Origins and Outcomes: Examining Systemic Barriers to Care for Female MST Survivors
What is MST?
The U.S. Code 1720D defines MST as "physical assault of a sexual nature, battery of a sexual nature, or sexual harassment (unsolicited verbal or physical contact of a sexual nature which is threatening in character) which occurred while the former member of the Armed Forces was serving on duty, regardless of duty status or line of duty determination" (Galovski et al. 826). A study conducted by Tara Galovski, a professor of Psychological Sciences, found that female veterans are more susceptible to Military Sexual Trauma (MST), with 52% of female veterans experiencing sexual harassment compared to 9% of their male counterparts (Galovski et al. 826).
Historical Genesis and Military Culture
Within the late nineteenth and early twentieth centuries, the U.S. Army interfered in the sexuality of their soldiers concerning prostitution and violence (Bailey et al. 20). Beth Bailey, a professor of Society Studies, explains these interferences began as the military became concerned with growing rates of Venereal Disease, or Sexually Transmitted Diseases (STDs), among soldiers who engaged with prostitutes. These inspections were performed from 1898-1918 in the Philippines and 1916-1917 in the US-Mexico Border, providing a pool of sanctioned prostitutes for soldiers (20).
Like the regulation of soldiers' sexual partners, responding to allegations of sexual assault and harassment remained a duty of military officials until the National Forces Act (NFA) was passed in 1863 (Bailey et al. 200). After the NFA's approval, 24 officials had been found guilty of sexual misconduct (200). The military emphasized the prosecution of the perpetrators to the public over the crimes, marking one of many attempts to distract from the sexual crimes committed by their soldiers (200). This is backed by Joanna Bourke, a professor of history at the University of London, who explains the U.S military began providing MST care in VA centers to distract from accusations of covering up soldiers' sexual crimes. The military only began to provide MST care through VA medical centers in 1993, due to public outrage sparked by the Tailhook scandal (Bourke 98). The Tailhook scandal exposed multiple U.S naval officers for sexually abusing 14 female soldiers, resulting in accusations of a military cover-up of the crimes (98).
Contemporary Social and Cultural Dynamics
The perpetual harassment of female veterans on VA grounds can be traced back to the hypermasculine culture within the U.S. military. In "Moral Courage and Intelligent Disobedience" by Ted Thomas, Director of the Department of Command and Leadership in the U.S. Army Command and General Staff College at Fort Leavenworth, Thomas states that military phrases such as "what happens in theater stays in theater" encourage problematic norms within the military. These norms include unethical behaviors, silence, and obedience (Thomas and Chaleff 10).
Hyper-masculinity, defined as an ideology "which views masculine interactions in terms of competition, dominance, and control" is rampant among male veterans, and contributes to high rates of MST (Carl Andrew Castro et al. 2). Hyper-masculine veterans often feel threatened by their competent female counterparts, therefore, they try to prove their masculinity through sexual language and behavior (2).
Castro explains that the military's structure reflects its soldiers' hyper-masculine behavior, emphasizing formality, rank, loyalty, camaraderie, and emotional control (2). Unit cohesion is heavily emphasized, and bringing issues experienced within one's unit to a higher chain of command is frowned upon, thus prompting female victims to stay silent about their assault (3). As a result of the hypermasculine structure and the intimidation male veterans experience towards their female counterparts, male veterans often engage in sexual language and behavior, prompting sexual assault of female veterans.
Health Consequences and Trauma Dynamics
The military's emphasis on unit cohesion increases the betrayal felt when experiencing MST. Nancy Lutwak, a physician at NYU School of Medicine, states that "MST is a form of high betrayal trauma, meaning trauma in which dependent-upon-for-survival individuals harm or violate a dependent person, thus breaking the social agreement of trust" (Lutwak et al. 359). This betrayal damages the well-being and self-concept of the victim (359). Due to this dependence, the victim often has to stay within proximity of the perpetrator, increasing the likelihood of Post Traumatic Stress Disorder (PTSD) (359).
Along with PTSD, links have been made between depression, hypertension, poor diabetic control, suicide, and self-harm, specifically among female veterans who have experienced MST (359). This is sustained by Lindsey L. Monteith, PhD, a professor in the department of physical medicine and rehabilitation at the University of Colorado, in which 75% of participants experienced suicidal ideation after experiencing MST, and 40.7% attempted self-harm following their experience with MST (Monteith et al. 304).
Systemic Failures in Current Care
A study performed by Ruth Klap, a PhD in sociology, expands upon VA care, stating they foster an unwelcoming atmosphere for servicewomen (Klap et al. 107). 25.2% of female veterans reported inappropriate comments or behaviors by male veterans on VA grounds, often leading female veterans to delaying or missing crucial care (107).
The campaign, 'End Harassment' (EH), utilized social marketing posters featuring slogans like "It's not a compliment, it's harassment" (Fenwick et al. 568). These posters were displayed in VA facilities; however, female veterans continued to experience harassment (571). Before the EH campaign launched in 2017, Fenwick reported that 20% of participants reported sexual harassment, and a year later, 17% reported sexual harassment (571). The lack of progress made in decreasing harassment on VA grounds opposes the argument made by fiscal conservatives, suggesting that further actions are necessary in order to prevent harassment.
Suggested Interventions
Mindful Self-Compassion Groups:
To address the inadequate care for female MST victims, a possible solution is to implement female MSC (Mindful Self-Compassion) groups within VA medical clinics. According to Shannon M. Kehle-Forbes, PhD, a research investigator at VA Boston Healthcare System, female veterans expressed frustration that they did not have access to the same services as their male counterparts (Kehle-Forbes et al. 4). MSC group programs fit this criteria, offering mindfulness and self-compassion skills to help survivors of MST improve coping skills and emotional processing (Braun et al. 6).
Bystander Intervention Training:
To address the root of the problem, another solution is to implement bystander intervention training in VA clinics. Harassment within VA facilities contributes to why female veterans delay care, explains Mark Relyea, a PhD and psychologist. When training staff, Relyea prioritized teaching VA staff how to intervene in harassment through strategies such as preparing what to say, identifying barriers, and group discussions (Relyea et al. 576). The implications of this training include a decrease in barriers when intervening in harassment and increased awareness among staff (577).
Final Thoughts
The U.S Military has taken numerous measures in combating female harassment in VA facilities; however, all of these attempts have been fruitless. Harassment against female veterans continues, further traumatizing female MST victims and discouraging them from seeking treatment. The Department of Veterans Affairs should improve current resources for female victims of Military Sexual Trauma by providing bystander intervention for staff after evaluating its effectiveness, as well as the significant impact it has had on VA staff. Bystander intervention training is essential to support and protect survivors of MST, encouraging them to seek necessary treatment and preventing further trauma.
Works Cited
Bailey, B., et al. (2022). Managing sex in the U.S. military (pp. 19–205). JSTOR. https://doi.org/10.2307/j.ctv2bz2n5z
Bourke, J. (2021). Military sexual trauma: Gender, military cultures, and the medicalization of abuse in contemporary America. Journal of War & Culture Studies, 15(1), 86–105. https://doi.org/10.1080/17526272.2021.1884785
Braun, T. D., et al. (2024). Mindful self-compassion for veteran women with a history of military sexual trauma: Feasibility, acceptability, potential benefits, and considerations. European Journal of Psychotraumatology, 15(1). https://doi.org/10.1080/20008066.2023.2301205
Castro, C. A., et al. (2015). Sexual assault in the military. Current Psychiatry Reports, 17(7), 1–13. https://doi.org/10.1007/s11920-015-0596-7
Fenwick, K. M., et al. (2021). Women veterans' experiences of harassment and perceptions of Veterans Affairs health care settings during a national anti-harassment campaign. Women's Health Issues, 31(6), 567–575. https://doi.org/10.1016/j.whi.2021.06.005
Galovski, T. E., et al. (2022). State of the knowledge of VA military sexual trauma research. Journal of General Internal Medicine, 37(S3), 825–832. https://doi.org/10.1007/s11606-022-07580-8
Kehle-Forbes, S. M., et al. (2017). Experiences with VHA care: A qualitative study of U.S. women veterans with self-reported trauma histories. BMC Women's Health, 17(1). https://doi.org/10.1186/s12905-017-0395-x
Klap, R., et al. (2019). Prevalence of stranger harassment of women veterans at Veterans Affairs medical centers and impacts on delayed and missed care. Women's Health Issues, 29(2), 107–115. https://doi.org/10.1016/j.whi.2018.12.002
Lutwak, N., & Dill, C. (2013). Military sexual trauma increases risk of post-traumatic stress disorder and depression thereby amplifying the possibility of suicidal ideation and cardiovascular disease. Military Medicine, 178(4), 359–361. https://doi.org/10.7205/milmed-d-12-00427
Monteith, L. L., et al. (2019). Identifying factors associated with suicidal ideation and suicide attempts following military sexual trauma. Journal of Affective Disorders, 252, 300–309. https://doi.org/10.1016/j.jad.2019.04.038
Relyea, M. R., et al. (2021). Staff and patient perspectives on bystander intervention training to address patient-initiated sexual harassment in Veterans Affairs healthcare settings. Women's Health Issues, 31(6), 576–585. https://doi.org/10.1016/j.whi.2021.07.003
Thomas, T., & Chaleff, I. (2017). Moral courage and intelligent disobedience. InterAgency Journal, 8(1), 8–16. https://thesimonscenter.org/wp-content/uploads/2017/03/IAJ-8-1-Winter2017-pg58-66.pdf
