Materials Ready to Explore (MRE) Practice Guidelines
Societal Myths, Stereotypes, and Stigma of the Military Culture
Mark A. Stebnicki, Ph.D., LCMHC, DCMHS, CRC, CMCC
The purpose of this MRE is to examine some of the more prevalent societal and clinical counseling myths, perceptions, and attitudes regarding the military culture. It is well documented that negative attitudes and perceptions impact the service members’ and veterans’ motivation for seeking medical and mental health treatment. Cultural myths and stereotypes regarding the military community can be both negative and positive. Some individuals in American society as well as clinical counselors attribute the characteristics and traits of military service members and veterans as possessing a high level of courage, honor, loyalty, confidence, toughness, and resiliency. Others in society may portray the military culture as possessing the potential to act in violence, have low impulse control, or be burdened with poor mental and physical health conditions (Ahern et al., 2015; Currier, McDermott, & McCormick, 2017; Quartana et al., 2014; Vogt, et al., 2014).
Because of negative stigma and perceptions, some service members and veteran’s themselves may internalize these negative attributes which may hinder good mental health and wellness. The most harmful effects of stigma are directly associated with mental health treatment-seeking and may even counteract or nullify positive treatment outcomes.
Myths, stereotypes, and stigma have existed throughout the centuries regarding the military culture. Approximately 2500 years ago, Sun Tzu wrote The Art of War (Tzu, 2013), a text on warfighting and the classical philosophies of Eastern thought. It addressed such issues as preparing for battle during wartime, taking tactical advantages on enemy armies, and reflections on the writings of Confucius and philosophies of Taoism that in part, have formed the foundation of today’s military culture. This extensive work also discussed expected behaviors, morals, and ethics of conscripted military personnel and high-ranking officers, as well as many more military-related issues that reflected the culture at the time. The influence of this and other historical references (e.g., writings of Carl von Clausewitz, Napoleon, memoirs of great generals of past wars) may have been responsible in part for Western societies’ perceptions and attitudes of the military culture within the United States.
There is a plethora of studies that address the myths, stereotypes, and stigma associated with its impact on various racial and ethnic groups, gender-related issues, the LGBT community, persons with HIV/AIDS, as well as persons with disabilities. However, few studies exist related to the myths, stereotypes, and stigma as it relates to the military culture (Ashley & Constantine Brown, 2015; Griffin & Ashley, 2013; Kim et al., 2016; Pietrzak, Johnson, Goldstein, Malley, & Southwick, 2009; Quartana, et al., 2014; Stebnicki, Grier, & Thomas, 2016a; Vogt, et al., 2014).
The essential points in this MRE are that because of negative military cultural myths, stereotypes, and stigma, medical and mental health professionals may directly-indirectly or consciously-unconsciously be facilitating treatment approaches based on cultural myths. The psychosocial impact on service members and the veteran culture may include the following:
- The person may feel “broken”, possess a low self-esteem, and have difficulties assimilating or transitioning into the civilian culture.
- Clinicians and society may project negative attitudes and perceptions that can create a reluctance and resistance by the service member or veteran seeking medical and mental health treatment.
- Many indigenous cultural groups or foreign nationals distrust the American military particularly while they are deployed to hostile countries. Many indigenous groups were taught to fear Americans. They are viewed and portrayed as violent people reinforced by American movies, electronic media, and political propaganda. Thus, if the service member over-personalizes this, they may endorse this belief about themselves or not feel committed to the mission.
- Stigma associated with the “suck-it-up” mentality, warrior ethos, indoctrination rituals, and other cultural attributes in the military hinders service members and veterans’ ability for mental health treatment seeking. Submitting to the values of seeking psychotherapy disavows military cultural philosophy and ideology.
MILITARY MYTHS COMMON TO THE CULTURE
There is an extensive list of myths attributable to the military culture. The following are commonly held myths and stereotypes about the military culture. These myths are critical to explore. The cultural dynamics within therapeutic interactions are of paramount importance in building the circle of trust. Unintended consequences that disrupts the therapeutic alliance could occur any number of ways. This can occur through verbal and non-verbal communication, meta language that portrays a cultural bias, negative attitude, or perceptions towards a group of individuals, and in many other ways. Overall, it is important in understanding that 75% of what we communicate to one another is done through non-verbal and metacommunication.
All Military Serve in Combat Operations: This myth assumes that all military service members and veterans are warfighters and have served in combat operations. The Pew Research Center analysis of information gathered from the DoD’s Defense Manpower Data Center (DMDC; 2019) indicate that in June 2018 there were approximately 1.3 million active duty military personnel across the Armed Forces. Despite a surge in U.S. troops sent to Iraq (2007 and 2009) approximately 15% of all active duty service members were deployed overseas to hostile areas of the globe. This is the lowest numbers of troops deployed since 1957. During the Viet Nam war 45% of all troops were deployed to combat operations overseas. Most troops (70%) are deployed to Asia and European military installations. Only 15% of troops are deployed to Middle Eastern countries (e.g., Iraq, Afghanistan, Syria) and North African nations while 3% are deployed to sub-Saharan Africa or the Americas (e.g., El Salvador). The remainder (14%) are located at sea or in other undisclosed locations around the globe. For every “trigger puller” in the military there are at least five others deployed to assist with food, ammo, and intelligence. Thus, most military occupational specialties (MOS) are in support of combat operations.
Psychosocial Implications of Myth: There are indeed distinct within-group cultural differences between combat versus non-combat service members and veterans. Despite that each branch of service has a different mission (e.g., dirty boots on the ground, fighting in the air, commanding the seas) there is a misperception that all military have engaged in combat operations. As a result of this stereotype, some service members and veterans may have low self-worth or self-esteem because they have trained-up for combat operations, yet were never called-to-duty, served in a combat unit, or deployed to a hostile region. Even those that deployed to hostile areas may have spent their entire deployment on a Forward Operations Base (FOB) and did not go out on patrols, reconnaissance missions, or engage in enemy firefight. Those not in the fight, may have lost unit buddies and feel survivors’ guilt for not being there for their brothers and sisters-in-arms. It becomes ambiguous and complicated for some service members that have screened positive for posttraumatic stress or another mental health disorder and were not directly involved with enemy combatants. Additionally, since most service members serve outside the continental U.S. (OCONUS) overseas on military installations in allied Asian and European countries, the phrase “thank you for your service” implies that the service member is worthy of society’s view of the warfighter. Alternatively, there may be the negative public perception by some, that the service member is seen in a lesser status primarily because they served as “just a cook” in the Navy, a truck mechanic in the Army, or an embarkation and logistics specialist in the Marines. Overall, there are unintentional psychological consequences to reinforcing negative stereotypes, attitudes, and perceptions towards the military culture. Clinical providers may project communications that devalues the service member because of their status (combat vs non-combat operator, enlisted vs officer rank, MOS of infantry vs counterintelligence).
It is Respectful to say “Thank You for Your Service”: Saying “thank you for your service” is indeed respectful. However, there is a mixture of anecdotal evidence and testimonials to support the notion that this should not always be expressed to active duty personnel or veterans (Brennan, 2019; Kelly, 2019; Richtel, 2019). Alternative accolades include phrases such as “thank you for your sacrifice”, “thank you for defending our country”, “thank you for your willingness to serve”, or “welcome home”. Yet, these expressions have much of the same meaning. Civilians that want to express gratitude for the military can volunteer with multiple service organizations (e.g., Wounded Warrior Project, VFW, USO, military base activities). At times, actions speak louder than words. Given the ratio of combat versus non-combat operators, if you express “thank you for your service”, statistically, 30% have served in a combat-related role while 70% did not. Thus, you may have to deal with the awkwardness of this situation that may not be consistent with the warfighter stereotype. Most active duty service members and veterans I have had in my psychotherapy practice and most veterans who attend my clinical military counseling workshops indicate they do not like the expression of “thank you for your service.” Many indicate that (a) civilians do not understand what they have seen or experienced so it is disingenuous to say “thank you” since they have never been in the military, (b) most politicians say “thank you for your service”, this also sounds disingenuous and does not reflect authenticity, (c) they are very jaded by their experiences in the military so this triggers an anger reaction because they were not honored by their own branch of service, and (d) it is a very superficial comment particularly if they have served in a non-combat role. Many service members and veterans view their enlistment in the military as an occupational choice. So why would we not say “thank you for your service” to mental health (crisis response) counselors, firefighters, law enforcement officials, all of which can also be hazardous jobs at times.
Psychosocial Implications of Myth: First and foremost, it is important that each expression of “thank you…” be taken individually rather than used impulsively with every service member or veteran you come in contact. Many are jaded or cynical by their military service because they are struggling with medical, physical, and mental health conditions that created their present situation. Some have a moral injury based on their horrific experiences in combat. Others find this expression disingenuous because it is repeated by multiple civilians, who will never understand their military experiences. A major point being is that clinical practitioners should avoid “sounding like everyone else” as seen in the media, by politicians, and uninformed civilians. Secondly, there are other ways to express your gratitude that are more proactive through volunteer service-related activities. Lastly, as helping professionals, it is critical to understand the psychosocial implications of stereotypes and stigma placed upon service members or veterans living in the civilian world. Also, it is essential to understand that many family members and spouses are left out of the conversation and acknowledgment of “thank you for your service” because they too have sacrificed their life alongside their loved ones’ deployments.
Most All Veterans have PTSD and other Mental Health Conditions: The prolonged war on terrorism that began in 2001 reflects 20-plus years of warfighting with frequent and longer deployments and increased mental health and co-occurring disorders. The epidemiological significance of military suicide completions is unlike any other war. However, the incidence and prevalence of suicide completions do not differ significantly from combat versus non-combat operators. At least half of all suicide completions involved active duty service members who were never deployed to combat theater (Kessler et al., 2015; Kline et al., 2016; Reger et al., 2015). Adjustment Disorders are one of the most frequently diagnosed conditions among both active duty service members and civilians; PTSD is not (Morgan & Kelber, 2018; Schimmels Fielden, 2012). Some studies have shown that among active duty service members 23-49% met the diagnostic screening criteria for PTSD (Kim et al., 2016; DoD, 2013b), 7% major depressive disorder, and 7.5% anxiety disorders (Witkiewitz & Estrada, 2011). As far as substance use disorders, approximately 23-50% reported binge drinking at least once during a 30-day period, while 17% of active duty service members were considered moderate drinkers, and 8% heavy drinkers (Department of Defense; DoD, 2013c). Interestingly, the literature suggests that the rates of substance use disorders and co-occurring mental health conditions are only slightly higher in incidence and prevalence in military versus civilian populations (Witkiewitz & Estrada, 2011). So how do we account for the approximate 50-70% service members and veterans that do not meet the criteria for PTSD or a co-occurring mental health disorder? Increasing awareness and access to military mental health treatment has never been more apparent than the print and electronic media’s coverage of veteran suicides. The media’s coverage reinforces the public perception that most all service members have severe psychiatric disorders. They tend to deemphasize success stories of those that have bounced-back from adversity (Edwards-Stewart, Kinn, June, & Fullerton, 2011). Overall, statistically, the research does not support the myth that most all service members and veterans have PTSD and other co-occurring mental health conditions. The myth concerning severe mental health issues in the military, sets up the stereotype that civilians have better mental health and wellness than the military culture. Military researchers are now examining the coping and resiliency skills possessed by service members and veterans. Generally, finding solutions to increase military mental health access and destigmatize treatment requires a more sophisticated and complex analysis.
Psychosocial Implications of Myth: Truly, there are negative societal attitudes and perceptions towards psychiatric disabilities in the military. The societal stereotype suggests that civilians have better mental health and well-being than those in the military culture. The result of this harmful myth hinders service members and veterans from seeking medical and mental health treatment. Some researchers suggest that the electronic and print media’s coverage of veteran suicides tends to over-emphasize the lack of mood regulation and behavioral health. Consequently, if the focus is on military service members’ “pathology” and their mental health “disorders” then this stigma becomes pervasive (Edwards-Stewart, Kinn, June, & Fullerton, 2011). The essential point is that if we focus solely on military mental health “disorders” this can isolate service members and veterans from acquiring job and career opportunities because employers may not want to hire a veteran for fear of mental and behavioral health concerns or that the veteran may be prone to violence. The focus on poor veteran mental health also creates conflicts in social-emotional relationships with family members and intimate partners. Overall, the media’s portrayal of veteran mental health problems creates stigma to the extent where the individual may want to socially detach, isolate, and not identify themselves as a member of the military community. Society’s image of the warfighter who is “broken” or “damaged goods” intensifies the service member and veterans’ negative emotion, mood, and affect. Consequently, over-emphasizing one trait or condition about a culture has potential to generalized over to all members of the culture and perseverates the myth of military mental health disorders.
All Veterans are Seeking or Receive Disability Benefits: Active duty service members and veterans are eligible to receive disability benefits under a comprehensive list of medical, physical, and mental health conditions, as well as many different chronic illnesses and diseases (Veterans Affairs, 2019). All conditions that are service connected must be evaluated and diagnosed by medical and mental health professionals connected with the Armed Forces and VA clinics. The Department of Veterans Affairs oversees the disability program. A medically determinable and objective disability rating system is used and expressed in terms of the percentage of impairment (0-100%). A medical board examines the alleged medical, physical, and mental health conditions in terms of etiology, functional limitations, and other evidence that contributes to the condition(s). There is other extensive documentation that is required such as the personnel record associated with the person’s military occupational specialty (MOS), After Action Reports (AAR) of combat deployments and other critical incidents the service member was involved. There are complex formulas and guidelines associated with receiving benefits. In some cases, the service member or veteran may have temporary or partial disability benefits before a total and permanent rating is established which can sometimes take up to five years to receive a favorable determination. Disability benefits in the military are different than the Social Security’s Administration program of Social Security Disability Income (SSDI). The principles of receiving disability benefits are to offset the average earnings lost due to the person’s disabling condition(s) preventing them from performing their military duties. Also considered is the future anticipated and expected treatment that will likely occur over the lifetime of the service member or veteran. In 2013, about 3.5 million of the nations’ 22 million veterans received some form of service-connected disability benefits (Congressional Budget Office, 2019). Approximately 1.1 million veterans have a disability rating of 70% or more and are medically retired. There are some 60,000 veterans that receive income from three different sources in which they are eligible; retirement income from the branch of service they served, VA, and SSDI benefits. Some active duty service members may have a disability rating and are assigned to light duty work until maximum medical improvement (MMI) is determined. Most who have a severe disability (e.g., moderate-severe TBI, spinal cord injury, amputation, severe muscular skeletal conditions) cannot serve and are forced to medically retire. Statistically, not everyone in the military qualifies for disability benefits. However, most service members when asked if they would rather be working and not disabled, indicate they would very much like to return to their jobs but cannot due to their medical, physical, and mental health conditions. Overall, eligibility for disability benefits is not automatic and not all service members receive the same exact benefits because of the variances in rank, length of time in service, MOS, types of disabling conditions sustained while in service, as well as other factors.
Psychosocial Implication of Myth: The U.S. military has had a long history of caring for the wounded and injured during wartime. Currently, 45% of veterans who served in Iraqi and Afghanistan report having some type of service-connected disability while less than 21% of Gulf War veterans receive disability benefits (National Veterans Foundations, 2019). Although there are many theories as to why disability claims have risen after 2001, the one viable explanation is that the service-connected disability eligibility standards have been expanded. Additionally, many service members are encouraged by unit commanders, veteran service organizations, and other government entities to apply for disability benefits to document their medical, physical, and mental health conditions. The intention of receiving disability benefits and compensation due to injury, whether you are a veteran or civilian, is to avoid the excessive out-of-pocket expenses over ones’ lifetime for medical, physical, or mental health treatment as well as maintaining financial stability for you and your family. There has also been a change in the military culture’s attitude and perceptions towards mental and physical disability. Many veterans communicate that there is “no shame” in receiving disability benefits that were earned while in service to their country. Today, being a veteran with a disability has a much different meaning because of the documented serious mental and physical health conditions (i.e., posttraumatic stress, suicide ideation, opioid addiction, TBI, amputation). However, there continues to be a reoccurring myth or stereotype in society that “all veterans are on disability benefits.” Unfortunately, this negative attitude only serves to stigmatize the veteran as being a member of a disenfranchised group possessing medical, physical, or mental health “deficits” further separating veterans from society which tends to see mental and physical disability as an aberration. The psychosocial impact of such attitudes are pervasive and harms veterans’ mental health and well-being. One reason is because of the ambiguity of physical (visible) disabling conditions versus mental health (invisible) disabilities. The attitude and perception by some in society views that those with a mental health (hidden disability) may not deserve the financial benefits as those that have suffered medical and physical disabilities.
Women in the Military Have Less Dangerous Jobs and Have it Easier: It is recognized in the literature that women have had a long history of serving in the military in various capacities. They were particularly utilized in medical units during WWII. Yet women in the military are rarely recognized for their valor, strength, resiliency, and high-level of job performance primarily due to the hypermasculine nature of the military culture. Part of the issue is that there have been less job opportunities and billets available to women that could advance their military careers. Currently, women comprise over 16% of all active duty service members (Reynolds & Shendruk, 2019). Women are now assigned to combat operations and are also casualties of war like men. The number of women vary across branch of service. Among the 200,000 women in the military approximately 8.4% are Marines while 20% are in the Air Force (Katzenberg, 2019). Women have a mandatory boot camp but are separated from their male counterparts during their basic training. Women are integrated into many of the same units and missions as men. Not all branches of service have billets available to women. The Army for example, has only 78% of their military occupational specialties (MOS) open and available to women. In 2017, the Navy’s elite special warfare operating billet (Navy SEALs) have recently accepted women into SEAL training school. The Army Rangers special operations group also graduated one female soldier in 2019. Although women in the military have many more career opportunities than in other wars. However, there is a long way to go before they are perceived as equivalent in status to males.
Psychosocial Implications of Myth: Military researchers such as the Pew Research Center and demographic data gathered by the DoD have provided more statistics than in the past regarding women in the military. For example, survey research suggests that gender integration within the various branches of the military has no negative effects on unit cohesion. However, the myths about women in the military persist due to the attitude and perception of what characteristics should comprise the image of the warfighter. Most women in the military show much hardiness and resiliency for mental and physical toughness and they have earned the right to become highly skilled at their MOS and wear the uniform within their branch of service. One of the more critical issues challenging women in the military today are the troubling statistics on the prevalence and incidence of military sexual trauma (MST). The psychological and emotional cost of unwanted sexual advances, harassment, assault, and rape of women in the military is a dark reality that women face in military life. Consequently, many women present with the clinical symptoms associated with complex PTSD and co-occurring mental health conditions.
GUIDELINES FOR PRACTICE
Competent and ethical clinical military counselors are aware of the negative societal attitudes, perceptions, myths, and stereotypes surrounding the military culture. The following guidelines are offered to assist in informing culturally competent clinical military counselors in the negative attitudes, perceptions, myths, and stereotypes that could hinder personal growth and optimal well-being of military clients.
- The service member or veteran, not the practitioner, defines their own unique identity within the branch of service they served, military occupational specialty, unit they were attached to, rank, and any exposure to combat operational stress.
- Avoid harmful attitudes and stereotypes by listening for the service member or veterans’ experience of their military life and how others in society or family members may attribute negative characteristics towards them ultimately affecting their self-worth, self-esteem, and identity.
- Recognize how service members or veterans choose to assimilate, acculturate, or transition to civilian culture and understand how the environment itself impacts the optimal mental and physical health functioning.
- Explore how psychosocial adjustment and adaptation to service-connected mental and physical disabilities can hinder the service member or veterans’ coping and resiliency.
- Interpret how negative perceptions and attitudes can follow the service member or veteran in civilian jobs, intimate partner and family relationships, social-recreational activities, and how it may affect their overall quality of life.
- Recognize that exposure to combat does not imply that the service member or veteran will have a life of PTSD and co-occurring mental and physical health conditions.
Few studies exist that explore military myths, stereotypes, and stigma and how it ultimately impacts the mental health and well-being of persons that have served our country. However, many scholars in the multicultural counseling literature underscore the relevance of how negative myths and stereotypes create harmful psychological effects when these are generalized to all members of a culture. Accordingly, culturally competent clinical military counselors work intentionally in meaningful ways to reduce negative stigma in therapy.
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