Military Culture 101:

Military Fitness and

Rehabilitation

Kathleen S. Brown, Ph.D.

Dir, Integrative Pain Center

Tripler Army Medical Center

Honolulu, HI

Disclosure Statement

The views expressed in this presentation are mine and do not necessarily reflect the official policy or position of the Department of the Army, the Department of Defense, or the U.S. Government.

Military affiliation(s)

No financial interests

Objectives

1. Describe the primary difference between the military (DoD) & VA health care cultures

2. Describe how the warrior ethos impacts health beliefs

3. Identify adjustment issues for returning service members & their families related to the deployment cycle.

4. Identify challenges to rehabilitation unique to military culture

Understanding Culture

Culture: The belief systems and value orientations that influence customs, norms, practices, and social institutions, including psychological processes (language, caretaking practices, media, educational systems) and organizations (media, educational systems).

Multicultural Guidelines, APA, 2003

Elements include: aesthetics, ceremony, ethics, health and medicine, myths, gender roles, gestures and kinetics, grooming and presence, ownership, recreation, relationships, rewards, and privileges

U.S. Marine Corps

Personnel in Each Service

(as of May, 2009)

Component Military Enlisted Officer Female Civilian

Army 548,000 456,651 88,093 73,902 243,172

Marine Corps 203,095 182,147 20,639 12,290

Navy 332,000 276,276 51,093 50,008 182,845

Air Force 323,000 261,193 64,370 64,137 154,032

Coast Guard 41,000 32,647 8,051 4,965 7,396

Total Active 1,445,000 1,174,563 224,144 200,337 580,049

Military Core Competencies

Maintaining service identity for joint effectiveness

Marines – Amphibious operationsMotto: Semper Fidelis, ―Always Faithful‖

Navy – Maritime operationsMotto: Semper Fortis ―Always Courageous‖

Air Force – Air operationsMotto: Above All

Army – Land operationsMotto: This We’ll Defend

Health Care Missions

DoD Mission - dual health care mission:

1. readiness mission - provides medical services and support to the armed forces during military operations; involves deploying medical personnel and equipment as needed to support military forces throughout the world.

2. benefits mission - provides health care to over 9 million beneficiaries, including active duty personnel, retirees, and dependents worldwide.

VA Mission - to serve America’s veterans in ensuring that they receive medical care promoting the health, welfare, and dignity of all veterans in recognition of their service to this Nation.

VA Structure

Three main service lines:Veterans Benefits AdministrationAll VA benefits - Compensation, Education, Home Loan

Guaranty, etc.Administered by VA Regional Office

Veterans Health AdministrationAll VA health care servicesAdministered by VA Medical Centers, Ambulatory Care &

Community Based Outpatient Clinics, etc.

National Cemetery AdministrationNational and State Veterans CemeteriesHeadstones , Markers & Presidential Memorial

Certificates

Veterans Integrated

Service Networks

Understanding Military Culture

Culture - what a group learns over a period of time as the group solves its problems of survival in an external environment and its problems of internal integration (Schein, 1985)

Why is it important?

American Military culture is focused on waging war and bringing as many warriors back as possible (survival).

Application of this culture exposes strengths and vulnerabilities that can be missed.

Failure to appreciate the culture will result in poor care

Immersion

• Video

http://www.youtube.com/watch?v=jhnPx-0lrU0&feature=related

• Narratives

▫ From Wood, T. (2006). What was asked of us: An oral history of the Iraq war by the soldiers who fought it. NY: Little, Brown & Co.

Combat Exposure & Deployment

• 55% military personnel - combat deployed one or more times since 9/11/01

▫ 25% deployed one time

▫ 16% deployed two times

▫ 14% deployed three or more times

• Army and Marine Corps personnel rates of high combat exposure (42% and 27% respectively) > other services ( 3% to 10%)

2008 HRB Survey

Stress Related to Combat Exposure

High Combat Exposure

Moderate Combat Exposure

Low Combat Exposure

High work stress 34% 26% 25%

High Family stress 23% 16% 14%

High stress on return home

45% 23% 17%

Heavy alcohol use 27% 17% 16%

(2008 HRB Survey)

Healthy People 2010 Objectives vs.

DoD vs. CivilianSubstance Use Objectives

Healthy People 2010 Objectives

Military (past month)

Civilian Benchmark

Cigarette smoking ≤ 12% 31% 24%

Smokeless tobacco ≤ 0.4% 14% 2.6%

Binge drinking(>/= 5 drinks)

≤ 6% 47% (35% 1998)

E1-E3 - 25% vs.E7-E9 - 13%

41%

Illicit drug use(including RxP misuse)(excluding RxP misuse)

≤ 2%12% (5% 2005)2%

(2008 HRB Survey)

Lew, H.L et al. (2009). Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: Polytrauma clinical triad JRRD, 46 (6), 697-702.

American Cultural Inventory of Values

Liberty – freedom to pursue one’s own purpose and freedom from interferenceEquality – of condition (or opportunity) and/or outcomeAchievement – to strive to do one’s bestJustice – system of law dedicated to moral endsPrecedent – past decisions should be followed in present

circumstancesRule of law – rulers and ruled alike are answerable by lawPrivate property – desire to be secure in one’s own material

comfortLocalism – government built on the foundation of federalismDemocracy – consent of the governed

Military Values

―Duty – Honor – Country. Those three hallowed words reverently dictate what you ought to be, what you can be, what you will be. They are your rallying points: to build courage when courage seems to fail, to regain faith when there seems to be little cause for faith; to create hope when hope becomes forlorn.‖General Douglas MacArthur, 1962

4 Basic Elements of Military Culture

Discipline

Military professional ethos

Ceremonial displays & etiquette

Cohesion & espits de corps

Lehman, J & Sicherman, H. (2006)

U.S. Army Values

(example as each service unique)Core values - guide service members throughout

their careers and day to day life.Loyalty—Bear true faith and allegiance to the U.S.

Constitution, the Army, your unit, and other soldiers.Duty—Fulfill your obligationsRespect—Treat people as they should be treatedSelfless Service—Put the welfare of the nation, the

Army, and your subordinates before your own.Honor—Live up to all the Army valuesIntegrity—Do what’s right, legally and morallyPersonal Courage—Face fear, danger, and adversity

(physical or moral).

Military Indoctrination – Codes, Army

U.S. Army Values

The Soldier’s Creed (appendix)

The Soldier’s Code (appendix)

U.S. Army Chain of Command

U.S. Army Ranks and Insignias

Military Service Ribbons and Awards

U.S. Army Acronyms

Warrior Culture & Health

Distinctive ethos emphasizing:

• Strength over weakness

• Wellness over illness

• Prevention over treatment

Shift from Stress-injury model to Combat/Operational stress continuum model

"Happiness and moral duty are

inseparably connected." George Washington

Time spent outside the wire in the badlands is intense, exciting, memorable and sometimes downright scary.

The wire is a boundary.

Inside represents security, control, community, acceptance, purpose, peace.

Outside represents something else.

Our families, cultures and societies establish similar boundaries for us.

We do not call them the wire; we call them values.

Independent vs. Interdependent

Four brave men who do not know each other will not dare to attack a lion. Four less brave, but knowing each other well, sure of their reliability and consequently of mutual aid, will attack resolutely. -Ardant du Picq, 1870

Cohesion is instilled during indoctrination (socialization). Different is not seen as good. Mass punishments for an individual’s infractions or poor performance instills that interdependence is necessary for success and survival

Hierarchical vs. Egalitarian

Hierarchical vs. Egalitarian―Unity of Command‖The more unified in effort the more effective on the

battle field. This unity of effort and command is the responsibility

of the commander

Rank has its’ privileges as well as responsibility to care for subordinates Subordinates are dependent upon superiorsThis can lead to interesting dynamics around the

concept of responsibility

Service vs. Recognition

Service vs. Achievement/Recognition

Long hours and working hard are held in high esteem

All who have been awarded the highest award (Congressional Medal of Honor) in our country in recent history (Somalia through now) were killed in action

Masculine Style of Interacting

Dominance is established (position or rank)

Dominance is backed by the authority of position and at times force

Subordinates follow

Less collaborative decision making

Weak leadership leads to organizational anxiety

The value of overcoming hardship and

pain – adaptive vs. maladaptive

―Pain is weakness leaving the body‖

―What does not kill you makes you stronger‖

Pushing through the pain

Ostracize the ―sick, lame and crazy fall out‖ in morning formations

Active vs. Reserve Cultures

Active DutyFull-time, permanent force1.38M AD service members

Reserve7 components: Federal: Army Reserve, Air Force Reserve, Navy Reserve,

Marine Reserve, CG ReserveStates: Army National Guard, Air National Guard,

Part-time, temporary: 1 weekend/month & 2 weeks/yr850,000 ReservistsApprox 125,000 activated at any point in time

Elements of Military Culture

Mission of the Service

Chain of Command

Military Acronyms and Terms

Expectations of the military lifestyle on family life

Coping with the impact of the mission on the family

Transition issues

Military customs and courtesies

Mission of the Army (example)

―To fight and win our Nation’s wars by providing prompt, sustained land dominance across the full range of military operations and spectrum of conflict in support of combatant commanders.‖

Preserve the peace and security, and provide for national defense

Support national policies

Implement national objectives

Overcome any nations responsible for aggressive acts that imperil the peace and security of the United States

Army Structure (as example)

Know chain of command

The Chain of Command

Structure used by all branches of military for command and control

Used for the flow of information

Military Ranks

Military Insignia

Worn on uniforms for visual identification of ranks

Military Pay GradesEnlisted pay grades E-1 to E-9

General Officer pay grades 0-1 to 0-10

Warrant Officer pay grades W-1 to W-5

Military Adaptability

Mental agility

Function outside MOS/ Rating

Realities of complex situation in the battlefield

Live with unpredictability

Insurgents are an adaptive enemy

Capable of operating within the broad boundaries intent

Military Customs and Courtesies

Reveille and Retreat: Bugle call played in the morning and end of duty day with raising and lowering of flag

Saluting: Military members salute one another, typically only if outdoors in uniform (sign of respect)

Addressing: SMs address each other by rank and surname or ―sir‖ or ―ma’am‖ addressing an officer of a higher rank

Change of Command Ceremony: Official passing of colors and responsibilities of command of a unit from one officer to another

Changing Pressures on Military Culture

Functional Imperatives

Cold War Military Post-Cold War Military

Strategic focus Major wars; emphasis on soviet threat

All manner of operations, esp. peacekeeping; terrorism threat

Financial resources Small (1960-1990 av. 7% of GDP)

Large (2002 > 20% GDP)

Personnel structure Large conscript/ professional force,emphasis ground troops

Smaller professional force

Technological orientation Emphasis on ground operations, heavy firepower

Emphasis on air & space operations, precision, computerization

Institutional icon ―Heroic‖ warrior (infantryman, fighter pilot)

Peacekeeper, ―win hearts and minds‖, information manager(Adapted from Hillen, 1999)

Defense Spending 1962-2015

(inflation-adjusted 2009 dollars)

Changing Pressures on Military Culture

Social Imperatives

Cold War Military Post-Cold War Military

Women in Combat Rigid combat exclusion Almost all military specialties opened

Homosexuals in military Not tolerated ―Don’t ask, don’t tell‖ to… ?

Gender integrated basic training

Air Force only (after 1974) Army, Navy & Air Force

Interaction between military & civilian cultures

Cultures not as distinct; pressure for complete uniformity

Gap widens; pressure increases to bring military in line with civilian culture

(Adapted from Hillen, 1999)

Incremental Inclusion of Others1940 - Blacks accepted into training for Army Air Forces.

1942 - Navy opened up more career fields (other than steward occupation) to blacks.

1948 - President Truman issued Executive Order 9981, mandating the integration of blacks in the military.

1948 - Congress passed the Women’s Armed Services Integration Act, which established a permanent but separate women’s corps in the military services.

1951 - Defense Advisory Committee on Women in the Services (DACOWITS) was established.

1963 - DoD established civil rights office and directed each military service to develop internal civil rights monitoring systems.

1967 - Public Law 90-130 removed the statutory ceiling on the number of military women (two percent) and grade limitation (one line colonel per each service).

1972 - Reserved Officer Training Corps (ROTC) admitted women.

1973 - Flight training opened to Army and Navy women; Air Force in 1976.

1974 - DoD rescinded policy which involuntarily separated pregnant servicewomen.

1976 - Military service academies admitted women.

Incremental Inclusion of Others1977 - Army began coeducational basic training of women and men recruits.

1977 - Air Force assigned the first women to Titan missile launch control crews.

1978 - Public Law 95-485 abolished the Women’s Army Corps (WAC), fully integrating women into the Regular Army.

1978 - First Navy women reported for sea duty aboard USS Vulcan.

1980 - DoD issued its first sexual harassment policy statement

1981 - DoD issued a policy that banned homosexuals from military service.

1985 - AF assigned first women to Minuteman/Peacekeeper missile launch crews.

1990-1991 Over 40,000 women participated in Operations Desert Shield and Desert Storm, many in nontraditional roles. 2 women were POW; 5 women died due to hostile action.

1993 - SecDef directed military services to open combat, aircraft and ships to women. Congress repealed laws prohibiting women from assignment on combatant vessels.

1993 - SecDef directed implementation of ―Don’t Ask, ―Don’t Tell‖ policy allowing ―discrete‖ homosexuals to serve in the military.

2008 - 92% (vs. 67% before SecDef Memo) of military positions are open to women.

Active Duty & Reserve Components

Combined

Women by Rank:E1 – E3: 15% E4 – E6: 15% E7 – E9: 10% O1 – O3: 18% O4 – O6: 13% O7 – O10: 6%

Active Duty & Reservists by Ethnicity

Active Duty & Reservists by Occupation

Enlisted Officers

Cultural Variable Traditional Model Evolving Model

Ethics/Customs Conservatism, Moralism Conservatism, Moralism

Enculturation Combat, Masculine Warrior Combat, Masculine Warrior

Laws/Policies Exclusion Inclusion

Force Structure Homogeneity Heterogeneity

Attitudes Seperatism Egalitarianism

Majority/MinorityInteractions

Hostility Tolerance

Dunivin, 1997

OIF/OEF Veterans & Evolving Culture

Age < 29yrs (DVANVAS, 2008)

Life stage - securing self identity/careers, establishing and maintaining romantic relationships (Tanielian &

Jaycox, 2008; Chartrand, Frank, White, & Shope, 2008)

Gender – women 11% (US Dept of VA, Office of Care Coordination,

2008)

Must incorporate gender specific reintegration, treatment and recovery in rehabilitative care efforts

Fast Fooders, Thinkers, and Do’ers (Brown, 2009)

Taking time to heal can seem counter intuitive in the fast doing culture of today

May engage in quick fix, high risk behaviors, to cope

OIF/OEF Veterans & Evolving Culture

Fast Fooders, Thinkers, and Do’ers (Brown, 2009)

Rehabilitation Implications

Non-Traditional Modes of Communication (Rank, 2008)

All Inclusive Care - holistic, convenient and efficient (US

House of Representatives Committee on Veterans Affairs, 2007; Rank, 2008)

Outreach interventions & home visits - 27% improved success

(McFall, Malte, Fontana, and Rosenheck, 2000)

Shy away from group experiences in preference for more one to one interventions (Alvarez, 2008)

More integrated, less stigmatized methods to combat the negative, societal, and military culture perceptions about mental illness (Mitchell & Selmes, 2007; Tanielian et al., 2008)

Standards of Military Fitness

Service specific, e.g. Army AR 40–501

Measurable medical elements as components of Individual Medical Readiness (IMR)

Equips unit commanders and primary care managers (PCMs) with tools to monitor IMR status of their personnel

Goal: a healthy and fit fighting force medically ready to deploy

Physical profile serial system

a system for classifying individuals according to functional abilities and their relation to military duties.

Physical Profile Functional Capacity

Guide

Table 7-1

ProfileP U L H E S

Serial Physical capacity

Upper extremities

Lower extremities

Hearing - ears

Vision -eyes

Psychiatric

Factors to be considered

Organic defects,strength, stamina,agility, energy,muscularcoordination,function, andsimilar factors.

Strength, rangeof motion, andgeneral efficiencyof upperarm, shouldergirdle, and upperback, includingcervical and thoracicvertebrae.

Strength, rangeof movement,and efficiency offeet, legs, lowerback and pelvicgirdle.

Auditory sensitivityand organic diseaseof the ears

Visual acuity,and organic diseaseof the eyesand lids.

Type, severity, and duration of the psychiatricsymptomsor disorder existingat the time the profile is determined.

Amount of externalprecipitating stress.

Predisposition asdetermined by thebasic personalitymakeup, intelligence,performance,and history ofpast psychiatric disorderimpairment offunctional capacity

1234

AR 40-501

Table 7-2

Profile Codes

Code Description/assignment limitation

Medical criteria (examples)

CODE A No assignment limitation. No demonstrable anatomical or physiological impairmentwithin standards established in table 7–1.

CODE B May have assignment limitations that are intended toprotect against further physical damage/injury. Mayhave minor impairments under one or more PULHESfactors that disqualify for certain MOS training or assignment

Minimal loss of joint motion, visual and hearing loss

CODES C through P Possesses impairments that limit functions or assignments.The codes are for military personnel administrative purposes.

AR 40-501

Military Family Transition Issues

Military family members are vulnerable during major life changes, such as:

Moving due to permanent change of station (PCS)

Parent absence due to long-term temporary duty assignments (TDA)

Mobilization and deployment

Changes in family demographics

Graduating to junior/high school/post-secondary education

Individual responses vary based on age, maturity, gender, personality, relationships, and coping skills

Units can ease transitions with awareness and preplanning

Social Issues/Needs

Adjusting to new or temporary family configuration

Managing new situations, especially being ―suddenly military‖ as reservists

Accommodating physical changes

Acclimating to new places

New licenses, e.g. DMV, professional

Health care supports

Coping with changing schools, friends, leagues, activities, etc.

Emotional Issues/Needs

Children need to know they are loved and cared for, regardless of their age

Frequent absences of parent

Emotional issues include:

Sadness — Excitement

Anger — Anticipation

Vulnerability — Confidence

Loneliness — New challenges

Lack of sense of belonging

Educational Issues/Needs

Reorienting to new classmates, teachers, schedules, and inconsistencies in school requirements and offerings, e.g.,

Immunization requirements

School calendars/scheduling/ course content and sequencing

Entrance and exit testing; Records/credit transfers

Discipline

Graduation requirements

Special Education qualification and services

Informing teachers, counselors, and administrators about deployment and its impact on youth

Deployment Cycle Impact on Families

Pre-deploymentFamily Readiness - prepare & equip with skills, tools and

knowledge to successfully meet challenges of the military lifestyle Education focused on prevention of challenges

DeploymentActive problem solving Problems with the flow of communication/informationBetween SM & family AND unit & familyEmotional issues flare Medical, dental or housing issues

Post-deployment (Redeployment) Ease stress, emotional flux and reunion challenges of

transition to home environment

Help Rejection Biases by Service

Member &/or Family

Pre-deploymentOverconfidence in self or spouse's ability to copeFeel they know all they need to know & have prepared as does spouse

Pride or unwillingness to appear in less than full control ―I can take care of it.‖

Desire to separate work from personal family life.

Increased demands on time availabilityMay feel it is more important to focus on unit training and preparation

Focus on unit training becomes all consumingAs this may have life or death implications once deployed.

Unsure of the resources available to accomplish tasks

Command does not set family preparedness as a priority

Fear of consequences of asking for help, not already having the answers, or admitting family problems.

Help Rejection Biases by Service

Member &/or FamilyDeployment:Spouse fearful of causing conflict in marriage by involving

others. Spouse fearful of getting SM into trouble with command. Spouse fearful of being a source of gossip within the unit. No Power of Attorney or other necessary document. Does not know who can help. Emotionally overwhelmed.Family no longer living near unit/ base.Post Deployment: Spouses do not want to cause ripples in relationship as the

SM has just gotten back from deployment and has seen/been through very hard times. Spouse not sure how to help. Spouse does not want SM to get into trouble.

Tasks of Reintegration & Families

Redefining roles, expectations & division of labor

Managing strong emotions

Abandoning emotional constriction to create intimacy

Create shared sense of meaning & coherent narrative emphasizing strengths of couple (Johnson, 2002) and family

Bowling & Sherman, 2008

Roles of the Military Psychologist

Unique Functions

Chapter evaluations

Command Directed Evaluations (CDE’s)

Medical Evaluation Boards (MEB’s)

Soldier Readiness Processing (SRP)

Security Clearance assessments

Training Evaluations (e.g., Sniper)

Multiple roles (therapist/assessor) and relationships (patient/UA tech) common

Roles of the Military Psychologist

Similar to Employee Assistance Program (EAPs) Providers

Employer (Commander or 1SG) has right to know if their employee (Soldier) has made his/her appointments

Employer involved in some emergencies

The soldier is the patient; the client is the Mission of the U.S. Army

Ethical Considerations

Confidentiality

Informed consent

Dual agency

Boundaries

Fitness for deployment

Treatment in combat

Dealing with detainees

Separation from the Military

Special Considerations

Military sexual trauma

PTSD vs. resilience & posttraumatic growth

Military Sexual Trauma (MST)

MST – sexual assault or repeated, unsolicited, threatening acts of sexual harassment that occurs during military service.

Sexual assault 14-43%; Sexual harassment 55-63% (Suris, Lind, Kashner & Borman 2007; Skinner et al., 2000)

45-70% female VA users w/ depression experienced MST (Suris et al., 2004)

Military Legal System

The Uniform Code of Military JusticeLegal source consulted by commanders

Not significantly changed since codified in 1950s

The Judge Advocate General (JAG) CorpsRepresent the commanding authority of the installation

Under authority of the Commander

Function as investigating authority (prosecutor) & as defense counsel

Command DiscretionIn command of both the victim & the offender

Empowers commander to decide if case goes forward to court martial

Military Sexual Trauma (MST)

Rape2 elements per UCMJ: by force & w/o consentProblems: males excluded by definitionno protection statutesforce element as loophole if prior social contact

Aspects adverse to victimsNo victim shield protectionsMandatory reportingContinue to serve w/ or under the offenderLack of training, e.g. MPs – fx: base security, not law

enforcement

Military Sexual Trauma in Women

Veterans

232 female veterans sought OP MH tx 2003-2006

2/3 (n = 163) experienced MST

No diff. in demographics or health behaviors

MST group

self-identified as disabled & higher starving behavior

rated by VA benefits board as higher distress sxs and functional impairment

Rowe et al., 2009

PTSD vs.

Resilience & Posttraumatic Growth

Trauma research pathogenic outcomes

Trauma exposure rates > 50%; lifetime PTSD prevalence 7.8% (National Comorbidity Survey; Kessler et al., 1995)

Resilience – stable equilibrium w/o reactive psychopathology (Bonanno, 2004)

Posttraumatic growth – develop + outlook following trauma (Tedeschi & Calhoun, 1996;2004)

Is it a form of resilience?

Is growth superior to resilience?Tedeschi, Calhoun & Cann, 2007; Westphal & Bonanno, 2007

Resources

Military One Sourcehttp://www.militaryonesource.comDefense & Veterans Brain Injury Centerhttp://www.dvbic.org/Center for Deployment Psychologyhttp://www.deploymentpsych.org/The Deployment Health Clinical Center www.pdhealth.milVA/DoD Clinical Practice Guidelines at Deployment

Health Clinical Centerhttp://www.pdhealth.mil/clinicians/va-dod_cpg.aspMilitary Student.ORG www.militarystudent.dod.mil or www.militarystudent.org

Objectives

1. Describe the primary difference between the military & VA health care cultures

2. Describe how the warrior ethos impacts health beliefs

3. Identify adjustment issues for returning service members & their families related to the deployment cycle.

4. Identify challenges to rehabilitation unique to military culture

Reports Referenced in Presentation

2008 DoD Survey of Health Related Behaviors in AD Military Personnel

http://www.tricare.mil/2008HealthBehaviors.pdfPopulation Representation in the Military Services FY06 Report,

Office of the Under Secretary of Defense, Personnel and Readiness.http://www.defenselink.mil/prhome/PopRep_FY06/Karney, B., and Crown, R. (2007). Families Under Stress: An

Assessment of Data, Theory, and Research on Marriage and Divorce in the Military. Santa Monica, CA: RAND National Defense Research Institute.

http://www.rand.org/pubs/monographs/2007/RAND_MG599.pdfDefense Manpower Requirements Report Fiscal Year 2008.

Prepared by: Requirements Directorate Office of the Deputy Under Secretary of Defense for Program Integration.

http://www.defenselink.mil/prhome/docs/DMRR_FY08.pdf

Other References

American Psychological Association (2003). Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists. American Psychologist, 58 (5), 377–402.

Brown, (2009). Societal culture and the new veteran. International Journal of Scholarly Academic Intellectual Diversity, 11 (1), 1-9.

Dunivin, K.O. (1997). Military culture: A paradigm shift? Air War College Maxwell Paper, No. 10, 1-37.

Hillen, J. (1999). Must U.S. Military Culture Reform? Orbis, 43 (1), 43-57.

Lehman, J & Sicherman, H. (2006). The future of American military culture: a conference report. Foreign Policy Research Institute.

Lew, H.L et al. (2009). Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: Polytrauma clinical triad JRRD, 46 (6), 697-702.

Questions?

Contact: kate.brown1@us.army.mil

Appendices

The Soldier’s Creed – Army (example)

I am an American Soldier.

I am a warrior and a member of the team. I serve the people of the United States of America and live the Army Values.

I WILL ALWAYS PLACE THE MISSION FIRST.

I WILL NEVER ACCEPT DEFEAT.

I WILL NEVER QUIT.

I WILL NEVER LEAVE A FALLEN COMRADE.

I am disciplined, physically and mentally tough, trained and proficient in my Warrior tasks and drills. I always maintain my arms, my equipment and myself.

I am an expert and I am a professional.

I stand ready to deploy, engage and destroy the enemies of the United States of America in close combat.

I am a guardian of freedom and the American way of life.

I am an American Soldier.

The Soldier’s Code – Army (example)

Code:I. I am an American Soldier — a protector of the greatest

nation on earth — sworn to uphold the Constitution of the United States.

II. I will treat others with dignity and respect and expect others to do the same.

III. I will honor my country, the Army, my unit, and my fellow soldiers living by the Army values.

IV. No matter what the situation I am in, I will never do anything for pleasure, for profit, or personal safety which will disgrace my uniform, my unit, or my Country.

V. Lastly, I am proud of my Country and its flag. I want to look back and say that I am proud to serve my Country as a soldier.

Battlemind Training

• Armor for the mind

▫ Self confidence: taking calculated risks and handling challenges.

▫ Mental toughness: overcoming obstacles or setbacks and maintaining positive thoughts during times of adversity and challenge.

• To aid survival in combat, but may cause problems if not adapted when home.

▫ Battlemind Training II – aiding the transition home

Seligman’s Resilience Training

• Comprehensive solider fitness program

▫ Assess physical, emotional, mental, social, spiritual aptitudes

▫ Resilience skills building to :

Improve performance in combat

Ward off mental health problems

DoD Terms & Acronyms

DoD Dictionary of Military Terms http://www.dtic.mil/doctrine/dod_dictionary/

DoD Heraldry – Awards & Decorationshttp://en.wikipedia.org/wiki/Awards_and_decorations

_of_the_United_States_government

VA Toll Free Numbers

Benefits Information & Assistance 800-827-1000

Health Care 877-222-8387

Education & Training 888-442-4551

VA Life Insurance 800-669-8477

Office of SGLI 800-419-1473

CHAMPVA 800-733-8387

Helpline (Agent Orange & Gulf War) 800-749-8387

Telecommunication Device for Deaf (TDD) 800-829-4833