Veterans’ Mental Health Crisis

The culture of active military personnel and veterans in the United States is a complex tapestry, woven together by shared values, norms, and assumptions that guide their actions and interactions. This essay aims to delve into this intricate culture, examining it on both a macro and micro level to illuminate the significant cultural aspects that define this group. Culture, as Wilson (2007) defines, encompasses the values, norms, and assumptions that guide human action, and understanding military culture requires a thorough exploration of these elements.

This paper will specifically focus on the intersection of military culture with mental health challenges, such as PTSD and suicide, which have become increasingly prevalent issues among veterans and active military personnel.

Mental Health Challenges

Suicide has emerged as a significant concern within the veteran and active military community, with rates surpassing those of the civilian population since 2004 (Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces [DOD TFPS], 2010). Alongside this, Post-Traumatic Stress Disorder (PTSD) is a prevalent challenge faced by many veterans attempting to reintegrate into civilian life. PTSD affects 11% to 20% of veterans from the Iraq and Afghanistan wars, 10% from the Gulf War, and an alarming 30% of Vietnam War veterans (Coll, 2011). This raises the question: Is there a correlation between PTSD and suicide among military veterans? While some researchers argue for a direct correlation, others suggest that PTSD might even have a protective effect (Gradus, 2017). The lack of consensus and limited data on past military suicides and PTSD diagnoses complicates the understanding of this issue, likely due to privacy laws protecting individuals and their families.

Cultural Relativity

Wilson (2007) identifies several criteria essential for building the interconnected yet complicated culture of military personnel: mission, relationship to the state and other institutions, relationship to society, and internal structure. These facets contribute to forming the larger systems that support military culture, which in turn influence issues like suicide rates. 1. Mission: The mission provides military institutions with a shared commitment, validating their existence and the resources, self-worth, rewards, and privileges of their members (Wilson, 2007). This shared mission fosters strong bonds through shared difficult experiences, which can be both a source of strength and stress for military personnel.

2. Relationship to State and Society: The military's relationship with the state allows for the potential destruction of personal life and property, creating a shared experience of societal taboo with peers (Wilson, 2007). This relationship also influences recruitment and the continual growth of military service.

3. Internal Structure: The military's internal structure, characterized by complexity, formalization, and centralization, encourages the formation of permanent units, further strengthening peer connections and solidifying military identity (Wilson, 2007).

These institutional aspects reveal a common theme: the intentional design of military culture to build strong bonds among peers. However, this same design can make reintegration into civilian life challenging, especially for those dealing with PTSD.

Military Mindset

A critical component of military culture is the mindset instilled in personnel, which is starkly different from civilian norms. Military personnel are uniquely trained as "warriors," embracing values that often contradict societal norms (Bryan, Jennings, Jobes, & Bradley, 2012). Tolerance for pain and discomfort is a crucial skill on the battlefield, but it can lead to avoidance behaviors that harm mental health (Bryan, Jennings, Jobes, & Bradley, 2012). Such avoidance is linked to mental health issues, including non-suicidal self-injury, suicidal ideation, and suicide attempts (Bryan, Jennings, Jobes, & Bradley, 2012; Najmi, Wegner, & Nock, 2007).

Additionally, the military emphasizes collectivism, prioritizing the mission over individual life (Bryan, Jennings, Jobes, & Bradley, 2012). This collectivist mentality fosters self-reliance and self-sacrifice, which, while beneficial during service, can create difficulties when transitioning back to civilian life, especially if paired with trauma exposure.

Disparities

The mental health diagnosis of PTSD is particularly prevalent among veterans, with significant rates across different wars. However, the correlation between PTSD and suicide remains inconclusive. Despite this, the suicide rate among veterans has increased at a rate 21% higher than that of civilians (Office of Suicide Prevention, 2017). From 1999-2010, the suicide rate among veterans was significantly higher than the national average, with 38.3 males per 100,000 and 12.8 females per 100,000 compared to the national averages of 19.4 and 4.9, respectively (Office of Suicide Prevention, 2017).

Although specific statistics on veterans with only PTSD who commit suicide are unavailable due to privacy concerns, data from the Canadian Armed Forces indicate that 7.1% of males who committed suicide were diagnosed with PTSD (Rolland-Harris, 2017). This highlights the need for further research into the connections, if any, between PTSD alone and suicide among veterans.

Analysis of Disparities

The disparity in suicide rates between civilian and military personnel could stem from various factors, particularly the unique aspects of military culture. The collectivist mentality, ingrained from the beginning to the end of military service, emphasizes the importance of the mission over individual life. This cultural aspect can make the transition to civilian life, which requires individual autonomy, particularly challenging (Bryan, Jennings, Jobes, & Bradley, 2012).

Moreover, the military's emphasis on pain tolerance and avoidance, while beneficial on the battlefield, can have negative mental health consequences in civilian life (Hayes, Wilson, Gifford, 1996). These cultural traits, combined with the stress of reintegration and potential trauma exposure, contribute to the alarming statistics, with military suicides surpassing combat deaths in recent years (Thompson & Gibbs, 2012).

Implications for Social Work

For social workers, understanding military culture is crucial in providing effective support to this population. Recognizing the cultural influences on mental health symptoms can aid in developing targeted interventions. The increasing suicide rates and PTSD diagnoses among military personnel underscore the need for innovative social service programs.

Researchers like Bryan, Jennings, Jobes, & Bradley (2012) propose alternative strategies, including strengths-based approaches, reconceptualizing deployment as a growth opportunity, integrating suicide prevention into all aspects of military life, and utilizing evidence-based treatments. These strategies aim to address the unique needs of military personnel and reduce suicide rates.

Personal Biases

Addressing personal biases is essential for providing unbiased, effective care. My biases stem from experiences with veterans who described moments of uncontrollable anger and substance use. To overcome these biases, I must remain open-minded and recognize that each veteran's experiences are unique. Continuous exposure and education will broaden my understanding and improve my ability to serve this population effectively.

In conclusion, the culture of military personnel is a double-edged sword, fostering resilience and strength while also presenting challenges in mental health and reintegration into civilian life. By understanding these cultural nuances and addressing personal biases, social workers and mental health professionals can develop more effective interventions to support veterans and active military personnel in overcoming these challenges.

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