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Breaking the silence of MST.

"Military Sexual Trauma victims more frequently know their assailant and have to live and work with them. This creates a different dynamic and one that is not completely understood by EAPs."

Many have referred to Military Sexual Trauma (MST) as the "Silent Syndrome" because victims frequently have not reported or dealt with it directly. Yet the scars can remain for a lifetime, especially if MST is never treated openly in a supportive environment. This article is aimed at raising employee assistance professionals' awareness about MST, its existence in the workplace, as well as the EAP's role in supporting veterans and educating the workplace about their needs.

Definition of Military Sexual Trauma

Military Sexual Trauma (MST) is a term used by the Veterans Administration that refers to sexual assault or harassment that occurred during a veteran's military service. Examples of MST, which is considered "psychological trauma," include unwanted sexual contact, threatening and unwelcome sexual advances, and offensive remarks about a person's body or sexual activities. Physical force may or may not be used (Blum, 2014).

There are some major differences between sexual assault in civilian life compared to sexual assault in the military. MST victims more frequently know their assailant and have to live and work with them. This creates a different dynamic and one that is not completely understood by EAPs. This slightly new twist on a familiar concern, along with a very different culture within the military, are issues that EA professionals need to understand better and educate others to these significant differences in both symptomatology and treatment.

In addition to the victim in the military typically knowing the perpetrator, one group of military victims are young, new recruits and, if assaulted or harassed, can't just go AWOL. Victims usually have the perception that career goals will be jeopardized by disclosing MST. In addition there is often repeated, continuing exposure to the perpetrator, and given military hierarchy, the victim may be dependent upon the perpetrator in many areas of life (Knoedel, 2009).

Contextual Background

Leading U.S. companies launched the 100,000 Jobs Mission in March 2011. As the name implies, the goal was to hire 100,000 transitioning service members and military veterans by 2020. It has been documented that most returning veterans (81 %) are able to make the transition to civilian life without any difficulties.

Following a Gallup 2010 report indicating that veterans' well-being in the workplace was lower than that of other Americans, the Department of Veterans Affairs requested that a national survey of at least 100 employers, consisting of small, mid-size, and large businesses, be conducted. The study gathered information regarding these businesses' "current policies, practices, and programs regarding veterans, National Guard, and Reserve." The survey investigated businesses' experience with hiring and retaining veterans, comparisons with prior veteran populations, and understanding of mental health and related needs. Link: http://www.va.gov/vetsinworkplace/docs/Veterans_in_Workplace_Final_Report.pdf).

Some respondents to this study (Blatt, 2013) revealed that although most veterans transitioned well to the workplace, there were some incidents of negative workplace behaviors and situations, such as angry outbursts, difficulties with co-workers, interpersonal conflicts, and attendance problems. Most respondents stated that such behaviors occurred occasionally and only a few respondents reported it as happening often or almost always. Yet, interestingly, more than half of respondents (57%) of this same study did report the perception that people who had served in the armed forces as being at a higher risk for post-traumatic stress disorder (PTSD) than the general population.

Given these findings, what is the role of the EAP in supporting soldiers who are either returning to the workplace from tours in Iraq or Afghanistan or individuals entering the civilian workforce for the first time after military service? In addition, what is the role of the EAP in supporting the workplace culture to effectively integrate returning soldiers/employees into the workplace in an effective and productive manner?

Another striking finding from the Blatt study was that, despite the publicity and focus on hiring veterans, less than one-third of the respondents felt that they adequately met the needs of veterans in the workplace. In particular only 23% of the responding companies described their EAPs as specifically tailored to assist veteran employees with mental health needs. The Blatt study itself does not deal with MST but others have linked an MST experience with a high likelihood of PTSD. (Maguen et al, 2012)

Sexual assault in the military is not new. In 1991 the Tailhook scandal revealed 83 women and 7 men who said they were victims of sexual assault and harassment at a convention in Las Vegas (DoD, 1992). Fast forward to 2010, when Department of Defense (DoD) statistics indicated 108,121 veterans who screened positive for MST, of which nearly 46% were men (SAPRO, 2012). Today, the Department of Veterans Affairs (2014) reports that 1 in 4 females and 1 in 10 males in the military report one or more incidents of MST. The issue of sexual assault in the military has been a growing concern, and one that the EA field needs to proactively address.

Case Examples of MST

Michael, a Vietnam War veteran, was raped in 1974 at the Whiteman Air Force Base in Missouri a year after his graduation from high school. He describes how three servicemen waited in the dark and struck him from behind as he walked past a construction site on the base. He was knocked unconscious, beaten and sodomized.

Afraid that he would be kicked out of the military if he reported the incident to his supervisors, Michael, like many victims of MST, suffered in silence throughout his 20-year career as a communications specialist. He states that he "lived with the beast in my head for nearly 30 years before I actually told my wife and finally went for counseling." Michael had two failed marriages and attempted suicide several times (Burgess, 2013). Michael is a prime example of how the experience of Military Sexual Trauma leaves lifelong scars.

A more recent rape case occurred on the warship USS Vella Gulf, which was at sea with a crew of 260. The E4 (rank) victim testified that her attacker, an E5 (higher rank) covered a storage room with black plastic trash bags that he secured with duct tape. He encountered her just as she was getting off her shift shortly before 2 a.m. and tricked her with a story about a leak. Holding a knife to her, he threatened that if she didn't do what he said, he would chop her up and toss her body parts out to sea. He forced her down two flights of stairs into a storage room with an equipment room, where he raped and sodomized her. Then he used zip ties to shackle her hands --all the while telling her that he loved her.

She managed to escape after promising not to tell anyone, but her bunkmate suspected something was wrong and clarified the victim's story and transferred her to the medical staff. Fortunately the jury believed the victim and sentenced the offender to life in prison with the possibility of parole after 10 years. The victim has also suffered PTSD with heightened distress to environmental reminders of the crime and lives in fear for her life if the offender is ever paroled (Cahn, 2012).

EAP Role Regarding MST

EAPs need to take an active role in dealing with two specific issues regarding MST:

1) Education of EAP staff about military culture and how victims of MST may present themselves in the workplace.

2) EA professionals then have the responsibility to educate the organization and entire corporate culture about the needs of these individuals.

Supervisors, managers, HR and co-workers will continue to require education about the particular needs of returning military servicemen and women and how to best reintegrate them into their work culture. Returning soldiers have been exposed to extremely stressful and frequently traumatic circumstances, which may affect their temperament, confidence, productivity, and resiliency. EA professionals are in a perfect position to help support the entire workforce in supporting veterans 'skill sets and translating them to the current work environment.

It is also important to remember that employees returning from active military duty and experiencing difficulties from MST or other trauma may feel more comfortable seeking help from those familiar with military experience. Thus, the EAP may not be the first place they choose to reach out for assistance. It is for this reason that EAPs need to be proactive in networking with local veterans' groups to provide an array of services for returning veterans.

In addition, the EAP needs to be aware of how MST affects spouses and other family members. A certain amount of creativity may be necessary to reach extended family members to support their understanding and coping measures for the changes they observe. Again this is where various veteran projects like Wounded Warrior could be extremely helpful to a family, (http://www.woundedwarriorproject.org/)

Perhaps a larger role for the EAP is to establish initiatives within the organizational culture to educate supervisors, managers, co-workers and others who might not be familiar with military norms and practices. Helping them understand the process of returning from active duty and attempting to re-enter civilian life can facilitate effective and important support in the workplace (Thomas, 2014).

In regards to MST itself, Knoedel (2009) identifies key factors that EAPs should consider while attempting to delineate whether a veteran has experienced MST. The author describes these elements in terms of characteristics of the experience, the individual and the environment:

Characteristics of the Experience(s)

* Gender

* Developmental level at time of the event

* Prior traumatic experiences

* Single event vs. ongoing set of events

* Rape vs. sexual harassment

* Separate perpetrator vs. multiple perpetrators

Characteristics of the Individual

* Does not question authority

* Subsumes his/her emotional needs to the mission

* Is loyal and focused on teamwork

* Ignores the physical needs/ messages of his/her body

* Is strong and self-sufficient

Characteristics of the Environment

* Response of others at the time of the event

* Need to keep seeing/working with perpetrator

It is very important to understand military culture in order to correctly identify MST. Knoedel (2009) reminds us that the implicit message in basic training is that a good soldier:

* Does not question authority

* Subsumes his/her emotional needs to the mission

* Is loyal and focused on teamwork

* Ignores the physical needs/ messages of his/her body

* Is strong and self-sufficient

* Does not divulge negative information about peers

* Is "owned" by the military

Since many veterans will probably not disclose a MST event, symptoms may only surface in the guise of other behavioral problems. For example, substance use and/or abuse is often the "presenting problem". Knoedel (2009) explains that drinking alcohol is a "gender-acceptable" and military-condoned way to manage/ numb intrusive thoughts, feelings, and images of rape. The behavior creates the appearance of being "just like all the other guys". In fact, drinking facilitates aggression, re-enactment and re-victimization and may be the "identified problem" unless MST is identified during the initial screening.

Summary

Military Sexual Trauma is, as Secretary of Defense Chuck Hagel recently declared, a "clear threat" to the lives and well-being of both male and female service members (Huffington Post, 2014). As veterans returning from war enter the workplace, it is EAP's challenge to help both the individuals who experienced this trauma as well as educating the corporate culture about the needs of these employees.

As mentioned earlier, the numbers of MST cases have gradually increased since 1991 and according to DoD records have increased by 50% in the last year alone. It is crucial that EA professionals educate themselves not only about the symptoms of MST, but also the ripple effects that may take place in the workplace as a result of this experience and how it affects co-workers, family members, and general workplace functioning.

Recommendations:

1. All EA professionals should take a Military 101 course, which educates non-military individuals about military culture. Here is

a site that has several helpful related courses: www.aheconnect. com. Scroll down to the "T's" for the course on "Treating the Invisible Wounds of War".

2. EA professionals should understand and evaluate how their particular work culture will either support returning veterans or promote uncomfortable and perhaps conflicting cultural values.

3. It is important in an initial interview to inquire about military service. Paul Maiden (2014) suggests asking: Branch of Service, whether still in Active Duty or Reserve, and what was their military Occupational Specialty (MOS).

4. EA professionals need to recognize that employees presenting to the EAP most likely will not disclose an MST experience, but may present other issues related to the experience.

5. More research is needed to better understand the challenges of returning veterans and their successful reintegration into civilian life.

--Patricia Herlihy and Ann Burgess

References

Baldor, Lolita, C. (6/30/14). Military sex assault claims rise after Pentagon launches campaign urging victims to report Huffmgton Post, (http://www.huffingtonpost.com/2014/05/01/militaas-sexassault-claims-rise_n_5245090.html)

Blum, Sarah L. (2014) Women under fire: Abuse in the military. Brown Sparrow Publishing.

Burgess, Ann, Slattery, Donna and Herlihy, Patricia (2013). Military sexual trauma: A silent syndrome. Journal of Psychosocial Nursing. Vol 51.2 (21-26).

Cahn, D. (2012) Sailor guilty of rape on ship gets life in prison. The Virginian-Pilot, 12/15/12).

Competitive Edge Services, Inc. Burton Blatt Institute. (2013). Veterans in the workplace: recruitment and retention--survey of 245 Businesses nationwide. Syracuse, NY. Link:

Department of Defense, SAPRO Director Briefing 3/22/2012.

Knoedel, S. (2009) MST, William S. Middleton VA Hospital. SAPRO Presentation, November, 2009.

Maguen, S., Cohen, B., Ren, L., Bosch, J., Kimerling, R., & Seal, R. (2012). Gender differences in military sexual trauma and mental health diagnoses among Iraq and Afghanistan veterans with PTSD. Women's Health Issues. 22-1, (61-66).

Thomas, RaeAnn. (2014). Assisting returning veterans. Employee Assistance Report. Vol 17, 5 (1-3).

Patricia A. Herlihy, Ph.D., RN, is the CEO of Rocky Mountain Research. Ann W. Burgess, DNSc, FAAN, BC, is a professor of psychiatric nursing at the William F. Connell School of Nursing, Boston College.
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Title Annotation:feature article; Military sexual trauma
Author:Herlihy, Patricia A.; Burgess, Ann W.
Publication:The Journal of Employee Assistance
Geographic Code:1USA
Date:Oct 1, 2014
Words:2357
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