In my last column, “The Importance of Military Culture Competence and Why Some People Join the Military” I discussed why I believe the military is a unique and distinct culture and why it is important for clinicians to approach working with military patients from a culturally competent framework.
I also discussed the reasons why some members of the military join. In this first column of a three part series, I continue the discussion about military cultural competence, specifically how certain traits, characteristics, and unique cultural influences influence mental health treatment.
Group over Individualism
In my opinion, the most notable contrast between the civilian and military cultures is the importance placed on individualism versus collectivism, respectively (Christian et al., 2009). McGurk, Colting, Britt, and Adler (2006) discuss three core components of this collective tendency seen in military culture: viewing self as part of the group, placing greater emphasis on group goals rather than personal goals, and the emotional investment that goes into the group.
Independence and individuation are the cornerstones of today’s American culture, however, these traits can be problematic in the military for a variety of reasons. In order to function as an effective team and accomplish difficult and complex tasks, a collectivistic approach is important. Individualism fragments the group, which creates an excess of “moving parts” leading to uncertain outcomes.
Consider a standard combat infantry platoon. In a combat environment, a common mission would be to breach, clear, and search an unfamiliar home in a known hostile neighborhood. In order to accomplish this task and minimize risk to the team, platoon members must work together on a unified plan. They must know each other’s role during the mission, protect themselves as well as their team members, and respond and react collectively if the mission does not go according to plan.
Collectivism also promotes morale and unit cohesion. In my past experience as an active duty Army psychologist providing consultation to commanders in Iraq on behavioral health issues regarding their service members, poor morale resulting from a lack of unit cohesion was invariably one of the primary culprits when it came to dysfunctional units and individual problems.
Problem units tended to have leaders who did not appreciate the importance of group cohesion and how it affected a service member’s job satisfaction, belief in the mission, and level of stress. They were more likely to put their needs ahead of those of their team members and either consciously or unconsciously splintered the unit by forming and promoting competing alliances.
Consequently, morale would diminish, and those service members who felt neglected or marginalized would become more self-focused and rebel against any perceived injustices. In a combat environment, this type of unit atmosphere can have dire consequences.
Implications for the Clinician
It is important for the clinician working with service members to appreciate and understand the emphasis placed in the military on group versus individual interests. Considering that individualism is a treasured and pervasive value in American culture, it is reasonable to assume that a clinician not familiar with the military may unintentionally impose the value of individualism onto the service member during treatment.
Consequently, the service member may become defensive and resistant. The service member may also view the clinician as possessing a selfish attitude and may be convinced of any preexisting perceptions that the non-military clinician is an outsider who can’t fully appreciate what the service member is going through.
An unintended consequence of such a knowledge gap on the clinician’s part may be a difficult and unproductive therapeutic relationship. This result, in turn, can lead to frustration on part of the therapist and service member resulting in reduced outcomes, early termination, and a negative attitude about mental health treatment from the perspective of the service member.
Christian, J., Stivers, J., & Sammons, M. (2009). Training to the warrior ethos: Implications for clinicians treating military members and their families. In S. Morgillo-Freeman, B. A. Moore, & A. Freeman (Eds.), Living and surviving in harm’s way: A psychological treatment handbook for pre- and postdeployment of military personnel (pp. 27–49). New York: Routledge/Taylor & Francis.
McGurk, D., Cotting, D., Britt, T., & Adler, A. (2006). Joining the ranks: The role of indoctrination in transforming civilians to service members. In T. W. Britt, A. B. Adler, & C. A. Castro (Eds.), Military life: The psychology of service in peace and combat: Vol. 2. Operational stress (pp. 13–31). Westport, CT: Praeger.
**This article was adapted from Dr. Moore’s latest book “Treating PTSD in Military Personnel: A Clinical Handbook-Second Edition” published by Guilford Press.