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Mental Health Support to Operations Involving Death and the Dead

Chapter 45

MENTAL HEALTH SUPPORT TO 

OPERATIONS INVOLVING DEATH AND 

THE DEAD

JAMES E. MCCARROLL, PhD, MPH*, and ROBERT J. URSANO, MD†

INTRODUCTION

MILITARY CARE-OF-THE-DEAD POLICY AND TRAINING

STRESSES OF EXPOSURE TO REMAINS

Physical Characteristics of Remains

Personal Safety

Emotional Involvement

PSYCHOLOGICAL EFFECTS OF CARING FOR REMAINS

ROLE OF THE MENTAL HEALTHcare PROVIDER IN MASS DEATH SITUATIONS

Recognizing Signs of Stress 

Assisting Soldiers With Exposure to Mass Death 

Social Effects of Proper Care of the Dead

SUMMARY

*Colonel, US Army (Retired); Psychologist, Center for the Study of Traumatic Stress and Department of Psychiatry, Room B3068, Uniformed Services 

University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814; formerly, Psychologist, Walter Reed Army Institute of Research, 

Silver Spring, Maryland

†

Colonel, US Air Force (Retired); Director, Center for the Study of Traumatic Stress, and Chair, Department of Psychiatry, Room B3068, Uniformed 

Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814
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Combat and Operational Behavioral Health

INTRODUCTION

Exposure to the dead and death is common in military and civil conflict, disaster, crime, and other violent 

events such as transportation accidents. “Exposure to 

the dead” means the viewing and handling of human 

remains. “Exposure to death,” on the other hand, refers to connotations associated with the deceased that 

bring forth cognitive and emotional reminders of the 

individual to the family and to other groups such as 

military units, communities, and even nations.

Many publications have addressed the effects of 

traumatic death on posttraumatic symptoms,1 but 

none has focused on the role of the mental health 

provider in assisting soldiers and commanders with 

adjusting to the stress of caring for deceased soldiers 

on the battlefield or at a site of mass casualties. Mental 

health personnel should be familiar with this topic 

for three major reasons: (1) to understand the nature 

of distress in personnel exposed to the dead; (2) to 

recommend policies to medical and line commanders 

to reduce soldier distress; and (3) to understand their 

own vulnerability to these same stresses. 

In the medical field, mental health personnel are 

probably among the most insulated from death. Psychiatrists dissect cadavers as medical students and 

attend medical school lectures about confronting the 

deaths of patients, but are unlikely to be exposed to 

traumatic death or even surgical or medical deaths 

on a routine basis. Psychologists and social workers 

may never have seen the dead outside of funerals. As 

a result, many, if not most, mental health personnel 

are largely unprepared to understand the nature of 

contact with the dead from mass disasters or war. 

These situations often involve large numbers of 

casualties, and most of the remains will not appear 

like those prepared for viewing in funeral homes. In 

the US Army mortuary affairs community, the term 

“remains” is used to refer to the dead; other terminology is often considered disrespectful. The term 

“bodies” is frequently used in the medical field and 

is occasionally used here to avoid repetition, but no 

disrespect is intended.

The purposes of this chapter are to (a) explain the 

stresses of handling remains, (b) describe common 

feelings and responses of persons who have handled 

or seen the dead, (c) provide procedures to help mental 

health workers support personnel exposed to the dead, 

and (d) prepare mental health workers to effectively 

communicate the situation of those caring for the dead 

to higher authorities, who may fail to understand the 

nature of the services of both the remains’ handlers 

and mental health professionals.

Persons who encounter remains may themselves 

have had a variety of previous experiences with the 

dead or no experience at all. Some gain experience 

through their professions. Among these are medical 

personnel such as pathologists, nurses, and some 

technicians; police, firefighters, and emergency service workers; and professionals who attend the dead 

such as military personnel who recover bodies from 

the battlefield, morticians, funeral directors and their 

staffs, and forensic investigators. Professional groups, 

for the most part, are protected from distress by their 

roles and identities. For example, pathologists are still 

serving a patient and achieve professional satisfaction 

in solving a mystery; they routinely provide the final 

medical procedures for their patients. The major goal 

of public service workers is to save lives, but over 

time their professionalism and frequent exposure to 

the dead generally protects them from the adverse 

consequences of such encounters.

A second group has encountered the dead episodically. Among these are people who have lived in a 

violent community, those involved in a natural or community disaster such as a building explosion or fire, 

victims of violent crime or violent civil disturbance, 

and military personnel whose regular job is handling 

the dead. A third group is composed of people who 

have rarely or never encountered the dead except at 

funerals or, secondarily, through the media. Members 

of these groups anticipate and experience exposure 

to the dead in a different manner.2

 Because of their 

relative lack of experience, the two latter groups usually need more preparation before exposure and more 

assistance afterward.

MILITARY CARE-OF-THE-DEAD POLICY AND TRAINING

The history and documentation of wartime care 

for the dead is very limited, although some official 

records of these services are publicly available.3

 A 

recent history, prompted by the invasion of Iraq in 

2003, has updated the record with personal stories 

and photographs.4

When a service member dies, the remains are no longer the responsibility of the Army Medical Department, 

but are handled through the military logistics system. 

Enlisted Army soldiers whose military profession is 

to collect, process, and return remains to the families 

are in the military occupational specialty of mortuary 

affairs and belong to the Army Quartermaster Corps. 

Following their basic training, they attend a 7-week 
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Mental Health Support to Operations Involving Death and the Dead

course at the Mortuary Affairs Center and School at Fort 

Lee, Virginia. The course curriculum consists of familiarization with the physical and psychological aspects 

of dying and death, search and recovery operations, 

tentative identification, decontamination, and accountability for the personal effects of the deceased. Students 

receive classroom and field experience at a morgue or 

mortuary where they are exposed to remains. They are 

also trained in the numerous Army procedures for the 

care of the dead, which helps ensure that the dead are 

handled in a dignified, reverent, and respectful manner, 

principles that are continually emphasized in the training. Following their initial training, mortuary affairs 

personnel can obtain additional experience in a variety 

of military and civilian mortuaries where they observe 

and sometimes assist in autopsies. Unfortunately, 

however, mortuary affairs operations are not usually 

included in Army training exercises, which limits the 

ability of commanders to understand mortuary affairs 

functions and operations in wartime.

Quartermaster Corps officers receive familiarization training in mortuary affairs and may command a 

mortuary affairs company, but this command is only 

one of a variety of positions these officers are expected 

to assume. Of the other US military services, only the 

Navy has a dedicated career field for persons who 

handle remains. The Navy requires that personnel 

at sea who handle remains be licensed embalmers to 

care for bodies that cannot be returned quickly to the 

United States.

Stresses of exposure to remains

Research on groups of experienced (mortuary affairs soldiers) and inexperienced (those whose military 

profession did not require exposure to the dead) soldiers found three main concerns about working with 

remains5

: (1) physical characteristics of the remains, 

(2) personal safety, and (3) emotional involvement 

associated with the remains. 

Physical Characteristics of Remains

Senses seem to serve different cognitive and emotional processes. Each sense has special qualities that 

may produce distress in an individual. 

Smell

The odor sensation has many special qualities6; 

aside from being immediately unpleasant, the smell 

of remains has additional effects. Smell is the most 

likely of the senses to trigger reminders at a later time. 

Odor memory is highly resistant to extinction, that is, 

there is long-term recognition of odors. A smell cannot 

be conjured up from the past, but can be recognized 

almost instantly (although a lemon’s smell cannot be 

mentally conceptualized, its appearance can be visualized). Also, the strength of the memory varies with the 

involvement a person has with the odor.

People working with remains often try to mask 

odors by some means, such as wearing a mask laced 

with a strong fragrance. However, this strategy can 

be problematic for several reasons. Fragrances may 

not always be available, and the use of an additional 

olfactory stimulus adds another scent to the mix already present, which may also bring back unpleasant 

associations later. Breathing through the mouth is an 

effective way of avoiding unpleasant odors. 

Sight

The sight of grotesque remains (burned, mutilated, 

dismembered, decomposed) may be the most dramatic 

aspect of casualties. Scenes of death are likely to be 

remembered and form the basis of conscious or intrusive memories. However, the most grotesque remains 

may not be the most bothersome to all observers. A 

body that looks natural with no or few visible signs 

of wounds may cause more distress than damaged 

remains. In addition, bodies that are badly burned 

or otherwise grossly distorted may not look human, 

which may make it easier for the handler to gain cognitive and emotional distance.

Touch

Tactile qualities of remains are disturbing to some 

workers, even when wearing gloves. For example, 

the skin of decomposing bodies will easily slip off the 

underlying tissue. Some tactile sensations are familiar, 

some are unfamiliar, and each has the capacity for 

disturbance.

Sounds

Dropping a body on a floor, truck bed, or table may 

remind the remains handler of sounds that would be 

painful to a living person. An example of such a sound 

is that of a head making a cracking noise against a hard 

surface. Autopsy equipment also produces potentially 

distressing sounds. 

Taste

Sensations of taste are usually associated with 
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Combat and Operational Behavioral Health

smell. Some remains handlers have an aversion to 

grilled meats after handling burned remains, but this 

reaction is not universal. People react individually to 

foods following exposure to remains, just as they have 

individual food references in other circumstances. 

Types of Remains

What will bother individuals, or what will relieve 

their distress, is not completely predictable. However, 

with varying degrees of certainty, the categories that 

bother almost everyone can be enumerated and described, providing a framework for understanding 

situations and reactions peculiar to one person or 

another. Almost without exception, caring for the bodies of children is the most distressing type of exposure 

to the dead. Also distressing to most people are the 

remains of torture victims, innocent persons (such 

as casualties of friendly fire in the military), women 

who died in combat, and persons killed in a grotesque 

manner, as well as body parts and large numbers of 

remains. On the other hand, some types of remains, 

or some scenes or situations, are bothersome to some 

people but not others. In one case, remains wrapped 

in gauze in preparation for casketing reminded an 

experienced handler of a rag doll.

Each military conflict is likely to involve a unique 

type of death or types of remains and situations. Examples from the current wars in Iraq and Afghanistan are 

torture victims, fragmented remains from bombings, 

mass graves, and civilian casualties including children. Additionally, cultural differences in procedures 

for handling remains are often poorly understood by 

Americans.

Personal Safety 

Remains handlers must protect themselves against 

battlefield dangers, disease, contamination, and occupational hazards. Battlefield recovery of remains 

can be hazardous. For example, remains can be boobytrapped with explosives. Local populations can be 

hostile, and the possibility of combat cannot always 

be ruled out. Physical contact with remains requires 

the same personal protective measures as are routinely 

taken by doctors and dentists to protect themselves 

from blood products and other sources of contamination. In addition to naturally occurring contamination, 

the enemy can contaminate remains with toxins such 

as chemical, biological, or radiological substances. 

Decontamination of remains and of the handler pose 

similar hazards.

In areas where certain diseases are endemic, remains 

handlers should be aware of necessary protective 

measures. Persons who die due to combat or disasters 

rarely have medical conditions that cause epidemics. 

Remains (including animal remains) do not cause 

disease except under certain circumstances. This point 

is especially important for commanders, supervisors, 

and medical personnel to understand because misconceptions can cause errors in the handling and processing of remains.7

 For example, if commanders or public 

officials incorrectly believe that remains can cause 

disease, a rush to bury or cremate them can occur, 

preventing the bodies from being returned to families 

or investigated for cause and manner of death. 

Remains can cause disease when diseases are present in the area—microorganisms causing disease can 

survive in remains after death, and environmental 

conditions can facilitate the microorganisms’ growth. 

Examples of such conditions are overcrowding, 

contaminated water, poor sanitation, and endemic 

disease. Some diseases that can be spread by remains 

are blood-borne diseases such as hepatitis B and C, 

human immunodeficiency virus, gastrointestinal diseases such as hepatitis A, Escherichia coli, cholera, and 

respiratory diseases such as tuberculosis. However, 

the most common risks to the remains handler are 

occupational hazards such as cuts, spills, sprains and 

strains, fatigue, and dehydration.

Emotional Involvement 

Emotional involvement refers to the feeling of distress by the remains handlers when some quality of the 

remains creates a sense of shared humanity, weakening 

or destroying the handlers’ psychological distance. 

The remains lose some of their inanimate quality, and 

the handler feels some sense of the loss of the life of 

another person. Emotional involvement often occurs 

when the handler is of similar age as the remains or 

has a child the same age. Other circumstances that can 

create a sense of emotional involvement are obtaining 

or preparing personal documents for deceased, media 

reports on the individual or situation that caused the 

death, contact with unit members in which more is 

learned about the history of the deceased, and contact 

with the family. These situations make the remains 

“like me.” Emotional involvement is sometimes referred to as identification with the deceased.8

The personal effects of the deceased are highly 

likely to create a sense of emotional involvement with 

the deceased and, often, with the survivors of the deceased.9

 Pictures, letters, and personal possessions and 

mementoes all help contribute to building a picture 

of the life of the deceased and a sense of loss or even 

threat for the handler (“it could have been me”). In the 

military, personal effects are given the same degree of 
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Mental Health Support to Operations Involving Death and the Dead

care and concern as the remains. Personal effects are 

sent to a personal effects depot where they are sorted, 

catalogued, inventoried, cleaned, and shipped to the 

next of kin. Mortuary affairs personnel staff these 

depots and are exposed in detail to the lives of the 

deceased. Policy requires that mortuary affairs staff 

read letters before they can be returned to the family 

to ensure that the material is returned to the correct recipient and to remove material that might be sensitive 

or embarrassing to the family. Government property 

and morbid material (such as blood-soaked clothing) 

are not returned to the next of kin. A summary court 

officer is appointed to review all personal effects and 

to assure that all legal matters are observed. 

Psychological effects of caring for remains

Reactions to death and the dead are varied and 

difficult to catalogue or predict. Some reactions are 

immediate, and others may not appear until later. 

Typical immediate reactions are surprise and shock, 

withdrawal, nervousness, and shame at one’s own 

reactions. Overworking is also common and leads 

to fatigue and errors. Other reactions are intrusive 

thoughts, avoidance of reminders of the situation, 

feeling “keyed up,” and problems with daily functioning. These reactions are normal and expected unless 

prolonged. More extreme reactions can impact negatively on health, including substance abuse, excessive 

smoking, failure to seek needed medical care, and 

other behaviors that indicate a lack of self-care. 

Additional behaviors can be expressed, and people 

respond differently and at different times. A longitudinal study of posttraumatic responses over a 13-month 

period in a group of mortuary workers found that 

intrusive and avoidance symptoms were elevated at 

1, 4, and 13 months, but decreased over time. The level 

of probable posttraumatic stress disorder symptoms 

was 11% at 1 month, 10% at 4 months, and 2% at 13 

months. Depression was not increased. Marital status 

was a factor in response: single remains handlers reported more avoidance and somatization than married 

remains handlers.10

Anticipation of exposure to traumatic death is 

stressful. In any remains-handling situation, anticipation of one’s own reaction must be considered,2

especially for inexperienced people. Training and 

experience can reduce anticipated stress and result in 

improved performance, decrease fatigue, and decrease 

the risk of adverse psychological effects. For example, 

inexperienced forensic dentists working with the remains of the badly burned victims of a fire reported 

more distress from handling decomposed, burned, 

and fragmented remains than the experienced dentists.11 However, both experienced and inexperienced 

dentists reported distress from handling the remains 

of children. These findings challenge the common 

belief that highly trained professionals are immune 

to distress. 

In most circumstances, the groups with the most 

exposure have the most distress. For example, the distress for forensic dentists who handled burned remains 

was related to the hours of exposure to the remains.11

In another study, the responses of mortuary workers 

were measured before and after exposure to the remains of service members killed in war.12 When age, 

sex, volunteer status, and experience were controlled, 

intrusion symptoms increased significantly for all 

groups exposed to the dead, and avoidance symptoms 

increased in the two groups with the most exposure. 

Even after controlling for symptoms expressed in 

anticipation of exposure to the dead, exposure itself 

increased posttraumatic symptoms. 

Role of the mental healthcare provider in mass death situations

To be maximally effective in assisting soldiers, the 

mental health provider must be knowledgeable about 

the stresses of operations and their likely effects on 

exposed personnel; be available, known, and trusted; 

and coordinate efforts with the local chaplain or other 

first lines of support outside the military unit or civilian organization.

Recognizing Signs of Stress 

No particular reactions or signs of distress shown 

by remains handlers differ from reactions of other 

persons. Experienced supervisors have reported witnessing or hearing about many common stress-related 

behaviors and feelings (Exhibit 45-1). It cannot be 

overemphasized that these reactions are usually normal signs of understandable distress about a difficult 

situation. Only when these reactions are prolonged 

should mental health workers seek to intervene. For 

day-to-day distress reactions, first-line supervisors 

and colleagues should offer understanding and allow 

respite for a reasonable period of time. Mission demands rarely prevent such temporary respite. Mental 

health workers can assist in preparing supervisors to 
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Combat and Operational Behavioral Health

EXHIBIT 45-1 

SIGNS OF STRESS IN MORTUARY OPERATIONS AND COPING WITH THE WORK

Behavioral signs of stress

•	 Fatigue, agitation, withdrawal, sleeplessness

	 •	 Loss of, or gain in, appetite

	 •	 Quitting (not reporting for work)

	 •	 Extreme agitation or crying

Psychological signs of stress

•	 Depression, sadness, apathy

	 •	 Major change of personality

	 •	 Other feelings

 ° Anxiety

 ° Frustration

 ° Anger

 ° Feeling sick and nervous

 ° Fear

 ° Loneliness

recognize the normal stresses of working in a mass 

casualty environment and provide temporary relief. 

Exhibit 45-2 provides examples of ways mortuary affairs soldiers deal with stress.

Assisting Soldiers With Exposure to Mass Death 

The plan recommended here for mental health professionals to assist soldiers, commanders, and other 

medical personnel after a mass death is based on a 

EXHIBIT 45-2 

HOW DO MORTUARY AFFAIRS SOLDIERS 

SAY THEY DEAL WITH STRESS?

	 •	 “Stay focused” (concentrate on doing their

job)

	 •	 Exercise or engage in sports

	 •	 Keep busy

	 •	 Read and write letters

	 •	 Talk to others

	 •	 Listen to music

	 •	 Get away from the mass death scene

	 •	 Communicate with family back home

three-stage model: (1) preparation, (2) on-site actions, 

and (3) follow-up (Exhibit 45-3). Commanders should 

be visible and available to soldiers for at least part of 

EXHIBIT 45-3 

GUIDELINES FOR ASSISTING SOLDIERS 

AND COMMANDERS in CARING FOR 

THE DEAD

Before: Anticipate operational procedures and 

train for them

	 •	 Obtain and share information

	 •	 Brief plans up (command) and down (soldiers) the chain of command

	 •	 Expose inexperienced personnel gradually

	 •	 Practice

	 •	 Anticipate reactions and prepare for them

During: Limit exposure to the remains and scene 

and support the soldier

	 •	 Avoid or decrease exposure to strong stimuli

	 •	 Provide respite: breaks, food, sleep

	 •	 Provide supervision

	 •	 Pair inexperienced with experienced person

	 •	 Encourage talk among workers and supervisors

	 •	 Recognize signs of stress and act

	 •	 Provide respectful and visible command or

authority

	 •	 Emphasize job and role of remains handlers

After: Inform, talk, and listen

	 •	 Provide operational debriefing and education on the facts of the event

	 •	 Acknowledge the existence of intense personal feelings

	 •	 Encourage family and organizational support systems

	 •	 Reinforce the positive aspects of the work

accomplished

Long-term: Follow-up guidelines for soldiers and 

commanders

	 •	 Posttraumatic symptoms are usually not

lasting—most people “move on”

	 •	 Time is the most effective treatment for most

people

	 •	 Watch for problems that do not go away

	 •	 Problems that persist should not be neglected
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Mental Health Support to Operations Involving Death and the Dead

the operation and ensure that all necessary logistic 

support has been provided. In the follow-up phase, 

they should speak to soldiers as a group about their 

work, reinforcing the soldiers’ role and the importance 

of their work. The question usually arises as to when 

soldiers should be ready to go back to work. Although 

there is no firm answer to this, it is recommended that 

soldiers be given some time off after the operation to 

rest and attend to personal matters. Several days of respite is common following a difficult mission. Sending 

soldiers back to work immediately, unless absolutely 

necessary, is likely to be detrimental to their functioning and may be interpreted as a lack of appreciation 

for them and their work. Support of soldiers in mass 

death operations involves three domains: (1) personal, 

(2) organizational, and (3) logistical. 

Personal Support 

In addition to normal social support, the supervisor and the mental health worker should attempt to 

reinforce in the soldier a pride of accomplishment 

whether the individual is distressed or not. Exhibit 

45-4 lists many points that can be made by the mental 

health worker, the supervisor, and the commander. 

The exhibit includes unique military aspects of caring 

for remains with which the individual, particularly 

the lower ranking soldier, should be aware. Immediately obvious are the services to the deceased and the 

family of the deceased. Less obvious are the honor of 

upholding military service traditions and fulfilling 

the nation’s cultural expectations. It is also vital that 

persons outside the mortuary affairs field understand 

the importance of recognizing these principles.

Personal support of soldiers also includes access to 

mental health and spiritual care. Because of the broad 

dispersion of mortuary affairs collection points and 

interruptions in transportation capabilities, mental 

health teams in the current Middle East conflicts 

often have difficulty establishing relationships with 

soldiers. Also, contact between soldiers and mental 

health personnel can be a touchy issue. In spite of the 

competency, good will, and attempts of mental health 

workers to be helpful, soldiers will not often engage 

with them if they are not known and trusted. Being 

credible requires frequent contact. Chaplains are often the primary resource for personal assistance, and 

mortuary affairs personnel report that chaplains from 

all the services are available and often spend time with 

them eating meals and staying overnight. Chaplains, 

medics, and mental health workers must be known as 

regular visitors to achieve credible status with soldiers. 

Regardless of these relationships, however, the commander or other supervisor who has the authority to 

EXHIBIT 45-4 

REINFORCE THE POSITIVE

Common individual reasons for care of the dead 

in war

•	 Upholding American military service traditions

	 •	 “Everybody comes back home”

	 •	 “If I do it for them, somebody will do it for

me”

Personal pride in care of the dead in war

•	 Doing something important forthe deceased

soldier

	 •	 Doing something important for the families

	 •	 Doing a job that others cannot do

	 •	 Personal mastery of a difficult job

Practical considerations of families in having 

remains returned

•	 Document place and cause of death

	 •	 Assist with grieving

	 •	 Resolve legal and personal issues

 ° Wills and inheritance

 ° Remarriage

 ° Government compensation

 ° Insurance

Effects on society

•	 Respect for and care of the dead as anAmerican tradition

	 •	 Social identity of the dead

	 •	 Funerals, memorials, and monuments

	 •	 National pride or shame

refer a soldier to mental health personnel should do 

so when the situation warrants.

Organizational Support

For mortuary affairs soldiers, the presence of commanders and their respectful attitude are extremely 

important when remains are being cared for. It is 

considered highly disrespectful for commanders and 

other visitors not to remove headgear or wipe their feet 

before entering the processing area when remains are 

present. Commanders and mental health personnel 

can assist the soldiers by adhering to these practices 

and preparing visitors to do the same.

Other forms of organizational support are related 

less to the stress of handling remains and more to oc-
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Combat and Operational Behavioral Health

cupational functioning. In widely dispersed conflicts 

such as Iraq and Afghanistan, soldiers operate many 

collection points, often with minimal personnel. Soldiers may be required to recover remains from distant 

locations and are always on duty. Processing remains 

requires physical work in lifting and moving the 

deceased as well as the transfer cases in which they 

are shipped. A large number of remains can require 

several hours to process. As a result, opportunities 

for rest, recreation, and personal time are limited. 

Commanders must ensure that soldiers have time for 

sleep and recuperation. Finally, collection points and 

mortuaries are often located at air fields away from 

Army support or are isolated to prevent unnecessary 

troop exposure. This isolation can have a positive effect in the freedom to accomplish the work without 

interference, but isolation can sometimes result in the 

mortuary affairs soldiers being shunned by others. 

Such situations require a great deal of command support for the soldier. 

Logistical Support

The psychological stress of mortuary affairs work 

can be greatly reduced if soldiers have the necessary 

supplies and equipment, adequate transportation, and 

good area or unit support. Mortuary affairs soldiers 

often do not operate at an organic organizational level 

(platoon or company) in war. In the current Middle 

East conflicts, soldiers who staff collection points in the 

field are usually assigned to other Army organizations, 

such as a division, or even to other military services. 

Soldiers returning from Iraq and Afghanistan have 

reported excellent support from the US Air Force and 

Marine Corps. However, occasionally collection points 

lacked some logistic support, including refrigeration 

equipment and vehicles for transporting personnel 

and remains. Army command authorities may have 

limited control over mortuary affairs personnel when 

those personnel are attached to another Army unit or 

military service. However, they can take steps to ensure 

that the organizations to which the mortuary affairs 

soldiers are attached provide them proper support.

Social Effects of Proper Care of the Dead

The effects on society are far from the battlefield 

but should be impressed on mortuary affairs soldiers to reinforce the positive aspects of their work. 

The requirement for dignified care of remains is not 

only doctrine, but becomes a creed for these soldiers. 

Members of American society must have faith that 

this tradition is carried on and that mortuary affairs 

soldiers accomplish this mission.

The social identity of the dead has meaning for 

the survivors of the deceased.4

 Social identity refers 

to the place that the deceased will have in the minds 

of survivors such as fellow soldiers, the family, and 

others who may or may not have known the individual. After death, an identity can be broader than 

the identity the individual had in life. This identity 

includes, but is not limited to, knowledge of the place 

and manner of death, the place of burial, and how the 

individual is remembered. The return of the remains 

and personal effects contribute greatly to the formation 

of this identity. 

Wartime funerals and memorials are legion. 

Whether humble or grand, funerals and memorials are 

less than complete without remains to memorialize. 

Families, without exception, want a remembrance of 

the deceased; if the remains are unrecoverable, then a 

memento is required. The memento can be a personal 

effect, soil from the area of death, or a symbol of the 

individual’s life or death.

SUMMARY

The mortuary affairs soldier has an important role in 

the long chain of events that support the recovery and 

return of the dead from war. The soldiers who perform 

this role obtain support primarily from each other, but 

also from their organization and those above them. The 

job stresses are largely compensated for by the soldiers’ 

own sense of accomplishment in performing an honorable but difficult task. Support from mental health 

workers, chaplains, or commanders, comes from (a) 

recognition of the work, including an understanding 

of the duties; (b) respect for the remains-handling process; (c) spending time with personnel to decrease any 

possible isolation caused by the nature or location of 

the work; and (d) understanding how the stress of this 

particular job interacts with those stresses that affect 

all soldiers in a deployed environment. 

The way a country cares for the remains of its war 

dead contributes to national pride or shame. This is 

reinforced in the soldier by the credo, “no one left behind.” The commander, the mortuary affairs soldier, 

and the mental health provider all play important roles 

in ensuring the endurance of this tradition.
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Acknowledgment

Thanks to Mr Tommy D Bourlier and Mr Douglas L Howard, Director and Deputy Director, respectively, 

of the US Army Mortuary Affairs Center and School, Fort Lee, Virginia, for their reading and comments 

on the manuscript. Thanks also to Jodi McKibben, PhD, Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, for her reading 

and commentary on the manuscript. And, finally, a special thanks to the many soldiers who shared their 

time and stories with the authors.

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