It is not a surprise to hear that men and women who grew up in stressful environments may be attracted to military life. Whether their histories included physical or sexual abuse, or bullying, in my experience, they are tough survivors. They had to be that way to get by – they know the skill of dissociating from strong emotions through zoning out, fighting back, drinking or drug use, or buckling down to be over-achievers. So, apart from what people may think, abused or traumatized children often grow up to be resilient, tough-minded, and reliable people who do extremely well within high intensity jobs. When the emotional toll of the job begins to wear them down, understandably, many of them go back to the coping skills that worked for them earlier in life. They learned to mistrust other people and to keep secret the things they got through on their own - they know how to rely on themselves when they are hurt. They also learned early in life that emotions are dangerous because they equate to exposing a weakness or stirred up fears that they would fall apart or go crazy.
What are we to make of the fact that these men and women can also be traumatized and experience things like PTSD just like other people who had a healthy development? There is a simplistic and incorrect belief that childhood abuse causes adult PTSD because of some weakness. I don’t think it is weakness at all. In fact, I think the opposite - they are too tough! When tough soldiers or policemen come forward with mental health issues, they have a much harder time trusting people they don’t know, have a harder time recognizing and valuing their inner emotions, and are continually tempted to ignore other people and go back to their early coping skills. Learning to trust someone to help them and to lower their emotional guards are the toughest challenges most of them will face. They have all the skills of being tough but have not learned the skill of being vulnerable – another basic part of the human condition. So, if we are to talk about developmental abuse and adult mental health issues we need to talk about the legacy of developmental abuse as a skill deficit not as a weakness.
So, I am back doing what I truly enjoy - Meeting with men in a PTSD group - soldiers and first responders - to help them understand what trauma and PTSD is all about so they can find a way ‘out of the box’. People who are willing to go into harm’s way can be the toughest people you will ever meet; they have to be that way to face the unimaginable and there can be no room for a weak moment where you might lose focus. And, they are also the people who will drop everything to be there for a buddy in need, care for a wounded animal, or defend the powerless with no fuss and no expectation of recognition or even a thank you. The biggest fear for many is that they may not up to the next task. I think they (we) can learn to be too tough and let’s not kid ourselves; people who are tough and dialed-in are respected. As things build up over the years, maybe even starting before we join and continuing during the years of seeing and doing the job, we often get tougher to squeeze out the emotional side. We hammer ourselves to keep pushing forward. This means bottling up and controlling things like anger and helplessness, loneliness, guilt and sadness, or loss and grief. But, when all the crappy stuff is pushed away and we shut down that side of us, we also risk squeezing out the other stuff - like gentleness, enjoying our kids at play, having tears of joy, self-compassion (I don’t mean self-pity), feeling safe, hope, and tenderness - the things that make life worth living. We know how to be tough but not how to be vulnerable, nobody ever taught us the skill of lowering the shield, of not being the protector. And, the shield has to be lowered from the inside because people hammering at it from the outside usually ends in making it stronger – tempered steel!
But, here’s what the guys say – “I am trapped behind the mask but I am something entirely different inside, I am alone and cut-off, or I am just so tired of having to be ready for anything.” When guys can find a place, often with their peers - the people who matter – they slowly learn to trust and to lower their guards and the true miracle I get to witness is that they start to come back to life. This is not easy work, and it is work, because everyone fears being turned into bowls of mush. But, that’s not the goal at all! To be a strong man (I do not mean to exclude women here but the fact is that I mostly work with men) means learning the balance of knowing when to draw on the tough side - the protector - and when to ask for support to let the vulnerable, human side out to have a say, as well. This is why I work with men who have learned to be too strong; and in the end it may be at the heart of what we call OSIs and PTSD. There is such a thing as being worn down by being too tough.
Bordered by the Arctic and the 49th Parallel and spanning two oceans, Canada is steeped in the stoic British ‘stiff upper lip’ and rugged individualism from our cousins to the South. We are also a conservative-minded country, with a not-so-minor secret belief in social Darwinism and coupled with a mechanistic view of human health issues, including mental health. We need only look at how we react to the homeless, the unemployed, or the mentally disabled segments of our population: “Why don’t they just get a job? It’s their genetics. They are faking. We should not encourage them. They need to toughen up.” While we espouse claims of being a compassionate nation, these other things, usually said privately in the interests of political correctness, occur on a daily basis. In truth, we stand divided on these issues as a country.
The recent flurry of public interest into the mental health of military and other first responders has occurred primarily because of headline-catching reports of suicides. Make no mistake, it is a terrible thing that these men and women decide that this is the only viable option to reduce mental anguish. But, realistically what are the alternatives? What are first responders to do about competing messages from the larger society and within some work settings? Training and operational duties demand toughness and independence while remaining task-focussed in the face of human suffering of all kinds. At the same time, frontline managers, operational imperatives, and the organization of work settings offer no leniency for those who cannot pull their own weight while insurers are always looking to liability and their financial bottom lines. In the midst of these realities, first responders are asked to step up to ask for help. While receiving care and guidance from another person can be a wonderful human experience, first responders often risk incredible embarrassment for being a drain on their buddies and they can face harsh financial and career realities when they come forward to ask for help. It is almost cliché to say that this takes courage; even so, I believe that it takes guts to face oneself and to admit to issues that cannot be overcome by following one’s training – sucking it up and trying harder. Stepping forward means wrestling with Canadian values based on our British legacy, the belief in individual strength and prowess, and the social value placed on survival of the fittest – heroes are invincible.
While specific programs can and probably will be put in place to address this present situation, I fear that they will carried out as quick fixes. If we are to face our shared stigma around mental health issues honestly, these social undercurrents will also need to be addressed directly. To exclude from discussions the social determinants of mental health leaves us ‘guilty of economics’ – only the financial bottom line matters. The solution might require a reconsideration of how first responders are trained and how they are expected do their work on our behalf. Maybe, the expectation of Canadian society that requires silent heroes to keep the harshness of life away from them is simply too high. Engaging these issues directly would be a true test of our commitment in addressing the mental health needs of first responders.
It is impossible to miss the media attention on the issue of mental health strains among first- responders driven by sensationalized reports of suicides among these men and women. This public attention and call for better interventions and services have produced responses in some sectors and at the same time the peculiar notion of ‘self-stigma’ is also entering our everyday language. It is no secret among people who know me that I am no fan of buzzwords – the latest fashion words among those supposedly in the know which are packed with assumptions and unspoken shared views among decision-makers about how the world is supposed to work. At its core, stigma is a social mark of shame; the failure to live up to the beliefs and values of the group warranting exclusion and banishment. It has an essential role in controlling everyday life, in almost every culture. Application of this term to the person amounts to a subtle shift of responsibility away from something done by the group to something done to oneself. Why reject and judge ourselves, then? Could it be a result of successfully internalizing the values of the larger group and then judging oneself because of a failure to meet these expected standards and values. Well, this is the whole premise of socialization – the process of becoming accepted members of the social group. In military terms, this amounts to internalizing military values as part of indoctrination into the culture. Along with values of strength, integrity, and dependability, the golden rule is to not stand out – to fit in with everybody else. A member’s sense of competence and self-respect hinges on the views of other members of the group. The risk of being shamed in military circles is ever-present because it serves as a powerful guarantor of uniformity. The risks range from possible embarrassment or ridicule in front of one’s peers to being singled out by superiors whose responsibility it is to root out suspected weak members of the group.
However, self-stigma carries the implication that a member’s self-judgement is independent of military culture and values, and prevents them from taking responsibility to solve the mental health issue. Sure, ultimately we each have responsibility for our health generally, including our mental health, but a soldier’s mental health is greatly influenced by group acceptance and shared values – what others think matters tremendously. Adapt, endure, overcome is a powerful mantra that is reinforced every day. It is in direct opposition to admitting to limitations and shortcomings. How are military members to reconcile these competing messages since they cannot both be true? The reaction by members to possibly judge themselves harshly for having mental health concerns excludes from the conversation the impact of organizational culture. Everyone knows of a horror story among one of their buddies – ‘hero to zero’, being left off a deployment, struggles to find adequate care, premature end of careers, and protracted disputes for pension and other supports following release. The centrality of military values and the occurrence of these other issues need to be discussed openly if we are intent on encouraging people to come forward. What if, part of the solution to the issue of ‘self-stigma’ meant challenging core military values around uniformity, strength and independence? I am not sure if anybody would or should tamper with the fabric of the organization but we can’t deny that it is also needs to be part of the discussion on military mental health.
For those who risk coming forward, solutions and possible ramifications need to be spelled out if there are to be safe alternatives to private suffering. As it stands, there are incredible risks to adopted military values, self-image, and livelihood for members to step forward and to self-identify. There have to be parallel assurances that these risks will be minimized and that they will be protected. Otherwise, introducing the idea of self-stigma to any first-responder group runs the risk of being just another weight for them to carry - not only do they have mental health problems but they may also be the cause of their own distress. The functioning of organizations, backward beliefs among key managers, and the day-to-day unrealistic expectations placed on these men and women are not discussed. Why is this? Part of the problem in Canada, is the reluctance to explore sociological factors that may challenge institutional priorities and accepted ways of doing business as usual. My question is always the same - What if Canadians had little choice but to think seriously about the responsibilities and expectations placed on ‘heroes and protectors’ – the terrible things they face every day while ordinary people remain oblivious to the harsher realities of life? Maybe, part of the problem is that these expectations are simply too high in the end.
John J. Whelan
John J. Whelan, Ph.D., is the author of Going Crazy in the Green Machine, available now on FriesenPress.