By Stephen Spotswood
HOUSTON – In recent years, DoD officials have admitted publicly that military sexual trauma (MST) is a serious problem among the services, one that’s more widespread than previously recognized.
VA, meanwhile, has made efforts to screen for MST, especially among female servicemembers, and to create safer environments in their facilities for veterans to talk about their experiences and to receive treatment.
Deciding what that treatment should be and how best to judge its effectiveness, however, is hampered by a lack of understanding of the causes and physical, psychological and social aftermath of MST.
It’s generally understood that MST can be more difficult to treat than civilian incidents of sexual trauma because symptoms of other illnesses, including PTSD, often are present. But it is not always appreciated how different MST can be from its civilian counterpart or how far the damage from such an incident can spread.
VA researchers in Houston are taking the first steps to answer those questions and provide for VA physicians everywhere an evidence-proven scale of MST – one they can use to help judge severity and, subsequently, treatment progress.
Pattern in MST Patients
It did not take long for Deleene Menefee, PhD, to realize that MST is substantially different from sexual trauma that occurs in the civilian sector.
A psychologist with extensive experience in treating sexual trauma victims, Menefee was hired by VA in 2008 to open the Women’s Inpatient Specialty Environment of Recovery Program (WISER) at the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston. The goal of the 10-bed unit is to provide a space for women who are not successfully progressing in an outpatient setting to focus on trauma-specific therapy.
Over time, Menefee and her colleagues began to notice some very obvious patterns.
“Women would say the same things repeatedly, like, ‘I feel like I have a sign on my forehead that says ‘Rape me,’’’ Menefee explained. “They continually talked about how, after the assault happened, they would change the way they dressed. They talked about the consequences that happened to them when reporting it or the guilt they felt for not reporting it.”
Menefee started collecting notes — clinical observations that she collected in a folder. The patterns were so apparent that new trainees, with no knowledge of Menace’s collection of notes, would mention them to her.
The WISER program includes a research protocol requiring self-evaluation, so Menefee began searching for a survey she could use to help her understand the range of MST among her patients. She wanted to know whether there are indicators of when it’s more severe, such as whether it’s different for patients when the incident involved a higher ranking officer or when it occurred in the barracks vs. out of town.
“I wanted anything that could clinically inform me about my women with MST,” Menefee said. “We came up with a big goose egg. There was nothing.”
While there were surveys about rape and sexual trauma, child sexual trauma and male-on-male sexual trauma, little was found on MST.
“I was really interested in what was unique with veterans — men and women — with military sexual trauma,” Menefee said.
So she and her colleagues at WISER decided to create a survey of their own — a proof-of-concept study that will collect a host of data from veterans and, if successful, provide a framework for better understanding MST.
Unique Sexual Trauma
Sexual trauma in a military setting involves an array of unique factors. Anyone who has spent time talking with veterans with MST for any length of time will recognize that, Menefee explained.
The survey Menefee and her team are creating recognizes that. It asks questions not only about where and when but also military-specific questions, such as about rank and power dynamic.
“So much of rape is about power, domination and humiliation. The first two are used openly in military training. There’s a big power differential and a very strict hierarchy,” Menefee said.
This can create an environment that makes it much easier for the perpetrator and much more confusing and traumatic for the victim. The perpetrator is more often than not either a colleague or a superior. And if the incident goes unreported — or even sometimes when it does — the victim will need to stand at attention in front of or beside the perpetrator the next morning.
The survey also asks about the period of time in which the incidents occurred. Menefee has had patients whose commanders had forced them to have sex for the entire duration of their deployment.
“Most [civilian] sexual trauma victims other than children or spouses can get away from their perpetrators,” Menefee explained. “If you’re raped by your commander or fellow soldier, you have to go out on drills with them the next morning.”
There are questions detailing the immediate consequences of the incident — an area where there are significant gaps in the literature.
“We don’t know what happens to them immediately,” Menefee said. “Do they seek medical help? Is a rape kit performed? Are the police involved? Do they report for duty with vaginal tearing the next morning?”
Perhaps the most striking question — the one that most clearly highlights just how different MST can be from civilian sexual trauma — is the one asking whether a service weapon was involved in the assault.
Menefee noted that personal service weapons were used to force victims to submit to rape in at least 20 of the cases she has seen in the last three and-a-half years.
Part of the survey will deal with whether the incident was reported and, if not, then why.
“Most say they don’t report because they’ll be seen as weak or nothing will happen or they’ll be ostracized by their peers,” Menefee said. “Sometimes they don’t because the perpetrator told them they would kill them.”
In an environment where the perpetrator is often armed, the victims have reason to believe the threat.
Questions also exist about the many possible after-effects.
“There are extensive long-term consequences,” Menefee said. “They frequently have body image issues, physical health [problems]. They’re unable to sustain marriages.”
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