We Don’t Understand Veterans

This is one in a series of short discussions of the myriad ways our society in general, and the mental health field in particular, fail to understand the veteran culture. That there is a such a thing as a “Veteran Culture” as something unique is itself a hotly contested when not summarily dismissed concept.

The first thing to understand is the necessity to recognize the veteran culture as a unique constellation of experiences. This seems an obvious statement to all who at one time raised their hand and swore the oath. Ask a civilian to define the veteran culture and the most common reaction is a slow, vacant stare. This will generally be followed by some recitation of tropes learned from Hollywood, or worse, repetition of sensationalized headlines. Both are not just inadequate they are at best insulting. When those are the responses of a mental health professional, the consequences are dire.

When studying to become any sort of mental health professional, a large part of the curriculum is rightly devoted to the importance of understanding the culture of a person as a critical context of personality and ostensible dysfunction. This trend has dramatically increased, and rightly so, over the past twenty or so years.

The human brain is often conceptualized as a staggeringly complex computer. The study of psychology can then be thought of as learning the Human Operating System. Where this apt analogy fails is when we assume every human being uses the same OS. While all OS serve the same function, i.e., drive the device to perform specific tasks and in certain ways, inputting C++ commands into a computer running on Python may not get the intended results. Persist in using the wrong language and you could crash the entire system.

The same holds true in psychology. If we define dysfunction according to a culture in ways that do not apply, we are either going to diagnose healthy people as crazy, or crazy people as healthy. The most often used example is the challenge in determining psychosis, specifically hearing voices. In some cultures, those who claim to hear voices are revered as seers or some type of divinely guided mystic. In most Western cultures, it is considered a break from reality that requires intervention, probable medication and possible institutionalization.

So, what happens when we fail to recognize there is a culture to be understood, as we currently do with veterans and to a similar if lesser extent, First Responders. Though we frequently lump these groups together, particularly as so many veterans choose to become civilian First Responders, there are distinct differences. Most of those differences are due to the facets that create the veteran culture as a distinct entity.

One of the most obvious components of what constitutes the veteran culture relates to the development of the adult identity. Between the ages of 17 and 25, our core adult values are formed. Granted, they may not be crystallized, but the experiences we have at this stage significantly shape a large part of who we will be for the majority of adulthood. Those who go away from home to a four-year college have a set of experiences different from those who left high school and immediately entered the workforce. We recognize that those who spent those years in the military had a different experience, but due in large part to the small percentage of the population that serves, it is under-recognized as a unique formative experience when it is not wholly misunderstood.

To make matters worse, relatively few in the mental health field served in the military, yet the VA is the largest mental health employer in the nation. It should come as little surprise then that what is assumed about the veteran culture is significantly skewed. It would be like trying to define the culture of womanhood based on observations in the maternity ward. Not all women give birth, nor do those that do have babies all do so in a hospital setting. In addition, that is defining all womanhood by one experience while ignoring the rest of what constitutes the life of a woman.

There is another development that occurs between the ages of 17 and 25 that is universal but differs significantly between veterans and civilians. First, it is important to recognize this event.

The fact that teenage boys mentally and emotionally mature more slowly than their female peers is well established. What is relatively newly understood is what happens in the brain between the ages of 17 and 25. This is when the final developmental structure of the brain begins. This structure, the uncinate fasciculus is not well understood in all its functions, but we seem to have figured out a few things. It is a white matter structure that is impeded by testosterone. In addition, just like every other part of the body, brain included, the more it is used, the more robust it becomes. Interestingly, it also seems to be somewhat fragile, even brittle and highly susceptible to shearing forces.

One of the functions of the uncinate fasciculus, in the most simplistic terms, is to act as a superhighway between the impulse and thinking centers of the brain. So, the direct connection between impulsivity and thinking being slower to grow/less robust in males can explain why teenage boys are more prone to car accidents, extreme sports injuries and overall poor decision making compared to girls of the same age. Its nice to be able to point to a brain structure to explain what actuarial tables and parents have always known.

How this relates to veterans is both very direct and obvious, and not well-recognized.

Most members of the military are males who enter around age 18. In the civilian world, young men are making decisions for themselves on a continuous basis. In the military, the biggest day to day decision may involve selecting which pair of socks to wear based on overall crustiness. What to eat, when to eat, what to wear (aside from the above), what to do, when to sleep and countless other minor decisions are made for young recruits. These are all inhibitors on impulsivity, by design. Meaning, we can add the military to the entities that have always known young men of a certain age, left to their own devices, generally don’t make the best decisions. Granted, that is not the primary reason for the structure of military training, but it certainly plays a part. Now we can also say this strict structure, lack of choice and lack of need to make decisions supports the robust growth of the uncinate fasciculus.

In the military, particularly in basic training, young adults experience more physical activity and of a higher intensity than most of their civilian peers encounter. The concurrent assumed increase in testosterone is more than balanced out by the lack of opportunity for impulsivity. Pairing that increase in testosterone with a lack of decision on what type, when and how that physical activity occurs seems to be the key. Ask any parent and they will tell you how much the child they sent off to basic training a few short months ago has matured, physically, mentally and emotionally. Now, ask the parents of a college freshman after the first semester if their son seems to have matured and the response will usually include some measure of dismay.

All of this is to say that in the most basic ways, the experience of being in the military is different than going to a four year college or directly into the workforce. That the significance of this is so under-recognized has far-reaching implications. If this is not understood, is it a surprise that the existence of a distinct military culture is not appreciated? Then we wonder why veterans are hesitant, or simply do not trust mental health professionals.

When a veteran seeks mental health services, it is usually well past the point it was necessary. The fault lies solely on the mental health community. While all of the above seems like common sense, particularly to those in the veteran community, it is revelatory to too many mental health professionals. When it is not dismissed as unimportant.

Just for the record, this is not an excuse for veterans not to seek mental health care. It is a reason many, too many, don’t. Veterans know they are not understood. They are not seen. They are not recognized or respected. Sadly, at least for the time being, the burden is on the veteran to find a mental health professional that does understand. Or, is at least open to learning. Afterall, it is your well-being at stake.

In future installments, we’ll look at some of the ways veterans can use even a sub-par mental health professional to their advantage. If you are struggling, reach out to a buddy or call 988, and press 1 if you want to identify as a veteran. If you are not struggling, reach out and be the buddy to someone else.

Category: The Warrior Mind