This may be hard for some to read, but not everyone is built to be career military. In fact, many people choose to serve one tour of military service and leave after their contract is complete. For those who choose to make military service a career and attempt a 20 or more year career of active duty service, promotion becomes increasingly complicated and competitive as time moves forward. From the outside, these men and women are the toughest, fittest, most competent and learned individuals, as they surpass their peers and are picked up for promotion after promotion. On the inside, however, this means later work hours than their peers, it means hiding any physical injuries or emotional struggles from others, lest they be seen as weak.
The culture within the military is not one that discourages visiting medical professionals. In fact, higher-ranking individuals encourage the men and women they lead to seek help when needed. Within every military unit there are both mental health and medical professionals embedded. The problem lies in the fact that many in leadership are so caught up in leading others, that they often neglect themselves. There can often be significant levels of guilt felt in instructing those they lead to engage in some type of physical training, while they neglect to participate themselves. I have seen those holding high rank run on sprained ankles, attempt pull ups with injured arms, and work full shifts fully aware they are experiencing problematic chest pain, just because they do not want to appear weak in front of those they lead. Complaints are held back from all but choice civilians and those of equal or greater rank. The pressure to excel, and the pressure to lead is so great that they would rather suffer in silence and come across as a strong leader, than leave early and rest (a response many would have when facing this type of pain or injury).
What does this mean for clinicians working with military or their families? First, lack of self-care is a great source of frustration for the significant others of these individuals. When your husband or wife has been instructed to rest and ice an injured ankle, it is deeply infuriating to discover they a running 5-10 miles a day on this injury. The spouse may be the only person the service member truly opens up or vents to about said injury because they don’t want to show weakness while at work. It is important, as a counselor working with these significant others, to help them to understand how important their self-image is and that they may truly not be comfortable opening up and sharing their pain with anyone else. This is an opportunity to better understand their partners’ struggles, though they have to remember that “fixing it” may not be possible or even the best course for them to pursue.
A counselor helps their client by providing a supportive ear and reflecting their frustrations at exercising on their injury, even using it as an example of unacceptable behavior in those they lead. For those counselors working with someone who is active duty and opening up about this specific problem, it is important to understand that their pushing through has been what has gotten them promoted and given them success. It may not make sense as most jobs do not reward pushing themselves like this but, in a combat situation it is those who push whom you want to have your back, and who should be leading others. It is a strange paradigm if it is not one that you live in, so understanding why they push through the pain, instead of rest, is complicated to grasp. This does not mean that the behavior is healthy, just that it is resilient and is likely one of the attributes that has made them successful.
Thinking of it in this way can help us to understand why these clients may not see these behaviors as negative. This behavior has brought them success in the past and is subconsciously associated with success and respect from their peers. Most military bases have workout programs created to maintain muscle mass in spite of injuries, physical therapists to retrain muscle groups, and mental health professionals to help cope with the stress of injuries. By learning about the resources offered locally and working cooperatively with them, it can help the individual find an avenue of healing while maintaining the “push” that earned them the right to lead others.
Jennifer Attila is a prevention specialist leading psychoeducational groups with active duty personnel. It is her passion to increase knowledge for current and future counselors on the unique experience that is Military culture, to better help those who serve and their families.