II
405,399- World War I
116,516- Vietnam War
58,209- Korean War
54,246- American Revolution
25,000- War of 1812
15,000- Mexican-American War
13,283- War on Terror
6,829
Grand total, all US wars
1,319,482

Army Mortuary Affairs Soldiers(Active Duty)
111th Quartermaster Company(Mortuary Affairs), Fort Lee, VA

54th Quartermaster Company(Mortuary Affairs), Fort Lee, VA

Mortuary Affairs Operational UnitsMortuary Affairs part of Army Quartermasters
Active duty Army – 54th and 111th Companies(Fort Lee, Virginia)
Army Reserve – 246th and 311th Companies(Aguadilla, Puerto Rico)
Four Army Reserve detachments in US and PacificRegion
Total Army mortuary affairs force structure = 1,500

Army Mortuary Affairs
Soldier Training
Advanced Individual Training (AIT)for MOS 92M at Fort Lee, VA, 8 weeks- Includes visit to Richmond, VA, morgue and- Dover Air Force Base Port Mortuary, Dover, DE

What Do Mortuary Affairs Soldiers Do?
Care and disposition of deceased personnel,including personal effects, from battlefield.
- Receive deceased from military unit atcollection point- Search and document personal effects- Perform tentative identification- Prepare for shipment to evacuation point- Includes personnel from other nations andlocal nationals under US operational control

What Happens at Dover Air Force BasePort Mortuary?
- Autopsy- Positive identification- Preparation for burial- Visit by family of deceased- Assignment of escorts- Shipment of remains

Collection and Evacuation Points
in Middle East

Stress and Resilience in MilitaryMortuary Workers:
Care of the Dead from Battlefield to Home*"We carry the dead. That's what we do.
For the rest of our lives, we're carrying that with us."

*Flynn BW, McCarroll JE, & Biggs QM. (2015) Death Studies; 39(2): 92-98

Study Description- Semi-structured interviews - 34 civilian andmilitary mortuary workers- Locations - Dover Air Force Base Port Mortuary, DE;
Mortuary Affairs companies and Joint Mortuary
Affairs Center and School, Fort Lee, VA- Work experiences - Active duty military service andveterans, forensics, anthropology, funeral direction,
law enforcement, and chaplaincy- Looked at both stresses and rewards- The power of their own words

Preparation For Mortuary Affairs
Work“Gradual exposure, Baby steps. You expose
them to it, but not all at once.”“Dover is good experience, but different from down
range. Nothing can compare to the actual job.”“We had one in Afghanistan. You open up the bag andit is just parts. It’s like all the world’s hate poured
onto this kid. Nothing like we trained for.”Psychological Stress inMortuary Affairs Operations
Stress Points in BattlefieldMortuary Affairs Operations
Physical characteristics of remains
Emotional involvement (“humanizes” the remains)
Personal safety (combat, disease, injury)

Stress Factors
Novelty - “Every single day you see something
and tomorrow I’ll see something new. The
conditions are just horrific.”
Physical characteristics – “Burned, decomposed,mutilated, dismembered, intact and lifelike.”
Sight - “It never really hit home for me until I walked
out and they have all the name tags for theuniforms. All laid out there on a table, all 248 ofthem. And it’s now like ‘That’s real’. I still see that.”Sensory Stimuli - Smell“My husband fixed ribs a few months ago and heaccidentally burned them on the grill. I was like,‘You're gonna have to get it out of the house.
I can’t smell it.’ ”“You smell it in your clothes. You smell it when
you’re away from it. You smell it in your hair.”“Just the smell and just looking at them. I always
had a sense of not being clean. I just felt dirty.”

Emotional Involvement“Humanizes” the Remains
Handling personal effects
Learning history of deceased through obtaining
or preparing personal documents
Contact with unit members
Media reports

Emotional Involvement
Contact with Unit Members

Emotional Involvement
Handling Personal Effects“For me, personal effects. I do not like working
with personal effects. Remains, I can kind ofcompartmentalize that. Portions, I cancompartmentalize it. When I’m working withpersonal effects, for me, I’m knee deep insomebody’s life… You’re looking at pictures,letters. There’s no way of keeping it at arm’s
distance anymore.”Emotional Involvementwith the Remains“So seeing your uniform there and seeing our tags
laying there and picking the dog tag chain out ofsomebody’s chest—it’s a lot different. Seeing youruniform, it’s a lot different, seeing how they comeback it’s a lot different. Being downrange andseeing your uniform laying there and they have therucksack, and it’s the same exact gear we all have.
It’s a big difference.”
Field Training Exercise

Interacting with Families of the Deceased“I’ve seen a six year old kid hug her teddy bear and lookat her mom and say ‘When’s daddy coming home?’
Well, Daddy just came home in a transfer case. It’s hard
not letting your emotions get into this, especially being
the parent of a two year old child.”Relationships with One’s Own Family“You can’t talk to your wife even. Outside that fence,
there’s no one you can tell what we do every day.
The only people we have are internal, behind thefences, and you’ve gotta get it out in here, because I
can’t go home to my wife. She has not a clue. Youtalk about some of the stuff you’ve seen, and unless
you’ve seen it, you can’t relate. You can’t explain it.”Disenfranchised Grief
When the individual does not openly acknowledge
the loss and society does not recognize that theworker has a right grieve and receive support.

“You just never ever get a chance to grieve, ever.
It’s like, ‘When do I get a chance to feel this?’
Maybe I’ll never actually get to really fully grieve
it the way I’m supposed to.”

Disenfranchised Grief“I’m tired of being the rock. Every time there’s adeath in the family, ‘Oh, well because of your job,
help us.’ I’m never able to go through the fullgrieving process because I have to put the gameface on for everybody else. I’m no different fromany of the rest of them. I don’t have any magic.”

Strategies to Manage Stress
Valuing the experience/pride in the work

“This work makes me a want to be soldier.
People ask me ‘What do you do?’ I say ‘I’min the Army.’ [They ask], ‘What do you do?’ ‘I process human remains and portions.’
Straight up. [They ask], ‘What do youmean?’ ‘Exactly what I said; I process
human remains and portions.’ ‘How do you
do it?’ ‘Because I love my job and I wouldn’t
trade it for the world.’ ”

Strategies to Manage Stress
Sharing/using group for support (families are nottypically not used as a primary support)“We talk about it every day. As soon as we see
something, we just talk about it. We talk about it all
day and don’t even realize it. It helps us...it releases a
lot of stress. I know he’s seeing the same thing thatI’m seeing, touching the same thing I’m touching. Atthe end of the day, he went through what I wentthrough. Sometimes I feel like I don’t need to tell him
anything because he knows what I’m going through.”

Strategies to Manage StressIndividual coping“For me, it’s writing it down. Nobody reads it. It’s
just a good way to vent it off for me. There areindividuals that I know that work out like a fiend.
That’s their vent. One of them told me, ‘When I’mworking out I’m thinking about it.’ The energy thatthey’re expending kind of releases it.”

Strategies to Manage Stress
Chaplains and Mental Health Professionals“Combat Stress came just to chill. They love chilling
there with our AC and goodies in the fridge. You
actually get to know the guy as opposed to thechaplain who’s coming in just talking about our job.”“At first they started bringing SFC Zeke [dog]. We all
knew Zeke, he’d come by, it was so cool. Then they
started bringing the bomb sniffing dogs, they saw
that it was doing good and they came by often.
They’d stop by maybe 30 minutes to an hour
and that really got your mind off things it.”

Strategies to Manage Stress
Chaplains and Mental Health Professionals“One chaplain, we were real standoffish. We
thought he was like any other officer, wanted
to check that box, look real good. But thenhe walks in the process room, puts on some
gloves and says ‘I’ve got your back right now,
let’s go, let’s do this.’ We opened it up. He
was like ‘Damn! What do we do now?’ Heworked with us so we were much more willingto talk to him about our job.”Strategies to Manage Stress
Supervision and leadership”It’s always good to have a leader you can talk to because a lotof us are really young when we go on these deployments.
When you have a leader that after the work is done comes overand talks to you, sits and smokes with you and just asks ‘How’s
your day going?’ That makes you feel a lot better.”“Every week I talk to all of them and we have a goodcommunication. I always ask how the guys doing, are you
taking care of your troops. I feel that it should be in theleadership. Leadership should look down and always visit oursites to make sure our soldier was taken care of in all aspects.”

Strategies to Manage StressSupport for Each Other“Soldiers, we stick with ourselves. If I have a problem, I go
to my buddy. He’s going to see it with the same eyes I have.
When that moment comes, there’s a buddy that says,‘Come on, sit down’ and listens to you. If he cannot
understand you, he listens to you.”Strategies to Manage Stress
Rewards“I did have times when I went to Dover that I just broke
down. I just broke down in front of everybody because I wasonly turning 18 and I’d never seen a dead body before I
went to the morgue, and I had never dealt with the types ofthings that I dealt with when I came to this MOS. I’m glad I
stayed in this MOS because I would never have been able
to say that I have done the things that I have done and I
have such an appreciation for life the way that I do now.
Those are the good things that I take away.”Strategies to Manage StressRewards“When I was deployed I made sure every flag was perfect.
I think we all work directly for the families.”

Strategies to Manage Stress
Rewards“We don’t make people happy, but if we can take away thismuch [gesture indicating a pinch] pain from them, then we’vewon. It’s frustrating sometimes, but it is extremely rewarding.”

Biggest reward is coming homeStrategies to Manage Stress
Memories“As bad as they are, they are a part of me. To take away amemory would be to take away a part of me”“I love my memories, from good to bad. If it were not forevery single memory that I’ve had, I wouldn’t be who I amtoday.”“Memories make me a person.”“They are mine and this helped mold me. Memories make memore appreciative of what time I have being a mom and awife. It makes me appreciate that everything can be taken
away in a second.”

Strategies to Manage StressThe Future“My coping skills are a lot better and I know if I leave themilitary whatever job I go to, I’m going to work my way up
just like I did here. If you take somebody my age who has
not been in the military, I guarantee you I’ll do it better andfaster because I have been in the military.”

They are highly motivated, express a remarkable
sense of mission and purpose and do not seek
rewards for their work beyond serving the fallen andthe families of the fallen. They also want to be heard
and understood. Many wanted to share theirexperiences, frustrations, and traumas, but because
their grief is largely disenfranchised, they feel unable
to do so except to colleagues and to a few specialothers. They fear being misunderstood, stigmatized,
and vicariously traumatizing others, especially family
members.

Many military mortuary workers live their lives
in a continuous struggle with issues ofisolation/integration, inclusion/exclusion,
sharing/withholding, and psychological
identification/distancing. They express feeling isolated
and not understood by their friends, family, andmilitary members outside their career field. But, at thesame time, they express intense emotional,
occupational, and existential bonds with their fellow
workers and feel tremendous pride in themselves,
their organizations, and their service to the nation.

Unanticipated Value“... I’m glad that you are here for whatever purpose you are
here…regardless of you’re doing research… I’m glad because
you’re allowing my fellow soldiers to speak.
I know that soldiers, we don’t get much of an opportunity tospeak our minds. Not because we are not allowed to, simply
because we are soldiers that have ACU’s and boots and wehave a soldier mentality.

It’s good that somebody listens to us, for whatever reason,
whether it amounts to something or it doesn’t. At least thesoldier had an opportunity to speak, and I feel that is good.”

Lessons Learned- Avoid/reduce emotional involvement. Objectificationof remains is a means of emotional survival- Reduce strong sensory exposure as much aspossible- Pair experienced and inexperienced workers- Distress is not avoidable - preparation, leadership,organizational support, culture of support are keys
- Provide a range of professional support options- Sense of mission, pride and desire to help the familyof the deceased are the primary rewards

What Does This All Mean to You?
- What has been your experience with military orcivilian mortuary/morgue workers? How do you
approach them? What has worked and notworked?
- How do the findings of this study apply to work
you do? What is transferable? What is not?
- Does the experience of Military Mortuary Affairs
workers seem at all similar to your work?
- What are the implications of this study for training
and education?

Thank You!
Reference
Flynn BW, McCarroll JE, Biggs QM. (2015)"Carrying the Dead of War: Stress and Resilience in
Caring for the Dead from the Battlefield to Home",
Death Studies, 39(2), 92-98.

Questions?