Page 130 - JSOM Winter 2024

individual, open-ended interviews with six participants from that includes but is not limited to human disease, death, dis-
13
2
each of the four clinical specialties represented in a SOST. figurement, and destruction —we turned to historical schol-
Additionally, focus groups and field observations were per- arship that emphasized the importance of communal grieving
formed across the two SOST detachments to capture team and after participating in combat violence. 14–18 This body of liter-
organizational dynamics. All identifying names, genders, loca- ature highlights the merit of constructing communal practices
tions, medical specialties, and military ranks were removed. To where individuals explore, emote, and interpret deeply held
further protect privacy and maintain confidentiality, themes emotions as well as construct shared meaning in the after-
described herein do not reflect individual commentaries. All math of combat violence. Although the emergent design of
39
quotes are constructed from various SOST medic narratives this study allowed us to develop a more comprehensive the-
that code under the theme discussed. As such, quotes are an ory of performance, in which our definition of unconventional
aggregate analysis, which not only draws a holistic blueprint resilience is situated, in this paper we return to our original
of the entire data set but also represents the co-ed composition aim of highlighting the impact of various types of communal
of the organization. grief-processing on unconventional resilience.

While data in this and subsequent papers focus specifically on Qualitative Exemplars
SOSTs, these findings are likely relevant to all SOF medics be-
cause the study focused on the phenomenon of catastrophic We present two exemplars of grief processes which either opti-
2
injury exposure in austere environments. Our approach to mize or degrade unconventional resilience. Optimal grief pro-
tactical engagement may be disruptive because it evaluates the cesses contain various external, group-oriented practices that
SOF medic’s practical skills as the most important aspect of not only allow individuals space and time to interiorly reflect
change agency by which performance possibilities are trans- and experience their personal pain, but they also build shared
formed real-time. As such, pragmatic power to change the meaning within the team and organization. Degraded grief
performance space amidst SOF missions lies with those who processes privatize and medicalize grief, leaving the individual
utilize everyday pressures to embrace resistance inherent in alone in the experience of personal pain. In these processes,
personal pain and use that resistance to actively contract such when the individual reaches out to the group for collective
that grief-processing fosters the ability to direct unconven- support, meaning-making is done by projecting diagnostic cat-
tional resilience toward the common political good. egories on the individual, which disregards personal pain as
pathological and inimical.
Grief­Processing: Bereavement,
Death­Stacking, and Communal Grief Practices Optimization of Unconventional Resilience
The first grief process that optimizes unconventional resilience
Social determinants are the connections that positively and/or is purification of the mass casualty (i.e., performing salve and
negatively facilitate the SOF medic, team, and organization’s restoration after catastrophic injury exposure). This process
ability to bear the weight of dynamic freedom of maneuver takes place during an acute encounter with death-stacking:
amid the ambiguity of SOF missions. Qualitative analysis
3
of ethnographic data led us to define the social determinant Our emergency room (ER)/operating room (OR) was to-
of grief-processing as unique interconnected processes found tally filthy to start, but after a mass casualty it was abso-
within the social context of the Western world that mature lutely disgusting because blood was smeared everywhere.
SOST dedication such that resilient performance is expressed Although there were limited supplies, we tried to sani-
as adaptive, real-time concern for humanity. tize our working space. We had a squeegee and would
spray the little tile floor with water in an attempt to mop.
Our study proposal began with the simple hypothesis that Pretty much all we did was dilute the blood and scatter it
communal grief processes would support resilience after cat- around. Sterility was non-existent from the outset, but this
astrophic injury exposure and aimed to identify connections cleaning process allowed us to decompress in the ER/OR.
between communal grief processes and resilience. To oper- After we were done, we would hang out for a minute. In
2
ationalize grief-processing, we turned to contemporary and a similar way, we found it really relaxing to refit our gear.
historical bereavement literature to develop a broader under- We would sit with music and maybe chat. Routine group
standing of the impact of communal practices on palliating the activities turned into little rituals done amidst the inten-
intensity of human loss. Bereavement literature highlights the sity of caring for large volumes of casualties—many who
critical importance of taking time to convalesce after the expe- were severely injured, dying or already dead. Whether we
4–8
rience of death. This body of literature primarily addresses talked or not, these rituals helped each us slow down for
the value of grieving in relationship to immediate family mem- a second so we could try to appreciate the amount of loss
bers who have lost a next of kin. Unlike typical bereavement we were all experiencing and make sense of what was
scenarios in which next of kin grieve individual deaths of fam- going on in deployment.
ily members, SOF medics accumulate grief from ongoing and
repetitive catastrophic injury exposure that caused them to The grief process described above illustrates a set of practices
stack the death as well as disfigurement of countless human typically associated with normal Western medical (sterilize
casualties of war that were generally not next of kin. 9–12 ER/OR) and military (refit kit) activities, which are tradition-
ally done to maintain medical-martial readiness in support of
To engage a broader understanding of grief-processing that SOF missions. Because these practices are familiar, patterned,
could account for the reality of death-stacking —collective loss repetitive, routine, and communalized, teams are also able to
ii
ii. This term was coined by one of our authors, MAJ Jennifer Armon, to describe her experiences of collective loss across multiple intense deploy-
ments, in which she participated in mass casualties coupled with the death of numerous immediate family members.

128 | JSOM Volume 24, Edition 4 / Winter 2024