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Stigma and Reluctance to Seek Help

Service Members and veterans face an array of post-deployment stress-related challenges.  Without an understanding of the physical/neurological roots of these challenges, Service Members and veterans can easily see their symptoms as defects, signs of weakness, or “emotional problems.”  Shame, stigma, and fear of jeopardizing their careers can keep people from seeking help, while small problems grow into big ones (Scaer et al., 2008).  The stigma connected to substance use disorders is even more potent, and adds an extra level of shame and reluctance to seek help (Woll, 2005).

For many veterans who seek services in the community, fear of being stigmatized and having “mental health problems” or “substance abuse” attached to their service records may contribute to their decision to stay outside of all structures even remotely connected with the military.  Experts at all levels—from the Department of Defense to the individuals seeking to heal the effects of these wounds—agree that shame, self-stigma, and fear of military stigma are significant blocks to help-seeking and recovery (Tanielian and Jaycox, 2008).

In the words of one soldier, “Asking for mental health services was like saying ‘I just could not cut it’” (Hutchinson and Banks-Williams, 2006, p. 67).  The most common barrier to treatment cited by Service Members is a fear that treatment will not be kept confidential, threatening future job assignments and military career advancement (Tanielian and Jaycox, 2008). 

Military leaders have taken important steps to eliminate this stigma within the military culture (e.g., primary care screening programs, training and information campaigns) and to protect the privacy of Service Members who seek help (e.g., the May, 2008 policy that Service Members who apply for security clearances no longer have to disclose any service-related mental health treatment they might have received).  But stigmatizing attitudes in a huge and deeply rooted culture are very slow to change, particularly when that culture is surrounded by a larger culture that shares the same attitudes.

Many Service Members, veterans, and their families have been told that acute stress reactions, PTSD, substance use disorders, depression, and other combat stress effects are normal, natural, and nothing to be ashamed of.  However, many simply do not believe it (Lighthall, 2008).  Human understanding of the effects of trauma is too new, and traditional misconceptions carry too much momentum.  Because these conditions have emotional and behavioral symptoms, most people tend to think of them as emotional or behavioral problems, despite their deep roots in our nerves, muscles, and brain chemistry.

Helping professionals can help heal the stigma by communicating that, in the words of Army Col. (Dr.) Tom Burke, “No one comes back unchanged” (Sample, 2004), and that post-deployment stress effects have their roots in natural stress and survival systems.  One of the strongest antidotes to self-stigma is an understanding of the specific ways in which stress and threat can affect physical and neurological survival systems—provided these effects are described in measured, matter-of-fact terms that:

  • Emphasize strengths, capabilities, and resources
  • Affirm that these are normal physical reactions to abnormal stress
  • Use neutral and inclusive terms like “post-deployment stress effects” and “substance use disorders” rather than the more stigmatized “mental problems,” “substance abuse,” or even “PTSD”
  • Do not “pathologize” people with post-deployment stress effects, including SUDs, or imply that they are somehow helpless, “defective,” or dangerous
  • Do not portray the stress-affected or addiction-affected brain or stress system as defective or “diseased"
  • Confirm that people can and do recover from many symptoms of combat stress and learn to manage any remaining symptoms
  • Confirm that people can and do recover from substance use disorders

Next: The Need for Veteran-Specific Education & Training



The material on all of the Clinical Pages is taken directly from the clinicians' manual Finding Balance:  Considerations in the Treatment of Post-deployment Stress Effects, published by the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This manual is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested. Click here for References and Other Resources.
Click the following links for PDFs of materials in the Finding Balance series:   Clinicians' Guide <> Workbook for Service Members and Veterans <> Quick Guide for Service Members and Veterans <> Workbook for Military Families <> Suggestions for Facilitators (Counselors, Trainers, Mentors) using the workbooks

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