Conflicting Notions on Violence and PTSD in the Military: Institutional and Personal Narratives of Combat-Related Illness

Abstract

Research indicates that soldiers struggling with PTSD under-utilize mental health care. Quantitative studies of barriers to care point to the importance of soldiers' beliefs about mental health and mental health interventions in their care-seeking behavior, yet these studies still struggle to understand the particular beliefs involved and the ways they impact care-seeking behavior. This preliminary study makes a start in examining these questions through qualitative literature analysis. It maps out dominant messages surrounding PTSD in military mental health interventions, and explores how they can both shape and conflict with soldiers' personal notions. It does so by analyzing these messages and notions as institutional and personal (illness) narratives. Institutional military PTSD-narratives, which draw on mainstream scientific and clinical models, appear to communicate contradictory notions on the meanings of violence and its psychological consequences, often without acknowledging these contradictions. As such, these narratives seem to shape struggles of soldiers, both within themselves and with the military institution. The identified conflicts indicate, contrary to the individualizing and decontextualizing focus of dominant PTSD-understandings, that soldiers' struggles also have social and moral dimensions. This has important implications for both research into PTSD-interventions and understandings of PTSD as such.

Medical Narratives of Military PTSD: Moving Beyond the Biomedical Approach

“…Adherence to traditional masculine behaviours has been negatively associated with helpseeking behaviours (Garcia et al, 2011;Lane & Addis 2005;Berger, Levant, McMillan, Kelleher & Sellers, 2005). With the military fostering greater adherence to these norms, it is vital that the effect of these norms be studied in relation to health-seeking behaviours, namely because Western soldiers underutilize mental health care (Molendijk, Kramer and Verweij, 2016;Hoge et al, 2004;Kim et al, 2010). According to Berger et al (2005), civilian men "who score higher on measures of gender role conflict and traditional masculine ideology tend to have more negative attitudes toward psychological help seeking" (p. 63).…”

“…It is an evident trend in Western society for soldiers with PTSD to underutilize health care ( Molendijk, Kramer and Verweij, 2016;Hoge et al, 2004;Kim et al, 2010). Hoge et al (2004) found that between 23 to 40 percent of active duty soldiers with a mental health issue sought professional care within the span of a year (Hoge et al, 2004).…”

“…Suffering is a common theme within the military, as soldiers are expected to deal with the both physical and mental suffering experienced throughout their military training by "sucking it up" and being resilient (Molendijk, Kramer & Verweij, 2016). It is when mental disorders begin to be perceived as a failure of the individual to "suck it up" or be resilient that we can see the process of stigmatization taking place.…”

“…Furthermore, Western soldiers experiencing PTSD tend to underutilize health care (Molendijk , Kramer and Verweij, 2016;Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L., 2004;Kim, P. Y., Thomas, J. L., Wilk, J. E., Castro, C. A., & Hoge, C. W., 2010). Under-utilization refers to failure to seek health care among individuals suffering from mental disorders.…”

“…It is important to note that both women and men within the military can experience PTSD, however gender was not explicitly discussed within this research. Much of the literature on barriers to health-care among military members with PTSD does not differentiate by gender ( Hoge et al, 2004;Kim et al, 2010;Molendijk, Kramer and Verweij, 2016). In order to build upon previous research in this area, a similar framework was used as to include all military members who experience PTSD, speaking to general narratives and perspectives of PTSD among practitioners that could be applied to all patients, and were not gender-specific.…”