There is a long history of Mental Health Stigma in the military
Many veterans believe there is a stigma in the military culture concerning mental health. All of those presently in the military will be veterans and will weigh heavily on future research. Military history has consistently shown that mental health issues play a part in any military branch. It is believed that mental health stigma was placed in the military to prevent soldiers from leaving the battlefield. The stigma is in line with masculine behavior within the military structure, creating self-stigma. Some believe the primary care system within the United States military and the Veterans Administration (VA) could address the mental health stigma if they choose to, it appears they are finally trying. It is also essential to know that the United States isn't the only country having issues with soldiers and mental health stigma. The United Kingdom also shows a troubling trend towards not trusting mental health professionals. Many do not realize that the stigma associated with mental health is deep-rooted in the history of military combat and was placed there purposely.
Military personnel has faced mental health stigma since ancient times. Military members are afraid they will be seen as weak; lose the respect and trust of their peers and leadership if they seek mental health help. These soldiers then lose respect for themselves even if they do not seek help and live with shame. The military culture possesses little tolerance for weakness, including mental health issues. Before the enlightenment period, commanders had little choice but to execute soldiers for cowardice.
In the American Civil War, soldiers having mental health issues were given labels such as "soldier's heart," "irritable heart," and "sunstroke," showing some compassion for their plight. During World War, I shell shock was the word. After WWI, Germany struggled due to the cost of paying disability compensation and their debt. In 1916, the German association for psychiatry convened and decided that those exposed to a traumatic stressor could only occur with those having "hysteria." Hysteria was the chosen word to be intentionally stigmatizing for male soldiers who felt it was a feminizing term.
The de-medicated model adopted in 1916 became a barrier to shame. The rates of wartime psychiatric evacuation have steadily decreased since then from 10% during WWII, 3.7% in Korea, and barely 1.2% in Vietnam. There is evidence from the Vietnam veterans that this model did not prevent long-term disability. In 1952 the Diagnosis and Statistical Manual of Mental Disorders (DSM-I) and DSM-II published in 1968 included the term hysteria as a synonym for over-reactive and various disorders, including anxiety and dissociative disorders. In the 1980s, the DSM-III started turning away from the prior medical model, reducing the stigma associated with acute distress. The DSM-IV added additional criteria for Post-Traumatic Stress Disorder (PTSD) requirements, including terror, horror, or helplessness. This wording was intended to soften the rhetoric about PTSD.
During WWII, the military made a massive and expensive attempt to screen out those with mental health issues. Even with this effort, the military failed to prevent large numbers of combat stress casualties. This stress spread through all military branches and all theaters of operation. It was confirmed in Italy in 1944 that all those exposed to constant combat exposure became a psychiatric causality after 210 days of continuous combat exposure.
Recently neurobiological studies have shown that intense, prolonged stress can inflict literal injuries to the brain refuting the personal weakness theory of the past. Still, male soldiers and veterans feel they are weak because of their status in society as being masculine. Men who join the military are very likely to present as hyper-masculine individuals even before military training. This training traditionally turns to established masculine gender norms. Seeking help may interfere with those norms, putting veterans at odds with seeking mental health care and producing excessive dependence on self-reliance. Seeking mental health care is seen as weak by 55 to 65% of recently deployed veterans, causing veterans who expressed distress problems; these men tend to avoid behaviors associated with trauma recovery, including social outreach, coping, and emotional processing.
Hyper-vigilant behavior is often synonymous with individuals having PTSD. Veterans with PTSD attempt to reduce perceived danger, take control over their environment or behavior, and adapt this control to their lives. Resistance to change concerning treatment interferes with the masculine ideal of self-control. Even with that said, masculinity may play a positive part in PTSD treatment. The experience of fear and anxiety may push the veteran into treatment because fear and anxiety are not traditional masculine behavior. Combat veterans show a complex relationship between PTSD and masculinity. Positive and negative effects have the potential to use male behavior to its advantage. A greater understanding of how they interact is essential. Masculine behaviors have the potential to possess positive and negative effects on their recovery. The possibility is that the traditional male behaviors may be dismayed because they feel unmanly because of fear and anxiety brought on by PTSD, exacerbating the symptoms causing them to seek mental health help. Recently studies have shown that self-stigma has become a significant issue with veterans and military members who struggle to ask for mental health help because of the stigma associated with it.
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