Abstract
Social reintegration of veterans following military service is a complex, nonlinear, and highly individualized phenomenon, yet much of the existing literature on transition of veterans represents a narrow and limited perspective of transition and trauma—mostly written from an external (nonveteran) perspective. We present an alternative based on concepts of personal and social transformation through collaborative, veteran-led social science research designed from an interdisciplinary Adlerian (social systems) perspective. Participants are military-connected students, defined as service members, veterans, family members, and mental health practitioners experienced in working with military and veteran populations. Research projects described were designed by the students, and these typically involved informal data gathering and self-reflection, combined with extensive review of current interdisciplinary literature in the military psychology field. A case study of informal participative research with a cohort of female Navy Chief Petty Officers by the first author is presented as an example. Conclusions and recommendations support further extension of this cohort-driven adult learning model as a means of combining personal growth and social transformation by including military, veteran, and family perspectives in research and literature directed toward veterans’ social and mental health programs and policies.
Keywords
Dedication
This article honors the memory of Navy Senior Chief Petty Officer Shannon Kent, MA, the first author of this article. It did not start out to be this way. Shannon had recently graduated from the Adler University MA in Psychology with Emphasis in Military Psychology program and was performing duties with Combined Task Force Operation Inherent Resolve in Manbij, Syria, where she lost her life in a n Improvised Explosive Device (IED) attack along with three of her American comrades on January 16, 2019.
Navy Senior Chief Petty Officer (Cryptology) Shannon Kent
At the time of her death, we were just 2 days from submitting the final draft of this article. In light of the circumstances, the style has been changed somewhat to foreground both her thesis/capstone work and also to underscore the transformative effect that her presence had on her fellow students and faculty at Adler University. This is captured well in the words of one of Shannon’s colleagues who was part of her graduating group: Through not just the Capstone project, but through the last two years and all the classes I have gotten to know myself, (met) an amazing group of people and (explored) the depth of the human soul with all the positives and also the negatives. I have learned that the human being is resilient, that you can survive and even thrive after experiencing events that shatter your concept of self, of what is right and wrong, of humanity. There can be growth, a new appreciation for life, for the things that make life worth living. I have learned that any kindness, any support we have received should be paid forward . . . we have a moral and ethical obligation to help others. In this program, we have been prepared to (help repay) the sacrifices military personnel and their families have made with kindness, with support, and with advocacy.
It was readily apparent to all who knew Shannon well that she had already seen and overcome a great deal of hardship, made family sacrifices during her previous four deployments, and yet lived her life in such a way as to inspire and lift up those around her. Compounding the irony of her untimely death, she had recently been competitively selected for a prestigious Department of Defense health scholarship that would have facilitated her subsequent doctoral-level studies and led to her commissioning as a Medical Corps officer in the mental health field, thus paving the way toward her goal of helping her fellow veterans. Standing between her and this goal was a Navy administrative policy that ruled her unqualified for the program due to a service-related medical treatment from an earlier deployment. With typical moxie, Shannon tackled this injustice head-on and prevailed, changing the policy to protect those coming after her, but not in time to put her back on the path, diverting her instead to the place and time where her life on earth came to an untimely end.
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We offer her work here as an illustration of what is possible when military-connected students are given the freedom and support to perform collaborative research and self-reflective learning among their peers and allies, focused on correcting injustices, and doing what is right based on the values, ethics, and culture of service. The difficulties and rewards of taking action for social change in this way are best stated in Shannon’s own voice: Sometimes the military doesn’t really appreciate it when you try to change something. I do it all the time, and sometimes it has cost me dearly. But I’ll keep doing it anyway. What we (learned in this program about) social change actually made me feel good, because . . . you can’t affect any change if you don’t try. The military expects people to follow the regulations, and expects senior NCO’s to enforce the standards and regulations. Well, not all of them are good or fair. I will not stop trying to change the unfair ones, because that’s what kind of person I am. I won’t just talk about not liking something, I’ll actively try to change it.
In life, Shannon never stopped questioning, pushing, advocating, making those around her better in the process. She had set her sights on publishing her work so that others coming after her could benefit, and her co-authorship of this article would have been just the first example. Her cousin Sharron Kearney described Shannon’s goals in this area: She is also a writer, and she had her sights on publishing a book (oh, who am I kidding . . . several books) one day. At this point, I’m sure you’ve gathered that Shannon was ferociously intelligent, and she was hungry for knowledge about everything. I loved discussing and debating anything and everything with her because even when we disagreed, we respected one another and moved on. Lord knows, in today’s day and age, we need more people capable of discussions and debates like that.
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We do indeed need more of what Shannon brought to the Navy, her close friends and colleagues at Adler, and ultimately to the world. It is our hope that her story will inspire others to pursue and share their insights boldly, competently, and with principle, in a way that helps us consider controversial topics and bold new ideas with courage and mutual respect.
Shannon Kent, MA in Psychology with Emphasis in Military Psychology, Adler University Class of 2018
Introduction
This article draws on experiences and graduate-level work by student veterans and allies in the Adler University MA in Psychology with Emphasis in Military Psychology (MAMP) program, with particular focus on the perspectives and capstone/thesis research and studies of the first author, Shannon Kent, a U.S. Navy Senior Chief Petty Officer who graduated from this program with distinction in Autumn of 2018. The second author, Barton Buechner, is a retired Navy Captain and professor in the Adler MAMP program who teaches research methods and supervises graduate theses and capstone projects in this program. The student cohort described here includes veterans, service members, their spouses and families, and clinicians. From further analysis of the rich and growing source of collaborative academic work being produced by students in this program between 2014 and 2018, we hope to shed light on the issues and phenomena that are of central interest and importance to this population. In this article, our focus is on a description of the underlying theory and methods that have been engaged to promote and facilitate transformative co-inquiry. This approach combines elements of participative inquiry, adult learning methods that draw on the lived experience of participants, and an interdisciplinary conceptual framing that helps account for the complexity of the bio-psycho-social dimensions of human experience (Bentz & Rehorick, 2008, Troiani & Buechner, 2016).
The Adler University MAMP program was established in 2014 as a way to help address a projected shortage of mental health professionals with military cultural competence (Troiani, 2012). Its primary goals were to increase military cultural competence among current mental health practitioners and to help prepare more military-connected students to serve in the veterans’ education and mental health fields. The design of the program, particularly the Capstone practicum, has also encouraged and facilitated research in subjects that are of particular interest to military-connected students. This practice has focused attention on several facets of the military psychology field that have been historically problematic for veterans. It has also shown potential of several emerging concepts in veteran’ social, career, and mental health services, and it has tested the utility of participative forms of research to help bridge the gaps between professional practice, currently available programs, and the actual needs of veterans. Some of the issues that have been considered to date by these student veteran–led research projects include the differentiation of moral injury from posttraumatic stress disorder (PTSD) (Jinkerson & Buechner, 2016; Meagher, 2014; Shay, 2014; Sherman, 2015), the use of integrated mind-body practices in therapy (van der Kolk, 2014; Herman, Sorbero, & Sims-Columbia, 2017; Wood, 2014), alternatives to deficit-based therapeutic and transition support programs (Cooperrider & Whitney, 2005; Walker, 2016), family systems support and counseling methods (Nelson, Fleurides, & Rosenthal, 1986), and social/psychological factors leading to posttraumatic growth (Tedeschi & Calhoun, 2004; Troiani & Buechner, 2016). In addition to some intriguing theoretical work with these bodies of literature, the peer-to-peer interaction among student cohorts has also helped focus more attention on the use of collaborative adult learning methods in veteran education that engage directly with their lived experience. To this end, the Adler MAMP program draws heavily on the “scholar-practitioner” model and adult learning approaches pioneered by institutions of higher learning such as Fielding Graduate University in the 1970s (Melville, 2016). Unlike traditional academic institutions that emphasize a pedagogically based top-down faculty-student relationship within narrowly defined areas of specialization, the use of adult learning methods and multidisciplinary frameworks allows student interests to direct the content of the learning, creating a context in which the instructor is a co-learner with the group, rather than a provider of content, putting students in the position to “take ownership of their learning . . . stretch themselves and stand on their own two feet” (Melville, 2016, p. 84). Much of the past research on which current mental health and social support services for veterans and families is based has typically been performed in traditional, segmented academic settings and conducted by persons other than veterans, typically undergraduate students with no prior military experience (Soeters, Shields, & Rietjens, 2014). Research conducted by veterans, with veterans, and for veterans in such a supportive context has great potential to facilitate expanded opportunities for participation of military service members, veterans, and their families in decisions regarding their well-being and support, giving them a voice in the process (Buechner, 2014). This supportive context is also particularly friendly to finding alternatives to clinical and empirical approaches to mental health such as complementary and alternative methods (CAM) therapies. These include various somatic approaches, animal-assisted therapies (equine, canine, and others), and social/philosophical interventions (Walker, 2016), all of which have been of significant interest to past MAMP cohorts at Adler University.
Our intention here is to present some emerging concepts that have come from military-connected students in pursuit of theses and capstone studies directed toward practical applications in military psychology as a way of considering what may be possible to create more space for the voices of veterans and families to be heard in policy formulation and change. We will first discuss some theoretical perspectives including basic principles of Adlerian (social systems) psychology, the adult learning model of reflection on experience and perspective-sharing, and the relevance of theoretical perspectives associated with transformative learning, social construction, and collaborative research. We will then illustrate some of these concepts with examples from a study conducted by the first author. Finally, we will draw some conclusions and make recommendations for further study or application of these concepts in other academic settings.
Theoretical Grounding and Method
Adlerian Psychology and the Social and Human Sciences
Adlerian psychology is differentiated from other branches of the field by its primary consideration of social context and relationship as primary forces in the mental health of individuals (Mosak & Maniacci, 1999). From an Adlerian perspective, social factors such as communication, relationships, emotions, and self-efficacy are all particularly significant. In contrast, the language and methods of clinical psychology are focused on pathology as the primary source of behavioral and adjustment issues. The primary emphasis is therefore on diagnosing and treating of individual forms of mental illness and disorder (Walker, 2016). This is generally a mismatch with strength-based cultures such as the U.S. military, in which admission of a mental health problem can be both a conflict with “warrior identity” (Buechner, 2014) and an immediate career-killer (Kent, 2018). By way of historical perspective, Alfred Adler parted company with Sigmund Freud over this same issue after his World War II military service, after which it became apparent to him that persons are not separable from their social contexts (Mosak & Maniacci, 1999). Still, Freudian principles, cognitive-behavioral therapies, and a strict reliance on empirical (evidence-based) evaluation methods still dominate most forms of clinical practice. As another way of saying this, Freud was an objective psychologist, but Adler was a subjective psychologist, “not interested in ‘facts’ per se, but the individual’s perception of the facts” (Mosak & Maniacci, 1999, p. 19). Dr. Bret Moore, a faculty member of the Adler Military Psychology program, describes the limits of using a solely clinically based psychology approach with military and veteran populations in the January 2017 edition of JAMA Psychiatry: Despite the large increase in availability of evidence-based treatments, considerable room exists for improvement in treatment efficacy and satisfaction appears bleak based on low treatment retention . . . We have probably come about as far as we can with current dominant clinical approaches.
He further observes that, “while our traditional approaches to treatment of Posttraumatic Stress Disorder (PTSD) may have gone as far as they can go, efforts and potential for breakthrough improvements in Posttraumatic Growth are just beginning” (Moore & Goldberg, 2018). System-based perspectives are useful for considering the complexity of human behavior in particular contexts, which has immediate practical ramifications as well as research implications. First author Shannon Kent used such an approach in framing her study of a closed Facebook group of female Navy Chief Petty Officers (CPOs), realizing from her own experience that the currently available formal, clinically based mental health treatments for stress were problematic for them. In one of her Capstone course reflections, she described her transformation in thinking around behavior and mental health in a social systems context: What I’ve learned over the last two years has really changed my worldview and how I approach problems. As a senior NCO, I see disciplinary problems all the time. During proceedings, things are no longer as black and white for me, and they never will be again. Now, I look at the situation through the lens of (an Adlerian) mental health professional. I think to myself, “Why is he acting out this way? He’s not following the most simple of regulations.” Obviously, the regulations are not the real issue, here. In the past, I may have just gotten in his face and told him to “stop being such a dirtbag and get with the program.”
In this sense, an Adlerian approach to the role of context also opens possibilities for examining human behavior in highly values-based cultures such as the military services. Adlerian theory intersects productively with other theories of sociology and social systems, including the phenomenological “lifeworld” envisioned by Alfred Schutz and various other forms of social constructionist thinking (Buechner, Van Middendorp, & Spann, 2018; Pearce, 2008). It also connects with a range of integrating constructs that cross scientific/academic silos such as the “All Quadrants, All Levels” (AQAL) model of integral theory (Wilber, 2006) and the “Mind, Brain, Culture, System” model of sociology put forth by Talcott Parsons (Matoba, 2013; Shay, 2010). This broad framing can be helpful in searching for interdisciplinary solutions that are culturally sensitive and socially responsible. For example, the sometimes-difficult conversation around contemporary veterans’ experience is normalized when considered within the perspective of communication, the humanities, and the human sciences (Parcell & Webb, 2015). In the context of storytelling, it becomes possible to unravel the meaning of the stories told, or not told, by returning veterans, and engages the capacity to reframe these stories in a way that allows the rest of the society to both participate and understand their role (Pearce, 2008). This quality or capacity can be referred to as cultural competency, or the ability to engage in “transcendent discourse” or “cosmopolitan communication” as a means of overcoming “moral conflicts” that are so deeply held that they prevent mutual understanding (Pearce & Littlejohn, 1997). This process of shared meaning-making in community is potentially transformative for the society as well as cathartic for the individual (Gergen, 1982). It also opens possibilities for the true “co-construction” of meaning and future identities, rather than simply forcing the veteran to transition from the role and cultural norms of the warrior to one (among many) civilian alternatives.
Far from being purely objective or value-neutral, Adlerian psychology embodies a particular set of values, particularly social interest, courage, pragmatism, excellence, and pluralism. 3 These values are consistent in many ways with military values, enhancing the value of an Adlerian social-systems approach to working with social science research in military specific contexts, and also contributing to the development of military cultural competence. Taking this Adlerian perspective also leads us to consider mental health issues facing many veterans as social justice issues, which is not the commonly used lens for looking at obstacles associated with transition. This, too, has further potential for productive collaborative social science research.
From Transition to Transformation
Most currently used conventional approaches to the life changes or transitions facing returning service members and veterans do not fully account for the cultural and psychological complexities of the associated change of context and identity, and the underlying stressors that frequently accompany such deep changes (Mezirow, 1991). Ken Wilber (1998), the founder of integral theory, refers to the thinking behind most models and studies of veterans in transition as a horizontal movement that he calls “translation,” or “giving the person a new way to think or feel about reality” (p. 141). In contrast, he describes “transformation” as a vertical movement, or growth in perspective or worldview, in which previously accepted conventions are “challenged, witnessed, undermined, and eventually, dismantled” (p. 141). In a transformational inquiry, episodes of difficult lived experience (or trauma) are engaged as a potential impetus for learning and personal growth. In a transition or translation approach, such experiences are generally left unexamined in the past, and focus is moved to a different identity or way of being that is offered as an alternative. Here again, the lens of transformation, or “transformative learning” theory (Mezirow, 1991), can be helpful. Such bodies of theory can be used to unpack the aspects of lived experience of transition that may be problematic. Failing to resolve the underlying dissonances of difficult experience and just “moving on” may be helpful in the short term but may not fully address the longer term effects (Buechner, 2014).
Transition Stress, Liminality, and Moral Injury
In the “transition” view of veterans’ social and mental health support programs, combat trauma is almost always looked upon as a principal object of study. However, there is increasing evidence that “transition stress” caused by the social factors of returning from deployments or leaving the service may be an even more significant factor than previously believed (Mobbs & Bonanno, 2018). This in turn has implications for researchers into the phenomena associated with veterans’ social and mental health issues. When we consider that the process of “coming home” for many veterans is not simply a matter of just moving on from one stage of life to another, the sources of potential stress become clearer as a form of “cognitive dissonance” in which the rules and codes of conduct for navigating the world around us have somehow shifted (Buechner, 2016). Such experiences may often be accompanied by a sense of liminality, or being “betwixt and between” in a situation where previous rules and values no longer apply, but the new ones are unclear (Dirkx & Dang, 2009; V. W. Turner, 1964). This state of liminality, combined with unresolved or troubling past experiences in light of an uncertain future or confusing or ambiguous social context, may open the door for the emergence of “moral conflicts,” or clashes of experience with deeply held convictions, values, and beliefs (Pearce & Littlejohn, 1997). If not confronted and addressed constructively, these moral conflicts may develop into “moral injuries,” generally described as feelings of guilt and/or shame connected with the (real or perceived) transgression of deeply held moral beliefs and expectations (Shay, 2014). Considered together, these social and psychological factors constitute forces that can significantly affect the way veterans come to see the mainstream social world, and its underlying meanings. Whether these forces result in dysfunction and alienation or positive personal and social change depends to a great deal on the ways that these are deliberatively engaged in communication by both veterans and public social institutions (Pearce, 2008). The following quote from a Capstone project by an earlier Adler MAMP student illustrates the phenomenon of co-construction of meaning through shared inquiry, and how it is different from the normal discourse of clinical treatment: I met with a female veteran who was a Navy Corpsman . . . When the veteran reported that she had been diagnosed with PTSD, I informed her that if she is ever interested, our organization offers counseling services free of charge. She immediately shut down, told me that she doesn’t identify with the diagnosis, and doesn’t benefit from therapy. After meeting her a few more times, we explored the concept of moral injury. It was like someone had turned on a light for her—she was able to identify so strongly with a concept that she considered to be part of the normal aftermath of having served in combat. She became an active participant in the Moral Injury groups offered, and has shown improvement in all aspects of her life.
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The example above illustrates one of the underlying reasons why many veterans do not want to seek care for mental health issues that are defined as mental illness, such as PTSD. This could be because of cultural factors related to warrior identity and pride or because of fear of negative consequences. For example, mental health conditions such as anxiety, depression, and PTSD are disqualifying conditions for officer commissioning programs, per the Navy Manual of Medicine (U.S. Navy, 2018), Chapter 15, Section 15-58, Paragraphs 2 and 12 (Kent, 2018). This helps explain why many service members specifically tell their doctors that they do not wish to be treated, particularly with prescription medications of any kind, for their mental health concerns. Shannon’s research with a cohort of her fellow Navy CPOs described later in this article tested the hypothesis that they might respond more favorably to an invitation to explore and make meaning of these difficult experiences in a supportive peer cohort (Kent, 2018).
Practical Application
Adult Learning Methods and Collaborative Social Research
The Adler MAMP program requires students to work together in fairly diverse, yet cohesive cohorts throughout an intensive 2-year program. Each student’s learning draws on his or her individual experience and interests, grounded in a common core of subject matter pertaining to the historical, cultural, and psychological dimensions of the experience of military veterans. While working together in seminar-based learning cohorts, the students have opportunity to mentor and support one another and also receive mentoring support from the faculty (Daloz, 1986). In the case of the Adler MAMP program, many of the faculty members are military veterans and can reciprocally relate to their experiences. The student’s individual interests may not overlap with those of other students in some areas, but they share a common grounding in working to complete their studies together along with their individual research projects, amid time constraints and multiple levels of other roles and responsibilities each student carries. Sorting through all of these factors is a part of the adult learning experience, prioritizing learning by pragmatic value and perceived relevance. The process of working together to uncover the underlying essence of a phenomenon of interest in a supportive and diverse environment of peers and mentors is in many cases inherently transformative in and of itself (Bentz & Rehorick, 2008). This is further assisted and informed by methods of inquiry and heuristic tools that help frame and draw out the underlying meanings inherent in social systems.
Practical Usage of Theories in Research
Some of the essential paradigms and theoretical concepts introduced at the Capstone studies level include social construction, or the concept that our social worlds are created largely by symbols and processes of communication (Gergen, 1982; Pearce, 2008); phenomenology, or the rigorous process of examining human consciousness and how it shapes our perceptions of the social world (Bentz & Rehorick, 2008); and somatics, which considers internal perceptions of the body, and ways in which certain experiences such as trauma become embodied (van der Kolk, 2014). These bodies of theory and inquiry in turn support a number of potentially useful constructs, including posttraumatic growth, which considers how difficult experience may translate into new ways of seeing the world and relating to others (Tedeschi & Calhoun, 2004), and moral injury, which describes the impact of dissonant experiences on the moral codes on which human beings base their worldviews (Shay, 2014). Students may select any combination of paradigms, theoretical perspectives, and constructs that best fit the phenomenon that is of central interest to them. In Shannon’s case, she chose to look at the potential for the use of mind–body medicine in alleviating stress of actively serving service members, framed in a somatic perspective (Kent, 2018). She described her self-awareness of being uniquely positioned to do this in the following way: We need to move away from over-prescribing (medications) and helping these service members regain control of their lives. I want to clarify certain areas for better understanding and really explain why exercise for healing is a fantastic approach and how the culture comes into play. I realized that taking this course, and in my case being raised in the culture, puts me in a position where I can make a contribution of data in an area that is still lacking.
Learning and Self-Reflection in Community
The learning and co-inquiry process itself can be both enlightening and therapeutic, both for the individual scholar/researcher and for those participating in research studies. Collaborative approaches to research involve all participants in practicing reflexivity, in which research groups continuously engage in their own experience as well as the social system under investigation from multiple perspectives (Rascon & Littlejohn, 2017). This involves several distinct “turns” in the inquiry, alternating in a nonlinear way between description, interpretation, critical analysis, and envisioning actions that would change the system (Rascon & Littlejohn, p. 20). This process of thinking together can expose members of the group to alternative ways of seeing and interpreting things and also surface otherwise unseen common human values and connections. Those going through difficult experiences may tend to believe that they are in it alone, whereas comparing stories and experiences with others can reveal a shared sense of humanity or communitas that can be both healing and growth promoting (E. Turner, 2012). Turner further describes communitas as a form of “collective joy” among (often temporary) temporary groups that band together after a shared experience of hardship or liminality, essentially “overriding the (existing) social contract” to create a new, shared sense of meaning and purpose (E. Turner, 2012, p. 3). This is perhaps the highest expression of the Adlerian value of “social interest” or “community feeling,” often accompanied by the emotional response of joy (Mosak & Maniacci, 1999, p. 153). Rudolf Dreikurs, a contemporary interpreter of Adler’s work, notes that this kind of deep enjoyment is a powerful motivator for learning, and an enhanced appreciation for life is one of the primary outcomes of collective social interaction and “thinking together” (Dreikurs, 1971, p. 160). Shared making of meaning has both spiritual and social connotations, and it serves to create new possibilities, not just presenting the participants with a narrow range of “either/or” choices in order to fit in somewhere else when they no longer feel connected to what has gone before—essentially co-constructing a new shared sense of reality together (Pearce, 2008). This may, in turn, help them think about their role differently as a leader of change within the system, or in a new identity or role in a different social system that is coherent with personal values. Shannon explains how she experienced this process of awareness and transformation in one of her final Capstone essays: When I reflect on my own “dark times” in the military, I find that this course of study has allowed me to forgive myself . . . I realize now that I was treated very poorly and was right to be angry during that time, and that the chronic stress of having undergone four combat deployments in six years is a load that is ridiculous for anyone to bear. As a senior leader myself now, I realize that I would never make my people do that much, especially in such a short amount of time. I realize that, while one is always responsible for their own actions, you reach a point where you have to ask, “Well, what did you think was going to happen when you put someone under that much pressure?” It’s kind of amazing that I didn’t end up much worse off than I did. I completely lost my “filter,” which got me into trouble, and some of my better judgment, which made me do crazy stuff I regret now, but I know now that all of that is pretty normal given the circumstances . . . I know what it looks like when someone is starting to spiral. I know what it feels like. And now, I know what to do about it.
This awareness of the debilitating effects of prolonged stressors, and the importance of military cultural factors in helping service members to deal with it constructively and without stigma, led to her collaborative research design. She focused her data gathering on dialogic engagement among a peer cohort of female Navy CPOs on Facebook, who voluntarily participated in her study as a way of helping others to better cope with stress. The following section is excerpted from her Capstone thesis (Kent, 2018), which focused on the potential of applying principles of mind-body medicine to expand nonclinical venues to help service members cope with various forms of combat and transition-related stress. Additionally, the study found that many of the participants found that prescription medication did not improve their conditions and that these veterans were open to alternative forms of treatment. Later in this article, we propose that the processes of collaborative inquiry and reflection inherent to adult learning methods may also be particularly helpful for opening up nonthreatening space (which does not otherwise exist) for potentially transformational conversations with and among veterans. This pertains not only to matters of moral injury, combat stress, and alternative treatment methods we have mentioned so far but also has implications for the broader range of institutions, cultural assumptions, and other issues of importance to veterans—as illustrated by this quote from one of Shannon’s colleagues: I found the different types of communication and questioning very informative and useful, especially in working with PTSD and other disorders. One of my biggest takeaways was the literature on transformative learning (and posttraumatic growth). I really feel applying that method has the potential to heal many. This came after discussion on emotional management and finding a way to channel those emotions. The possibility of helping someone not just bounce back to their previous norm, but to actually move on with a new sense of self is pretty amazing.
Case Study: Co-Inquiry Into Mind–Body Practices Among Female Navy Chief Petty Officers
Background
This section draws from the Capstone project study undertaken by the first author, Shannon Kent, while serving as a Navy CPO on active duty. The purpose of the study was to help identify how a group of peer female CPOs address their physical and mental health concerns, other than with the use of medication. Focus was attuned to mind–body practices for coping with stressors from a variety of sources, whether formally diagnosed or not, with symptomologies possibly related to moral injury, transition stress, or PTSD. Several of the theoretical principles relative to veterans discussed earlier in this article were interwoven in the interview protocol, introducing the study to participants in a way that provided some grounding and education on the potential value of mind-body approach to both psychological and physical health, as uncovered in the literature review prepared as a part of the study.
The collaborative portion of the research was conducted on a Facebook page created for and by female Navy CPOs between the ranks of E7 and E9. Participants were informed and aware that the researcher was a peer CPO and that the intended use of this data was to assess whether there was sufficient interest among service members to participate in mind–body medicine techniques in order to warrant investment by the Department of Defense in offering such therapies as nonclinical interventions. The survey instrument was designed to measure the level of participant engagement in a range of somatic modalities including physical fitness routines, meditation or yoga services, massage therapy, acupuncture, chiropractic services, and group activities including various sports. Direct responses were also solicited regarding the perceived efficacy of various mind-body related techniques, including yoga, tai chi, acupuncture, massage therapy, diet and “natural” medicine, and group-level activities, in alleviating stress.
As a peer CPO, the second author designed the online survey with awareness of the context of military service, in which there is not much spare time for extended forms of treatment due to operational and training pressures, and a perceived stigma around seeking care or therapies. One hypothesis to be tested was that mind–body practices such as CAM may not be as stigmatizing as other clinical forms of mental health treatment (Herman et al., 2017).
Theory and Hypothesis
This participative study was designed to test the hypothesis that mind-body health care methods would be accepted among service members if the Department of Defense were to invest in them. The “mind–body” psychological approach to wellness is closely related to concepts of well-being referenced in positive psychology (Seligman, 2002), which can include calming practices such as physical exercise and meditation. However, mind–body psychology takes these principles a step further and also involves nutrition as well as other techniques to promote overall wellness. This field of study is especially applicable in a military context, where it is believed that 22 veterans per day may be committing suicide (Kemp & Bossarte, 2012). This study also sought to test the additional hypothesis that there may be less perceived stigma attached to mind-body approaches to health care than those involving the use of prescription mental health drugs, and/or clinically administered “talk” therapies. If so, availability of these therapies may attract the participation of more military members, which could help a wider swath of service members who may need treatment but do not seek it now out of fear. This may be especially attractive to service members who hold a national security clearance, as a portion of the SF-86, a mandatory security review form, looks at mental health treatment as a risk factor.
Mind–body medicine not only treats symptoms of physical and mental illness, but research indicates that it can even help prevent disease from taking root in the first place. For example, a 2002 study led by Dr. David Krantz indicated that psychological and social factors potentially play a very important role in the predisposition and likelihood of women to develop organic coronary artery disease (CAD). This study focused on five key variables identified as possible psychosocial risk factors for CAD, specifically acute and chronic stress, hostility, depression, social support, and socioeconomic status. It produced convincing evidence of the impact of psychological and social support on CAD morbidity and mortality (Krantz & McCeney, 2002), making a convincing case for incorporating mind-body psychology into programs to support overall well-being. It adds to evidence in the literature that psychological and physical health are connected and that psychosomatic symptoms of a disease may be better treated not just with prescriptions and surgeries alone but with a complement of mind-body psychological treatments as well.
Method and Approach
For the initial study, 224 female Navy Chiefs who are part of a closed group Facebook page especially for female Navy Chiefs, of which the researcher was a participating and trusted member, were surveyed. The approach taken by this study was to ask a group of service members to consider how mind-body medicine can best be used to alleviate the psychosomatic symptoms of mental and physical illness. The survey questions were derived from a focused literature review, including uses of some of the most popular forms of mind-body medicine in other contexts. The survey was provided via a link on the group page. Although the survey did not ask demographic information related to age or ethnicity, the respondents who (voluntarily) identified themselves were ethnically diverse and ranged in age from approximately 27 to 65 years.
The link was available to all women in the closed female CPO Facebook group. All members were invited to take the survey. This group page had a history of being generally supportive of attempts by other group members to collect data for educational purposes, and it routinely used to provide feedback on any of a number of issues posed by group members. To be a part of this particular Facebook group, one must be a female Navy Chief, Senior Chief, or Master Chief (pay grades E-7, E-8, or E-9), either active or retired. Members are not allowed into the group without being vouched for by at least two other members of the group. Access was tightly controlled in order to prevent anyone who is not a member of the female “Chief’s Mess” from entering. To date, there are 5,073 members. Of this overall number, 224 (4.42%) elected to take the survey.
The survey contained 10 questions designed to gauge current usage of mind-body psychological techniques, whether or not the participants experienced relative improvement through the use of these techniques with respect to physical or mental symptoms of illness, and to gauge interest in such techniques among those who may not have tried any before. The survey was available for 1 month to encourage maximum participation. At the end of the month, the survey was removed and replaced with a brief summary of the findings, as promised. This level of inclusion and transparency was considered essential to maintaining trust and to encourage future participation in similar studies. Although no demographics specific to age, race, or identification were collected, many participants reached out to the researcher to indicate that they had completed the survey, and from this personal contact, some demographic information was available. From this observation, there was no observed pattern in age or race, as the participants varied greatly in these.
Results
This survey confirmed the hypothesis that, among this group of female Navy CPOs, CAM of health care were utilized, and these approaches were perceived to be effective in combating the psychosomatic symptoms of mental and physical illnesses. Most significantly, 87.5% of participants responded that they would be willing to engage in CAM to augment their health care, and 69.6% reported that they noticed an alleviation in the negative effects of stress, anxiety, and depression when following an exercise regimen.
Cardio was by far the favored method of physical activity, at 72%. Diet was not reported to be an effective way to combat psychosomatic symptoms of mental/physical illness, although 87.5% of participants indicated willingness to try a nutrition-based form of CAM (e.g., a specialized diet) to augment their health care.
Outside physical exercise, most participants (65%) reported using other forms of CAM methods successfully. The most favored method, at 45.45%, was massage therapy. The next most popular methods were aromatherapy/essential oils at 20.9%, meditation at 19%, chiropractic services at 15.45%, and acupuncture at 12.3%. Just over 60% of the surveyed population had an interest in meditation, with half of this percentage having already tried it and loved it, and half having never tried it but interested in it. Of those who had tried it, there was a 2:1 reported efficacy rate.
The use of antidepressants was a particular concern with 31% of participants. These participants are those who currently take antidepressants with unsatisfactory results, participants who think that perhaps they should be on antidepressants, and people who specifically told their doctor that they do not want to take any pills whatsoever. However, when the 46% of participants who responded that they had never taken antidepressants because it never came up are excluded, a striking 72.7% (88/121) of participants had problematic experience with antidepressants. Only 27.3% of this second pool reported that antidepressants helped them immensely. All other categories indicated that antidepressants either were not helping them fully or they had personal reasons for not wanting to take pills. A third category indicated that they might benefit from antidepressants, implying that their mental/physical health was in a less-than-ideal state that could benefit from an outside intervention, either pills or CAM.
A surprising result, which was not anticipated in the survey design, was that “calling a friend” was one of the top two ways in which participants reported making themselves feel better, separated by only a narrow margin from “engaging in physical activity.” This suggests that both social connectedness and some form of engagement with physical or mind–body practices are underlooked in the mental health support of veterans, and this should receive further study—particularly in light of growing evidence that social isolation, or feelings of not belonging, are a significant factor in suicide risk (Van Orden et al., 2010).
Perhaps more important than the specific data gathered by this survey was the willingness of the participants to discuss issues of mental health openly, and in a supportive way, with a peer. It is clear that some service members do not trust military mental health care providers, both through survey results and anecdotal evidence. This mistrust is not necessarily placed at the feet of the mental health care providers themselves but in the military writ large for fear of what can happen once that data are in a service member’s medical record. For example, there are certain Department of Defense policies that indirectly discourage service members from seeking care for mental health issues. Although many policies exist to promote mental health care, such as DODI 6490.08, other policies disqualify individuals from entering the military or, once in the military, may disqualify them from commissioning to the officer ranks and can affect security clearances. This could explain why “calling a friend” was rated so highly as an effective action to making oneself feel better.
The study referenced above highlights the need for multiple mind–body wellness avenues and the need for open, encouraged dialogue between peers about their value and impact. This idea of promoting open peer communication and inclusion also connects with emerging understanding of a strong link between interpersonal connectedness and identity as a deterrent to suicide (Van Orden et al., 2010). The results also point toward a need for more integration between the various domains of human experience, spiritual awareness/mindfulness, somatic practices, organizations/concepts, and intercultural values/competence.
Conclusions and Recommendations
The outcomes of collaborative study and research as described in this article can be classified into three broad categories: (1) contributions to knowledge of the social and cultural dimensions of military and veterans’ mental health from the perspective of systemic examination of direct experience by military-connected students, (2) approaches for creation of space in academic discourse for the sharing of perspectives and gaining mutual understanding of service and combat experience across cultural boundaries between military/veteran communities and the general public, and (3) therapeutic value of sharing stories in temporary yet inclusive forms of community (communitas), in this case, as part of personal growth and development in an adult-learning process. While Adler University’s military psychology program is admittedly somewhat unique due to being built on a foundation of adult learning, collaborative inquiry, Adlerian social values, and military psychology content, the authors believe that a similar approach can be adapted to more universities that include military-connected students as part of the population.
In the first category, contributions to knowledge in the field, the findings of the studies conducted by, with, and for veterans, such as the one presented in this article, have particular consequence for the civil and military leadership and the field of veterans’ mental health. First, the inclusion of veteran and active duty students into these types of studies in a broader scale is essential to aligning many fields of professional practice in psychology and social service with “the reality on the ground” for veterans and their families. Many veterans avoid seeking care on the basis of available treatments being perceived as not applicable for them. The current conflation of the diagnoses and treatment of traumatic brain injury, PTSD, and other DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) mental health diagnoses such as depression and addiction/substance abuse disorders serves to create confusion and mixed messages for veterans and families. To get around the fear of negative consequence and stigma, service members may be taking their mental health care into their own hands, rather than seeking professional help where and when it is appropriate. The use of the more “objective” forms of research, such as large-scale surveys and “big data” quantitative analysis, does not necessarily surface the cultural and behavioral nuances of “what is really going on” as service members and veterans make pragmatic yet isolated decisions to try to stay under the radar and avoid real or perceived negative consequences.
In the second category, collaborative inquiry projects of this type that include both veteran and nonveteran perspectives can do much to break down the real and perceived barriers of understanding between the veteran and civilian population. Collaborative inquiry projects are useful in nearly any course of study where interpretation of human behavior or translation of meaning between cultural contexts is a factor—particularly around issues that involve moral or ethical conflict (Pearce, 1989). War almost inevitably implicates such ideological divides. Therefore, we advocate for more military-connected students to engage in such studies within or outside their chosen fields of study or practice, as a way of healing both the self and society. The current scarcity of published research conducted or led by military-connected students speaks to an unmet need in this area. Broader dissemination of the results of these veteran-led student research initiatives is also needed in the public sphere in order to shed light on serious issues affecting the military today that are also of great consequence to the broader society, if only they were aware of them. This also challenges the notion that it takes a veteran to understand a veteran, and this supports the concept of expanding integrated, community-based veterans’ programs through further development of military cultural competence at the community level.
The emerging category of moral injury is just beginning to be discussed in academic circles and is not well-known outside them. And yet the resonance of this conceptual model appears to be strong when such conversations are held (Buechner et al., 2018). Understanding more about the nature of the way in which our current national policies are formulated based on potentially outdated concepts of “just war” are essential to an understanding of the responsibility all Americans bear for the moral injuries experienced by service members who are on the front edge of the consequences of those policies (Meagher, 2014). Finding ways to heal these moral injuries is therefore more than just creating better therapies; it may also be about sharing the experience—and responsibility—more openly and broadly outside the confines of the military and veteran community (Sherman, 2015). Spreading the practices of collaborative inquiry within the services and the veterans’ community may also be useful in elevating more complete “ground truths” on various topics to leaders of each of the services and legislative policy-makers, which they can then use to affect positive policy changes.
Finally, there is an unrealized opportunity to further engage the healing value of participation in communities of inquiry into the human dimensions of difficult and complex social issues, especially for those marginalized in some way by mainstream society. Such collaborative experiences may have therapeutic and inspirational value far beyond the academic and practical usage of the data they create, by creating a space of loving acceptance, shared happiness, and fulfillment that connects individual lived experiences with the universal human story (Buechner, 1991). Qualities of joyfulness, caring, and mutual support were characteristics of service described by Shannon’s study cohort of female Navy Chief Petty Officers (Kent, 2018) and also observable within her learning cohort of peer Adler students.
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This suggests that these qualities may be linked in many ways to personal and social transformation, and the effect may be transferable. If improving the overall well-being of service members and veterans is at the heart of our social policies and institutions, then more of this kind of participative and collaborative research should be further fostered and encouraged. Such deep and reflexive conversations may also serve to inspire others to pursue service to society in different forms and contexts. One of the nonveteran students in Shannon’s Capstone cohort described the impact of participation in her learning cohort in the following way: Through my Capstone project, I got to know ten individuals that fulfill my definition of heroes. They are resilient, courageous, and honorable; they see their service as a duty fulfilled. I am humbled by their spirit and all those who have served and are still serving. I aspire to be a scientist-scholar-practitioner who advances systems, methods, research, and practice to serve those who have so honorably served us.
Although we cannot estimate what the world has lost through Senior Chief Petty Officer Shannon Kent’s untimely death, we can also not underestimate what will yet come from her inspirational leadership and personal example. One of the many reasons to remember her and to share her story.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
