Reflecting on youthful times is a popular pastime these days. Many of us have reconnected with high school friends and acquaintances over social media. But what about remembering times that may not have been pleasant, such as wars? Public commemorations of traumatic events are popular activities, such as annual September 11 remembrances. The Honor Flight Network flies thousands of veterans to Washington, DC, every year to view monuments built in commemoration of wars. This article will provide history/background of the Honor Flight Network along with details of an Honor Flight from Chicago and discuss whether such a trip might exacerbate or diminish posttraumatic stress (PTS) symptoms.
The Honor Flight Network was the brainchild of Earl Morse, a physician’s assistant and retired Air Force Captain in Ohio. After the World War II Memorial was completed in May 2004, Morse began asking his patients at a small Veterans Administration clinic in Springfield, Ohio, if they thought they would ever visit the memorial. Most responded that they would like to someday visit the capital to see the memorial. However, when they returned for a follow up appointment several months later, most patients had not moved forward with plans to travel to Washington. Morse soon realized that his World War II patients, now in their 80s, did not have the finances or the family support to make that trip (Southeast Florida Honor Flight, n.d.).
Morse was also a pilot and a member of an aero club at the Wright-Patterson Air Force Base in Dayton, Ohio. In December 2004, he asked two of his patients if they would like to be flown to Washington to see the memorial. The men accepted his offer and were overjoyed with the trip. Next, Morse addressed a group of pilots at an aero club meeting. Eleven pilots volunteered to fly WWII veterans to Washington, and the Honor Flight Network was underway. By the end of the first year, 137 veterans had been flown to Washington. In 2006, commercial flights were used, and more than 300 veterans participated in the program (Southeast Florida Honor Flight, n.d.).
The program soon spread to other cities, such as Chicago. One of the Chicago founders was Suzanne Stanits. She provided the following information about the origin of the Chicago Honor Flight program.
My husband and I came across what we later learned was a group of WWll veterans being honored at their memorial the summer of 2007. It was an Honor Flight from Fargo, North Dakota. One of their board members gave me the contact information for Earl Morse, in Ohio. While watching the ceremony at the memorial, I called my dad in Minnesota, explained what was going on and promised him I would get him on an Honor Flight.
When we returned to Chicago, I was relentless in trying to get him on a flight but the few that were operating at the time were only flying their own local veterans. I made a number of calls to Earl and or his office. Finally, in December of 2007, I got a call with the names and contact information for three other women who, I was told, were as determined as I was to get veterans on a flight. In early December 2007, a meeting with Nancy Kapp, Jeanmarie Kapp, Mary Pettinato and I was arranged. We cut right to the chase. There was no question that we were all ready to move forward. We agreed to set up the organization as a 501(c)3, agreed on Honor Flight Chicago (HFC) name, and chose our positions on the board. Jeanmarie was president, Mary Vice President, Nancy treasurer, and I was the secretary. By February we were an official not for profit Honor Flight Chicago and the “bones” of our plans were laid. On June 11, 2008, we had our first flight of 83 veterans and my dad was on it.
Before our first flight, the 4 of us flew to Springfield, Ohio to go on an Honor Flight with Earl Morse and Jeff Miller. We all took different assignments and took copious notes. We went home and compared notes to work out any bugs in our program. Earl’s Honor Flight had guardians, but none was assigned specifically to an individual veteran. We saw that the veterans tended to wander so we decided to have one guardian for every 2 or 3 veterans. That later changed to one per veteran due to their advancing age and difficulty with mobility. We also started out with 12 wheelchairs in case they were needed and ended up on later flights with one for each veteran on the flight.
Amazingly, each of the founders had different talents and interests as we worked together to get this off the ground. We all contributed by adding some stellar board members. Mary was a wiz at fundraising. Jeanmarie was an amazing organizer. Nancy handled incoming and outgoing money. I just followed my heart in doing talks and presentations explaining HFC for fundraising purposes and signing up veterans for the first “season.” I gave talks at churches, rotary clubs, retirement homes, VFWs, American Legion groups, etc. Soon we had over 1,000 signed up. Many were on waiting lists for the following year. The waiting list carried over all the years I was on the board.
There were no significant changes in the flights. We gradually moved from mostly family guardians who managed 2–3 veterans to one-on-one guardians with medical backgrounds and more use of the wheelchairs. Logistics fluctuated somewhat. Arlington Cemetery was not always on the docket, but we were often invited to Fort Meyer to have lunch with the soldiers who guard the Tomb of The Unknown Soldier. One soldier sat at each of our tables, talked about his experiences, and answered questions. The veterans and everyone else were in awe of this experience.
The crowds of proud families, patriots, active and retired military, firefighters, police, school, and military bands welcoming the veterans in DC, and again back in Chicago, were large in the beginning and only got bigger. Every flight was a surprise—something new, different, bigger pulling on our heartstrings. It was generally Mary who pulled off this magic.
Our mission was to gradually move from WWll veterans as their ability to travel started reducing our numbers and start adding Korean War veterans. From there the plan was to start including Vietnam veterans.
To watch my dad’s face on his flight and all the surprises that came with it was a gift.
When I could no longer fly due to our medical requirements and my bad back, I continued to do presentations and fundraisers. I missed the thrill of spending flight time with the veterans when I worked to get on flights. Jeanmarie and Nancy had resigned, and the board was following the natural flow of transitioning. My dad died and I decided it was time for me to turn my beloved vets over to the many dedicated people who have been connected with HFC from the beginning. (S. Stanits, personal communication, Jan. 22, 2022).
Today The Honor Flight Network remains a nonprofit organization dedicated to providing all-expense-paid trips for veterans to Washington, DC, to view the memorials built in honor of those who served. The flights currently originate in over 125 cities across the United States. Over 245,000 veterans of World War II, the Korean War, and the Vietnam War have participated in an Honor Flight since its founding in 2005 (Honor Flight, n.d.). Vietnam veterans were first eligible to participate in Honor Flights in 2019.
This article will focus on a flight organized by Honor Flight Chicago. The author has served as a medical guardian on several Honor Flights originating in Chicago. Flights from other cities may differ considerably.
The National Mall and Memorial Park in Washington, DC, contain many memorials to famous Americans and as well as memorials to the country’s recent wars. The World War II Memorial consists of 56 tall pillars, each representing the 48 states and 8 territories that were a part of the country at the time. There is also a wall of over 4000 stars, each representing 100 Americans who died in the war (US Department of Interior, n.d.b). The Korean War Veterans Memorial was dedicated in 1995. It consists of four parts: the statues (19 poncho covered stainless steel statues), the mural wall (representing all the forces supporting the foot soldiers), the pool of remembrance (reflecting pool), and the United Nations Walkway (engraved markers that depict the 22 nations that contributed troops to the conflict (Korean War Veterans Memorial Foundation, n.d.). The Vietnam War Memorial, commonly referred to as “The Wall,” was dedicated in 1982. It is composed of two 200-foot-long black granite walls that meet to form a V. It contains the engraved names of 58,281 service members who remain missing in action or died in the war. The names are arranged in chronological order from the casualty date (US Department of the Interior, n.d.a).
The US involvement in World War II was from 1941–1945 (WWII Foundation, 2020). Over 16 million Americans served their country in WWII (Vespa, 2020). The Korean War was fought between 1950 and 1953, involving 1.8 million US service personnel (National Center for Veterans Analysis and Statistics, 2020; US Department of Veterans Affairs, 2021). This war is often referred to as the “Forgotten War” as it did not receive as much media attention as other conflicts. The Vietnam War was a tumultuous time for our country. More than 2.7 million Americans served in this war (US Department of Veterans Affairs, n.d.). The median age of a World War II veteran, Korean War Veteran, and Vietnam Veteran today is 98, 89, and 74 years, respectively (Vespa, 2020).
Mitima-Verloop and colleagues (2020) examined the paradoxical nature of public commemorations of disruptive events. While the purpose of commemorations includes remembering those who died and assisting survivors in coping with their loss, qualitative studies have demonstrated a relationship between commemorations and posttraumatic stress reactions.
The aim of this article is two-fold: to provide information on the Honor Flight pre-flight process and the flight day itself and discuss the possible effects of commemoration of past events, such as an Honor flight, on posttraumatic stress symptoms.
The Honor Flight application includes basic information such as dates of service, branch of service, and countries served. Medical information includes ambulatory and continence status, seizure history, need for oxygen and a medication list. This information is reviewed by the medical team prior to the flight and is available to the team during the trip. Covid-19 vaccination is required for everyone on the flight. There is an option for a non-spouse guardian to accompany the veteran, but this person must attend a 3-hour training session and pay for a portion of the costs of the trip. The training session outlines in detail the schedule of the day, role responsibility, and other important information such as the location of washrooms at each stop. There may be a wait of several years before the applicant is called for a flight, although veterans of WWII, the Korean war, and those who are terminally ill are given priority. Each flight accommodates approximately 100 veterans. The majority of veterans participating in honor flights this year were veterans of the Vietnam War.
The Chicago attendees were instructed to arrive at Midway Airport at 4:00 a.m. They were greeted by friendly volunteers who stayed with them until they boarded the plane. They were placed in groups of about 20 fellow veterans. An attempt was made to place veterans from nearby communities together, so they might easily reunite after the flight. They were also introduced to the medical guardians who accompanied them throughout the day. There were about 8–10 medical guardians (MD, DO, APN or RN) on each flight. The role of the medical guardian is to provide first aid and triage as needed. They carry a backpack of medical supplies, as well as extra clothes and rainwear. Participants are responsible for their own medications. Everyone involved in the flight wears a color-coded polo shirt—the veterans wear gray, the medical guardians, red, etc. Wheelchairs were provided for all veterans, regardless of ambulatory status. The veterans are not required to use them, but they are available just in case. Breakfast was provided at the boarding gate.
Once on board, the flight staff (often veterans themselves) encouraged the veterans to look out the window to view the water cannon salute, a high honor, provided by the local fire department. Upon arrival at Dulles International Airport, the veterans were greeted by a marine band lining the corridor. Throughout the day, they heard “Thank you for your service” and receive handshakes from bystanders, fellow veterans, and perhaps high-level government officials. Once on the buses, the veterans were paired with a local guardian who accompanied the veteran during their entire time in Washington. If the veteran is ambulatory, the guardian is instructed to push the wheelchair alongside them, so it is available in case of fatigue. The guardian and veteran are instructed to always stay within conversational distance of each another. The guardian is encouraged to take plenty of photographs of the veteran, which are sent to trip photographers for distribution to the veterans after the trip.
The bus caravan was escorted to the city by a police motorcade. An early lunch was provided enroute to the Iwo Jima memorial. As the bus circles this monument, it appeared as though the famous flag is rising over the mountaintop. The first official stop was the Air Force Memorial. At this site, an Air Force Honor Guard Drill Team performed for the veterans. At the next stop, the World War II Memorial, a group photo was taken in front of the Rainbow pool, followed by time for photos and reflection at the wall of gold stars. The next stop was at the western end of the National Mall where the Lincoln Memorial, Korean Memorial, and Vietnam Veterans Memorial are located. Veterans had time to leisurely explore each monument with their guardians. At The Wall they were assisted in finding (and etching, if desired) the names of fallen comrades.
The last stop of the day was the aviation museum, the Steven F. Udvar-Hazy Center. The veterans were greeted by museum volunteers who had extensive knowledge of aviation history and were excited to show the veterans aircraft flown during their conflict. World War II veterans were awed by the Enola Gay, the aircraft that dropped the atomic bomb on Hiroshima; they also saw a Pearl Harbor era plane. Korean veterans saw planes that were in action during their service time, such as a North American F-86A Sabre, while Vietnam veterans marveled at the Huey helicopter. Dinner was served at the boarding gate at Dulles, prior to the flight back to Chicago.
After exiting the plane at Midway, each veteran was greeted by a young service member from a local Navy base. The walkway was cordoned off with cheering family members, veterans, volunteer groups, and travelers on each side. Many family members made posters and waved flags, welcoming their service member home.
Veterans received official photographs in the mail a couple of weeks after their trip. Post-trip comments from veterans include: “an unforgettable experience,” “a highlight of my life!” Founder Suzanne Stanits reported “I was never aware of a veteran who complained or was unhappy with any aspect of their Honor Flight” (S. Stanit, personal communication, January, 22. 2022).
The Honor Flight organization does not survey the veterans. It is unknown the percentage of veterans who regret the trip, if any. What about posttraumatic stress disorder (PTSD) symptoms after a pilgrimage to memorials? Might there be an improvement or exacerbation of symptoms? Posttraumatic stress symptoms include distressing, intrusive memories and dreams, flashbacks, marked physiological reactions and, most importantly for this discussion, “Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)” (American Psychiatric Association, 2013, p. 144).
Mitima-Verloop et al. (2020) reviewed published studies that investigated the relationship between commemoration of traumatic events and posttraumatic stress reactions. They identified 26 studies that focused on posttraumatic stress reactions in relation to commemoration. Eighteen of the studies involved people directly affected by war. The subjects of the other studies were the general community or second or third generation of those affected. The articles focused on WWII, the Vietnam conflict, the Rwandan genocide, the Israeli-Palestinian conflict, or other major conflicts. They noted a large variation in individual responses to commemoration. Five studies, all qualitative, described clinical cases in which commemoration was associated with PTS reactions. Conversely, two qualitative studies of WWII veterans highlighted a decrease in posttraumatic stress related to commemoration. The authors noted that recognition and social support were two factors that affected how a commemoration is perceived by an individual. Recognition, the acknowledgement of loss and suffering, may have been lacking for Vietnam veterans, as there was no national ticker-tape parade to welcome these veterans’ home and acknowledge their service to the country. Many studies documented that commemoration has the potential to “bring people together, feel united, reconstruct social support, and reduce disengagement and isolation” (Mitima-Verloop, et al., 2020, p. 11).
Faltus and colleagues (1986) described three anecdotal cases of significant exacerbation of PTSD symptoms in men who visited The Wall for its dedication in 1982, less than a decade after the end of the war. The men, all in their 30s, experienced an increase in nightmares, flashbacks, or intense feelings of survivors’ guilt. One man experienced a resurgence of nightmares, emotional detachment, guilt, and alcohol abuse. Another man became emotionally overwhelmed during the ceremony. He experienced intense feeling of survivor’s guilt, as many of his friends did not survive. A third man experienced a severe flashback three weeks after returning from the dedication. He destroyed his apartment and was brought to the hospital by the police.
Watson et al. (1995) examined the effect of a 5-day bus trip to Washington, DC (from St. Cloud, MN), on 31 Vietnam veterans who were diagnosed with PTSD. The group was accompanied by a psychologist and a chaplain. The participants, mean age of 43.8, attended a 4-hour ceremony to rededicate The Wall on the 10th anniversary of its unveiling. The majority of participants also had unstructured time at The Wall where they found the names of fallen comrades and made “rubbings” of the engraved names. They also toured Arlington National Cemetery. The men were administered the Mississippi Scale for Combat-Related Post Traumatic Stress Disorder before they arrived in the capitol, soon after leaving he city, and 6 months after the trip. The results of these surveys were compared to surveys of veterans with PTSD who did not participate in the trip. The authors concluded that the exposure to symbols of war had positive short-term benefit on PTSD symptoms but no long-term effect.
Watkins et al. (2010) studied whether a trip to the Vietnam Veteran Memorial affected PTSD status in 32 men who visited The Wall. The mean age of these men was 58. The men were compared to 30 men from the same center, who did not visit The Wall. Veterans from both groups had documented PTSD. They were administered the Impact of Event Scale-Revised (IES-R) survey, a survey that had been used in previous PTSD research. The veterans were surveyed one week before the trip, one week after the visit, and one month after the trip. Statistical analysis of the results of the study did not demonstrate a statistically significant difference between the two groups at any of the times with respect to PTSD symptoms. PTSD symptoms neither diminished nor were exacerbated after a trip to The Wall.
Both the Watson et al. (1995) and Watkins et al. (2010) studies compared the effect of a trip to the Vietnam War Memorial to a similar group who did not visit the capitol. The average age of Watson’s group was 43 and the average age of Watkins’ group was 58. The studies mentioned above differed in several ways from the individuals described by Faltus (1986). First, they were older, and more removed in time from the war compared to the men described by Faltus. In addition, they visited The Wall in large groups. The support and comradery of the large groups may have diminished the possibility of exacerbation of PTSD symptoms. Although not mentioned, the groups may have provided anticipatory guidance to men prior to visiting The Wall. The more distant the event, the less likley a trip to the memorials would affect PTS symptoms.
The Honor Flight Network is funded entirely by donations from individuals, corporations, and other groups. Should it be publicly funded, through a subdivision of the Veteran’s Administration, for example? No doubt such funding would increase the bureaucracy of the program, adding an unnecessary layer to the application process. The current system is working well. WWII and Korean War veterans do not have to wait long to be scheduled for a flight.
The current Honor Flight Network website provides a state-by-state locator of honor flight hubs. An enhancement to this website, such as a zip code locator “Find an Honor Flight Near You,” might make locating honor flights easier for elderly veterans or their families. Continued publicity is necessary. Getting the word out through veteran correspondence, Medicare and Veterans Administration emails and mailings, or even school groups—grandchildren would encourage their grandparents to take part—could encourage more veterans to participate in an Honor Flight. Expansion to more population areas and to all 50 states would decrease extensive travel to the flight origin, thus encouraging more veterans to participate.
By participating as a medical guardian on Honor Flights, I have learned that this organization provides an outstanding, well-organized trip for veterans to view the memorials built in their honor. From photographers and guardians to bands and buses, the organizers have considered all possibilities to bring joy to the veterans. Honor Flights are extremely well-organized trips to Washington, DC. Veterans should expect a long day, full of heartfelt “thank-you for your service,” gratitude they may not have experienced after their completion of service. Based on a review of the literature on posttraumatic stress related to commemoration ceremonies, it is unlikely that there will be a change in PTS symptoms after an Honor Flight. As co-founder of Honor Flight Chicago, Suzanne Stanits summed it up:
I wish I would have kept all of the personal letters I received. I bonded with every one of the veterans I had an opportunity to spend time with. Their gratitude and, for some, newfound ability to talk about their experiences during the War was remarkable. (S. Stanits, personal communication, January 22, 2022)
The author has no competing interests to declare.
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