Pain and Masculinity: A Cohort Comparison between Mexican American Vietnam and Post

Abstract

Using twenty-six interviews with Mexican American veterans, this study analyzes cohort effects between Vietnam War veterans to Iraq and/or Afghanistan veterans on the meanings and experiences of pain from combat, masculinity, and how ethnicity affects expressions of pain. Although there were relative similarities between the cohorts, differences arose because of age. Vietnam veterans understood their pain to be long-lasting and have built coping mechanisms around a lifetime of pain, as opposed to younger veterans who have not yet solidified coping strategies. Machismo plays a dynamic part in the expression and daily experience with pain for young veterans, as opposed to older veterans who enjoy relaxed gendered obligations based on their age. Finally, older veterans used family as a base of social support, as opposed to younger veterans who found support from peer-mentor programs. In addition, respondents indicated that machismo acted more as guiding principle and offered them motivations to seek help, and not necessarily barriers to health. Overall, both cohorts are governed by strict gender standards and expressions influenced by their ethnic identity. Findings suggest that the study of race/ethnicity and age plays a fundamental framework from which to understand the experiences and behaviors of pain.

Keywords

veterans war Hispanics ethnography ethnicity

Exposure to physical and emotional trauma, specifically combat experience, has long been associated with psychiatric injury, particularly post-traumatic stress disorder (PTSD; Cancio 2017; Coleman 2006). Pain is the most reported identifier of PTSD (Roth, Geisser, and Bates 2008). PTSD and pain co-occur because traumatic events lead to the experience of pain (Sharp and Harvey 2001). Both the physical pain from combat-related injuries associated with PTSD and emotional pain from PTSD resulting from combat experiences pain from combat associated with PTSD are serious problems among Mexican American veterans. Approximately 1.1 million Latinos aged eighteen and older are veterans of the US Armed Forces (United States Census Bureau 2009). According to a study conducted by the US Department of Veteran Affairs, Latinos have much higher rates of psychiatric injury as compared to whites, 28 percent and 14 percent, respectively (Loo 2014). Latinos are proportionally represented in the military, comprising approximately 17 percent of the general population and 12.3 percent of active duty service members (US Department of Defense 2011). However, Latinos are overrepresented in combat positions by as much as 85 percent; consequently, they face a higher risk of developing PTSD (Arminio, Grabosky, and Lang 2014). Additionally, Latino veterans in the United States are expected to have a 23 percent enrollment increase by 2030 (Office of the Under Secretary of Defense 2011; US Department of Veterans Affairs 2014). Therefore, with growing enlistment rates (Tanielian and Jaycox 2008), the number of Mexican Americans experiencing pain¹ (either physical and/or emotional) from combat has the potential to be increased and continue to climb above other ethnic and racial groups.

The high prevalence of PTSD among Latinos has generated many studies that present various inconclusive results attempting to explain why this group is at higher risk of developing PTSD (Craven et al. 2014; Heilemann, Kury, and Lee 2005; Pole et al. 2005). This is because these studies have exhibited various methodological shortcomings (e.g., poorly defined samples and substantial lack of systematically applied diagnosis criteria). Moreover, studies have been more anecdotal in nature, relying on minimal observations or few case studies. Additionally, none of these studies have attempted to investigate the lived experiences of this veteran population. Since ethnic and gendered identities govern how individuals share experiences about pain, what experiences they share, and the contexts in which they share these experiences (Zborowski 1952; Zola 1966), research about what it means to be a Mexican American male offers potentially important contributions to sociological, ethnic studies, Chican@, and psychology literature.

Using symbolic interaction² (SI), this study examines how pain—as a physical and emotional experience—shapes situations in which the person learns new definitions of self and often relinquishes old ones. The individual in pain draws upon past social experiences, cultural meanings, and knowledge to engage in a mental dialogue about the meanings of present physical, and social existence. This study assumes that ethnicity is socially constructed self-identity; the self is intimately connected to respond to pain as a reflection of ethnic and cultural norms.

Although machismo, war, and PTSD have been documented in research, there is a scarcity of information concerning its association with physical and emotional pain, mental health, and the construction of identity. It is important to understand how gender roles relate to cognitive emotional factors, especially when considering that gender role experiences also occur cognitively, emotionally, and behaviorally (O’Neil 2008). Thus, the present study uses in-depth interviews in order to constructing meanings and experiences from Mexican American veterans who suffer from physical and/or emotional pain from combat. This study attempts to flesh out some of the existing constructs and concepts (e.g., machismo, familism, and PTSD) from the participants’ point of view and will serve as an important step in unraveling the influence of ethnicity on the construction of social meanings, providing a deeper and more critical theorization of masculinity, race–class–gender intersectionality, and machismo. In addition, I conduct a comparative analysis between Vietnam and contemporary veterans (Iraq and Afghanistan)³ who have been diagnosed or self-identified as having PTSD resulting from their military experiences. I ask the following research questions:

What are the meanings of pain?

What does it mean to be a Mexican American man living with pain/in pain?

What are the similarities and differences between veterans who served in Vietnam to those who served in Iraq/Afghanistan?

Literature Review

Understanding the complex relationships among Mexican American veterans and their experiences with pain requires an examination into understanding the ways in which ethnicity establishes conditions by which pain behavior takes place. For example, being Mexican American—though conditioned to some degree by other social mechanisms like acculturation—contributes to the experience and understanding of pain (Cancio 2015). Since the study is concerned over ethnic identity differentials over two veteran cohorts, symbolic interactionism provides an ideal approach to examine the relationship between being a man, a veteran, and Mexican American, and how these factors contribute to their expressions of pain. Various empirical studies have contributed to studies on ethnic/racial and pain behavior (Cancio 2015; Kwok and Bhuvanakrishna 2014; Mahadeva, Mahfudz, and Vijayananthan 2015; Matsuura et al. 2012), the impact of PTSD-related pain in the context of ethnicity (Shin et al. 2012), and the developmental effects of ethnicity on perceptions of pain (Boissoneault, Bunch, and Robinson 2015; Bourke 2014).

Ethnicity influences pain beliefs and health behaviors in several ways. For example, many Latinos believe that experiencing pain should be without complaint (Sobralske 2006). Furthermore, expressions of pain rooted in ethnicity vary and prompt ethnically appropriate behaviors (Anderson 2001). This suggests that reactive patterns or manifestations of pain (e.g., moaning or crying) may have different functions among various ethnic groups. Different ethnic groups have diverse sets of values, norms, and attitudes about health and the experience of health (Bourke 2014).

A sociohistorical understanding of being Mexican American allows for an understanding of the various intersectional influences that contribute to its particular beliefs for Mexican Americans. Mexican Americans, as a group, are not completely homogenous. According to Guillermo B. Batalla, a distinguished Mexican anthropologist, the culture of being Mexican was an imagined identity manufactured by bourgeois metropolitan intellectuals to rally a highly diverse group of mixed indigenous, African, and European cultures (Guemes and Bonfil 1995). However, there still exists a standard of ethnic beliefs for Mexican Americans (Horevitz and Organista 2013; Murrillo et al. 2015). This adherence depends on the degree of acculturation (Jasso 2015; Murillo et al. 2015). Acculturation is the degree from which individuals adopt culture in the context of migration. The Children of Immigrants Longitudinal Study formulated that of all the ethnic groups in their sample, 92 percent of second-generation Mexican Americans were not ashamed of or embarrassed by their Mexican parents (Portes and Rumbaut 2012).⁴ This finding is a clear indication that there is a high acceptance and continuation of Mexican norms and values among this group. It also points to the idea that high adherence to parents’ cultural norms and values may reflect understandings of parental views among offspring, even though their own norms and values may differ. Additionally, this finding supports both Horevitz and Organista’s (2013) and Murrillo et al.’s (2015) finding that Mexican Americans have an intense adherence to Mexican culture and a more traditional Mexican outlook on health beliefs.

The foundational norms and values of Mexican Americans provide a conceptual framework for understanding the relationship between ethnicity and health. For example, first-generation Mexican Americans believe a healthy person is one who is fulfilling his or her functional role and is free of any pain (Horevitz and Organista 2013; Murrillo et al. 2015). Moreover, research has suggested that a key behavior among Mexican Americans who are experiencing pain is self-control (Williams et al. 2014). Horevitz and Organista’s (2013) study on Mexican health beliefs found that the concept of self-control is important in Mexican culture. This is because self-control is a guiding behavior exercised in conjunction with Mexican cultural norms (Horevitz and Organista 2013). Concepts of masculinity have a fundamental role in the health behavior and definitions of pain for Mexican American men (Fragoso and Kashubeck 2000). Mexican American masculinity is an important area to study because gender is a common antecedent of health behaviors (Fragoso and Kashubeck 2000; Houle, Mishara, and Chagnon 2008).

The sociocultural script of male gender role socialization in Latin@ communities is referred as machismo. The construct of machismo is the intersection between beliefs and expectations regarding the role of men in society. Machismo encompasses positive and negative aspects of masculinity, including bravery, honor, dominance, aggression, sexism, sexual prowess, and reserved emotions, among others (Nuñez et al. 2016). Machismo is an overarching grand narrative about Latino masculine cultural history, social experiences, and gendered behavior (Falicov 2010). Machismo involves “doing” cultured masculinity (West and Zimmerman 1987). This conceptualization of gender contextualizes the relevancy of being Mexican American and a male combat veteran because it sheds light on the different intersections that factor into the self-concept and contribute to exacerbating behaviors toward pain.

In addition, gender and ethnicity contribute to emotion management and specifically emotion work where individuals induce or inhibit feelings so as to render them appropriate to any given situation (Hochschild 1983). The conscious effort on managing emotions in order to maintain social relationships may explain how veterans experience pain management both in and out a military setting. This perspective allows us to examine how coping works with emotional trauma from combat experiences. Over time, individuals who have been systemically conditioned and socialized by the military (by means of boot camp, military training, and military culture) learn to rely on emotion work not only during training but also during deployments, during combat situations, and at home. Military socialization makes emotional management an overarching component of a successful military service member, making emotional management a normal function within the context of the military. These work-performance coping strategies may contribute to issues with resocialization when returning home and/or transition back into civilian life. The dependence on emotion work, while integral in a military setting, may be an unwanted domestic and personal consequence in PTSD-related pain. The challenge lies as veterans try to learn how to reverse or undo their dependence on emotion work.

Machismo for Mexican Americans is a salient a part of men and women’s cultural self and ethnic identity. Moreover, machismo can be most salient when operational demands of high-risk, high-stress occupations such as when military combat service are experienced (Cañive et al. 2001; Herrera, Owens, and Mallinckrod 2013). For example, restricting emotional expression may complement military training during a deployment. However, this may become problematic at home, after a deployment, due to the long period of separation and adjustment. The culmination of both machismo and military norms exacerbates behaviors toward pain (Canive et al. 2001; Craven et al. 2014; Sobralske 2006; Herrera, Owens, and Mallinckrod 2013). Therefore, Mexican American men follow socially approved gendered behaviors and expectations shaped by their ethnic identity.

Data and Method

Although machismo has been documented in research, there is a scarcity of information concerning its association with emotional and physical pain. It is important to understand how gender roles relate to cognitive emotional factors, especially when considering that gender role experiences also occur cognitively, emotionally, and behaviorally (O’Neil 2008). Thus, given the possible relationship of gender roles with emotional and physical health, the present study examines associations of machismo with negative cognitive emotional factors (i.e., PTSD) in a Latino sample. Using in-depth interviews, this study contributes to existing literature by constructing meanings and experiences for Mexican American veterans who suffer from physical and/or emotional pain from combat. Pain is a ubiquitous experience, simultaneously influenced by several factors, and subjective (Kotarba 1983; Osborn and Rodman 2010). This makes inferences on pain dynamic and extremely difficult to quantify (Osborn and Rodman 2010). Since the private nature of pain makes drawing quantifiable inferences problematic, a qualitative approach is appropriate, as it elicits thorough explanations that cannot simply be investigated by biomedical evidence (Cahana 2007). Furthermore, qualitative methods to inferences about pain are appropriate because qualitative approaches attempt to explore the personal experience of pain, access the insider’s experience, and adopt a different ontological position to quantitative work. In other words, qualitative work does not set out to discover a real or irreducible thing that is stable enough to be generalized to other populations of people but articulates the many and plural meanings surrounding pain that might be attached to it.

Data

The data utilized in this study consist of twenty-six in-depth interviews. Interviews lasted between thirty to forty-five minutes. Interviews were conducted in public areas easily accessible to the respondents. Data for the study were collected using a snowball sample in San Francisco and Los Angeles, California, from 2014 to 2015. The process of recruitment involved contacting personal references and networks. Personal references are those who have shared personal experiences associated with combat stress and PTSD prior to this project. Networks are individuals who have been referred by personal references as potential participants. Selected participants met the following inclusion criteria: (1) male,⁵ (2) self-identified as Mexican American, (3) served in the US Armed Forces during the Vietnam War or the Afghanistan and Iraq wars, and (4) diagnosed or self-identity as experiencing post-traumatic stress from combat military service. The average age of Vietnam veteran (n = 11) respondents was sixty-eight, meanwhile Iraq/Afghanistan veterans (n = 15) was thirty. Information about each respondent and descriptive statistics is given in Table 1. The Vietnam War veteran cohort (VV) differs from the Iraq/Afghanistan War veteran cohort (IAV) in terms of their military experience. The Vietnam veteran cohort was mainly composed of drafted personnel versus the Iraq/Afghanistan veteran cohort, which consisted primarily of volunteers. In search of the meanings of pain, interviews were grounded through the collective responses of respondents.

Table 1.

Participant Demographics and Statistics.

Participant Pseudonyms	Age	LOC	Conflict	No of Deployments	Service Branch	Years of Service	Military Occupation
Ocotillo	24	OC	Afghan.	1	USA	4	Calvary Scout
Tomas	26	SF	Iraq	1	USA	5	Combat Engineer
Lucas	28	SD	Iraq	3	USN	8	Military Police
Manuel	28	CA	Iraq	1	USMC	4	Mechanic
Uriel	28	LA	Iraq	3	USMC	9	Transportation
Wilfred	28	LBC	Afghan.	1	USA	5	Military Police
Ivan	29	BA	Afghan.	1	USA	4	Military Police
Kiko	29	SVF	Afghan.	2	USMC	9	Motor-t
Diego	30	SD	Afghan.	1	USA	4	Mechanic
Pablo	30	LA	Afghan.	1	USMC	4	Mechanic
Alfredo	32	LA	Iraq	3	USMC	6	Infantryman
Yago	32	CV	Iraq	1	USA	4	Radioman
Hector	33	LA	Iraq	1	USN	4	Corpsman
Carlos	35	LA	Iraq	3	USMC	10	Infantryman
Xavier	35	LA	Afghan.	3	USA	8	Infantryman
Nicholas	65	OX	Vietnam	1	USMC	4	Infantryman
Francisco	66	LA	Vietnam	2	USA	3	Radioman
Guillermo	67	LA	Vietnam	1	USA	3	Infantryman
Roberto	67	LA	Vietnam	1	USA	4	Infantryman
Valentino	67	SF	Vietnam	1	USMC	4	Infantryman
Emmanuel	68	LA	Vietnam	1	USA	4	Rifleman
Queretaro	68	SF	Vietnam	1	USMC	4	Radioman
Baldomero	69	LA	Vietnam	1	USA	4	Infantryman
Santiago	69	SFV	Vietnam	1	USA	4	Infantryman
Joaquin	70	LA	Vietnam	2	USMC	3	Medic
Zapata	71	SFV	Vietnam	2	USA	4	Infantryman
Descriptive Statistics VV	67.9		Vietnam = 100%	1.3	USA = 7 USMC = 4	3.7
Descriptive Statistics IAV	29.8		Iraq = 53.3% Afghan. = 46.6%	1.7	USA = 7 USMC = 6 USN = 2	5.9
Total Sample	45.9		Total Deployed 100%	1.5	Army = 14 USMC = 10 USN = 2	5

Note: Locations: LA = Los Angeles; SF = San Francisco/Bay Area; LBC = Long Beach; SD = San Diego; SFV = San Fernando Valley; CA = Calexico; BA = Bakersfield; CV = Central Valley; OX = Oxnard. Service branches: USA = US Army; USM = US Military; USN = US Navy; USMC = US Marine Corps.

Method and Procedures

The current study uses a symbolic interactionist theoretical approach complemented with a grounded theoretical methodology. Grounded theory methodology allows for the study of a group of people who have experienced a similar process and allows for a personalized theoretical understanding created by the participants (Charmaz 2006). This methodology works well with the symbolic interactionist perspective, which understands processes and meanings as social constructions rooted in social interaction (Charmaz 2006). In attempt to understand pain and ethnicity, grounded theory allowed the researcher to attend to what was heard, seen, and sensed during the interviews.

The interview questions were deliberately open-ended to explore all aspects of physical and emotional pain, the impact of pain on the lives of participants, and questions about ethnicity. Once the first interview was transcribed, the researcher began line-by-line coding, giving initial codes to the data. Three levels of coding were employed: open coding, selective coding, and theoretical coding (Charmaz and Belgrave 2012). The coding stages were consecutive, sequential, and not iterative. The product of each stage guided the following phase. Using this methodology, data formed categories of similar phenomena. As the categories began to fill, those that were most dense were identified as core categories (Glaser 2001). Through this process of densification, core categories become the core focus of theoretical articulation through to the development of basic social process (Glaser and Strauss1967).

Findings

Findings were divided among the following subsections: (1) Mexican American Culture and Ethnicity, (2) Meanings of Pain, (3) Machismo and Pain, and (4) Cohort Comparison in order to discuss the following four themes that emerged in data analysis: meanings of pain, machismo, hiding self, feeling disconnected, and dealing with pain. Table 2 presents descriptions of the themes constructed from the data used to examine the four subsections.

Table 2.

Themes and Descriptions.

Theme	Description
Meanings of pain	Expressing and emphasizing the degree to which physical and emotional pain from combat affects their life. Includes, constantly struggling with pain, feeling distressed and/or embarrassed by the sensation caused by any physical or emotional pain, and describing pain as undesirable
Machismo	Exhibiting masculine social traits (e.g., hide emotions, work ethic, and present manhood in daily tasks). A form of “being” masculine. The cultural effects of masculinity affect health beliefs. Exhibiting masculine standards is considered ideal
Hiding self	Respondents identified that being in physical, emotional, and/or both forms of pain were a shameful experience. Involves hiding painful experiences, feelings, and expressions about themselves and the trauma experienced by war
Feeling disconnected	Returning from deployment and losing the sense of family and community ties and personal involvement with the family. Consequently, this could result in the possible loss of social support. This does not mean that the individual has lost family in the literal sense. The individual fears loss of connectedness, security, and well-being. Feeling that no one understands them
Dealing with pain	Dealing effectively (coping) with pain using familial support and/or social/institutional support groups. Alternatively, not dealing with pain effectively by isolating one’s self from others, possibly causing bodily harm to self and others (e.g., bottling feelings, drinking excessively, excessively smoking, and/or using other substances).

Mexican American: Culture and Ethnicity

People’s adherence to a particular ethnic group can have many implications for their self and collective personality, interaction with others, and behavior (Burkitt 2008). Throughout the interviews, the concept of ethnicity arose frequently. Tomas (IAV) shared how seeing the men in his family and interacting with his mother gave him a sense of how to live with his pain and suffering but more importantly how to be Mexican:

My apa and my grandpa had jacked up nails. They were all dirty, bent, some were missing and even some were cut in pieces with fungus too. I remember I asked my mom once, why their nails were so ugly. She would say things like, they got that working, with their hands. And their nails got like that because they were too busy to stop and too manly for medicina (medicine). “…Se chingan, no se cuidan las manos para que tengas lo que tienes, para la familia” {They grind, they don’t take care of their themselves, so that you can have what you have, for the family} That’s what it was, that’s what it’s about…that’s what being a man is about. Machismo!

The concept of ethnicity arises within the context of familialism. Familialism is a concept that respondents said differentiated them from other ethnic groups as their relationship with and attitudes among the family were more important than individuality. Like Tomas, other respondents discussed manifestations of masculinity, being Mexican, and living with pain, with examples from fathers, grandfathers, brothers, and uncles. Furthermore, all of the interviews give examples of family closeness. As respondents interact with their families, they responded and subscribed to attitudes, beliefs, and ideas expressed to them from their family, like Tomas and working hard.

The concept of work ethic is another important value for Mexican Americans. As seen in the previous quote, the general agreement is that Mexicans work hard, strive, and provide for the family. Moreover, some respondents pointed out that Mexicans in their military units were willing to take the jobs that no one wanted. This related to respondents overwhelming agreement that being Mexican American was about work ethic was a source of pride for them and facilitated a sense of belonging. Although Vietnam veterans shared similar notions about being Mexican American, these veterans often shared a different source of their understanding of being Mexican, masculinity, and pain. When asked what it means to be Mexican, Juaquin (VV) shared how being Mexican and being a man:

Look look buddy, I’m from a different time, the El Movimiento {The Chicano Movement} with pomes from Corky Gonzalez was all over the barrio {neighborhood}. It’s a religion, being Mexican, being Chicano, or whatever type you want to be called, it’s all the same shit. It’s about being Azteca (Aztec), it’s about being a warrior like Pancho Villa and Emiliano Zapata. Being Mexican to my generation was about revolt. Güeros {Whites} called us dirty, but even the dirt has salt, we have flavor. Your generations forget that being a Mexican man is about survival. Since Cortez, we survive…we survived the diseases, the war, the racism. Being Mexicano, a macho, and your pain is what we always were since before you and I. It’s our cross to bear, our burden. And we love it. From Aztec to Marine, from Mexico to the U.S., we survived it because we are real men.

Veterans expressed pride in being Mexican Americans because their identity reflects survivability across time and geographic location. Mexican American is a reality shaped by complex sociohistoric forces that include culture, aspects of ethnicity, and discrimination. For respondents, Mexican Americans have strong family ties, work ethic, and hypermasculine norms. Being Mexican American places a sizable impression on the development of the self (Burkitt 2008) and an important lens to understand pain because meanings are shared among ethnic groups (Boissoneault, Bunch, and Robinson 2015; Bourke 2014; Burkitt 2008; People and Garrick 2010). A large part of being Mexican American consists of presenting ethnically appropriate norms, values, and beliefs. Following Goffman’s concept of dramaturgy (1959), respondents consciously and unconsciously follow impression management as they follow ethnically, gendered, and military-approved manifestations of pain management.

Meanings of Pain

There are different expectations of health beliefs and behaviors based on age, gender, sex, occupation, and so on (Meinhart and McCaffery 1983). Therefore, the experience of illness is knotted up with the social and structural arrangements in society (Charmaz 1995), this includes stigma. According to Goffman (1963), social stigma is the social discrediting of an individual’s mental health condition and the imposition of negative stereotypes to the illness. This contributes to the illness experience of those stigmatized. The stigma of being in pain, both physical and emotional, can affect the self-esteem, social positioning, and the overall health of an individual (Goffman 1963). Zapata (VV) shared his understanding of pain and stigma as:

Dolor esta en todo- cuando me siento, en mi espalda, en mi brazo, en mi alma y esta en mi corazón {pain is in everything- when I sit, in my back, in my arm, in my soul and in my heart}. It’s not like you can pop a few pills and it all goes away. The shit is still there…but I’ve learned that every scar is a reminder of who I am and who I must never be again…you have to learn to accept yourself…and that didn’t happen one day, I learn to accept myself every fucking day…every God damn fucking day…[tears rolling down his cheek]….

Kiko (IAV) expressed a similar response:

You could be in pain inside and outside. It’s not just one place. I mean some people have one or the other or both, but everyone have it differently.

Participants saw pain as an overarching concept, affecting every aspect of their lives, and essentially changing them. Zapata and Kiko, like other participants, articulated that pain and the definitions tied to it are negotiable, flexible, and constantly changing. Pain was not a singular concept. Some respondents expressed what pain means to them in terms of how people see Mexican men and veterans. Following Goffman’s (1959) impression management, many participants expressed how and with whom they share their feelings about pain based on socially approved roles and statuses. Their expressions differ depending on context, setting, and person. Guillermo (VV) shared:

It’s something that you can feel in you, in your heart…all over, in and out. It’s not just in my dreams it’s in my mind and on my scars. I’m strong you know, I grew up strong, pero {but}, it doesn’t matter how strong you think you are, it still gets you, it still hurts you. And that’s what the guys at the VA don’t understand; I don’t want to talk about it to you, just give me my meds and that’s it vato {dude}. You weren’t there, you don’t know what it feels to give a part of yourself up forever, you don’t know what it feels to lose something and take something. And at home, they [my family], knows that they [the prescribed medicine] make me feel better. I can’t tell them why I feel like this; because they count on me being strong…I’m their hero you know…I never took a vacation day…paychecks every two weeks.

Other participants shared similar experiences in terms of how they express their feelings and to whom. When asked what Pablo (IAV) meant when he called himself “like Zorua,” a Pokémon, he explained:

Listen, it’s simple. Zorua changes form whenever it wants, and I do the same thing. When I’m with a girl, I pretend like everything is cool, I’m a Marine, and I’m strong. When I’m with my pops, you know I just tell him it was tough pero no me rajo {but I don’t let it bother me}. When I’m with the guys, I tell them I’m okay, I got this.

Both participants are from different cohorts, Guillermo is a Vietnam veteran and Pablo is an Afghanistan veteran. Across the interviews, one phenomenon was similar among all participants: pain and the experience of pain are both physical and mental. Vietnam veterans tended to report having both physical and emotional pain associated with their combat experience. They spoke more freely of having both types of pain; they attributed physical pain because of war versus emotional pain as a continuing development they are able to identify and know to navigate. Iraq/Afghanistan veterans tended to respond ignoring or acknowledging to a minimal extent the existence of emotional pain and only discuss physical pain as the primary source of their pain. This may be associated to the length these veterans have learned about their pain. Vietnam veterans have had more time “dealing with it,” throughout their life. Santiago (VV) sheds some light on temporality and dealing with his pain currently, as compared to previously in his past:

I’ve come a long way. I remember at first I would drink all the time. I would smoke a pack a day. Just felt clogged inside. Sometimes my head would be going a million miles per hour, then other times I would just be numb. Some guys never get out of it, but thanks to my family, to my wife, I’m still here. Now and then I get a little moody, se me bota la canica {expression meaning: I lose my mind}, but I am able to calm myself down, take a breath…cry…yeah, that too, but I’ll do that in the garage. I’ve come a long way. Does it hurt, yes; will I be okay, yeah I think so.

Santiago’s response captures a specific difference between cohorts: the ability to express ones emotions more freely over time. Santiago, as other members of the Vietnam veteran cohort, has had a longer time dealing with pain. As demonstrated in his reply, pain for Mexican American veterans is a process of negotiation between who can they show my pain to, when can do so, and how do, all while simultaneously balancing masculine norms. Meanings of pain follow factors such as emotion management where respondents managed their feelings about pain so as to render them appropriate to any given situation (Hochschild 1983). Respondents’ dependence on emotion work from military experiences, while integral in a military setting, lies in conflict in PTSD-related pain as veterans. Other concepts such as gender also affect meanings of pain (Fragoso and Kashubeck 2000).

Machismo and Pain

Various studies focus on the negative aspects of machismo. Scholars like Falicov (2010) describe Mexican masculinity as violent, rude, and womanizing. However, instead of following the negative nature of machismo, data instead pointed to the functional role of machismo. Queretaro (VV) explained how being masculine works for him:

You have to be strong, tough, be a man…take the bull by its horns, because you are the only person that can. Being macho is not just about being, but doing like a man, not like that cochino [dirty person]. You have to be a man to control all the pain and hate you have inside, you have to be a man to address those issues only you know you got. That’s how I see it, that’s how I do it…like the Army says, “Army Strong,” [laughter], no one has to see you like that- it’s all you, by yourself, take care of yourself.

Moving away from the rigid depiction of machismo characterized by hypermasculinity, this example follows Nuñez et al. (2016) who argued that machismo has a positive side as well; moreover, this positive image of male gender role characteristics encompasses concepts such as chivalry, bravery, and family provider attributes. Similarly, other participants connected their roles and responsibilities to positive masculine behaviors and norms as well. Uriel (IAV) shared how it was important to be a man when it came to his pain because his family depended on him as the primary source of familial income:

I keep things to myself. I have to man up because they [my family] depend on me. I bring the checks in. I have a wife and a kid and I just don’t have time for it. I don’t want my girl to get sad, especially ‘cause she thinks so highly of me. She fell in love with me wearing uniform, I’m not going to tell her those things, and I don’t want her to think I’m crazy. I just don’t want to think about it right now, I have bigger things to worry about.

Across the cohorts, being healthy was important. However, being in pain is unhealthy only when it impedes with daily responsibilities. Manuel (IAV) highlighted the importance of identifying being unhealthy and seeking help, with the aim of returning to a state of normalcy:

When I came back from Iraq, I had two toddlers depending on me. I lost my sanity in Iraq, but not my responsibilities. When I left the Corps I didn’t want to be that shit bag that picked up drinking and losing his family. I had to man up and talk to someone. So yeah, I did some counseling when I was still in Camp Pendleton. I didn’t tell anyone I would go see the chaplain, but you know what, it was worth it because I felt better after.

Xavier (IAV) also shared why it was important to him to “man up” in stating:

I didn’t want to visit a chaplain because I didn’t want them sending me anything at home or me walking out of the office and there’s someone I know. But I knew that I had a problem that could only get worse. I didn’t want to lose my job or my family. So I started going to a counselor at my community college. It wasn’t formal, but he was a veteran, too, and he would let me unwind. We would work out. I would call him my workout buddy.

In the context of the interviews, machismo exists and is responsible for sustaining the health beliefs of Mexican Americans. For the participants, machismo enhances men’s awareness of their health because they have to be healthy to be good fathers, husbands, brothers, sons, and workers (Sobralske 2006). Arciniega and colleagues (2008) also found that male gender roles represent multidimensional behaviors that fall on a continuum from positive to negative. This finding amplifies the idea that machismo includes many positive elements not previously addressed in the literature.

As pain impedes daily responsibilities, respondents find ways to regain their ideal health so they can return to work and return to their families. For example, Ocotillo (IAV) expressed that being a man is about work and providing for one’s family and acknowledging pain is not necessarily a contradiction of manliness. He shares:

You need to be tough and have the balls to take care of business. I just pretend that everything is okay. I have a daughter and I have to think about her. She depends on daddy to feed and clothe her. If I hurt, okay, I hurt. Let’s get this shit fixed up because I have things to do and responsibilities. Yeah, sometimes I wait until the end when I can’t take it, to get help. But I get it, and I get back to what I need to do.

Zoucha and Purnell (2003) suggest that men may not seek health care until they are incapacitated and unable to go about their activities of daily living. Functional limitations caused by pain serve as motivating factors in seeking treatment and finding ways to regain optimal health (Sobralske 2006). Zoucha and Purnell (2003) claim that good health for many Mexican Americans is being free of pain and being able to work; however, as participants suggested, it is not being free of pain that constitutes being Mexican American. More so, it is the ability to work through pain. Ultimately, when pain inhibits functional capacity, respondents found it necessary to seek help. This process of negotiation between masculinity and pain is strictly an internal process informed by external understandings of masculinity.

Furthermore, many respondents discussed how hiding painful experiences was a way to preserve relationships. In addition, masculinity and the military had and/or continue to have a silencing impact on the participants. Baldomero (VV) shares:

Sharing is caring, until you tell your family you kicked around Charlie brains around like a soccer ball, you pissed on dead bodies, killed people, and burned people’s homes and villages. How am I supposed to say that? How am I gonna share those things? No! No se puede {it can’t be done}. You shut your mouth, keep it in, and pray you don’t blow up, holding all that stuff in.

Participants use silence as a mechanism to reconnect/maintaining bonds among family and friends. For example, Tomas (IAV) explained how he came back from deployment, initially feeling disconnected, and how he opted not to talk about his traumatic events in Iraq in order to protect his family from the person he thought he had become:

Yeah I just didn’t click with anyone. Sometimes I wanted to be around them; sometimes I wanted to go back to MRE’s [meal ready to eat] and being deployed with my unit. My primos {cousins} would come around a lot so I would kick it with them, you know. So they would ask me, “Hey killer, did you blow any Iraqis up?” I would just laugh and shake my head, no. But I fucking wanted to ball out. I didn’t want them to leave me, I didn’t want them to stop kicking it with me or think I’m some crazy killer. I grew up with my primos {cousins}, so I would just suck it up.

The emergence of adaptive underlying beliefs, or feelings about hiding themselves, was used to maintain or build bonds with family and/or friends in postdeployment, which evolved as a consequence of such interactions. Consistent with literature on the evidence-based practice with psychiatric patients, Jones, Fitzpatric, and Rogers (2016) suggest that silence is a coping mechanism used to maintain respondents’ relationships, maintain autonomy, and control over feelings of pain. Gender-based roles influence pain beliefs. Role distance explains how veterans practice military-learned coping strategies and/or coping process in an attempt to deal with PTSD-associated pain (Goffman 1959). However, respondents’ inability to resocialize and practice nonmilitary coping strategies follows Turner’s idea of role merger (1978), where respondents are not able to role compartmentalize and/or acquired of new role appropriates attitudes. This finding however is not common across respondents. An examination between VVs and IAVs allows for an examination of the similarities and differences between the cohorts.

Cohort Comparison

An exploration of the themes between the cohorts illustrates the complex dynamics between the cohorts. Most themes held similar between the VV and the IAV cohorts. Table 3 offers a cross tabulation of the themes explored in this study. The issue of being in pain for a longer period might also explain why both cohorts are different in terms of dealing with pain. VVs understood the process of coping as an everyday phenomenon. Meanwhile IAVs have not come to terms with dealing their pain. Temporal issues are more likely to define the contrast between cohorts, as concepts, ideals, and notions of machismo were similar between the groups.

Table 3.

Cross Tabulation of Themes between Cohorts.

			Meanings of Pain	Machismo	Hiding Self	Feeling Disconnected	Dealing with Pain
Cohort		VV	Physical and emotional pain lasts a lifetime. It is part of my identity.	Be tough, family expects paternal strength; work hard, emotional pain does not alter masculinity so long as you can control your emotions while presenting a control of pain	People do not understand me; I have to adhere to a standard of masculine obligations, so I have to hide myself. Hiding yourself is being a man	Initially feeling disconnected (when returned from deployment). Every day is a new battle. Frustrated and confused	Throughout life have learned to accept self and find coping strategies. Every day is a process. Medicine does not cure pain. Manhood is important. Females in family help
Cohort		IAV	Pain is physical and emotional. However, do not discuss too much of the emotions caused from pain, it’s not masculine	Be tough, family expects you to continue fulfilling masculine responsibilities. Keep coping at a minimum. Do masculine things as a form of dealing with pain	Change self to accommodate to social context. Hiding feelings by controlling self allows me to deal with other more important masculine obligations	Initially feeling disconnected (when returned from deployment). Frustrated and confused.	Difficult dealing with pain. Find comfort outside of the family. Coping through other supports (e.g., programs that have peer-mentors)

Note: IAV = Iraq/Afghanistan veterans; VV = Vietnam veterans.

Furthermore, VVs express those influential figures in the family, specifically women in the family, contributed to how they dealt with pain. According to this cohort, female family members reinforced masculine norms. This process is pivotal because it demonstrates that not only do males see acting masculine as healthy but so do females. On the contrary, IAVs found that dealing with pain outside the family reaffirmed that nothing was wrong with the participant, which also reinforced the masculinity of the participant in the eyes of his family. As previously demonstrated, masculinity becomes a positive tool for coping/feeling connected. A possible explanation as to why similar notions of masculinity could lead cohorts to different mechanisms for dealing with pain can steam from the advancement of services and the accessibility of these resources to veterans today. In the late 1970s, only 140 specialized PTSD programs existed nationally (Rosenheck and Fontana 2007). Currently, a simple Internet search demonstrates that the vast network of specialized PTSD programs has at least quadrupled since then. Furthermore, advances in funding, technology, and therapeutic techniques have improved the support systems in place for contemporary veterans.

Conclusion

The manifestation of any sort of pain, if it be a physical and emotional phenomenon, is influenced by intersecting social and ecological factors. The sensations of pain are intertwined with the processes of coping, disconnect, and masculinity. Pain becomes an overarching experience depended on age and ethnicity. For participants, being Mexican American was a social context that revolves around and is composed of the intersection between family, work ethic, and tradition. Pride in being Mexican American derives from the sociohistorical experience Mexicans. This identity is rooted in its history of survival and adaptation. Mexican American governance of pain behaviors focuses in ways an individual can survive and adapt to physical and emotional pain for the purposes of maintaining familial expectations. For men, silence reconnects/maintains bonds among family. In this context, masculinity provides a context from which individuals can maintain ethnic norms. Therefore, for Mexican American veterans’ health is rooted in tolerating pain, so one may fulfill perceived responsibilities. Ethnicity is a standard from which individuals exercise gendered expression of pain and coping strategies. Machismo plays a dynamic part in the expression and daily experience with pain for veterans. Ultimately, findings suggest that the study of race/ethnicity and age plays a fundamental role in understanding the experiences and behaviors of toward the pain of combat.

Considering the contributions of symbolic interactionism on study findings, Goffman’s (1959) idea of role distance⁶ may explain how the separation from the role of being a service member and detachment of self may potentially be a survival strategy and/or coping process as an individual attempts to deal with PTSD-associated pain. Conversely, masculine roles may include Turner’s (1978) idea of role merger,⁷ which may conceivably be an impediment to coping with PTSD-associated pain. Other possible manifestations of gendered identity on pain beliefs might include Cooley’s (1902) idea of looking-glass-self,⁸ where gender identity may shape a person’s self-concept and their understanding of how others perceive them.

The findings also have implications for the study for the ethnocultural dimensions of pain and age. By reflecting on the in-depth understandings of the meanings associated to the emotional and physical pain of combat, this study was able to observe the phenomenon of pain as a daily experience, tangled in the interpretation of the self. Furthermore, ethnic identities are not stagnant, but in constant movement, adapting through intra- and intersocial processes in the life course.

In addition, there needs to be a similarly framed qualitative comparative analysis in thirty years to reassess the IAV cohort. At that time, they would be around the same age as the current VVs. The IAVs new experiences with pain should be compared those found in this study to examine the effects of the life course. In addition, it is worth noting that some study participants are still serving in the military. A closer examination of this group can evaluate how the ongoing influence of working in the military plays a role in shaping the meanings of pain and masculinity for this subgroup. Lastly, more research should address families of combat veterans.

Overall, the interviews echoed a deeper and more critical theorization of masculinity, ethnicity–class (as it relates to working class ethics for Mexicans)–gender intersectionality, and machismo. Through participants’ responses, the intersection of ethnicity and class was forged under a dominant masculine frame. The general agreement is that Mexicans work hard, strive, and provide for the family. This adherence was particularly salient for respondents as they overwhelmingly expressed pride in being hardworking and familial Mexican Americans. Their ethnic identity was a sociohistoric reference that reflects survivability across time, geographic location, and circumstances. For respondents, Mexican Americans have ridged norms and values that regulate health behaviors and health views. More importantly, they provide guidelines for men as they navigate a world of disproportionate discrimination and systemic racism. This notion forces us to recognize the intersection between stratification of race/ethnicity, class, and gender. Ethnic/racial, gender stratification forces men to accentuate their masculinity as a socially valued resource when there are no other resources allotted to them. This is problematic for social groups where masculinity is already a dynamic social force, integral to the group dynamics. Following Zinn’s (1982) work on masculinity, race, and class, I argue that, for participants, machismo is viewed as a compensatory stance by men who are marginalized and subordinated by their race/ethnic and class situation. These men, due to their intersectional positionality, disproportionately pay high costs of masculinity, including health costs; dangerous military service; and the psychological and interpersonal constraints that are so evident in the interviews (i.e., stuffing pain inside, taking it like a man stoically) are amplified for these men by the combination of military training and culture with the narrow conceptions of masculinity. Thus, many respondents have internalized, perhaps as compensation for their marginalized ethnic/race–class status.

While this work contributes to the understanding of pain among Mexican American veterans, there are several limitations that need to be addressed. First, participation was strictly voluntary, making it impossible to examine the ways participants may have differed from nonparticipants. However, this study is still beneficial, as it can serve as a possible frame for future studies. Furthermore, while this study successfully identified factors that partially account for differences among participants from varying armed conflicts, service eras, and deployment experiences, some potential influences (e.g., frequency of deployments) may not have been uncovered and therefore excluded. While many clear themes emerged, it is beyond the scope of this study to survey the magnitude to which these themes contributed to the meanings of pain. Going forward, researchers should consider the programs the military has developed to deal with incidents of pain-related PTSD and whether they have considered specific ethnic and cultural barriers. Furthermore, masculinity does not solely exist for Mexican Americans, future research should begin asking, how is being a man in other cultures differ in terms of health beliefs and behaviors to other masculine cultures?

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.

Notes

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Pain and Masculinity: A Cohort Comparison between Mexican American Vietnam and Post–9/11 Combat Veterans

Abstract

Keywords

Literature Review

Data and Method

Data

Method and Procedures

Findings

Mexican American: Culture and Ethnicity

Meanings of Pain

Machismo and Pain

Cohort Comparison

Conclusion

Footnotes

Declaration of Conflicting Interests

Funding

Notes

References