One of the most insidious and commonly repeated tropes about mental illness is that people can bootstrap their way out of it; they just need to ‘try harder’ and ‘stop moaning’ and they’ll magically get better, even if this defies all known knowledge of neurochemistry, human emotion, and psychiatry. There’s tremendous pressure on people with mental illness to ‘snap out of it’ and a common belief that we will do so if we want to…so obviously, if we’re still mentally ill, we don’t want to get better.
The military has been struggling for some time with a growing suicide rate among veterans and soldiers, along with general mental health problems in the military community. Stress of participating in extended military conflict tends to put people at risk of, or exacerbate, mental health conditions. While aware of this, the military hasn’t figured out an effective way to deal with it. Perhaps because the most effective way to deal with it is to take soldiers out of combat, which isn’t being presented as a viable option.
Trying to find a way to address the rising rates of mental health problems, and the negative public associations that come along with it, the military has cast about for a variety of solutions. The latest is a real doozy. Welcome the Comprehensive Soldier Fitness Programme, which aims to change everything for military mental health both by assessing soldiers more fully when they join the military and providing them with discussions about mental health issues as part of their training.
In theory, this might seem like a good idea, but of course the execution is something very, very different. It’s boostrapping supreme, as the poster child of the programme illustrates, and before we go on, be advised that this article, and what I am about to quote, have a strong content warning for rape.
Brig. Gen. Rhonda Cornum found out what combat stress was in the back of a pickup during the first Gulf War in 1991 when one of her Iraqi captors unzipped her flight suit and, as she lay there with two broken arms and an injured eye, sexually assaulted her.
The reed-thin Army physician, whose Black Hawk helicopter had been shot down, became a symbol of everything America was worried about in sending women to war. Her successful return home — sane and not that much the worse for her ordeal — became a powerful argument for the irrelevance of gender in conditions of indiscriminate violence.
…The most important of them she learned as a prisoner, she said, “is Put It in Perspective: PIP” — understanding that although a situation might be bad, it could be worse.
She argues that her ability to survive the experience was the result of preexisting ‘mental strength,’ effectively, and the military seems to agree, pointing out that 80% of soldiers weather combat well, suggesting that the remaining 20% must just have flawed personalities or something, apparently. Brig. Gen. Cornum is traveling through the military as part of the program, providing instruction and mentoring to soldiers, but it’s raising, for me, rather a lot of questions. Like whether it’s really an awesome thing to have a rape victim telling people to put it in perspective, given the huge number of sexual assaults in the military, and the fact that some of the women she may be talking to are probably also rape victims, who may not have returned from it as successfully as she did.
There’s something deeply upsetting about women who are put forward as role models because of ‘strength’ when ‘strength’ involves responding to something like rape in a socially approved way. Her story is about how tough she is, how resilient she is, how she’s bounced back, and how you can too, unless you’re a total weakling. Other women in the military also have more complex, less cut and dried, situations when it comes to their rapes; because they are being raped by fellow soldiers, by officers, they are being raped in nebulous and difficult situations. They are being denied abortion services and told they’re lying and being reminded that they could ruin careers by speaking out. They are not brave captives who survived an ordeal: They are trying to survive an ordeal right now.
Because what’s being implied by this and other aspects of the programme is that normal reactions to trauma are actually signs of weakness and something wrong with you. It argues that many people come back from war ‘mentally stronger,’ as though the experience of war is somehow personally improving, except for those pesky people who don’t react as expected. The military seems to be convinced that it’s possible to teach people how to react to trauma more ‘competently,’ rather than addressing the root causes of that trauma and maybe getting some action done in that area, and it’s embarked on an extremely ambitious project to do just that.
A project that has some psychology professionals worried, because it’s also a very large and potentially very dangerous experiment. Psychological experiments in the civilian world require institutional review board approval and careful monitoring, but that’s not the case here; APA endorsement or not, this is an experiment on a very large scale, and these are real human lives. If the Comprehensive Soldier Fitness Programme helps people deal with trauma more effectively, that will be fantastic…
…but will it? Or will it only shame people who don’t approach trauma in approved ways, and who have difficulty reintegrating after military service? Will it be a reminder to people already struggling that they are weak, failures, useless? This programme is about ‘toughening up’ and bootstrapping your way out, not about examining how and why it is that soldiers are under such immense psychological stress.
The military is tasked with obeying the commander in chief, which means that it sends troops where the President says to send them. Those troops are facing harsh conditions in a protracted war, and know that they may not come home to much; Congress threatens to stop their pay while slashing benefits for veterans, partners are using food stamps to survive because their allowance from the military is not enough, and Arlington’s records are so hopelessly tangled that it’s hard to tell who is in which grave, at this point. It’s pretty hard to see how people are supposed to toughen up and bootstrap their way out of these conditions.
18 Comments
I hate the bootstrap mentality, and it’s used for everything. I read an article the other day about someone who woke up from a coma, and it’s astonishing the kind of language they used to describe the process. They were basically saying that this guy had bootstrapped his way out his coma – he’s so strong! I know that it was supposed to be feel-good and stuff, but seriously, you need more than bootstraps to get through life.
The military seems to be convinced that it’s possible to teach people how to react to trauma more ‘competently,’ rather than addressing the root causes of that trauma and maybe getting some action done in that area, and it’s embarked on an extremely ambitious project to do just that.
Having participated in some of the beta testing for the program, I have not gotten the impression that’s the case. It’s not about teaching people to react more competently to *trauma*, but to stress and to improve coping skills. They’re drawing heavily on psych research related to resiliency, although it remains to be seen how successful that will be. I suspect that they’re also planning to implement some additional screening at the recruiting phase related to resiliency and mental health, but I’ve not see that rolled out yet.
Historically, the Army hasn’t even recognized combat-related trauma, so its acknowledgement is a huge watershed within the community.
Disclaimer: I am not a member of the armed forces of any country, particularly not the USA. I have a pre-existing mental illness.
That said, I have my doubts about this. From what I’m aware of, applied military thinking (i.e. the stuff which happens at the working end) tends to favour a form of hyper-masculinised behaviours which tend toward denying the existence of emotional and psychological traumas. The attitude is one which has been aptly summarised as “suck it up, and soldier”. Complaining about anything is seen as “girly”, “sissy”, and “wimpy”, and admitting you’re hurt or damaged is seen as a licence to be targeted by bullies.
While I have no doubt the high command end of things is probably very admirable, extremely thoughtful, and built on a sound theoretical basis, I have questions about how it’s all going to be translated into rank-and-file terms, because I suspect a lot of the nuance will be lost, and what will wind up remaining is bootstraps, suck it up soldier, and more of the same hyper-masculinised junk as before – just with added terror for those who are genuinely traumatised and suffering.
I’d love to know where they’re getting that 20%. Doesn’t add, definitely after 6 months. Way, way off the further from combat you go. I am an NG wife who pays attention to my elders.
It’s interesting that the active military seems to be taking this tack and the Veterans Affairs people seem to be on the other side, trying to prove categorically that Post Traumatic Stress is a real injury which needs to be supported and destigmatized on the same level as amputations. General Peter Chiarelli refuses to even say the D in PTSD because he finds offensive the idea that it’s a “disorder” experienced by people who were secretly mentally unstable all along, rather than an injury which is done to them. I was really moved to hear the way he talked about it – cspan put it online here:
http://www.c-span.org/Events/US-Naval-Institute-amp-Military-Officers-Association-Wounded-Warriors-Forum/10737424386/
‘Suck it up’ means ‘I don’t want to change, YOU change.’
On ‘perspective’: perspective is the ability to switch between levels of focus. Yes, it’s important to not get lost in the small detail and lose sight of the big picture, but it’s also important to not do the reverse. True perspective is about being able to see both: so even if what you’re going through is not ‘as big’ as someone else is… it can still be devastating. So telling someone that their trauma doesn’t measure up by some sort of objective measure is self-defeating, EVEN IF it is true (which, as you point out, it is not necessarily so in this instance).
Here, as in most other cases I’ve seen it, ‘perspective’ is used to mean ‘shut up’.
From Brigadier General Rhonda Cornum’s biography at http://www.notablebiographies.com/newsmakers2/2006-A-Ec/Cornum-Rhonda.html
Others may have seen her experience as an example of why women should be protected from combat’s front lines, but Cornum did not. In June of 1992, Cornum made headlines when she revealed in advance of her book’s publication that she had been molested while in Iraqi custody. She said she did not want to make light of sexual assault, but she did not seem to consider it the worst part of her imprisonment. “Since everything that happens to you as a prisoner of war is non-consensual, then the fact that one thing they did was non-consensual is not very relevant, ” she told the Washington Post ‘s Allen. “So then you have to organize the bad things that can happen to you in some other hierarchy. My hierarchy was, is it going to make me stay here longer, is it life-threatening, is it disabling or is it excruciating. If it’s none of those things, then it took on a fairly low level of significance.”
Bootstrapping or survival skill? If this kind of life saving technique is implemented in CFS and helps soldiers cope, OOH-RAH
This news freaks my shit out for about 10 reasons I don’t feel comfortable stating here.
But it definitely explains a lot about semi-recent personal events. This isn’t exactly a revolutionary new way for the military to be looking at all things mental, from what I’ve seen.
@Videre- Ok, she survived. Great. But what’s in place when it catches up with her? Nothing. THAT is the problem. My experience says 1) my own traumas took time to “digest” if you will, and its not unusual for what you soldiered thru to become a problem 6 months out (in fact, that’s pretty common) 2) even 30 years later I still had to process what happened to me 3) I damned well know I am not alone in that, I am hearing talk about soldiers still having post traumatic effects of various levels 10, 20, 30 or more years later 4) I also damned well know the military isn’t taking the right steps to fix the issues, and this run of pushing back on the soldiers ain’t it. I am tired of Tommy take a walk, and it’s galling to get it from the military as well as the civilians.
Soldiers are trained to be disposable, to take whatever’s thrown at them, and to dehumanize themselves as well as others. Getting broken seems like a professional requirement. In this light, it isn’t surprising that 1) most soldiers come from poor families with few options for their children’s future and 2) the military will not easily favour a life-centred and life-giving approach to healing.
@Catherine
Firstly, let me thank you for your service. I pray that you find some way to not let your trauma define who you are now.
I do not want to take up too much room in the comments section so:
http://www.pbs.org/wgbh/pages/frontline/gulf/war/5.html (WARNING: It gets pretty graphic.)
When I played the audio of her interview I was horrified at what she went through and grateful that such a brave woman survived at all! When you hear her own voice, it makes you cry.
http://www.blogtalkradio.com/dot-mil-docs/2009/04/02/episode-53-comprehensive-soldier-fitness
It is hard to retain any sort of optimism when you consider the times we live in. Pessimism seems rampant. Yet here is someone, a woman brigadier general, who is spearheading an effort to address the psychological problems of her soldiers.
Maybe I am being naive. I hope I am being cautiously optimstic
This kind of just reminds me of how if you put people in horrible situations, some people will cope by “normalizing” what’s going on, to the extent where you can look at getting raped as just another part of a bad day. To me this isn’t success at all, it’s failure for the whole human race.
I also worry that if too many people talk about how well they are doing despite ordeals like the ones described people who aren’t doing so well will feel stigmatized and not want to speak up that they aren’t coping well.
This issue also is relevant to me since I have schizo-affective disorder but, outside of hospitalizations every few years, I’m mostly functional. I don’t generalize that other people with the same condition are necessarily going to be as lucky as me though and I see myself as more of a fortunate exception to the rule. I would never talk about how well I cope with mental illness since I don’t feel my state is anything due to my own effort.
@ Vivere Videnda
you’re missing the point. She survived, great! But what is in place when she is ready to process? N-O-T-H-I-N-G. IF she doesn’t need it, so be it, or if she chooses to front it out til she dies, that is her choice, but she isn’t everyone, and a good chunk of everyone needs some help of some kind along the way. This remains improperly addressed.
And I am not in service myself, but my husband is, I am active in our family group, and like I said way above, I pay attention. I have had my own traumas unrelated to the military. Do they completely define me? No Do they have some effect on me? Damned straight, and this is no bad thing. Being a trauma survivor doesn’t make me a ripped up doll, only good for the scrap heap, it just means I needed a little work to be all good again (better, even. letting people see my “scars” allows me create a safe place for fellow survivors- I feel no more shame for being a victim any more than I feel shame over my torn knee, and that’s how it should be!). This is about 50% of the problem with how we view trauma in this culture (and its much worse in the military).
I don’t understand how a “Put It in Perspective [because others have had worse]” method could ever be deemed successful when most people who have experienced PTSD, anxiety or depression (either triggered by trauma or not) will tell you how shitty they feel when they think that there are people with much worse to deal with than them.
Guilt about “lack of coping”, or feeling like you have “no right” to feel a certain way compared with other people’s (‘worse’) experiences can exasperate mental health issues. It’s well-documented by health professionals, one of the first anecdotal things people supporting loved ones with mental health issues will tell you, and it’s really irresponsible this point seems to be overlooked by this initiative.
My dad was on the Enterprise during WWII. He suffered from PTSD for YEARS and never talked about it, just sucked it up. Finally, at 70, he saw someone at the VA and joined a group. He was the oldest one there, but it really helped.
slightly off-topic, but this reminded me of the “mental health bootstrapping” problem: “trying to use willpower to overcome the apathetic sort of sadness that accompanies depression is like a person with no arms trying to punch themselves until their hands grow back. A fundamental component of the plan is missing and it isn’t going to work.” -hyperboleandahalf.blogspot.com
From a purely scientific standpoint this is an interesting experiment. We don’t generally know ahead of time who is going to be faced with severe trauma and who isn’t so there hasn’t been any large scale study designed to prevent the development of or worsening of an existing mental health condition in response to trauma.
On a human level I’m disturbed. Why put a nutritionist in charge? Why not one of the army’s many psychiatrists? Surely a doctor as seen a much wider range of responses to trauma and has a better grasp of resilience studies. Also, the PIP thing? I can see that working in the short term, but I have a hard time seeing that as a shield against the development of problems long term.
Brigadier General Rhonda Cornum holds PhD’s in nutrition and biochemistry. She has survived breast cancer and supported her husband through two occurrences of cancer. How she survived her military ordeal has already been covered. Should she need help in the future she has the Department of Veterans Affairs and the people who love and care for her.
She has been described as a “poster child” in this post. Her ordeal has been summed up with, “Ok, she survived. Great.”, in the comments. Faint praise for what she withstood. These things are being said about her because she is an excellent example of resiliency. She is directing the military’s attempt to deal with the psychological problems suffered by a voluntary armed force that must serve multiple tours of duty in the pursuit and destruction of those responsible for the innocent deaths of thousands of our men and women. She should be accorded some respect.
Our volunteer military is at war, but our day to day life as civilians is pretty much business as usual. That leaves a lot of people on the outside looking in, feeling free to conjecture and speculate as they please.
2. Anonymous has it right. CSF is a work in progress, being implemented in boot camp and to existing personnel. Be it success or failure, an attempt IS being made. If no attempt is made, what are the chances of success?
or…
We can all put on our tinfoil hats and hide in our lead-lined basements.