Soldiers Raped by Other Men 24 08 2009 Men

Gentlemen with MST, we know you are there. We work with some of you, and we know the isolation and shame that you have been feeling for so long. We also know that now is the time to give up that shame and regain the peace and joy that is just on the other side of all the pain.
You are not alone. 4% of male soldiers experience MST¹, which equates to almost 1 in 20 of you. The VA says that more than 50% of the veterans who have screened positive for MST are men.² Thanks to your sheer numbers, more men have experienced MST than women (there are almost 22 million male veterans, compared to less than 2 million female veterans³). You are not alone.
Call us if you need someone to talk to who will listen with understanding and patience. If you want to talk privately and securely to other men with MST, please go here to request an invite to a confidential, all-male, online message board. They are waiting, because it is time to come home.
A male survivor who is also an MST advocate has this to say to you:
“The Silent Wounded. That is what I call us: the MST survivor . . . It is difficult to explain what it is like to enlist in the military service for our country – male or female – to be motivated to serve as an honorable duty. Our discharge papers may say under “honorable conditions,” but we feel no honor . . .
“The pain in one’s soul from being a rape survivor is no different from man to woman – the shame and guilt we feel are equally the same. Because of the way society places a stigma on male sexual assault that is compounded by the military comradeship and brotherhood instilled in us from our first day, we remain the “silent wounded.” Because of the way we were brought up to be men – the male image – these things are not supposed to happen. That is why we remain silent.
“The silence continues to victimize us . . . [but] once I found a voice through the use of the internet, I found myself with a freedom that had not been mine since the attacks on my body in 1969. I was able to speak out where once I felt I would never say a word. To understand the pain inside of you – the silence – it is like a poison and continues to eat at your soul . . . the written word of your voice gives you strength. I believe that is what the author of this web-site is offering you . . . the male survivor, to have a way to speak – to purge ourselves from the poison.
“Find that freedom. The more each of us speak up and say “that happened to me too!” the more our voice is heard further and further from the walls of our silence.
“We need to open up the eyes of everyone. The silence needs to change – awareness of how sexual trauma affects males needs to advance. We are hurting; we should quit doing it alone.”


¹Source: “Sexual Assault Among Male Veterans.” Psychiatric Times. 1 April 2005. <http://www.psychiatrictimes.com/display/article/10168/55225?pageNumber=3>
²Source: “Military Sexual Trauma.” National Center for PTSD. <http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/military_sexual_trauma_general.html?opm=1&rr=rr1758&srt=d&echorr=true>

³Source: “Veterans Numbers from the Census Bureau.” The Tacoma News Tribune. 16 October 2008. <http://blogs.thenewstribune.com/military/2008/10/16/veterans_numbers_from_the_census_bureau>

UCMJ Definitions of Military Harassment, Sexual Assault and Rape.

Men with military sexual trauma often resist disclosure

Clinical Psychiatry News, March, 2008 by Jeff Evans

BALTIMORE -- Male veterans who have a history of military sexual trauma often fail to disclose their condition until well into treatment for posttraumatic stress disorder and have many motivations for covering up their problem, according to speakers at the annual meeting of the International Society for Traumatic Stress Studies.
Another complication is that few clinicians know of community resources to whom to refer male military sexual trauma (MST) patients, said Ilona L. Pivar, Ph.D., of the National Center for Posttraumatic Stress Disorder in the Veterans Affairs Palo Alto (Calif.) Health Care System.
"I speak from experience because of the difficulty getting referrals [and] the difficulty educating providers that this is a problem and that I am there as a resource for referrals," Dr. Pivar said.
Other contributing factors to the low awareness of MST among men include shame and stigma, and resistance to being labeled or targeted as a victim of MST. These are perpetuated by myths about male sexual assault, such as the notion that males cannot be raped, sexual assaults against men happen only in prison, male adult victims must be homosexual, heterosexual males do not rape men, and males are less affected by sexual assault than are females.
"I have veterans who I've treated who do not want to have that box in the VA system checked 'MST,' and they don't have it [checked]; however, they have MST and they have PTSD," she said. "Their initial treatment in the military may have been a precursor for this kind of sensitivity. Certainly, my veterans who are older experienced this as 'something that doesn't happen'" and are told to keep it quiet or are moved away to another unit or even punished."
She said this kind of shifting drastically disrupted and ruined the military careers of some veterans. "Once you've been targeted, I think the feeling is that you lose control of how people behave toward you," Dr. Pivar said.
Many of these veterans experienced MST in the Vietnam or post-Vietnam War era and have kept their trauma a secret for 30 or more years.
The types of sexual trauma include unexpected sexual overtures that are disruptive to self-identity, assault during or after combat (such as an assault by a medic), assault while in military prison, and being targeted by a person higher in command or being assaulted for being weak or small.
Possible clues to identifying MST in men include substance abuse (often severe), problems with sexual intimacy, difficulties with male relationships, marital relationship problems, problems with authority, fear of being labeled homosexual or sexually impotent, history of child sexual abuse or exposure to abuse, anger and aggression, and a history of violence.
The VA does have an effective screening program ("VA Data Reinforce Need for Treatment of Sexual Trauma," CLINICAL PSYCHIATRY NEWS, January 2008, p. 1), but Dr. Pivar suspects that some patients are missed because of stigma and shame. When patients are suspected of having MST, the best approach is to ask directly and empathically," Dr. Pivar said. After veterans begin to learn about their problem, they are "extremely amazed that other men have had this experience and also extremely surprised to know that the numbers of male and female MST survivors are about the same."
Dr. Pivar's presented a small pilot study of 10 male veterans from all military service branches who had experienced MST at a mean age of 20 years. Men were the perpetrators, except for one veteran who had been assaulted by two women. All patients were heterosexual; one man was bisexual.
When the men received treatment at a mean age of nearly 53 years, seven had had some combat exposure, six had been exposed to life-threatening disasters or accidents, four had experienced childhood loss of parental figures, six had observed domestic violence as a child, eight had experienced serious physical or verbal abuse as children, eight had sexual experiences as children with someone who was at least 5 years older, five had experienced a life-threatening illness since their MST, six have tried to commit suicide or self-harm as teenagers or adults, and all had severe substance abuse problems following their MST.
Only one patient had experienced a second sexual assault as an adult outside of MST.
Of the 10 patients, 7 have completed treatment in cognitive processing therapy (CPT) outpatient groups with 12-15 sessions (once per week) and significantly reduced PTSD symptoms (improved severity of depression, guilt cognitions, and self-esteem). Although the patients initially were resistant to joining a support group, after crossing that hurdle, they were motivated to continue treatment, she said.
The three dropouts faced medical problems, financial and housing problems, or they had the highest Clinician-Administered PTSD Scale (CAPS) symptom severity scores.
In conversations with veterans in the Cincinnati area about 3 years ago, Kathleen M. Chard, Ph.D., who directs the PTSD and anxiety disorders division at the Cincinnati Veterans Affairs Medical Center, said she continued to hear that the VA did not provide a suitable treatment setting for their problems.
These men said they had MST and would not feel comfortable in the center's 12-bed, 7-week residential treatment program for victims of all types of traumas, including MST and child sexual abuse. A separate resident program exists for females. A PTSD and anxiety disorders outpatient clinic also is located in the center.
"When you're sexually traumatized in the military by other veterans, combat veterans sometimes don't believe you and may in fact mock you," Dr. Chard said. Some residential trauma programs across the country also have been accused of saying things like:" 'We'll only take you through combat trauma, and if you have other types of trauma, we may allow you to talk about that privately--if there's time and therapist availability.'
"When I heard that, I immediately made a decision that we're going to change our modality," she said.
Now any veteran with PTSD from any event (such as child abuse, MST, or combat trauma) is welcome in the residential treatment programs.
Dr. Chard and her associates began offering CPT in 13 individual and/or group sessions. During group sessions, patients discussed their feelings associated with doing a homework assignment, sharing details of their life, participating in individual therapy, and sharing skills they've developed with others. In addition to CPT, the program added skills training in anger management, affect tolerance from dialectical behavioral therapy, relapse prevention, safety-seeking behaviors, mindfulness, relaxation, sleep, and medications. Patients who discussed the program in or outside of the groups faced immediate discharge.
This was a drastic culture change when it was possible to talk about trauma with anyone at any time. "I'm not saying that we're the best model, but we're the model that fit the needs of Cincinnati veterans at the time and with this response: Referrals have gone up about 25% since we created this change," she said at the meeting, which was also sponsored by Boston University.
In a sample of 30 male veterans with MST who were treated at the Cincinnati VA residential treatment program over a 1.5-year period, only 3 divulged their MST at the outset. None of the assessments that the clinicians ran (CPT, CAPS, Lang's information processing theory, Beck's cognitive-behavioral therapy) provided information to predict MST. Their MST had not been identified in any pretreatment notes at their home VA before coming to the Cincinnati VA. All met criteria for MST at some point in treatment. The veterans served in the Vietnam War (18), the post-Vietnam War era (9), and in the first Gulf War (3).
These 30 veterans "did very well" in treatment, Dr. Chard said, but even though they had similar pretreatment CAPS scores, they had less improvement in those scores after treatment than did non-MST veterans in the residential treatment program. The veterans with MST also entered treatment with poorer Beck's Depression Inventory scores than did non-MST veterans.
The veterans may be hindering their own treatment by not disclosing MST until trauma processing already has begun or even until after it has been completed. It seems to take 5-6 sessions for such veterans to build up enough trust with the therapist to mention their MST, Dr. Chard explained.
To avoid burnout, health care professionals at the center rotate between two residential and single outpatient clinics. Staffing averages at least half a psychiatrist, half a registered nurse, half a nurse practitioner, one psychologist, and one social worker per residential program, she estimated.
BY JEFF EVANS
Senior Writer

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