The Importance of Military Cultural Competency

"I wish I could prescribe medical marijuana to veterans," the doctor said as she noted his veteran status in the chart. "I think it could be so helpful."

"I'm here for my gallbladder," he said, confused.

"Are you sure you only have anxiety?" Said the same doctor to a different patient who was also prior military.

This is just one provider amongst many that are letting implicit biases impact their ability to be present with and effectively treat their patients.

Neither of those veterans ever went back to that doctor. Her assumptions were rude and disrespectful.

Because NOT ALL VETERANS HAVE PTSD.

While Post-Traumatic Stress Disorder (PTSD) is an issue for the military community, those that grapple with it actually make up a small percentage of the population. Implicit biases around the military community play out in physical and mental healthcare and can make it hard for veterans to trust doctors and therapists alike, and get the care that they actually need. Many veterans feel they will be judged and their symptoms misread, and too often, they are absolutely right.

While the counseling community talks about the ethical imperative of cultural competency, the conversation is generally centered around racism, gender, and sexuality. It is rarely acknowledged that the military community is also its own culture. And a rich culture at that! Each branch of the military has its own history, traditions, and dialect; its own functions, dynamics, and challenges. And every veteran is going to have a unique experience and unique needs.

I've seen it myself more than I'd like to recount. I've even encountered it among my own friends and colleagues. I've had clinicians direct me to treat the husband of their client because he was a veteran and they automatically assumed his "military-related issues" were the problem in the relationship. It turns out, more often than not, what was happening in the marriage had nothing to do with military experiences at all. Military men, especially, get stereotyped as aggressive, traumatized, ticking-time bombs because of their service.

I'm not going to say that PTSD doesn't play an impact on marriage (how could it not) or that military members can't be aggressive. But again, not all veterans have PTSD, and not all veterans are bringing their military experiences to the table. Yes, folks, even if they've been to a combat zone it does not mean that they'll come home with PTSD. And not every traumatic experience becomes a chronic issue. Sometimes we can experience acute trauma that doesn't stick with us long-term. But, most people's issues go farther back than experiences that occurred in their late teens and 20s, most people's issues, especially surrounding relationships, stem from much, much earlier experiences. - but that's a whole other blog post.

As a clinician, it is important that if the client isn't making an issue out of their service, you don't make it one either. If a client has been to combat zones or served doing hazardous or imminent fire duty, don't automatically assume they have seen horrific things and have been remarkably impacted by them. AND FOR F*CKS SAKE do not ask them if they've killed people! Use your tools to explore the issues they are presenting with and if their service is an issue it'll come up. If it doesn't, leave it alone. I can't tell you how many stories I have heard of clinicians digging around in those experiences as if they were getting off on the war-porn. If they do share those experiences with you, learn to keep your pearl-clutching on the inside and work on that poker face. Those that have had difficult or horrific experiences DO NOT need your moral high ground or political opinion. Keep your curiosities inside your head, you're not here to live vicariously, you're here to treat this person. Treating veterans is NOT like watching a crime or murder documentary. We are not entertainment.

Veterans face issues just like everyone else. Anxiety, depression, substance use, eating disorders, grief, and chronic pain to list a few. Oftentimes, their mental health challenges are not what's unique but it's the veteran identity that is. It is where the concept of mental health and identity intersect that become the focus of attention. This is why the cultural component is so important. Through this, we can enhance patient/client outcomes and lower the risk for a population that has astounding statistics around suicide deaths.

It is important no matter what culture we are talking about, to examine what we think we know about it and educate ourselves better. Implicit biases are the prejudices, attitudes, or generalizations we have heard or that have been perpetuated to us that are not based on facts. Although automatic and often unintentional, these ideas affect our judgment and can lead to discriminating actions or viewpoints. So, check your biases at the door. Do a little research to understand this culture and educate yourself so that you aren't making these mistakes and further ostracizing, exploiting, or shaming these men and women. Every time a veteran has a bad experience with a healthcare professional and the more people perpetuate the stereotypes of their culture, the less they will get the help that they need.

Get more curious about the various jobs and places a military member could work. Get more interested in learning some of the lingo and terminology so you can better understand and communicate with them. Get more reflective on what assumptions you have of military members and their culture and whether or not those biases are coming out sideways in session.

If you feel that you are unprepared and deficient in the area of treating this population, then please don't. Find out where you can direct them that would be more helpful to them.