Abstract
This article aims to expand our understanding of military culture as it relates to gender and veterans’ mental health, drawing from rich qualitative data. Fifty in-depth interviews (25 men, 25 women) were conducted with veterans who had a recent suicide attempt (within 6 months). Interviews revealed major themes of unequal standards and a hostile environment in the military. Women strived to fit in and experienced differential treatment in their physical training, professional expectations, and family life; men recollected masculine bonds and camaraderie through drinking. Women described the hostile environment of the military through their experiences of sexual violence and both genders described a culture of silence where signs of weakness were shamed. Findings support a cultural shift toward equitable gender norms for military members. Policy should focus on increased transparency institutionally—and between members—as well as improving protection and response to reported abuse.
United States (U.S.) military service members enter the military with higher rates of suicidal thoughts than the general population and leave the service with elevated rates of self-directed violence, including suicide attempts (Monteith et al., 2020; U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, 2020). Since 2005, the suicide rate for veterans has increased from 1.2 to 1.5 times the rate for non-Veteran adults (U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, 2020). Much is known about how combat-related trauma affects veterans’ mental health and well-being, including risk for suicide (Bryan et al., 2015). However, there are a broad range of negative experiences that may occur during a veterans’ years of service which harm their mental health—some of which may be rooted in military service experiences and culture, such as bullying, hazing, and sexual assault, or military sexual trauma (MST) (Braswell & Kushner, 2012; Kim et al., 2019).
U.S. military culture, often referred to as a “warrior culture,” promotes pride, machismo, competitiveness, cockiness, and partying (Callahan, 2016). Long-standing practices and traditions uphold these norms and hypermasculine ideals (Dunivin, 1994). At the same time, beliefs that women are vulnerable, less physically fit, and in need of protection are prominent among service members; for example, men and women are often held to different fitness standards, even in cases without differing capabilities (Pendlebury, 2020; Weitz, 2015). Also prevalent in discourse among service members is the notion that femininity may undermine military effectiveness (Van Gilder, 2019). Together, these norms and practices reinforce beliefs that devalue and stigmatize women service members and femininity. Moreover, these norms contribute to bullying, hazing, and sexual assault among its members (Koeszegi et al., 2014; Rough & Armor, 2017). Research suggests that 11.9% of active-duty service members perceive bullying in their units, while 4.4% perceive hazing in their units (Farmer, 2016). Hypermasculine norms, service members’ inappropriate behaviors, and socialization to ignore these behaviors foster an environment in which sexual violence is more likely to occur (Wood & Toppelberg, 2017). Women service members experience higher rates of bullying in the military than men (Koeszegi et al., 2014) and, despite barriers to reporting, it is well documented that more than half of women enrolled in the armed forces experience sexual harassment (Firestone & Harris, 1999; Sagawa & Campbell, 1992). The Department of Defense estimates that during 2018, 6.2% of active-duty women and 0.7% of active-duty men may have experienced sexual assault, but notes that sexual assault is underreported among service members (United States Department of Defense Sexual Assault Prevention and Response, 2021).
High-traditional masculinity, norms associated with men that include “competitiveness, emotional restriction, and aggression,” has been found to contribute to elevated suicidal ideation and death among men (Coleman et al., 2020). In addition, prior research suggests that being bullied by others is linked to experiencing suicidal ideation (Brailovskaia et al., 2019). However, no studies have explored how U.S. veterans may experience this risk via masculine military culture, or how the traditionally masculine norms of the military might harm women veterans. As such, the present study aims to expand our understanding of military culture as it relates to gender and to explore how military culture is perceived by veterans who go on to attempt suicide. Using semi-structured interviews, we asked 50 U.S. military veterans (25 women, 25 men) who had previously attempted suicide about their military experiences and suicide attempts. We examined how these veterans describe their gendered experiences in the military, comparing the experiences of women and men.
Methods
This study was part of a national, mixed-methods project investigating suicide risk and resilience among Veteran Health Administration (VHA)-utilizing U.S. military veterans. Methods for the original study are described in more detail elsewhere (Denneson, Tompkins, Mcdonald, et al., 2020). Informed consent was obtained from all participants before engaging in study activities, and the study was approved by the medical center’s institutional review board where the study was conducted.
Setting and Sample
The VHA is an integrated health care system that serves over 9 million patients across 1,255 facilities in the United States. Over a third of U.S. veterans use VHA care (33% of women veterans, 36% of men veterans). We recruited study participants from VHA administrative databases, which contain diagnosis and health care utilization data for all VHA patients. Suicide Behavior and Overdose Reports (SBORs) are used by clinicians to record self-harm-related events in VHA patients’ medical records, including drug overdose as well as suicidal and non-suicidal self-directed violence. Information in these reports contains details of the self-harming behavior (i.e., date and time of reported event, description of behavior, level of suicidal intent, and assessment of lethality). International Classification of Disease Clinical Modification–10th (ICD-10) diagnoses codes for self-directed violence (codes X71-X83, T14.91, T14.91XA, T14.91XD, and T13.91XS) are also sometimes used to document self-harming behavior in patient medical records. To identify patients with recent self-harm behavior, we used SBORs and ICD-10 codes from the prior 6 months in conjunction with medical record review. Patients with a suicide attempt (self-directed violence with the intent to die) within the prior 6 months were eligible. Patients who were hearing-impaired, non-English speaking, institutionalized, had a designated guardian, or a dementia diagnosis were excluded from the study.
We recruited a demographically, geographically, and clinically diverse sample. Throughout recruitment, we used purposive sampling to target underrepresented populations such as women veterans and racial/ethnic minorities. Study staff contacted eligible patients’ clinicians to provide an overview of the study and invite them to refer their patient(s) to the study. We obtained informed consent and collected self-reported demographic information prior to scheduling interviews with participants. Half of our sample self-identified as women (n = 25), and half self-identified as men (n = 25). Fifty-six percent of participants were white, non-Hispanic (n = 28), 14% were Black (n = 7), 12% were Hispanic/Latino (n = 6), 8% were multi-racial (n = 4), 6% (n = 3) were American Indian or Alaskan Native, and 4% (n = 2) were Asian. Military service history ranged from Vietnam to post-9/11 eras, and the mean age of participants was 45 years old (ranging 23–70 years).
Data Collection
Semi-structured telephone interviews were conducted by a master’s level qualitative analyst. The interview began with building rapport and asking about participants’ military history and experiences (e.g., “Can you tell me a little bit about why you joined the military?”). The majority of data reported here were obtained in the interview guide section on military history, beginning with the question: “Can you share your experiences or opinions on what it was like to be a [man/woman] in the military?” To probe further, we asked follow-up questions about other identities that could have impacted their experiences: “What about your race, family upbringing/income, or sexual orientation? Did any of those things affect your military experience?” Some data reported here were obtained in latter portions of the interview covering topics of suicidal ideation, recent suicide attempt(s), and health care experiences. For the purpose of the present analysis, data pertaining to participants’ military experiences were used; other data from these interviews are presented elsewhere (Denneson, McDonald, Tompkins, et al., 2020; Denneson, Tompkins, McDonald, et al., 2020, 2021). Interviews averaged 79-min long, and all interviews were audio recorded and transcribed. Participants received $50 for participation.
Analysis
Analysts used a thematic analysis approach to identify themes inductively and deductively. Two primary analysts (KT and LD) dual-coded interviews in Atlas.ti 7 with continued discussion of themes to ensure agreement. Upon completion of coding, analysts independently reviewed the coded military culture data and came together to identify major themes of gendered military experiences salient to both men and women, along with relevant themes around suicidal behavior and gender differences.
Results
Unequal Standards: Masculinity Is Normative
Interviews revealed a primary theme of the unequal standards that exist between men and women in the military. Among most women participants, masculinity was described as status quo, or the ideal to which they compared themselves. Men participants described their experiences from the perspective of what they enjoyed doing with other men during their service, or what they thought makes a man when serving in the military; that is to say, men did not perceive masculinity whereas women tried to embody it to fit into military culture. Men veterans described normative military culture as ungendered and many did not name exclusionary practices that women endured.
Fitting In and Proving Oneself
Women veterans shared that they were treated as a nuisance in the military until they proved their worth. Worth and value, according to women in this sample, were gained by becoming “one of the guys,” and keeping up with men in job duties. Before a woman proves herself, she is thought of as less smart, less capable, and not belonging in the service. Women felt they had to work harder than men just to be taken seriously. Some women said they learned how to fit in and acclimate to men’s behaviors; only then, did they earn the respect of their men colleagues.
It was a lot of proving yourself, and once you have done that—to prove there was brain with the tits, if you will—then the dynamic changed. But initially it was just strictly, you were “just a girl” [sic]. (Woman, Gulf War/OEF/OIF/OND era) I would say it’s definitely harder than being a man in the military [laughter]. ’Cause, you know, everyone in the military is pretty much a man, especially in the Marine Corps of all branches. And ultimately it was great because for the most part . . . you’re one of the guys. In the Marine Corps you’re not supposed to have a gender, you’re just a marine. And that was a good part of that. But there were some individuals who kind of thought of us as less of a Marine or less of a Military member than the male that does half as good as we do. (Woman, OEF/OIF/OND era)
In addition to having to work harder than their men peers, women were barred from opportunities to socialize with men and were given fewer opportunities to advance in their military careers. This further stunted their social acceptance. Several women described being passed over for opportunities that were given to men, or not even considered for opportunities because they had children to care for.
We all just got treated like a nuisance and we’d ask for help or something, or even ask for certain positions so that we could build our evals, try to get promoted. And even if we put in work, it would be like, “well, you don’t compare to this person, because when they’re not on shift, they’re doing volunteer work . . .” (Woman, OEF/OIF/OND era)
Conversely, men often felt that women were given equal opportunities during their service. Many of them felt that they treated women exactly the same as men service members. A few men, however, pointed to stark realities of how challenging it seemed to integrate women into the military.
I had a friend of mine that was in the Navy and he was supposed to go on a ship and he would’ve been the senior enlisted person on that ship . . . he got out to avoid having to deal with males and females both on the same ship. I don’t want to sound sexist, but that’s basically what it was. (Man, Post Vietnam to Persian Gulf War era) Interviewer: What was it like to be a man in the Marine Corps? I couldn’t speak on behalf of women, so I couldn’t compare it, but I would assume a lot easier than being a woman [laughs] . . . That’s the way that I’ve been told it’s always been like. Female Marines are looked down on, they’re kind of like second-rate citizens in the Marine Corps, generally the butt of any kind of joke. (Man, OEF/OIF/OND era)
Physical Training
Unequal standards in physical training were salient for women veterans, as they were expected to perform both the same and differently from men. Women were excluded from group workouts and opportunities to improve, yet they were also driven beyond the limits of their physical comfort during military training.
Well, they have a cook put in a lot of hours during the week, a lot of hours . . . When I got off at one to two o’clock in the afternoon [the drill sergeant] would make us stay and do physical training, PT. And being tired, you don’t want to be bothered with that stuff, but he insisted that we do it. And he would make us come to the company and run around the track, and my stamina was not that good to run so I had to walk. I cried a lot dealing with that man, because I wanted to hurt him, but I knew that I couldn’t, so crying was the only way that I could get my frustrations out. He made my life miserable and turned me bitter, I guess. (Woman, Vietnam era)
One woman noted the difficulty in managing the line between the equality of the military’s expectations of her and the inequality of training opportunities received:
There were just so many things that they expected you to do to keep up with the men and it just wasn’t fair . . . they treat you different all the way until it comes to being physically fit and then they expect you to be exactly the same. (Woman, Gulf War/OEF/OIF/OND era)
Family Life
Mothers reported differential treatment due to pregnancy or child-rearing, losing opportunities because of parenting responsibilities, and receiving punishment from superior officers because they had to balance child care with their military duties. While the participant below talks about how no woman would want to leave her children behind for deployment, she also touches on the complicated feelings of being left behind by her unit:
My deployment was hard because I had to leave my child behind. No woman wants to get deployed when you have children. And in my case, the first time my unit got deployed . . . I was already six months pregnant; they didn’t do it intentionally. That just broke my heart. (Woman, Gulf War/OEF/OIF/OND era) I had a supervisor at my first command who was bashing me for getting pregnant and was saying that I had made a commitment to the military, and by getting pregnant I was violating that commitment [by saying], “if you’re going to be a woman in the military, you should be single, and you shouldn’t have kids.” (Woman, OEF/OIF/OND era)
Party Culture
There was a distinct difference between women and men veterans when asked about their gender: while women shared how femininity was rejected in the social structures of military culture, men focused on the pleasures that come with masculinity in military culture without naming the norms as gendered. More specifically, when asked about what it was like to be a man in the military, men often spoke of partying and bonding with other men. Men veterans shared many stories of working hard and partying harder. Alcohol was described not only as a bonding experience, but as an incentive for hard work. Women spoke very little of their partying experiences, though some did regard heavy drinking as a bonding experience, or an attempt to fit in.
There were always pubs that served you all the alcohol you wanted . . . If you went for seven flights on the plane, without having any discrepancies, the pilot and copilot each bought you a case of beer for doing a good job. (Man, Vietnam era) You know, eating pizza with the guys, with the females, going out on liberty. They had everything on the base, drugs, plugs, it was crazy. I think there should have been more discipline after basic training, because after basic training it’s too much! It’s like drugs, everything—It’s just like the street again! That’s what it looked like. (Man, OEF/OIF/OND era)
Hostile Environment
The second main theme to emerge was the military’s hostile environment. Hostility was experienced differently by men and women veterans. We conceptualize the “hostile environment” as violent, unpredictable, and without equal interest in the safety and well-being of all members. While all genders can be subjected to abuse in the military, women in our sample reported more cases of sexual harassment and assault, and men spoke more to expectations of concealing hardships. Thus, the hostile environment was found to have two subthemes: sexual harassment and violence and a culture of silence.
Sexual Harassment and Violence
The military environment was made hostile for women by the sexualization of women service members outside of consensual, off-duty relationships. Women reported being regularly harassed by men colleagues, including unwelcomed advances. Sexual harassment was both overt and covert; while many men unabashedly harassed their women peers while on duty, some harassment occurred behind the scenes, hindering women’s ability to ever let their guard down.
I had a guy that was basically stalking me. He lived in the dorm next to where I lived. He left notes on my car stating that he was watching me from his window . . . I had no support from my squadron. They basically laughed it off, which is kind of unusual because I was in a good unit then. That was hard; there is a lot of sexual harassment that goes on. (Woman, Gulf War/OEF/OIF/OND era) Being sexually assaulted made me feel super vulnerable and weak. And in the beginning, I told you I wanted to become a Marine for the discipline and the strength and all those things, so the last thing I would ever want to feel was that I was weak, or [that] someone could make me do something that I didn’t want to do, and it happened. So, I deal with reminding myself that I’m not weak, but I feel weak. (Woman, OEF/OIF/OND era)
Unfortunately, many women participants experienced rape and sexual violence during their service, most often perpetrated by fellow service members. Many of our participants experience continued repercussions of MST today; the violence they faced shapes their mental health and how they interact with the world years beyond their service.
. . . one night we were both with friends at the base club and he left me there and I asked the fellow sailor to take me outside because—I wanted air, I was hot and a little nauseous . . . he took advantage of the fact that I was inebriated, and I was—raped outside of the club. (Woman, Post Vietnam to Persian Gulf War era)
Culture of Silence
Men and women service members alike experienced a culture of silence—that is, the shared social behavior of silencing concerns, violations, and physical and emotional harm done within the military. The culture of silence protects military members from being reprimanded for abusing other members. Sexual violence and a culture of silence are intertwined in the fact that women not only experience MST, they are also not protected from it, and justice is not often served. This creates a perpetually unsafe environment for women who must continue to serve with their abusers. The participant quoted below was raped in an act of “punishment” by her subordinates. Although she was higher in rank than anyone in the group of men, she did not report the incident, as it would have reflected poorly on her and may have led to her own punishment:
I guess they didn’t like how I ran them, and they decided to put me in my place. And in the military—I know this sounds awful, but you don’t report it. You don’t report in house stuff like that because—you wind up getting a spot on your record and transferred out and nothing ever happens with it. It’s usually always kept hush-hush. (Woman, OEF/OIF/OND era)
The culture of silence was discussed as less problematic among men participants. Hazing, bullying, and other abusive behaviors among men were chalked up to “just something you deal with,” or even as a fun rite-of-passage. Verbal abuse was interpreted as character-building.
It was described essentially as a “sock party,” where after you did something to get somebody else in trouble even if it was unintentional or you didn’t do it, a group would put soap in their socks and beat you with it. (Man, OEF/OIF/OND era) The belittling part is . . . to try to show you your bad side without destroying you. If you have bad habits like you don’t wash your feet, or you don’t take a bath, or so on and so forth, that would be part of the belittling. Interviewer: So, you said soldiers belittling other soldiers? Yes, it’s common. It’s—how can I say this—just guys being guys, I guess. (Man, OEF/OIF/OND era)
The culture of silence encouraged participants in our sample to hide their physical weaknesses, emotional weaknesses, and mental illnesses. The participant quoted below discusses how keeping silent is wired into service members during military service and carries on throughout your life. He links this to the shame of having suicidal thoughts:
I believe that in the military you’re taught that any kind of illness is a weakness, and that mentality is kind of just hard to let go of. When you get out and you feel like you’re having these kind of [suicidal] thoughts, you’re taught that this is a weakness, you’re taught that this isn’t what men do. (Man, OEF/OIF/OND era)
Discussion
Despite a previously identified link between traditional masculinity and suicide risk, no prior qualitative research has sought to understand how military culture—which is highly masculine—may affect veterans who go on to attempt suicide. In this study, we used qualitative methods to examine the military experiences of veterans with histories of a suicide attempt to understand how the military’s cultural norms may contribute to harmful experiences and may differentially affect the experiences of women and men. Overall, our findings reinforced the notion that military culture reflects traditional masculine gender norms and that these norms contribute to creating a toxic environment for men, and especially for women. We discuss these findings in the context of their potential impacts on mental health.
Our findings illustrated how unequal standards for men and women service members supported the notion that women’s presence in the military was non-normative. Women reported having to fit in with and prove oneself to men peers; the environment was described as masculine first, and women had to learn to acclimate. These unequal standards are demonstrated through physical training, professional and social opportunities, and are exacerbated by motherhood and social exclusion from the bonding that men share, as seen with party culture. These findings reflect how the military holds its members to a hypermasculine ideal (Pendlebury, 2020) and other literature that suggests women must acclimate to masculine norms in the military through constant awareness and negotiation of their gender performance, as well as constantly proving their worth (Archer, 2012; Callahan, 2016; Crowley & Sandhoff, 2016; Silva, 2008). This experience of one’s competence being regularly questioned and having to repeatedly prove one’s worth may contribute to feelings of low self-worth among women veterans. Importantly, other research suggests a link between perceptions of low self-worth and suicide risk (Bhar et al., 2008; Denneson, McDonald, Tompkins, et al., 2020).
Our data reveal how a hostile environment exists for service members. Women reported experiences of sexual harassment and violence; these hostilities prevented them from feeling safe, had further negative repercussions when reported, and resulted in MST—all experiences that many still struggle to overcome. Men veterans reported a culture of silence regarding the abuse, hazing, bullying, and the silencing of emotions and mental illness (i.e., “weaknesses”). Other studies have implicated military culture in creating an environment conducive to MST through sexism, disproportionate numbers of men compared with women, and a lack of consequences (Burns et al., 2014). When our participants did report these harmful experiences to military leadership, they witnessed a stifled response as well as negative repercussions for speaking out, echoing the literature on institutional betrayal (Smith & Freyd, 2013). MST and institutional betrayal are both risk factors for suicide (Kimerling et al., 2016; Monteith et al., 2016).
Limitations
This study has limitations that should be considered. Despite the rich narratives provided by qualitative methods, we cannot draw definitive causal reasons between military experiences and suicide attempts. However, this analysis explored how gender and socialization in the military might be a contributing factor. Although study recruitment was open to veterans of all genders, and we tried to purposively sample transgender veterans, no veterans identifying as transgender or non-binary enrolled in our study, thus we can only speak to the gendered experiences of those who operate within the cisgender binary. In addition, we did not enroll non-VHA utilizing veterans, who may have different experiences in the military and with their mental health. Further research should compare military culture’s relationship to suicide risk to a sample of veterans without a history of suicide attempts to test the relationship.
Conclusion
This analysis illustrates the complicated and rich gender differences that exist in the military from the perspective of veterans who are at risk of suicide. Military service members’ well-being may be improved by a cultural shift toward equitable gender norms, encouraging transparency institutionally and between members, and improving protection and response to reported abuse. As such, we echo McCormick et al.’s (2019) call for scholarship to advance knowledge on the “internalization and longer-term impact of military culture.” This study should serve as a springboard for future scholars to critically examine the relationships among gender, military culture, and suicide risk among veterans.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This material is based on work supported by the U.S. Department of Veterans Affairs, Veterans Health Administration, and VA Health Services Research & Development (HSR&D) project IIR17-131. Writing of this article was partially supported by the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veterans Affairs. Mx. Kyla Tompkins is a Research Associate at the VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or U.S. government.