U.S. Army combat operational stress control throughout the deployment cycle: a case study

As military conflicts around the world persist, a comprehensive approach in managing behavioral health issues will continue to be a key component of military healthcare. Deployed military personnel frequently exposed to trauma are well-known to be at high risk for developing behavioral health disorders, including combat stress reactions and posttraumatic stress disorder. In the U.S. Army, members of combat operational stress control (COSC) units have unique skills to assist soldiers and their families not only throughout all phases of a deployment, but also throughout a soldier's entire career. The purposes of this article are twofold, first to describe the role of COSC operations with an emphasis on interventions in a deployed environment. The second purpose is to present a case study from Operation Iraqi Freedom highlighting the efficacy of the COSC approach to meet a Soldier's behavioral health needs in a deployed environment.     

The Buffering Effect of Relationships on Combat Exposure,Military Performance,and Mental Health of U.S. Military Soldiers: A Vantage Point for CFTs

This study examined the role of cumulative combat experiences with regard to military performance and conduct and mental health among a sample of young soldiers from the Army STARRS dataset (N = 5,283). Higher levels of cumulative combat experiences were directly related to poorer performance and conduct and a greater likelihood of anxiety, depression, and post-traumatic stress disorder (PTSD). Military performance and conduct served as a linking mechanism between combat experiences and mental health. Using moderated mediation structural equation modeling, relationship disruptions were found to exacerbate the adverse effects of combat experiences; conversely, unit cohesion buffered the impact of combat experiences. Implications for military helping professionals include identifying leverage points for intervention, particularly strengthening the social connections of service members within and outside the military.     

Part I. Work hardening for warriors: Occupational therapy for combat stress casualties

Combat stress is an occupational hazard of the military. Soldiers who become job-ineffective due to combat stress are termed "battle-fatigued." Occupational therapy, in the form of work hardening, is an important part of the management of these soldiers. Occupational therapists possess specialized knowledge and skills which make them uniquely qualified for this role. These assets include knowledge of neuromuscular and psychosocial aspects of occupational performance; the ability to do task analyses; the ability to assess occupational performance deficits; the ability to synthesize appropriate therapeutic occupations to rehabilitate functional deficits and match these to the needs of dysfunctional soldiers. These same resources serve occupational therapists equally well in civilian work hardening settings. This paper reviews the management of combat stress casualties, describes the Army units which minimize the impact of combat stress reactions, and delineates the Army occupational therapists' roles of soldier, mental health practitioner, and work hardening coordinator.     

Organizational processes and gender integration in operational military units: An Israel Defense Forces case study

This study examines collective action by men and women in operational military units deployed on Israel's borders. Gender integration is generally perceived by soldiers and commanders in these units as a trivial matter rather than an issue for discussion or a disadvantage. The integration results from organizational qualities, which include military leadership with accumulated experience in gender integration; division of labour between men and women that gradually develops during protracted training; screening processes within the units; and professional development of commanders. Our findings negate a large corpus of sociological literature on gender integration in military organizations. We discuss the micro‐social processes that enable or deter mixed‐gender integration in operational units. Our findings are presented as an alternative to arguments on the inevitable marginality of women in the military and that equality is neither a prerequisite of a cohesive mixed‐gender unit nor a barrier for the inclusion of women into combat units.     

Military,Masculinity, and Citizenship: Tensions and Contradictions in the Experience of Blue-Collar Soldiers

This article seeks to problematize the relationship between military service, masculinity, and citizenship, from the perspective of lower-class soldiers who serve in blue-collar roles in the Israeli military. Introducing class and ethnicity into the “taken for granted” equation of men, military, and the state reveals counter-hegemonic conceptions of masculinity and citizenship, and exposes tense and often contradictory relationships between them.

Based on in-depth interviews, I argue that blue-collar Israeli soldiers simultaneously accept and challenge the hegemonic Zionist conceptions of both masculinity and citizenship. Unlike the combat soldiers, blue-collar soldiers demonstrate gender and national identities that are not anchored in military life. Rather, these soldiers present an alternative version of “home-based masculinity,” which grants the family superiority over the military and the state. This masculinity is expressed through two recurring themes: ongoing resistance to military discipline and authority, and an emphasis on the role of the provider over the role of the soldier. Through these daily military practices, the soldiers express their rejection of the republican “principle of contribution” as a criterion to one's belonging to the collective. However, their conception of citizenship emphasizes a militant ethno-national discourse. The discrepancy between their antimilitaristic practices and their militant patriotism reflects their ambivalent socio-political location in Israeli society between their preferred location as Jews and their marginal location as Mizrachim of lower classes. These ambivalent identities reveal that a mutual affirming connection between the military, masculinity, and the state exists only for hegemonic groups. For non-hegemonic groups, the relationship between masculinity, military, and citizenship is ridden with conflicts and inner contradictions.     

Suffering in the Shadows: Interviews with Wives of Combat Veterans Suffering from Post-Traumatic Stress Disorder and/or Traumatic Brain Injury

The body of research examining issues confronting combat veterans of the Afghanistan and Iraq wars continues to grow. However, this research focuses primarily upon veterans with very less attention given to the challenges confronting their spouses. Using a semi-structured interview methodology and a feminist perspective, this study examines what it means to be a wife of a combat veteran who suffers from post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). Our findings indicate these women—who experience tremendous emotional, financial, and social challenges that arise from being the caregiver for their husbands—feel isolated from and abandoned by both the military community and the civilian community. Furthermore, the social and emotional disconnection of these women experience amplify the stresses they confront in daily life—stresses that are unique to their relationship to being with a combat veteran spouse who has PTSD and/or TBI. We argue future research should build upon this exploratory study to better understand how both the military community and the civilian community impact the subjectivity of these women and their efforts to reintegrate themselves and their families into civilian life.     

Health disparities in military veterans with PTSD: influential sociocultural factors

Health disparities based on sociocultural factors such as gender, race and ethnicity, socioeconomic status, culture, and access to health care can potentially complicate the early diagnosis and effective management of posttraumatic stress disorder (PTSD). Research indicates that among those individuals affected by health disparities, there is a greater burden of illness and disability, higher morbidity and mortality rates, and increased behavioral risk factors. The purpose of this article is to highlight the sociocultural factors that affect the development of PTSD and to publicize health disparities in military combat veterans.     

Feminism and Military Gender Practices: Israeli Women Soldiers in "Masculine" Roles

Women's military service is the focus of an ongoing controversy because of its implications for the gendered nature of citizenship. While liberal feminists endorse equal service as a venue for equal citizenship, radical feminists see women's service as a rei•cation of martial citizenship and cooperation with a hierarchical and sexist institution. These debates, however, tend to ignore the perspective of the women soldiers themselves.
This paper seeks to add to the contemporary debate on women's military service the subjective dimension of gender and national identities of women soldiers serving in "masculine" roles. I use a theory of identity practices in order to analyze the interaction between state institutions and identity construction. Based on in-depth interviews, I argue that Israeli women soldiers in "masculine" roles shape their gender identities according to the hegemonic masculinity of the combat soldier through three interrelated practices: (1) mimicry of combat soldiers' bodily and discursive practices; (2) distancing from "traditional femininity"; and (3) trivialization of sexual harassment.
These practices signify both resistance and compliance with the military dichotomized gender order. While these transgender performances subvert the hegemonic norms of masculinity and femininity, they also collaborate with the military androcentric norms. Thus, although these women soldiers individually transgress gender boundaries, they internalize the military's masculine ideology and values and learn to identify with the patriarchal order of the army and the state. This accounts for a pattern of "limited inclusion" that reaf•rms their marginalization, thus prohibiting them from developing a collective consciousness that would challenge the gendered structure of citizenship.     

Will You Die for Your Country? Workplace Death in an Era of Mass Incarceration

People with criminal records in the United States continue to face limited employment opportunities due to social stigma and legal barriers. In contrast to the civilian sector, the military conducts a “whole person” evaluation to screen potential recruits and regularly hires people with felony and misdemeanor records. Moreover, evidence suggests that the military serves as a socially integrative institution and may facilitate desistance from future crimes. However, critics argue that the military exacerbates inequalities by subjecting marginalized communities to the unequal burden of service. Using the data obtained from the Army, we examine the relative risks of combat exposure and casualties between enlisted soldiers with and without criminal records who joined between 2002 and 2009. The results suggest that soldiers with felony and misdemeanor records are more likely to be assigned to combat occupations than those without criminal records. We also find that among soldiers assigned to positions with low combat exposure, ex-offenders face a higher risk of death compared to those without criminal records. Findings do not dispute the idea that the military facilitates desistance from future crimes and provides second chances to people with criminal records, but reaffirm the fact that military service costs lives and limbs.     

The social construction of peacekeeping in America

Although other nations have participated extensively in international peacekeeping operations, the use of American soldiers as peacekeepers is a recent change in their military role, and is not well understood by American society, the U.S. Army, the soldiers, or their wives. We use a social constructionist perspective, which has rarely been applied to the study of the American military, to analyze the definition of peacekeeping missions and of the nature of the military, by soldiers assigned to peacekeeping duty, their families, and other social institutions such as communications media and churches. We suggest that, because peacekeeping is an inherently ambiguous process, this theoretical perspective may prove useful in understanding the social definition of the emerging military role of peacekeeper.     

Traumatic Stress and Affect Management in Military Families

The war-time deployment of a service member creates significant stress for the family system that supports that person’s transition into combat, combat duty, and readjustment into civilian and family life upon return. The stressors associated with the deployment cycle are significant and can lead to depression, anxiety, and behavioral concerns for all family members including the children and partners. A family’s adaptation to these stressors can also impact the functioning of the service member during the phases of mobilization, deployment, sustainment, and reintegration. Social work interventions that offer support to the military family can reduce levels of distress within and between the members and improve overall family functioning. A case vignette will be presented that highlights some of the salient interpersonal challenges that can develop in a military family when a veteran returns home with posttraumatic stress that is left untreated. Recommendations for interventions will be considered through the application of psychoeducational approaches for managing traumatic stress in families.     

“Why are you trying to destroy the last good thing men have?” Understanding resistance to women in combat jobs

This article argues that opposition to expansion of women's roles in the US military and peer armed forces, particularly into combat-related military occupational specialties, is based on defending a means of proving masculinity and preserving access to power. Research is based on policies of US, UK, and other NATO countries, public statements made by officials, academic articles, and interviews with current and former members of the US military. The article examines shifting definitions of combat, historical examples of American women’s military service, and common and persistent themes of resistance to women in combat roles. The article argues that resistance to women in combat roles is not only inconsistent with operational realities, but is both counterproductive to mission effectiveness, and may even put lives at risk. The article concludes that in an ever-shifting security environment requiring critical thinking, cross-cultural communication, and civil–military collaboration, rethinking gender roles may be advantageous.     

Viewing psychopathology through a trauma lens

Many symptoms and behaviors associated with a range of psychiatric disorders, including those not designated as trauma- or stressor-related, result from unprocessed and unintegrated traumatic experiences, requiring therapeutic assessments and interventions that consider the complex dynamics brought on by trauma. While the focus on symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM) may lead practitioners away from a consideration of etiology when choosing interventions, the exclusions of “disorders of extreme stress not otherwise specified” in DSM-IV and “developmental trauma disorder” from DSM-5 may further predispose practitioners to disregard traumatic etiology and symptoms when assessing, diagnosing, and treating clients. Because a majority of recipients of public mental health services suffer deleterious effects from trauma exposure, social work and other mental health professionals have an ethical responsibility to incorporate trauma-based screenings, assessments, and interventions with clients. Thus, trauma-informed evaluation and treatment approaches must be included in graduate curricula, practitioners must seek continuing education to supplement their knowledge and practice skills, and agency administrators must provide inservice training to professional staff.     

Not Just about Posttraumatic Stress Disorder: A Call for Military-Centric Social Work

Most warriors do not get PTSD but can still be affected by war. The “military gestalt,” defined as the complex myriad of “all things military” including the functions, processes, and human elements related to combat, is seriously impacted by the warrior-in-combat construct that is reflective of the person-in-environment construct. Thus, it suggests that problems within the gestalt can be understood and addressed from a military-centric social work perspective and approach. The situation is so insidious that it requires a call to action from all disciplines but, most important, for the social work profession to take the lead.     

The Effect of 21st Century Military Service on Civilian Labor and Educational Outcomes

I estimate the effect of military service during the Afghanistan and Iraq wars on civilian labor and educational outcomes using several empirical methodologies including sibling fixed effects and propensity score matching. Since military occupations and training have changed significantly in the past few decades, these effects may be different than those found in previous studies on veterans of earlier theaters. I find that veteran status increases civilian wages by approximately ten percent for minorities but has little or no effect on whites in this regard. Veterans of all demographic groups are found to be equally employable and equally as satisfied with their civilian occupation as non-veterans. For females and minorities, veteran status substantially increases the likelihood one attempts college. These veterans are found to be more apt to pursue and obtain a two year (associate’s) degree instead of a four year (bachelor’s) degree. Lastly, I find mixed evidence that veteran status increases the likelihood of public sector employment.     

Talking as a primary method of peer defusing for military personnel exposed to combat trauma

1. Humanitarian relief missions and military operations are unquestionably stressful and clearly have potential to affect the mental health of soldiers. 2. After being exposed to traumatic events, soldiers may develop acute stress reactions, a historically known phenomenon better recognized and understood today. 3. Although organized resources exist, they may not be accessible or appropriate. Soldiers are the most precious asset the military forces have and their peers may be the best and only resource available to them. 4. The need to ventilate and the relief that follows after talking about distressing events are evidence that defusing by talking should be encouraged after exposure to a traumatic event.     

The Things They Carry: Combat, Disability and Unemployment among US Men

Sociologists have long recognized that historical events, such as wars, depressions, and natural disasters, can affect the trajectories of people's lives and can reproduce or alter social structure. The following paper examines the effect of a type of event, war, on a facet of people's lives, their ability to work. It uses data from the Panel Study of Income Dynamics to test three accounts regarding how wars affect men's lives. The direct cumulative disadvantage account sees wars as negatively affecting the service-men who see combat regardless of their pre-combat characteristics. The moderated cumulative disadvantage account suggests that combat most negatively affects those who, before they fought, had lower status. The turning point account suggests the reverse: combat most negatively affects those who, before they fought, had greater status. The evidence suggests that, with regard to disability and unemployment, the effects of combat are most consistent with the direct cumulative disadvantage account.     

COMBAT EXPOSURE,CIGARETTE CONSUMPTION,AND SUBSTANCE USE

This study estimates the relationship between combat exposure and several risky health behaviors: cigarette consumption, binge drinking, and drug use. We find that the U.S. active duty military personnel deployed to combat zones with enemy firefight are more likely to subsequently smoke cigarettes, consume alcohol, and use illicit drugs than their counterparts deployed to noncombat operations. Our results suggest that the mental health effects of combat can explain up to two‐thirds of the estimated association between combat exposure and risky health behaviors. (JEL H56, I12)     

21st Century American Military Families: A Review in the Context of the Wars in Afghanistan and Iraq

This article has three interrelated objectives designed to highlight military family studies in the context of the wars in Afghanistan and Iraq. Often referred to collectively as “the war on terror,” Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom represent the most comprehensive wars fought with an all‐volunteer force since the nation's independence. I review the literature on American military families with an emphasis on the challenges facing military families during these operations. First I provide coverage of issues specific to military marriages and then address the research on children of military families. The article ends with an argument for scholars to take a more integrated approach to the study of military families that would help break down the current state of family scholarship and military family scholarship as parallel lines of inquiry.     

Evaluating homelessness – a comparative analysis of top 10 articles from the US and Europe

Homelessness as a political and social dominion has a number of features that make it particularly difficult to tackle. In addition to being a wicked problem, homelessness offers several analytical avenues. How do these characteristics affect the evaluation of programmes and projects aspiring to combat homelessness? Dissimilar pictures and solutions regarding homelessness in the US and in European countries will likely affect recommendations given as a result of evaluations performed. For this study, the empirical base is a sample of the most cited evaluations of homelessness programmes published in professional journals between 1996 and 2010. Most of these evaluations are from the US. These US evaluations more often use large-scale national programmes and quantitative methods, whereas European evaluations more often have smaller sample sizes and qualitative methods. In both regions, the evaluators seldom use theory from social science when analysing their findings. It is suggested that European evaluation research should be noticed to a larger extent since it is probably better suited for application in a European context.