WomenVeterans with PTSD
WomenVeterans with PTSD
Providingclients of diverse cultural backgrounds with ethical and responsivetreatment is an expectation and an agreed upon goal in the field ofpsychology for all practicing psychologists. The AmericanPsychological Association (2002) has this provision in its ethicscode to ensure that psychologists have some guidelines to observe intheir practice (Gallardo,Johnson, Parham, & Carter,2009). It is of paramount importance that practitioners integrateculturally responsive practices with more traditional psychotherapymodels in their repertoire, especially in an ever-changing and highlydiversifying population (Gallardo et al., 2009). As such,conceptualization of culture and culturally responsive practice needsto be reconsidered by all practitioners if they are to meet the needsof diverse clients (Gallardo et al., 2009). According to the AmericanPsychological Association (2002), people often group themselves andtend to be grouped in terms of in-groups and out-groups. Therelationship among members of an in-group is that of interdependenceand support for each other. There is preference for collaboration asopposed to competition, something they often engage in with membersof out-groups (Gallardo et al., 2009). Every other person in thesociety belongs to some kind of an in-group and psychologicalpractitioners are not exempted American Psychological Association,20002). Practitioners in the field of psychology have noted thegrouping of individuals in the society and there are subspecialtiesin the field of psychology to study the various groups (AmericanPsychological Association, 20002). That is why fields such asmulticultural psychology exist, specifically to handle multiculturalaffiliations in the society.
Theunderstanding and acknowledgment of multicultural affiliations anddifferences in the society are what psychologists are being calledupon to do if they are to remain useful to today’s clients. Thefemale veterans with PTSD population is one of the multiculturalpopulations in the U.S. that psychologists have to deal with everyday (American Psychological Association, 20002). Female veteranscomprise of people from all cultures in the U.S., includingAsian/Pacific Islanders, Hispanics, African-Americans and whiteAmericans, which makes it one of the most culturally diversein-group inthe country American Psychological Association, 20002). Being sodiverse, it calls for a thorough understanding of the sharedworldviews and other factors that unite this population in order tobe able to diagnose, treat, and manage PTSD among individual members(American Psychological Association, 20002). In this paper, I willdiscuss the unique background of women veterans with PTSD and whatpsychologists need to do in order to handle this population optimallyAmerican Psychological Association, 20002).
CulturalMores and Norms Worldview
Accordingto Hawk (2012), a traumatic event is one in which an individualexperiences or witnesses an event that poses the possibility of oractual death or serious injury to oneself or that of other people(Hawk, 2012). Therefore, the individual in question reacts to theincident with great fear, horror, or helplessness. The diagnosis ofPTSD usually requires the aforementioned conditions to prevail (Hawk,2012). Veterans are differentiated from the general populationbecause of the exposure they have had to combat during their servicetime. Exposure to combat and other traumatic military experiencesresult in adverse outcomes as far as mental health is concerned. Therisk of PTSD among veterans is increased by combat-relatedexperiences and stress (Hawk, 2012). Research indicates that theprevalence of PTSD is highest among service personnel who haveexperienced some kind of atrocity (Hawk, 2012). ).
Thecombat-related atrocities may range from being involved in afirefight and killing an enemy to witnessing the death of a fellowsoldier (Hawk, 2012). Women veterans are exposed to and are at thesame risk of experiencing PTSD as their male counterparts accordingto recent research (U.S Department of Veterans Affairs, 2015). Womenwho return from the war zones have a hard time reintegrating into themainstream society and moving on with their lives as the generalpopulation (U.S Department of Veterans Affairs, 2015). Afterabandoning service ranks, the long journey of returning home beginsand it is usually not an easy one. Women veterans are often facedwith employment, housing, financial, and health care problems amongother issues in their attempt to abandon the military culture and fitinto the general population (Villagran, Ledford & Canzona, 2015).They need to maintain a good financial status, optimal health andothers need to care for or start a family (U.S Department of VeteransAffairs, 2015). However, the experiences that these veterans comehome with from the military never go away. Both the good and badcultures persist throughout and after the transition period(Villagran, Ledford & Canzona, 2015). Traumatic experiences suchas sexual assault and military atrocities leave a permanent imprintinto their beings that sometimes never go away forever (Villagran,Ledford & Canzona, 2015). Various departments in the UnitedStates, including the Department of Defense, the Department ofVeteran Affairs and the Department of Labor all embark on the journeyof returning and resettling women veterans inthesocietythrough various programs (Villagran, Ledford & Canzona, 2015).These programs give women veterans more recognition in the country,allowing them to receive full benefits that their male counterpartsreceive (Villagran, Ledford & Canzona, 2015).
Womenveterans with PTSD have a very different worldview from that of thegeneral population (Villagran, Ledford & Canzona, 2015). Theirexperiences in the military place them in a unique place in thesociety. According to research by the Department of Veteran Affairs,(Murphy & Hans, 2014), women have a harder time transitioninginto civilian life. The evidence of these statistics lies in the highunemployment rates forcertain groups of women veterans,including those with PTSD and the older women veterans (Villagran,Ledford & Canzona, 2015). There are twice as many women veteranswho are homeless compared to their non-veteran counterparts (Murphy &Hans, 2014). The same research paper by the Department of VeteranAffairs indicates that women veterans are more likely to get or bemarried, but they are also more likely to get divorced compared tothe women in the general population (Murphy & Hans, 2014). Thisplaces women veteran in a unique position, where they relive theirlives in service even after they return home (Murphy & Hans,2014).
MulticulturalConcerns and Therapeutic Needs
Treatingwomen veterans with PTSD can be a complicated issue that requires thepsychologist to understand all the factors that come into play in theprocess of doing so. According to Hooyer (2015), feelings of rage,guilt, alienation, grief, and mistrust are completely normal amongveterans given the abnormal experiences that the military imposes onthem (Murphy & Hans, 2014). As opposed to what medical expertsclaim to be PTSD, mental health providers, military commanders, andveterans themselves view these feelings as completely normal. Infact, the feelings are being discarded by the aforementioned groupsof people as the main causes for the increased suicide among veteransin the U.S (Hooyer, 2015). The increase in suicide rates amongveterans, in turn, is attributed to self-stigma of the veterans andthe labeling of veterans by medical practitioners and the public(Murphy & Hans, 2014). The self-stigma and labeling with PTSD islargely the main cause why veterans do not seek medical treatment forPTSD. Instead, they would rather stay in isolation and seek otherways of solving their problems rather than seeking the help ofmedical practitioners who end up labeling them as having PTSD(Hooyer, 2015). As such, most women veterans fail to identify withthe professional medical system that is proposed in the United Statesas being the solution to their supposed PTSD problem (Hoyer, 2015).That is not the only problem that psychologists are faced with whenhandling women veterans with PTSD (Hooyer, 2015).
AsI mentioned earlier, women veteran with PTSD is a diverse populationthat is comprised of all the ethnic groups in the United States(Hooyer, 2015). That makes it one of the most multicultural groups inthe US. In the same way, the pool of psychologists that attend towomen veterans with PTSD is also a culturally diverse group. Both theveterans and psychologists belong to individual in-groups within thewider groups of veterans and psychology experts (Hooyer, 2015). Someof these in-groups coincide in that psychologists and veterans belongto the same in-group such as African Americans, Hispanics, white, andPacific Islanders (Hoyer, 2015). The idea of belonging to the samein-group has always raised the concern of prejudice and favoritism inthe dispensation of psychological care to patients. The AmericanPsychological Association (2002) recognizes this possibility andproposes various solutions for it. Even with practitioners who claimto hold egalitarian views about the way they conduct their work,automatic biases and stereotypic attitudes towards members ofout-groups seem to happen at a subconscious level without theirknowledge (Hooyer, 2015). It is more of an automatic response thatthe egalitarian psychologist may not be aware of (AmericanPsychological Association, 2002).
Eventhough times have changed, psychologists should understand that notall women veterans understand what their rights are and what benefitsthe country has made available for them (American PsychologicalAssociation, 2002). The women need to be educated and informed onwhat they have a right to. Bureaucratization continues to be aproblem that scares many veterans away from accessing medicaltreatment they need, especially with the changes in focus frompolitics in the country (American Psychological Association, 2002).Besides, there exists a disparity between the access that white andother minority groups have to mental health services. According tothe American Psychological Association (2002), more white veteranshave access to mental health services compared to members of minoritygroups, something that has often resulted in failure to seek medicalattention by such members of those groups. Because of this variancein how women veterans with PTSD access mental health services,diagnosis and treatment of the condition may differ among the variousgroups (American Psychological Association, 2002). White women aremore likely to seek help, leading to early diagnosis and bettertreatment chances of the condition as opposed to women from theminority groups (American Psychological Association, 2002).
Thereis also a major cultural difference between white women and AsianIslanders in that white women prefer to be independent and ambitious,while Asian Islanders prefer sticking to their respective groups(Cohen, 2009). The result of this cultural difference is that whitewomen may seek help for PTSD from medical practitioners when theyexperience symptoms of the condition (Cohen, 2009). They takeresponsibility for their health and seek medical health to know howto combat the situation. This is opposed to Asian Islander women whoprefer interdependence and relying on their respective in-groups forhelp (Cohen, 2009). They will share their problems with the membersof the in-groups first and whether or not they seek medical help maybe dependent on what those members advice (Cohen, 2009). In somecases, Asian Islander women may end up seeking alternative medicationupon receiving the advice of members of their respective in-groups(Cohen, 2009). African American women, on the other hand, preferappearing strong and enduring. They are likely to endure the symptomsof PTSD and appear like nothing is wrong with them amidst theirsuffering. This is evident in the number of African American womenthat seek medical treatment for PTSD (Cohen, 2009). Even though otherfactors such as lower access to mental health services contribute,African-American women are also more reluctant to seek medicaltreatment for PTSD in comparison to their white counterparts (Cohen,2009). These cultural differences need to be kept in mind bypsychologists when treating members of the various ethnic groups inorder to achieve good results in providing care (Cohen, 2009).
Thenumber of psychologists in regard to distribution among the variousethnic groups in the country is also very biased. In fact, accordingto the report made by the American Psychology Association (2002), thenumbers were too small to be represented in any meaningful way. Theprofession is dominated by white women, a factor that contributes tothe huge disparity in access to mental health services among thevarious ethnic groups (Cohen, 2009). The lack of trust andmaintenance of stereotypical attitudes makes it harder for minoritygroups to access mental health services if they know that they willbe served by white practitioners (Cohen, 2009).
Additionalfactors a psychologist should keep in mind when working with womenveterans with PTSD
LikeI have stated above, veterans alienate themselves and feel alienatedfrom the society. According to Hoyer (2015), the society is massivelyinvolved in alienating and labeling veterans with PTSD. The politicalrealm is all about how to save soldiers who return home damaged withpsychological baggage that they cannot handle (Cohen, 2009). Thiskind of labeling scares women veterans away and makes them not toseek the help they need. With that in mind, psychologists need to becareful with their choice of words to use when talking to thispopulation of Americans. The veterans should not be made to feel likethey are being labeled as mentally weak or similar expressions(Cohen, 2009). They need to be shown support and appreciation for theservices they rendered to the country. According to Hoyer (2015),psychologists should maintain open minds when dealing with womenveterans as a way of encouraging them to open up during therapysessions and to make them feel encouraged to continue coming for morehelp (Hoyer, 2015). Since some of the women veterans still do notunderstand the kind of rights and benefits they are entitled to, itis upon psychologists to spell out the various treatment options theyhave access to (Hoyer, 2015). The veterans should be allowed tochoose whichever treatment option they feel is most suitable forthem. Allowing women veterans a chance to choose from varioustreatment options creates confidence and trust in the treatmentitself and the practitioner (Hoyer, 2015).
Veteransoften fear that PTSD treatment erases the memory that they have aboutcombat in the military (Hoyer, 2015). In erasing those memories, theyfeel like they also lose memories of lost comrades in the military(Hoyer, 2015). Military service men and women maintain a culture ofloyalty to each other and they prefer carrying memories of fallencomrades with them (Hoyer, 2015). It would require a lot of guidanceand counseling to make them understand that the eradication of thosememories is for their well-being. Most of them will resist fiercelyhaving their memories eradicated because of the loyalty culture inthe military (Hoyer, 2015). The military is a complicated professionand the experiences soldiers go through are not like any other. Forthat reason, veterans have it rough erasing the memories of what theywent through with their comrades (Hoyer, 2015). It would be similarto not having been in the military at all, and not every veteranwould like that to be done to them (Hoyer, 2015). It is a way ofdishonoring the sacrifice made by the soldiers. Veterans consider thediagnostic procedures as a way of toying with their lives.Conversations that Hoyer (2002) covered in their journal give a clearpicture of what veterans feel about the diagnosis process (Hooyer,2002). Whereas it is a matter of the whole lives of the veterans, topsychologists, it is a simple diagnosis that does not hold muchmeaning to their lives (Hooyer, 2002). This feeling can be a majorsource of contention and psychologists need to understand how to goabout it (Hooyer, 2002).
Anotherimportant factor for psychologists to pay attention to is thepossibility of recurrence of PTSD after treatment (Sholer, 2012).After discharge from a veterans inpatient facility, veterans areassigned to reintegration programs to help them fit into the society(Sholer, 2012). Follow-up programs are also in place to ensure thatveterans have the best care after being discharged. However,statistics show that many women veterans relapse into the conditiondue to societal pressures that they have to cope up with (Sholer,2012). Difficulty securing employment, domestic violence, lack ofproper housing, poverty and several other factors push femaleveterans into depression, causing PTSD to set in again (Sholer,2012). Some of them opt for stress relievers such as drugs andalcohol, which push them to a more desperate situation (Sholer,2012). Psychologists in charge of watching veterans on follow-upprograms need to be proactive in their approach to their job (Sholer,2012). They need to take charge of their clients’ lives and ensurethat they do not relapse. This task is likely to be hard, especiallybecause the clients can be hard to deal with. Clients who have a hardtime securing employment, finding a house or staying away from drugsare likely to cause more trouble to the psychologist (Sholer, 2012).
Inconclusion, women veterans with PTSD is a unique population in theUnited States that requires special treatment (Sholer, 2012). Womenhave been determined to be at the same risk of suffering from PTSD astheir male counterparts even though the number of female veterans isone of the highest rising right now. Many women are being dischargedfrom the military today than any other time in the history, whichleads to an influx of a new generation of women veterans every year(Sholer, 2012). With these come a number of problems associated withsettling back into the society after several years of being ondeployment around the world. PTSD among female veterans isparticularly a major concern for psychologists given the high levelof diversity in that population (Sholer, 2012). Several factors comeinto play which require psychologists to have a thorough knowledge ofhow to handle these clients in order to be effective (Sholer, 2012).
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