“I’m Coming Home, Tell the World I’m Coming Home”. The Long Homecoming and Mental Health Treatment of Iraq and Afghanistan War Veterans
- 852 Downloads
This study explored the journey of American armed forces personnel from their decision to join the service, through their service in an active military conflict and how these factors may be associated with potential resistance for mental healthcare. The data came from qualitative interviews with 46 OIF/OEF/OND active-duty military, reservists, and discharged veterans of the average age of 25 years, who presented for a new episode of mental health treatment to a large Veterans Affairs Hospital (VAH) in Northeastern United States in 2011–2012. Qualitative analysis of veterans’ perceptions revealed several major themes describing how a mental health diagnosis would negatively impact both their sense of identity and pragmatic career-building goals: enlisting as a career-building avenue, ‘noble superhero’ identity, escaping from hardship, and mental illness as a career-killer. Findings suggest that factors making young veterans resist mental healthcare may be reduced by partnering VAH psychiatrists with career counselors, and by enhancing military leadership’s awareness and understanding about how to support soldiers with emotional and mental health needs, with a goal to eliminating stigma.
KeywordsYoung US veterans Mental healthcare resistance Qualitative interviews Sense of identity Pragmatic career-building goals
This study was funded by the Department of Veterans Affairs HSR&D MERIT award PPO-09-265-1 to Dr. Ilan Harpaz-Rotem.
Funding for this research was available through a Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D) Merit Review award PPO-09-265-1 awarded to the senior author. The views presented here are those of the authors and do not represent the position of any federal agency or of the United States Government.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and Animal Rights and Informed Consent
The study was approved by the human subjects committees of the VA Connecticut Healthcare System and Yale University, New Haven, CT. Informed consent was obtained from all individual participants included in the study. The manuscript has been de-identified.
- 1.Kemp JE: Suicide rates in VHA patients through 2011 with comparisons with other Americans and other veterans through 2010. Veterans Health Administration. 2014. http://www.mentalhealth.va.gov/docs/Suicide_Data_Report_Update_January_2014.pdf Accessed 10 Jan 2015.
- 3.Elwy RA, Glickman ME, Bokhour BG, Dell NS, Mueller NM, Zhao S, Eisen SV: Using mixed methods to examine the role of veterans’ illness perceptions on depression treatment utilization and HEDIS concordance. Medical Care, 2013Google Scholar
- 8.Vogt D, Di Leone BAL, Wang JM, Sayer NA, Pineles SL, Litz BT: Endorsed and anticipated stigma inventory (EASI): A tool for assessing beliefs about mental illness and mental health treatment among military personnel and veterans. Psychological Services 11(1): 105–113, 2014CrossRefPubMedGoogle Scholar
- 11.Jarrett T: Warrior resilience training in Operation Iraqi Freedom: Combining rational emotive behavior therapy, resiliency, and positive psychology. US Army Medical Department Journal 32–38, 2008 Google Scholar
- 12.Sherman N: Stoic Warriors: The Ancient Philosophy Behind the Military Mind. Oxford, Oxford University Press, 2005Google Scholar
- 13.Desai MU, Pavlo AJ, Davidson L, Harpaz-Rotem I, Rosenheck R: “I Want to Come Home”: Vietnam-Era Veterans’ presenting for mental health care, roughly 40 years after Vietnam. Psychiatr Q. doi: 10.1007/s11126-015-9382-2
- 15.Zinn JO: The biographical management of risk and uncertainty—British Veterans [116 paragraphs]. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research 11(1): Art. 10, 2010. http://nbn-resolving.de/urn:nbn:de:0114-fqs1001102
- 21.Casey B: Broken promise: The need to improve economic security for veterans. Report by the U.S. Congress Joint Economic Committee Chairman’s Staff. 2011. http://www.jec.senate.gov/public/index.cfm/democrats/reports1?ID=7E8BF4EF-56FF-4A21-B8D4-C1FCFE22EDD3 Accessed 10 Jan 2015
- 23.America: The American dream: Out of reach? 205(9): 6, 2011Google Scholar
- 27.Jones E, Farina A, Hastorf A, Markus H, Miller DT, Scott R. Social Stigma: The Psychology of Marked Relationships. New York, Freeman and Company, 1984Google Scholar
- 29.Crocker J, Major B, Steele C: Social Stigma. In: Gilbert DT, Fiske ST, Linzey G (Eds) The Handbook of Social Psychology, 4th edn., Vol. 2, Boston, McGraw-Hill, pp. 504–553, 1998Google Scholar
- 31.Manis JG, Meltzer BN: Symbolic Interaction: A Reader in Social Psychology. Boston, Allyn & Bacon, 1967Google Scholar
- 32.Davidson L: Living Outside Mental Illness: Qualitative Studies of Recovery in Schizophrenia. New York, New York University Press, 2003Google Scholar
- 33.Giorgi A: The Descriptive Phenomenological Method in Psychology: A Modified Husserlian Approach. Pittsburgh, Duquesne University Press, 2009Google Scholar
- 34.Wertz F, Charmaz K, McMullen L, Josselson R, Anderson R, McSpadden E: Five Ways of Doing Qualitative Analysis: Phenomenological Psychology, Grounded Theory, Discourse Analysis, Narrative Research, and Intuitive Inquiry. New York, Guilford Press, 2011Google Scholar
- 36.Massey D, Denton N: American Apartheid: Segregation and the Making of the Underclass. Cambridge, Harvard University Press, 1998Google Scholar
- 37.Wilson WJ: The Truly Disadvantaged: The Inner City, the Underclass, and Public Policy. Chicago, The University of Chicago Press, 1987Google Scholar