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Last week, I shared Part 1 of my interview with Katie Webb, L.C.S.W., Military Sexual Trauma Coordinator for the VA Palo Alto Health Care System. Katie received her Master’s Degree in Social Work from New York University. Prior to joining the Palo Alto VA, she served as Assistant Director at a community non-profit agency in New York City, working with survivors of interpersonal violence who have disabilities. Her clinical interests include the treatment of PTSD and comorbid diagnoses, intimate partner violence, military sexual trauma, and the implementation of telehealth technology to expand mental health care access to underserved communities.
I spoke with Katie about MST, PTSD, the risk of suicide, and how the VA experience can inform the national debate about college campus rape. Here is Part 2 of our interview.
Shaili Jain: Can you share how MST has impacted lesbian, gay, bisexual, and transgender (LGBT) veterans?
Katie Webb: The research parallels some of the discrimination that LGBT people face in that there isn't a lot of research on MST in LGBT veterans. We do know that, to some extent, LGBT veterans are more likely to have experienced childhood sexual abuse (CSA) than their heterosexual counterparts. CSA is also a risk factor for experiencing MST.
We know that the “don't-ask-don't-tell culture” created a very dangerous environment. Again, thinking about how social support is so key after trauma, if LGBT veterans can't really be fully honest about who they are and then are often isolated from social support, that is not a good situation. We know that sexual minorities are targeted for MST in the military and then have little social supports in the aftermath. They are put in a bind - they can’t even state why they were targeted for MST for fear they might be discharged from the military.
I think it's great that “Don’t ask, Don’t tell” was repealed. I think it's great that they're now allowing transgender people in the military. I think we also have to acknowledge it's a really slow culture shift to match some of the policy changes. It would be reasonable to expect that some of that is still going on.
Also, when you factor in the stress of being a minority to begin with, that can mean you are more likely to have a mental health problem after a traumatic experience, too.
Shaili Jain: It strikes me that LGBT veterans who have MST would be very high risk for suicide.
Katie Webb: Right, and then when you think about that and you think about trauma sequelae and how those unhelpful responses might be even more extreme with the LGBT population, it makes total sense that they will experience a lot of mental health distress. Unfortunately, how that can get translated is, “There's something really wrong with me.”
It's our job to flip that and say, “No, you're the one making sense, it is your surroundings that don't.”
Shaili Jain: I cannot help but draw parallels between recent research reports of college campus rapes and military sexual trauma. From my perspective as a psychiatrist, there are some striking similarities between these two types of sexual violence. MST raises similar issues to college rapes in that victims are often inexperienced younger people who are living away from home for the first time and are thrown into environments where it may be unclear what types of behaviors and boundaries are acceptable. There are also institutional factors that play a role in how the victim is treated and justice is served. Can you comment on these parallels? In particular, how generalizable is the VA experience to non-veteran populations?
Katie Webb: I agree, there are so many parallels. Probably with MST you see a little bit more extremity in everything.
For example, to some degree on college campuses, you're living and working with your peers, just like in the military - you're battle buddy is your room mate or your officemate or your chore mate. Both settings encourage unit cohesion, but I think in the military that's more extreme because if your unit doesn't get along, you're more likely to die. I think in the military that creates this pressure, particularly on minorities, e.g. women, to bond in ways that definitely push the limit and push what's acceptable.
I think you raise a very legitimate fact that younger people are still developing, they are still forming their schematics of how the world works. This is then used against them, as a tool that can be blaming. “Well, you don't know how the world works. Maybe you misunderstood the situation.” Then that really creates this manipulative dynamic that I think perpetrators can use and systems can use, so that is a striking similarity.
Colleges and the military try to keep the issue within their system of discipline, whether it be campus police or a military court system. I think military survivors of sexual trauma and college survivors of sexual trauma are isolated and blamed. Oftentimes, the powers that be say, “Well, we responded. We kept the survivor safe by transferring them to a new base.” They transfer the victim away from people they know with detrimental impacts on their careers. Sometimes, a college student may transfer to a new college and interrupt their goals while perpetrators stay put. If the survivor chooses not to report, they may have to continue to co-exist with the perpetrator. The same thing can occur on college campuses.
Copyright: Shaili Jain, MD. For more information, please see PLOS Blogs.
