Rebekah Myers
“Duty, Honor, Country” is the motto that thousands of United States Army men and women live by. Taught to follow a strength narrative of high leadership and character in both military and civilian activities, military personnel are considered to be one of the strongest subsets of the population (Bartone, Snook, & Tremble, 2002; Kelly, Matthews, & Bartone, 2014). They are able to handle high stress situations, behave under a rigid discipline, and maintain a group mentality (Driskell & Salas, 1991; Kelly et al., 2014; Matthews, Eid, Kelly, Bailey, & Peterson, 2006). These characteristics allow military men and women to lead soldiers through dangerous conditions and maintain face during difficult circumstances. However, upon return to the less-surveilled civilian life, these same qualities can pose emotional adjustment difficulties and can increase the likelihood of developing a mental illness (Wintre & Ben-Knaz, 2000; Verey & Smith, 2012).
In 2003 alone, nearly 30% of military personnel presented symptoms of major depression, generalized anxiety, and PTSD upon returning from deployment in Iraq and Afghanistan, yet most of these men and women failed to seek mental health care (Hoge et al., 2004). Military members tend to forgo seeking help for mental illness because they have learned to stigmatize mental illness as a weakness, which is a contradiction to the strength narrative they were taught to uphold (Greene-Shortridge, Britt, & Castro, 2007; Hoge et al., 2004). Whereas most researchers claim that a negative mental health stigma exists within the whole military (Hoge et al., 2004), little research examines the effect stigma may have on help-seeking behaviors at specific levels of position, such as among officers, compared to enlistees. Rather, most studies employ samples comprised solely of enlistees but generalize their findings to every rank of the military. Differing from enlistees who join the military right after high school, officers are required to receive a college education at a military academy before starting active duty. Gradually exposing the officers to the gritty military environment for four extra years, this education may have an impact on officers’ beliefs about utilizing mental health resources. Thus, this review explored this gap in the literature by examining the following research question: To what extent does attending a military institution affect mental health stigma and help-seeking behaviors for military officers?
The Effects of Stigma on Help-Seeking Behaviors
Current research supports a negative relation between mental health stigma and help-seeking behaviors in a variety of samples, including civilian adults, college students, and military personnel (Britt et al., 2008; Greene-Shortridge et al., 2007). An individual’s mental health stigma, or negative judgment toward people with mental illness, derives from societal attitudes that mentally ill individuals are weak, undependable, unsafe, and responsible for developing their illness (Ben-Zeev, Corrigan, Britt, & Langford, 2012; Corrigan & Penn, 1999; Corrigan & Watson, 2002). When individuals suffering from mental health problems perceive these negative attitudes about mental illness, they develop a lower sense of self-esteem and self-efficacy, and fear being mistreated by peers, losing their jobs, and not receiving adequate treatment (Ben-Zeev et al., 2012; Britt et al., 2008; Greene-Shortridge et al., 2007; Mengeling, Booth, Torner, & Sadler, 2014). Ultimately then, these fears hinder individuals from wanting to seek help for their illness (Verey & Smith, 2012).
The fear of appearing weak is a common reason for low help-seeking among military personnel (VanSickle et al., 2016; Verey & Smith, 2012). Immersed in an environment of grit (Kelly et al., 2014), aggressive masculinity (Verey & Smith, 2012), and conformity (U’ren, Conrad, & Patterson, 1973), military personnel are expected to maintain high levels of strength at all times. Not only do military schools initially accept these men and women based on their high physical performance and emotional stability, but they also expect them to maintain this status throughout their time in the military (Bartone et al., 2002; Matthews et al., 2006). Showing any sign of physical or emotional weakness, or deviating from the “healthy” norm, guarantees that a student will be ranked lower amongst his peers or encouraged to drop out (Gold & Friedman, 2000; Lerew, Schmidt, & Jackson, 1999). Indeed, Lerew et al. (1999) found that physical and psychological conditions characterized those who were asked to leave the Air Force Academy during basic training. Thus, many military personnel fear that exposing mental illness will put them at risk of being judged as incompetent and losing their rank (VanSickle et al., 2016; Verey & Smith, 2012).
Because military personnel constantly fear portraying any sign of mental weakness due to its status as being emotionally unhealthy according to the military’s standards, they tend to negatively stigmatize mental illness and subsequently forgo treatment for any symptoms they may experience (Ben-Zeev et al., 2012; Greene-Shortridge et al., 2007; Verey & Smith, 2012). Regardless of the intensity of the psychological pain, such as the pain following a sexual assault experience, the fear of being mistreated by peers and superiors hinders most military men and women from seeking help (Mengeling et al., 2014). In fact, only when they see extreme differences in their relationships or changes in their behavior do they eventually seek out mental health care (Snell & Tusaie, 2008). However, failing to get help until the extreme occurs ultimately causes many suffering men and women to further exacerbate their symptoms through social isolation (Greene-Shortridge et al., 2007) and using substances to cope (Ben-Zeev et al., 2012), which consequently contribute to the high suicide rate (18.7%) amongst military members (Smolenski et al., 2013). Thus, because mental health stigma has drastic effects on the livelihoods of military men and women, it is important to determine potential protective and/or risk factors for developing mental health stigma at various levels of rank.
Protective Factors of Military Schools on Stigma and Help-Seeking Behaviors
Commissioned officers, who attended military colleges before beginning active duty, may struggle less with mental health stigma simply because they might develop mental illness less often. Most importantly, these men and women have been found to have certain protective personality factors in dealing with stressful situations (Bartone et al., 2002; Herrmann, Post, Wittmaier, & Elsasser, 1977; Kelly et al., 2014). Successful cadets have been found to be more conscientious, agreeable, and to have fewer neurotic tendencies. These characteristics help cadets be successful, as they are effective for learning to manage a group and adapting to sudden changes (Bartone et al., 2002). While these personality characteristics subsequently make individuals more inclined to seek out the military environment, military institutions also have a selection bias to only accept individuals whose personalities align with military values and who appear to have high levels of grit and hardiness (Atwater, Dionne, Avolio, Camobreco & Lau, 1999; Bartone et al., 2002; Kelly et al., 2014). This bias helps the military ensure that their students will be successful and remain at the schools through graduation. Accepting only those applicants who demonstrate high levels of hardiness, military schools may protect officers from developing a mental illness because they offer a structured curriculum that strengthens officers’ resilient qualities while indoctrinating them into the stressful military life (Bartone et al., 2002; Herrmann et al., 1977; Kelly et al., 2014; Matthews et al., 2006).
Compared to enlisted soldiers who are placed immediately into basic training and then combat, commissioned officers may also experience less mental illness because attending a military school provides officers with four additional years to adapt to the stress of military life and further develop their hardiness (Atwater et al., 1999; Gold & Friedman, 2000). For example, students are expected to participate in basic training every summer with different roles and responsibilities, such as acting as commanding leaders of their companies, in order to slowly introduce them to higher levels of leadership and authority (Gold & Friedman, 2000). Purposely exposing the officers to situations that challenge their resilience, military institutions provide students more opportunity to develop persistence and effective coping strategies that could ultimately protect them against developing mental illness symptoms and needing to seek help (Kelly et al., 2014).
However, even if officers were to develop mental illness, military schools foster high levels of camaraderie and social support that may act as a buffer against mental illness’ effects (Gibson & Myers, 2006; Myers & Bechtel, 2004). Research has found that being in a highly cohesive unit diminishes the stigma of getting mental health help (Wright, Cabrera, Bliese, & Adler, 2009). This may be due to the fact that relying on each other, which contributes to the functioning of the team, helps individuals feel as though they are not alone in their decision to seek professional help. Furthermore, knowing that they are all suffering together (Gold & Friedman, 2000), students are able to help each other by giving specific, empathetic advice to get through stressful situations (Verey & Smith, 2012). Overall, military schools have the potential to be a protective factor in officers’ stigmatizations of mental health and help-seeking behaviors with their specific clientele, curriculum, and brotherly environment, as they ultimately protect them from developing mental illness in general.
Risk Factors of Military Schools on Stigma and Help-Seeking Behaviors
While military academies may protect officers from developing a mental health stigma by protecting them from developing a mental illness and giving them a support system if they do struggle, they also hold significant risk factors for promoting mental health stigma. Because the schools expose military officers to the strength narrative at an intense level in order to prepare them for their upcoming positions of authority, officers may be more indoctrinated to think that mental illness is the highest form of weakness. Held to higher standards of face and strength as the leaders of their companies (VanSickle et al., 2016), officers admit to struggling to seek help for their own mental illness, because they have the weight of taking care of the other soldiers in their companies (Verey & Smith, 2012). Having more responsibilities for the group and subsequently feeling pressured to appear stronger, officers may feel more of a need to put aside their own problems for the safety of the group (Gold & Friedman, 2000; Verey & Smith, 2012).
Despite beginning school with high levels of self-care, officers’ health has been found to decline throughout their four years as their leadership responsibilities for their units increase (Gibson & Myers, 2006; Gold & Friedman, 2000; Myers & Bechtel, 2004). For example, many upperclassmen students claim that the weight of such responsibilities cause many to suffer from sleep deprivation in order to focus on the group’s functioning (Gold & Friedman, 2000). In fact, the lack of self-care that arises out of the group mindset results in many older students isolating themselves from others, losing their social support systems, and failing to seek help (Gold & Friedman, 2000; Greene-Shortridge et al., 2007). Consequently, because officers are constantly aware that they have more to lose with their high ranking and that they must always exhibit individual strength for the better of the group (Gold & Friedman, 2000; Verey & Smith, 2012), they may be at a higher risk of stigmatizing mental illness as a weakness.
Most importantly, there are currently no programs in place that teach students how to emotionally adjust to military life and that further enrich their hardiness levels (Atwater et al., 1999; Ben-Zeev et al., 2012; Gold & Friedman, 2000). Despite the fact that hardiness is a learned quality that needs to be further developed, officers leave the academies with hardiness levels similar to those at the start of their schooling (Atwater et al., 1999; Maddi, 2007). These schools accept men and women who they believe already have high levels of hardiness and simply put their efforts toward re-orienting students’ hardiness to the needs of the military (Atwater et al., 1999; Kelly et al., 2014). Without implementing official hardiness trainings and continuously trying to develop these qualities, military schools leave students to figure out how to cope with high levels of stress on their own (Maddi, 2007). In fact, when comparing military students’ physical, emotional, and academic stress to that of civilian college students, it is evident that military students’ self-care is inadequate with their stress management skills mirroring those of their less stressed peers (Gibson & Myers, 2006; Myers & Bechtel, 2004). Therefore, military schools negatively affect the physical health, performance, and mental health of their students by having little focus on their emotional development.
Although military students have access to counseling services, many have observed breaches of confidentiality in which other students’ superiors found out about their visit (Mengeling et al., 2014). These breaches ultimately dissuade students from seeking help in order to avoid any negative ramifications that they may experience with their own superiors. Without being taught how to appropriately cope with stressors and being given a safe space to discuss how they feel, officers are subsequently faced with high stress levels and a lack of knowledge about how to cope. Rather than initiating the conversation about mental health, creating preventative measures for when they do show signs of mental illness, and assuring students that mental illness is nothing to be ashamed of in this line of work, military schools create a deeper sense of mental illness as taboo. In conjunction with the weakness stigma, this lack of mental health education perpetuates a negative mental health stigma and inhibits officers from learning how to cope in a healthy manner.
Conclusion
Military schools have the means to be protective against mental illness and stigma. In their current state, however, they function as a risk factor by failing to properly educate officers on appropriate self-care in the military. Despite accepting students who already demonstrate high levels of grit and hardiness, military academies fail to implement specific trainings that deepen these strengths and instead push these students into experiences of high stress as a way to build resilience (Kelly et al., 2014; Maddi, 2007). This unstructured strategy leaves students to develop their own, typically unhealthy coping mechanisms for stress management, like isolating themselves from the group to avoid appearing incompetent or weak (Atwater et al., 1999; Ben-Zeev et al., 2012; Gold & Friedman, 2000). The lack of structure also eliminates the schools’ protective nature of creating social support systems, perpetuates the military’s stigma of mental illness as a sign of weakness, and forces students to develop stigmatized beliefs that inhibit them from seeking help (Gibson & Myers, 2006; Greene-ShortRidge et al., 2007; Myers & Bechtel, 2004; VanSickle et al., 2016).
Officers’ stigmatizations and lack of help-seeking behaviors have important implications since officers are expected to run military units of enlisted soldiers and foster in them a similar belief system (Wright et al., 2009). As this is one of the first explorations of specifically officers’ help-seeking behaviors, future research is needed to explore more in-depth the various factors associated with a lack of help seeking within this particular ranking. Most importantly, government and school policies should incorporate mandatory resilience, stress management, and mental illness trainings as a part of the curriculum in order to save the many military lives taken by suicide every year.
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