Healing Combat Trauma

Combat Veterans, PTSD and Domestic Violence - A Sometimes Deadly Combination

Domestic Violence a Growing Problem for Veterans

“The increasing number of veterans with posttraumatic stress disorder [PTSD] raises the risk of domestic violence and its consequences on families and children in communities across the United States,” says Monica Matthieu, Ph.D., an expert on veteran mental health and an assistant professor of social work at Washington University in St. Louis. “Treatments for domestic violence are very different than those for PTSD. The Department of Veterans Affairs [VA] has mental health services and treatments for PTSD, yet these services need to be combined with the specialized domestic violence intervention programs offered by community agencies for those veterans engaging in battering behavior against intimate partners and families.”

Matthieu and Peter Hovmand, Ph.D., a domestic violence expert and an assistant professor of social work at Washington University, are merging their research interests and working to design community prevention strategies to address this emerging public health problem.

“The increasing prevalence of traumatic brain injury and substance use disorders along with PTSD among veterans poses some unique challenges to existing community responses to domestic violence,” says Hovmand. “Community responses to domestic violence must be adapted to respond to the increasing number of veterans with PTSD. This includes veterans with young families and older veterans with chronic mental health issues.”

VA research shows that male veterans with PTSD are two to three times more likely than veterans without PTSD to engage in intimate partner violence and more likely to be involved in the legal system.

— Source: Washington University in St. Louis

The Woman's Bill of Rights to Sexual Intimacy and Pleasure

Periodically we revisit the all-important topic, "Healthy Sexuality for Combat Veterans."  In this installment, we include a "bill of rights" that's essentially written for the woman partner, from Gina Ogden, Ph.D., author of "The Heart and Soul of Sex," and, most recently, "The Return of Desire." The author of five books, Ogden is a marriage and family therapist and a sex therapist.  In a conversation directed primarily to women, she says:

"It's important for you to know what your sexual rights are -- no matter what your age or sexual orientation or physical ability.  Some of us seem to know our rights instinctively and are able to set effective boundaries and ask for what we want.  But many of us have never thought about our rights to intimacy and pleasure -- or even imagined that we had such rights.  When we're unaware, we're extra vulnerable to being taken advantage of by others, whether they intend to take advantage of us or not."

The following advice comes from a guide by Ogden for women about "how to say "yes" to pleasure and "no" to unsafe sex."

My Rights to Intimacy and Pleasure:

1.  I have a right to my own body and all of its sensations, including pleasure and pain;

2.  I have a right to think my own thoughts, whatever they may be;

3.  I have a right to feel the full range of my emotions – excitement, joy and anger, sorrow and depression, love and fear – whether or not my feeling them is acceptable to others;

4.  I have a right to acknowledge my memories, whether they are memories of delight or of abuse, and to base present relationship decisions on them;

5.  I have a right to be – or not to be – a sexual person at all ages and stages of my life, and a right to chose how I define what I mean by sexuality;

6.  I have a right to expect that my partner respect my body, thoughts, feelings, and general well-being, and a right to insist on respect, if necessary;

7.  I have a right to ask for what I want;

8.  I have a right to say “no” to any sexual encounter that feels unsatisfactory or threatening – physically, emotionally, spiritually, or sexually;

9.  I have a right to say “yes” to pleasure that is physically, emotionally, spiritually and sexually safe; and

10.  I have a right to feel good about saying both “yes” and “no.”

-- Source: "The Heart and Soul of Sex," by Gina Ogden, Ph.D.

Projects Target PTSD-Related Relationship Aggression

"Living with posttraumatic stress disorder (PTSD) can strain any relationship—sometimes to the point of violence against a loved one. University of Arkansas psychologist Matthew T. Feldner, Ph.D., is part of two national research projects aimed at preventing relationship aggression in couples coping with PTSD and treating this type of aggression when it has already developed.

“The main aims of these projects are to reduce the number of new cases of interpersonal violence and reduce the number of cases already existing,” Feldner says. “We teach couples skills for better relationship behaviors, such as how to communicate better and how to manage anger.”

All people receiving these interventions will be closely monitored and referred for more intensive individual therapy should the need arise. Rather than going back to focus on the roots of the PTSD, Feldner says the couples in these interventions “will focus on the here and now of how the PTSD is affecting their relationship.” While teaching couples about the features of PTSD and improving their relationships, the group treatment can also serve as a gateway to further treatment for PTSD and other services.

If these interventions succeed in preventing or treating relationship aggression, Feldner says that these would be groundbreaking, landmark projects. “Ultimately, we are hoping we can conduct these interventions in such a way that they could be useful for the VA and could be extended to community populations as well, for situations that are not specifically military,” Feldner says."

— Source: University of Arkansas, Fayetteville

In the News: Two Articles Worth Reading Recently

Two articles worth reading that have been in the news recently:

"How the VA Abandons Our Vets," by Joshua Kors, in The Nation, linked here; and the poorly-headlined but otherwise worthwhile"Military Town Newspaper Challenges U.S. Military on Murder of Military Women," by Ann Wright, in TruthOut.org on the Web, linked here. 

Kors' article talks about the recent veterans' class-action lawsuit against the VA, fought in Federal court, and WHY it was necessary -- and there are some interesting and unexpected points, which didn't show up elsewhere in enough detail.  The biggest one is about the "fuzzy math" the VA employs to calculate claim times, and how this uniformly works against veterans (no pun intended on the "uniformly" thing.) It also confirms a longheld impression on my part that a veteran who struggles intensely with the mammoth difficulty of being his or her own advocate in the process, and ends up committing suicide, is actually counted as a "victory" for the VA, who calls their claim "resolved" in the time it took them to kill themselves.  In other words, fellow veterans killing themselves while waiting for their claims to be resolved actually makes the VA look "better and faster" at resolving claims, if you can believe that.  Yikes.  Talk about a system that needs to be overhauled and addressed...

Another great point Kors makes is that "someone" already attempted -- but was fired for her efforts.  That "someone" is Frances Murphy, M.D., who in 2004, according to Kors, "helped draft the Mental Health Strategic Plan, a blueprint for overhauling the VA.  The plan called for 256 changes to the organization, among them: installing a tracking system to stay in touch with suicidal veterans, creating rehabilitation programs that involved veterans' families, and streamlining the benefits process to resolve wounded veterans' immediate needs."  However, after expressing her frustration in public (to mental health providers) about the barriers the VA erects to veterans' speedy care, and how this causes veterans to suffer additionally and unnecessarily -- she was summarily fired.

Read the Kors piece to understand what wounded veterans have to go through, and how unfair it is; and to get a better picture on the fuzzy math that's employed to make things seem much better than they are.

The Ann Wright piece talks about military wives and women servicemembers murdered recently by other servicemembers, and mainly serves to remind us of how this is a problem that isn't going away.  The "news peg" for her article is a recent editorial in the Fayetteville, NC Observer -- Fayetteville is close to huge Army and Marine bases -- called "Our View: Military Domestic Violence Needs More Aggressive Prevention" (speaking of odd word choices).  That editorial is linked here.  The editorial references a recent vigil to memorialize the murdered women locally.

In conjunction with the Helen Benedict material and the other writings on Military Sexual Trauma, blogged about recently, here -- this is a topic worth keeping in the forefront of our minds.  Collateral damage from combat trauma? Or just crimes committed by otherwise sick individuals who happen to be in the military?  Either way, "more" needs to be done about this terrible problem.  (A similar and related topic is the "non-combat deaths" one we discuss from time to time, which can sadly be what's used to describe what more actually is a victim's suicide or a "domestic violence" type murder, of one servicemember by another.) We're just about to add a series of blog posts about domestic violence, and why it's important to leave when you're at risk, but ideally how to do so in a way that preserves your life.  Look for that shortly.

About the authors:

Joshua Kors is an investigative reporter for The Nation, where he covers military and veterans' issues. He is the winner of the National Magazine Award, George Polk Award, IRE Award, National Headliner Award, Casey Medal, Mental Health Media Award, and the Military Reporters and Editors Award.  He was also a finalist for the Michael Kelly Award, Tom Renner Award, Harvard's Goldsmith Prize for Investigative Reporting, and the American Bar Association's Silver Gavel Award.

Ann Wright is a retired US Army Reserves colonel with 29 years of military service. She also was a US diplomat who served in Nicaragua, Grenada, Somalia, Uzbekistan, Kyrgyzstan, Sierra Leone, Micronesia and Mongolia. She is the co-author of "Dissent: Voices of Conscience," profiles of government insiders who have spoken and acted on their concerns of their governments' policies.

Why Soldiers Rape - Helen Benedict on Military Sexual Assault

If you've been following our recurring coverage on military sexual trauma (MST), here is an important addition to it: Helen Benedict, a professor at Columbia University's Graduate School of Journalism, currently on sabbatical, has a book coming out next year from Beacon Press called "The Lonely Soldier: The Private War of Women Serving in Iraq."  (You can pre-order the book at Benedict's own website, linked here.)

On Memorial Day weekend, she published an OpEd recently on the subject, in the New York Times. The piece, which was entitled "For Women Warriors, Deep Wounds, Little Care," is linked here.

A few months later, in August, she published another OpEd, called "Why Soldiers Rape," in a different outlet, which is linked here. Compared to the NYT piece, this one is more overtly politicized, both in thinking and in language.

While that strategy can have pros and cons, one positive is -- whether you agree with it or not -- that it's a useful stance to take to provoke thinking and/or discussion.  (Although I'd also like to compare the two essays side by side to see how Benedict treats the same material slightly differently, for different audiences.)

Decades ago, feminist authors and filmmakers were able to accomplish traction by taking on topics like rape (Against Our Will: Men, Women and Rape, by Susan Brownmiller) and pornography (Not a Love Story: A Film about Pornography, by Bonnie Klein, with Susan Griffin and others) as aspects of the culture that harm women substantially, yet are frequently overlooked.

(Benedict's website indicates that a previous article published in Salon last year, "The Private War of Women Soldiers," was awarded the James Aronson Award for Social Justice Journalism in 2008. That article is linked here.)

Some of the terms Benedict uses, like "misogyny" (literally, hatred of women) are very strong indeed.  How big a problem is this really? My hunch is less so than what Benedict suggests.  But by using such volatile language to communicate similarly incendiary thinking, Benedict succeeds in drawing greater attention to the problem.  Doubtless what she portrays, however, is not "everywoman" servicemember's experience in the military.  (The comments to the NYT piece make that abundantly clear.) But for those who are harmed by military sexual trauma, no doubt she makes some very good, and thought-provoking points -- even if you don't end up agreeing with everything she says, or how she says it. 

Another difficulty is the topic is so polarizing, based on individuals' own experiences -- that those who have suffered from it tend to see the pervasive nature of it; whereas those who haven't personally experienced also tend to believe their experience is the norm, and shut out the other point of view.  (See the comments section in the NYT piece for examples of this "all or nothing" thinking.) In this way, both sides run their own risk of illustrating the cliche that "when all you have is a hammer, you tend to see everything as a nail."

The following is an excerpt from that piece:

"Rape in civilian life is already unacceptably common. One in six women is raped or sexually assaulted in her lifetime, according to the National Institute of Justice, a number so high it should be considered an epidemic.

In the military, however, the situation is even worse. Rape is almost twice as frequent as it is among civilians, especially in wartime. Soldiers are taught to regard one another as family, so military rape resembles incest. And most of the soldiers who rape are older and of higher rank than their victims, so are taking advantage of their authority to attack the very people they are supposed to protect.

Department of Defense reports show that nearly 90 percent of rape victims in the Army are junior-ranking women, whose average age is 21, while most of the assailants are non-commissioned officers or junior men, whose average age is 28. . . "

Benedict ties rape to misogyny -- literally, hatred of women -- and what she suggests is the systematic, institutionalized degradation of women in the military:

"Two seminal studies have examined military culture and its attitudes toward women: one by Duke University Law Professor Madeline Morris in 1996. . . and the other by University of California professor and folklorist Carol Burke in 2004 . . . Both authors found that military culture is more misogynistic than even many critics of the military would suspect. Sometimes this misogyny stems from competition and sometimes from resentment, but it lies at the root of why soldiers rape. . .

Morris and Burke both show that military language reveals this "unabashed hatred of women" all the time. Even with a force that is now 14 percent female, and with rules that prohibit drill instructors from using racial epithets and curses, those same instructors still routinely denigrate recruits by calling them "pussy," "girl," "bitch," "lady" and "dyke." The everyday speech of soldiers is still riddled with sexist insults. . .

The view of women as sexual prey has always been present in military culture. Indeed, civilian women have been seen as sexual booty for conquering soldiers since the beginning of human history. So, it should come as no surprise that the sexual persecution of female soldiers has been going on in the armed forces for decades. . ."

Benedict then goes on to suggest why rape is under-reported in the military:

"Having the courage to report a rape is hard enough for civilians, where unsympathetic police, victim-blaming myths, and the fear of reprisal prevent some 60 percent of rapes from being brought to light, according to a 2005 Department of Justice study.

But within the military, reporting is much riskier. Platoons are enclosed, hierarchical societies, riddled with gossip, so any woman who reports a sexual assault has little chance of remaining anonymous. She will probably have to face her assailant day after day and put up with resentment and blame from other soldiers who see her as a snitch. She risks being persecuted by her assailant if he is her superior, and punished by any commanders who consider her a troublemaker. And because military culture demands that all soldiers keep their pain and distress to themselves, reporting an assault will make her look weak and cowardly.

For all these reasons, some 80 percent of military rapes are never reported, as the Pentagon itself acknowledges. . . ."

And then Benedict suggests two reasons, not exactly complimentary to recruiting, about how violence is perpetuated in and by the system.  Hmmmn.

"Misogyny has always been at the root of sexual violence in the military, but two other factors contribute to it, as well: the type of man who chooses to enter the all-volunteer force and the nature of the Iraq War.

The economic reasons behind enlistment are well understood. The military is the primary path out of poverty and dead-end jobs for many of the poor in America. What is less discussed is that many soldiers enlist as teenagers to escape troubled or violent homes.

Two studies of Army and Marine recruits, one conducted in 1996 by psychologists L.N. Rosen and L. Martin, and the other in 2005 by Jessica Wolfe and her colleagues of the Boston Veterans Affairs Health Center, both of which were published in the journal Military Medicine, found that half the male enlistees had been physically abused in childhood, one-sixth had been sexually abused, and 11 percent had experienced both. This is significant because, as psychologists have long known, childhood abuse often turns men into abusers. . .

Worse, according to the Defense Department's own reports, the military has been exacerbating the problem by granting an increasing number of "moral waivers" to its recruits since 9/11, which means enlisting men with records of domestic and sexual violence.

Furthermore, the military has an abysmal record when it comes to catching, prosecuting and punishing its rapists. The Pentagon's 2007 Annual Report on Sexual Assault in the Military found that 47 percent of the reported sexual assaults in 2007 were dismissed as unworthy of investigation, and only about 8 percent of the cases went to court-martial, reflecting the difficulty female soldiers have in making themselves heard or believed when they report sexual assault within the military. . ."

(Those last statistics are perhaps most troubling of all...)

Benedict also has an essay on her website that's worth reading, called "For Women Warriors, Deep Wounds, Little Care," which is linked here. (Same title as NYT piece, slightly different content.)  Watch for her book to come out in the Spring of 2009, from Beacon Press.

Twice Betrayed: Women Veterans and Military Sexual Trauma

It's my deep-seated belief that women veterans who suffer military sexual trauma risk being twice betrayed: once by their perpetrator in uniform, once by the system itself, which should be doing a much better job of protecting them from a problem that's too apparent, widespread, and part of the actual culture to pretend that it doesn't exist.

 

See Jeff Benedict on this:

"But an occupation that thrives on a unique capacity for aggression among participants runs the risk of being a home for troubled men who cannot contain their rage against the opposite sex." -- Jeff Benedict, author of "Public Heroes, Private Felons"

Preventing Psychological Injury, Betrayal and Trauma: The Real “Costs” and “Treatment” of Military Sexual Trauma

 

Sometimes I think I miss the point on some of these blog posts: I’m too busy trying to set the stage and establish the “milieu” so that a thoughtful person can absorb it all and come away with a new outlook or two on a “same old” problem.  But maybe I’m failing to come right out and say what I’m really thinking, and God knows enough people are floundering around on this topic who shouldn’t be, so maybe I just will.  Here goes the suddenly editorial portion of our program:

 

We heard Jonathan Shay, M.D., Ph.D., pretty much the foremost expert nationally on veterans and PTSD, talk the other day about the “psychological injury” that troops are exposed to from lack of sleep, before and after combat, and how that sets them up for significant problems.  True; agreed; understood.  What we’re talking about here with women in the military and military sexual trauma is a similar thing: preventing and treating what is a grievous psychological injury. It's a situa