Military Sexual Trauma

Overview

The Veteran’s Association (VA) defines Military Sexual Trauma as “sexual assault
and repeated, threatening sexual harassment occurring during military service” (Hyun, et Al., 2009). This term was invented by and specific to the Veteran Health Administration (VHA) and the populations it serves.  According to a 2003 screening conducted by the VHA, the recorded prevalence of MST was 21.5% among active duty women, and 1.1% among men.

Though sexual assault in the military is not a strictly contemporary problem, significant research and public awareness of MST did not gain traction until the early 90’s. This was informed by a series of high-profile cases, one of the most notable being the 1991 “Tailhook Scandal” in which over 100 commissioned officers from the Navy and Marine Corps were accused of assaulting nearly 100 men and women at the Tailhook Association Symposium in Las Vegas, Nevada (Sughrue, 2013).

The classification of MST as a discrete condition represents a movement within the military an Veterans Association to adequately address incidents of military sexual assault and provide assistance to victims. Efforts include improved diagnostic measures, universal screening protocol, free healthcare for victims, and condition-specific treatment measures (Hyun et Al., 2009). This has precipitated changes both within the VA healthcare system as well in active duty army protocol. For example, some components of the Sexual Harassment/Assault Response and Prevention Program (SHARP) implemented by the Army mandated sexual assault and intervention training, improved anonymous reporting measures, and aims to promote the elimination of victim-blaming climates (Eur.army.mil, 2018).

History of MST

The VA definition of MST was adapted from Title 38 U.S. Code 1720D, and is “psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training” (Ptsd.va.gov, 2018). Situational components defining these events are the presence of coercion, force, threats of negative consequence, and general lack of consent. The location of the assault has no bearing on MST classification- nor does whether or not the individual was on duty when it occurred. This definition includes but is not limited to the acts of rape, unwanted physical touching or grabbing, unwanted verbal contact of a sexual nature, and threatening or unwelcome sexual advances (Ptsd.va.gov, 2018).

Risk Factors and Consequences

Risk factors for MST include younger age of enlistment, those with a history of childhood sexual trauma, enlisted ranking, and not having a college degree (Suris & Lind, 2008). Women victims of MST frequently present severe mental and physical health consequences. When controlled for current and past health history, these women were more likely to have experienced a heart attack within the last year (Frayne et Al., 1999).  Other correlates include PTDS, sleep disorders, depression, gastrointestinal symptoms, headaches, and chronic fatigue (Suris & Lind, 2008) (Kelly et Al., 2011).

A Comparison of Military & Civilian Contexts

Surveys conducted by the VA indicate that 1 in 4 women and 1 in 100 men self-reported “yes” when asked by a VA healthcare provider if they had ever experienced MST. As of 2017, women comprised 14.6% of active duty soldiers (Statistic Brain, 2017). In spite of this fact, the total number of men treated for MST is still below women. This highlights the disparity between its prevalence with women, and the corresponding disproportionately low report rate in men. However, the actual prevalence of MST reporting in former soldiers is significantly higher. When surveyed, 60% of women and 27.2% of men reservists revealed having experienced “repeated or severe sexual harassment” while in the military (Street et Al., 2008). There lies an important distinction between the number of soldiers reporting assault while enlisted versus former soldiers acknowledging past trauma. Reporting incidents while in active duty is correlated with worse health, job, and psychological outcomes (Bergman et Al., 2002). Another factor influencing report rates comes from the perspective that the armed forces serves as an employer of the victims, and MST and its acknowledgement poses a significant threat to workplace safety (Kimerling e Al., 2007). Furthermore, the average perpetrator-victim relationship within the military differ greatly from civilian contexts (Suris & Lind, 2008). These structural barriers within the military which prevent victims from seeking help are areas of concern which recent reporting procedures attempt to address.

As of 2016, 1.2 per 1000 individuals in the US were victims of sexual assault and rape (Morgan & Kena, 2016). Adult Sexual Assault (ASA) is reported in the civilian population at approximately 22% in women and 3.8% in men. 11% of women report completed rape (Fisher et Al., 2000). While the rates for women is relatively consistent in and outside of the military, civilian men are reporting sexual assault at nearly 4x the rate. This may evidence how the sociocultural climate of the military and according gender scripts may serve as a barrier for men MST victims to seek help. Unlike their civilian counterparts, victim and non-victim service men and women do not utilize health services at a significantly higher rate (Suris & Lind, 2008).

Treatment and Prevention Efforts

In response to the high prevalence of military sexual assault, the VHA instituted a universal screening protocol. One of the greatest structural changes has been the allocation of resources to MST victims regardless of service-connected disability ratings or qualification for any other VA health services. Treatment does not require evidence of assault- it is based simply on self-report. All mental health providers also receive MST specific training (Ptsd.va.gov, 2018). Service men or women who screen positive for MST are offered free treatment to any physical, psychological, or otherwise manifesting consequences of MST. This response represents the greatest effort undertaken by any major US healthcare system to address medical issues associated with sexual violence (Kimerling et Al., 2007). Studies analyzing populations who screened positive for MST indicated that such individuals present comorbid mental conditions with 2 to 3 times greater odds, in particular Post Traumatic Stress Disorder (PTSD), other anxiety disorders, and substance abuse disorders (Kimerling et Al., 2010). VA facilities are now staffed with at least one MST coordinator who is responsible for connecting veterans with relevant VA services, benefits information, and community resources.

MST provides a basis for individuals to seek monetary disability compensation from the VA. The VHA also offers a variety of outpatient, inpatient, and residential services. While one cannot receive compensation for MST itself, its frequent comorbidity with other mental and physical disorders make it easier for veterans to the prove service-connection of their conditions. Standards for MST determination have been expanded and made less stringent. Some markers include substance abuse, decreased work performance, sexual dysfunction, and evidence of past incident reporting (Benefits.va.gov, 2016). Servicemembers who previously had PTSD claims denied are offered the opportunity to re-submit their applications and reexamine their condition by presenting associated markers of MST.

Controversy/Perspectives

In 2012, a documentary titled The Invisible War investigated personal accounts of survivors of military sexual assault. This sparked a significant structural change ordered by Secretary of Defense Leon Panetta- that cases of sexual assault would no longer be handled by the units in which they occurred, but rather by higher ranking commissioned officers. This additionally increased investigative measures and instituted changes such as the documentation of sexual assault related disciplinary outcomes, enhancing training programs for current servicemembers, and a mandatory briefing on sexual assault policies to soldiers within the first two weeks of their enlistment (Archive.defense.gov, 2012).

Some of the greatest areas of contention have been the difference in diagnostic measures for sexual assault between civilian populations and the armed forces, the lack of a standardized definition across the VHA and military, differing reporting standards and prevention efforts across military branches, and inclusion criteria for studies on MST and associated comorbid conditions (Bergman, 2002). Fundamentally, the lack of cohesion between civilian, VA, and military authorities has made the documentation and research of MST prevalence inconsistent between sources.

A consistent barrier to MSA reform has been dispute about false-reporting. This has been particularly applicable when false-reporting has been studied in civilian contexts and results have been hypothesized as relevant to the prevalence in the military (Lisak et Al. 2010). Over a 10 year period, Northeastern University reported an estimated 5.9% false-report rate of all sexual assault allegations. Changes made to the definition of assault in order to encompass the wide range of its manifestations has been criticized as too general.

Additionally, one area which has failed to be adequately addressed is the disproportionate rates of MST in non cis-gendered or heterosexual servicemembers. There has been a call to implement prevention measures to protect against the harassment and sexual assault of lesbian and gay men within the military. This has been attributed to the legacy of “Don’t Ask Don’t Tell” and its ostracization of victimization of LGBT servicemembers. There still lacks standardized policy as to how to address this subset of sexual harassment, and little effort made on behalf of the armed forces to isolate these incidences and protect this particularly vulnerable population (Burks, 2011). Contemporary discourse has tied the victimization of LGBT soldiers  to the issue of whether or not the military should be fiscally responsible for gender reassignment surgery or hormone therapy of active duty soldiers, and its implications of decreasing vulnerability

Relation to Politics of Health

MST’s greatest connection to Politics of Health is through the concept of Biopower. As a total institution, the military exercises control over servicemember’s bodies, actions, and ultimately their right to life. The institution’s classification of MST and deservedness of care, and victim recognition are a manifestation of biopower, as is the corresponding adjudication and disciplinary procedures. Increased healthcare access and rights of victims may offer an illusion of unity, but obscure the fact of how these procedures align with and promote the objectives of the institution. As noted, these measures have been instituted in response to public backlash and awareness, rather than prevalence. As noted, rates of MST have not seen a drastic increase over a considerable period of time. On the contrary, the public has empowered individuals to act in resistance of control over their bodies which has forced regulation to change. An underlying tenant of these changes is the desire to maintain power- whether that be over servicemembers actions or public reception. This is further elucidated by the notable historical absence of subjectivity and voice of victims in MST investigation. While there has been a greater allocation of resources, there have not been promotions of victim empowerment. As these individuals function as agents of the institution, their wellbeing is subject to recognition of the institution as well as the actions taken upon them by other agents. The control the military chooses to exercise over their soldiers, for example, prevention efforts, has the ability to directly influence violence to and subjugation of bodies. The freedom individuals have to seek protective measures are still dictated by the institution, which ultimately has the power to exercise control over their bodies.

 

Sources

 

Archive.defense.gov. (2012). Defense.gov News Article: Panetta, Dempsey Announce Initiatives to Stop Sexual Assault. [online] Available at: http://archive.defense.gov/news/newsarticle.aspx?id=67954 [Accessed 4 May 2018].

 

Benefits.va.gov. (2016). DISABILITY COMPENSATION FOR CONDITIONS RELATED TO MILITARY SEXUAL TRAUMA (MST). [online] Available at: https://www.benefits.va.gov/BENEFITS/factsheets/serviceconnected/MST.pdf.

 

Bergman, M., Langhout, R., Palmieri, P., Cortina, L. and Fitzgerald, L. (2002). The (un)reasonableness of reporting: Antecedents and consequences of reporting sexual harassment. Journal of Applied Psychology, 87(2), pp.230-242.

 

Burks, D. J. (2011). Lesbian, gay, and bisexual victimization in the military: An unintended consequence of “Don’t Ask, Don’t Tell”? American Psychologist, 66(7), 604-613.

 

Eur.army.mil. (2018). Sexual Harassment/Assault Response and Prevention | U.S. Army in Europe. [online] Available at: http://www.eur.army.mil/SHARP/.

 

Fisher, B. S., Cullen, F. T., & Turner, M. G. (2000). The sexual victimization of college women. Retrieved from http://www.ojp.usdoj.gov/bjs/pub/ascii/svcw.txt

http://dx.doi.org/10.1037/a0024609

https://www.statisticbrain.com/women-in-the-military-statistics/

 

K.C. Basile, J. Chen, M.C. Black, L.E.Saltzman. Prevalence and characteristics of sexual violence victimization among U.S. adults, 2001–2003

 

Lisak, D., Gardinier, L., Nicksa, S. and Cote, A. (2010). False Allegations of Sexual Assault: An Analysis of Ten Years of Reported Cases. Violence Against Women, 16(12), pp.1318-1334.

 

Morgan, R. and Kena, G. (2016). Criminal Victimization, 2016. [online] Bureau of Justice Statistics. Available at: https://www.bjs.gov/content/pub/pdf/cv16.pdf.

 

Ptsd.va.gov. (2018). Military Sexual Trauma – PTSD: National Center for PTSD. [online] Available at: https://www.ptsd.va.gov/public/types/violence/military-sexual-trauma-general.asp.

 

Sapr.mil. (2018). SEXUAL ASSAULT AWARENESS AND PREVENTION MONTH. [online] Available at: http://www.sapr.mil/index.php/saapm.

 

Street, A. E., Gradus, J. L., Stafford, J., & Kelly, K. (2007). Gender differences in experiences of sexual harassment: Data from a male-dominated environment. Journal of Consulting and Clinical Psychology, 75, 464-474.

 

Sughrue, Karen. (2013). “The Legacy of Tailhook”. Retro Report. Retrieved from: https://www.retroreport.org/video/the-legacy-of-tailhook/

 

Suris, A. and Lind, L. (2008). Military Sexual Trauma. Trauma, Violence, & Abuse, 9(4), pp.250-269.

 

Susan M. Frayne, Katherine M. Skinner, Lisa M. Sullivan, Tara J. Tripp, Cheryl S. Hankin, Nancy R. Kressin, and Donald R. Miller.Journal of Women’s Health & Gender-Based Medicine.Jul 1999.ahead of printhttp://doi.org.proxy.library.vanderbilt.edu/10.1089/152460999319156

 

Ursula A. Kelly, Kelly Skelton, Meghna Patel, Bekh Bradley. More than military sexual trauma: Interpersonal violence, PTSD, and mental health in women veterans. Research in Nursing & Health, 34 (2011), pp. 457-467

 

Violence and Victims, 22 (2007), pp. 437-448

 

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