Military Sexual Trauma: A Silent Syndrome
Ann W. Burgess, Donna M. Slatterly & Patricia A. Herlihy
Ann W. Burgess, DNSc, FAAN is Professor of Psychiatric Nursing at the Connell School of Nursing, Boston College, Chestnut Hill, MA.
Donna M. Slattery, RN, BS is a graduate student at the Connell School of Nursing, Boston College, Chestnut Hill, MA.
Patricia A. Herlihy, RN, PhD. is Visiting Scholar at the Connell School of Nursing, Boston College, Chestnut Hill, MA.
Military Sexual Trauma: A Silent Syndrome
Abstract
This article examines an age-old problem, sexual assault, through the lens of its occurrence within the military culture. Specific cases as well as Department of Defense responses to better handle these issues are offered to educate psychiatric mental health nurses of the potential differences in symptomatology and presentation of MST. It is clear that this fact appears to be an increasing problem with the predicted cohort of returning Veterans appearing both in the VA system as well as in civilian locations, hospitals, community centers and especially the workplace. It will be critical to develop training materials and pursue further research to identify this silent syndrome of MST in order to better meet the needs of our returning Veterans.
Introduction
Sexual assault has been an inherent part of human history adversely having an impact onevery culture, race and socioeconomic group around the world. It is a serious health, social, and economic issue,that is often silently played out in the lives of individuals who frequently feel fearful, intimidated, or ashamed to disclose the actual abuse.
Over the course of the last two decades, there has been a slightly different and perhaps even more concerning version of sexual assault that has emerged in our culture – Military Sexual Trauma (MST). Since the early 1990s there has been an increase in the amount of sexual abuse reported and documented by active duty military personnel (Valente & Wright, 2007). Military sexual trauma is defined by the Department of Veterans Affairs as repeated threatening sexual harassment or physical assault of a sexual nature (Department of Defense, 2011).
It is reported that approximately 1.4 million of the 2.3 million service members deployed to the wars in Afghanistan and Iraq have already left active duty and begun their transition to civilian life. A Rand Corporation study, Invisible Wounds of War (Tannielian & Jaycox, 2008), estimates that 300,000 or 20% of these returning military are suffering from major depression or post-traumatic stress disorder. One particularly troubling statistic is the number of active military members who have experienced MST. According to the Department of Defense 2011 Annual Report on Sexual Assault in the Military, there were 3,198 incidents of sexual assault throughout the entire military in 2011; however, Defense Secretary Leon Panetta said he believed that number was underreported and estimated that the actual number was probably much higher and more in the 19,000 range. Specifically, 1 in 5 women and 1 in 500 men are reported to have experienced some form of MST while in active military service.
The nursing profession has been instrumental in initiating assessments and treatment protocols for sexual trauma and continues to play a major role in dealing with this new version of an old trauma. Nurses in hospitals, clinics and even in the workplace can have a huge role in once again breaking the silence and helping victims of MST to acknowledge their trauma and re-enter civilian life in a productive manner.
This article reviews several high profile cases of MST as well as the administrative response to the public outcry. In addition, it explores a few of the realities of military personnel reporting and disclosing sexual abuse, and the psychological and workplace/career impacts. Itreviews the history of this silent syndrome andmakes suggestions for further training and studies to better understand the difference of this relatively new issue particularly as it presents itself in the workplace.
Background
Before delvinginto the specifics of sexual assault, it is instructive to recall two ancient paintings depicting rape to validate the culture of rape in history. First, painted for the King of Spain, Phillip II around 1562, Titian’s mythological painting of the Rape of Europaportrays a surprised and resistant Europa with arms and legs flailing as she is carried away on Jupiter’s back, who is disguised as an ornamented white bull. Second, Nicolas Poussin’s 1633 Abduction of the Sabine Women, features a Roman army led by Romulus, in the early days of his founding of Rome, abducting the Sabine women against their will, noting that the soldiers wished to take the women as wives. This ancient history of war and its victims has continued through the ages as we fast forward to the 21st century and what is occurring to members of our military.
Contemporary military sexual trauma has its own culture and history. The statistics since 1990 reflect increasing numbers of people who report sexual abuse and domestic violence inflicted by active duty military personnel (Valente &Wight, 2007). The military first pledged to crack down on sexual assault and harassment in 1992, in the wake of a scandal that surfaced at the Navy fliers’ 35th Annual Tailhook Association Convention in Las Vegas. Over 4,000 attendees: active, reserve, and retired personnel, participated in a 2-day debriefing on Operation Desert Storm.
In a Department of Defense report, 83 women and seven men stated that they had been victims of sexual assault and harassment during the Tailhook meeting. At that convention, it was reported that Navy aviators surrounded unsuspecting female guests, including 14 female Navy officers, and passed them down a gauntlet, grabbing at their breasts and buttocks, attempting to strip off their clothes while jeering and taunting them the entire time. (Valente &Wright 2007).
An initial investigative report suggested the incident was the result of low-ranked men behaving poorly but Assistant Secretary of the Navy Barbara Pope refused to accept the report, especially after hearing Rear Admiral William’s remarks in Pope's presence that he believed that "a lot of female Navy pilots are go-go dancers, topless dancers or hookers" (Healy, 1992, p. 2). A year and a half later, a Pentagon report found that Tailhook was not an isolated incident. Secretary of the Navy Henry Garrett III resigned over the scandal stating he took full responsibility for his leadership failure. Ultimately, the careers of 14 officers and over 200 naval aviators were affected by resignations, early retirement of 2 admirals and other officers being demoted, denied promotion and/or given reassignments.
These incidents spurred a Congressional mandate in 1992 for the Department of Veterans Affairs to treat distress related to military sexual trauma. Following the mandate, 61% of Veterans Affairs medical centers developed sexual trauma treatment teams by 1995 (Allard, et al. 2011). But in 1996 there was yet another scandal at Maryland’s Army Aberdeen Proving Grounds, where assault charges were brought against a dozen male officers for sexual assault of female trainees. When a hotline was established, 200 investigations were launched in response to more than 1000 incoming phone calls requesting assistance. And then five years later in 2000 the Veterans Health Administration (VHA) finally mandated universal screening for military sexual trauma for all veterans using VHA facilities (Hyun, Kimerling, Cronkite, McCutcheon & Frayne, 2012).
In 2003 the U.S. Air Force Academy was also accused of systemically ignoring an on-going sexual assault problem on its campus. More than 50 cases of sexual assault were identified as having occurred at the US Air Force Academy between January 1993 and December 2002 (Mullen & O'Connor, 2011). The uproar over these incidents led to the establishment of sexual assault nurse examiners (SANEs) within the military health system in both the active and reserve component force structure.
Due to all these documented incidents Secretary of Defense Donald Rumsfeld in 2004publically expressed concern regarding the number of sexual assault cases in the military. He specified that in the combat theaters of Afghanistan, Iraq, and Kuwait there were more than 100 sexual assaults reported over an 18-month period. As a result of this concern he authorized the formation of an official Task Force to investigate current reporting and prevention policies as well as a means to provide recommendations for improvement. This report reviewed current barriers to effective reporting and management of sexual assault cases. It summarized 35 factors influencing and affecting the reporting of sexual assault and proposed 9 corrective actions (Mullen & O'Connor, 2011).
Even with these new measures in place there was yet another incident in 2010-2011, at Lackland Air Force Base in Texas. This time four male instructors were charged with having sex and in one case raping female trainees. One Air Force instructor was convicted of 20 counts of rape and aggravated sexual assault and sentenced to 20 years in prison (Ellison, 2012).
One can see from this brief history of MST that the problem remains supported in the culture despite attempts by the Department of Defense (DoD) to curtail these incidents and provide needed services to victims. The MST incidents that were publically reported and the administrative response are offered as a backdrop to understand the tenacious nature of this issue in our current culture.
Military culture, disclosure and reporting
There are various outcomes to disclosure of militarysexual trauma. If the soldier does not disclosure, he or she has to deal individually with the consequences silently and manage the long-term residual effects. If there is disclosure, the soldier has to deal with the social meaning of the incident and the reaction of others including authority, peers, family, friends and when returning to civilian life, co-workers and their employers.
The DoD has a two-tiered system of restricted and unrestricted reporting of sexual assault. The introduction of this new concept significantly increased reported incidents of MST (Ferguson, 2008). For victims seeking medical assistance and counseling, they can file a restricted report and remain anonymous, but if they seek punishment for their attacker, they must file an unrestricted report and confront their attacker (Williams & Bernstein, 2011).
One of the unique features of military sexual trauma is that it usually occurs in a workplace setting. This fact differs from rape in the civilian world, which tends to happen more frequently in social or community settings.Thus, MST victims must continue to live and work in proximity to their perpetrators, often leading to feelings of helplessness and placing them at risk for additional harassment. MST victims may have to rely on their perpetrators (or associates of the perpetrator) for approval before being referred for medical and psychological care. In addition MST can disrupt career goals as perpetrators are often supervisors responsible for work-related evaluations and promotions of those attacked. It has been reported that victims may have to choose between continuing military careers or sacrificing their career goals in order to protect themselves from future victimization (Street & Stafford, 2009). It is important to note that all of these factors are slightly different than the challenges that a victim of rape or sexual assault faces in the civilian world.
Many MST victims are encouraged by their superiors to keep silent. Some report that when they did report the harassment they were not believed.In addition to the trend of their reports being ignored, frequently the victims themselves were blamed for the experience. Researchers have discovered that having this type of invalidating experience following a sexual trauma is likely to have a significant negative impact on the victim’s post-trauma adjustment (Street & Stafford, 2009).
Non-disclosure of MST experiencesseems prevalent in that the Pentagon report estimates that 80% to 90% of sexual assaults go unreported. The report concluded that most victims stay silent because of fear of harassment, ridicule, gossip, being labeled a troublemaker, or simply convinced that no action will be taken.Most (97%) of the military victims in the report knew their assailant(Street & Stafford, 2009).
It may take years for some veterans to disclose a rape as in the case reported by Michael. He described howhe was raped in 1974 at Whiteman Air Force Base in Missouri, a year after graduating from High School. He described how three servicemen waited in the dark and struck him from behind as he walked past a construction site on base. He was knocked unconscious, beaten up and sodomized. Afraid he would be kicked out of the military if he reported the incident to his superiors, Michael, like most victims of military sexual trauma, suffered in silence for his 20-year career as a communications specialist and electrician in the military. He said, “I lived with this beast in my head for nearly 30 years, before telling my wife and going for counseling,” Michael spent years with pent-up rage and depression and incurred two failed marriages. In addition he actually tried to commit suicide several times (Evans, 2012).
Hoyt, Rielage, &Williams (2011) remind researchers and clinicians not to assume that lower reported MST prevalence rates in male veterans implies that men’s MST is not a problem. The number of MST cases in men versus women identified in the Department of Veterans Affairs Health Care System (VA) is very similar in fiscal year 2003, VA universal screening identified 31,797 cases of men’s MST and 29, 418 cases of women’s MST. In fiscal year 2005, universal screening identified 6,227 additional cases of men’s MST and 6,469 cases of women’s MST (Hoyt et al.).
Among the men being treated by the VA, sexual trauma victims have described officers gang raping recruits. Stories included incidents of soldiers sodomizing victims with gunbarrels and forcing young enlistees to perform oral sex.Paul, another MST victim,explained that he did not disclose for 23 years because he was threatened with death if he told anyone. After the rape, Paul relates standing in the shower for 3 hours trying to wash away the dirt and feelings of shame. He said that anyone who had reported anything was classified by the military with a section 8 claiming they were homosexuals (Snel, 2012).
Some of the sexual assaults are violentand based on revenge. In December 2005, Kori was serving in the US Coast Guard, and was assaulted and raped by a commanding officer. She was threatened that if she pursued a complaint, she would face court martial for lying. Kori now has PTSD, along with nerve damage to her face from a broken jaw. She is fighting the Veterans Administration (VA) to receive approval for surgery she urgently needs; she has also become a plaintiff in a class action civil suit against the Department of Defense. She reported, ''He didn't rape me because I was pretty or because he wanted to have sex with me; he raped me because he said that he hated me” (Dick, 2012). Additional statements from victims are noted in Table 1.
Table 1: Statements of Victims
“He put his locked-and-loaded .45 at the base of my skull [and] engaged the bolt, so I knew there was a round chambered”“He slammed my head against the concrete wall and & forcibly had sex with me”
“He screamed at me and he grabbed my arm and he raped me”
“Within a two-week period, he raped me five times”
“The entire time I was screaming and yelling for help and for him to stop, nobody came to the door…. nobody came to help me”
When I got tested, I had trich [trichinosis] and gonorrhea, and I was pregnant”
“They made it very, very clear that if I said anything they were going to kill me”
He said that if I told anybody, that he was gonna have his friend Marv, from Indiana, kill me and throw me in a ditch, ’cause that’s how they took care of things in Indiana”
Source: Dick, K. (2012) Statements from victims. Invisible War documentary.
The comments highlight some of the key issues that these victims constantly deal with such as: threats made by their assailants,physical violence, verbal and physical assault,multiple rape events,failure of rescue,sexually transmitted infection and pregnancy, gang assault, and finally actual death threats.
A member of the Army Criminal Investigation Division reported being told that she should have been a social worker, that she had no business being in a police field, that there was great resistance there toward the idea that victims should be afforded some sympathy and that sexual assault was almost a laughing matter. She was raped by her superior officer and administratively discharged with no benefits after nine-and-a-half years of service. She analyzed the culture as women having two options: suicide or AWOL and noted that several women did try to kill themselves (Stebner, 2012).
In 2006, when Marine Lt. Elle Helmer reported to her commander that a superior officer assaulted and raped her the night before,her colonel discouraged her from obtaining a rape kit. In spite of his objections, she sought a thorough medical investigation. One Marine officer advised her to pick herself up, dust herself off adding that he could not “baby sit” her all the time. Helmer appealed to her rapist's supervisor, who refused to press charges or significantly punish the assailant. Instead he focused on her as the subject of investigation and prosecution. She was ultimately forced to leave the Marine Corps. Her rapist remains a Marine in good standing (Stebner, 2012).