Week 9 Long Military Experiences as Extreme and Unusual Environments (EUEs)

Support Services and Crisis Contacts

• If the information discussed in military EUE content brings up distress, several help resources are available:     - Lifeline: Phone $13\,11\,14$ (available $24$ hours) or online chat between $7\text{pm}$ and midnight.     - Beyond Blue: Phone $1300\,22\,4636$ (available $24$ hours) or online chat between $3\text{pm}$ and midnight.     - Emergency Services: Call $000$ if life or safety is in immediate danger.     - Open Arms: Provides individual, couple, or family support for current or former Australian Defence Force (ADF) personnel and their families. Phone $1800\,011\,046$ ($24$ hours).     - University of Tasmania (UTAS) Student Support: Free and confidential personal support is available for enrolled students via the Student Support and Wellbeing page (note: these are not crisis services).

Learning Outcomes and Requirements

• Upon completion of the module, students should be able to:     - Explain how the military differs from other Extreme and Unusual Environments (EUEs).     - Explore the impact of military experiences on human functioning.     - Outline military-specific issues regarding emotional impact, ambiguous absence and presence, and PTSD and stigma.

• Attendance Activity: Requires a discussion board post due by Sunday at midnight.     - Students must complete $7$ out of $10$ scheduled activities across the semester to meet requirements.

• Required Readings:     - Adler, A. B. & Castro, C. A. ($2012$). An Occupational Mental Health Model for the Military. Military Behavioral Health, $1(1)$, $41$-$45$.     - Bale, J. ($2014$). PTSD and Stigma in the Australian Army. Army Research Paper No. $3$.     - Faber, A. J., Willerton, E., Clymer, S. R., MacDermid, S. M., & Weiss, H. M. ($2008$). Ambiguous absence, ambiguous presence: a qualitative study of military reserve families in wartime. Journal of Family Psychology, $22(2)$, $222$.

Characterizing the Military as an EUE

• Research Depth: Compared to other EUE populations, the military is highly researched. Unique data exists across personal, relationship, and organizational levels regarding wellbeing and performance.

• Definition of Military as EUE: The military "per se" is not an EUE. Many individuals spend much of their work life in non-operational circumstances (not deployed to conflict or disaster relief).

• Exposure to EUEs: Personnel are more likely than other occupations to experience EUEs by being called to:     - National and international relief efforts.     - Conflict interventions.     - Peace-keeping missions.

• Dynamic Extremeness: Unlike stable EUEs like Antarctica or Outer Space, the military environment is constantly changing at physical, social, psychological, and technological levels.

• Nature of Risk: In EUEs like Antarctica, participants sign up for known risks. In the military, individuals sign up for a broader range of risks with higher exposure likelihood.

• Core Military Stressors (Adler & Castro, 2013): Personnel are likely to:     - Care for wounded individuals.     - Attempt to avoid being killed.     - Witness serious injury or death, including that of peers or innocent civilians.

• Variability of Experience: Experiences vary by nation (primarily researched in Australia, the UK, and the USA), specific service branch (e.g., Australian Army, Royal Australian Navy, Royal Australian Air Force), and status (e.g., Reservists).

Parameters of the Military Environment

• Physical Parameters:     - Fitness: Demanding physical work requires standards often beyond "normal" or "average." Specialist units have extreme physical rigours.     - Environmental Stressors: High heat or sand-storms in deserts; humidity and infection risks in tropical climates; sensory stimuli like noise and smells.     - Accommodation: Often basic and shared. Historical practices included "hot bunking" (sleeping in shifts sharing the same bed). Deployments may involve temporary housing like tents or dug-outs.

• Psychological Parameters:     - Need for sustained heightened attention and concentration for long periods.     - Disruptions to circadian rhythms (shift work, changing time zones).     - Working in dangerous conditions requiring a state of hypervigilance.     - Engaging in work sometimes unsupported by the wider public.     - Routine separation from support networks.     - Risk of self-injury/death or inflicting injury/death on others.

• Social/Interactive Parameters:     - In-group Dynamics: Constant interaction with non-chosen teammates leads to high cooperation and a sense of "belongingness," where members define themselves as "military."     - Public Perception: Community opinions (positive or negative) can lead to personnel being the target of protests or attacks due to government decisions they did not make.

• Technological Parameters:     - Communication: Modern technology has improved family contact, though it remains dependent on the specific environmental resources and time availability.     - Survival: Westernized forces provide access to medical supplies, dehydrated foods, gas masks, and camouflaged clothing based on environment demands.

Impacts on Human Functioning

• Research Bias: Literature predominantly focuses on negative outcomes; there is a lack of empirical evidence regarding "salutogenic" (health-promoting) experiences, despite people voluntarily selecting this industry.

• Short-term Impacts (Single Deployment):     - Positive: Belonging, personal efficacy, meaningfulness, travel, professional development, resilience, access to specialized healthcare (doctors, psychologists).     - Negative: Family absence, relocation between bases, trauma exposure, value conflicts, lack of community support, stereotyping, the "let-down phenomenon," difficulty making non-military friends.

• Long-term Impacts (Cumulative):     - Positive: Achievement, tolerance for diversity, lifelong friendships, high adaptability, transferable skills.     - Negative: Difficulty reintegrating into civilian life, increased post-trauma symptoms, relationship dissolution, substance misuse or dependence (including alcohol).

The "Greedy Institution" and Organizational Support

• Greedy Institutions (Coser, 1974; Segal, 1986): Organizations that demand high commitment, loyalty, time, and energy at the expense of personal and family roles.

• Military as Greedy: Requires physical/psychological separation, high-risk work, and a willingness to sacrifice one's life.

• Institutional Support: Unlike other EUE organizations, the military has formalized support structures (e.g., Australian Department of Defence Health Portal, Mental Health Online, Defence Community Organisation, and the "At Ease" initiative).

The Emotional Cycle of Deployment (Logan, 1987)

• Military work cycles repeatedly through pre-deployment, deployment, and return phases.

• Stages of the Cycle:     1. Anticipation of Loss: $4$-$6$ weeks before deployment.     2. Detachment and Withdrawal: Final days before departure.     3. Emotional Disorganisation: Early days after departure.     4. Recovery and Stabilisation: Second month after departure onwards.     5. Anticipation of Homecoming: $1$ to $2$ months before return.     6. Renegotiation of the Relationship Contract: Early days after homecoming.     7. Reintegration and Stabilisation: $4$-$6$ weeks or more after homecoming.

• Alternative Models: Pincus et al. developed similar models with slight variations in stage naming and duration.

Ambiguous Absence and Ambiguous Presence

• Historical Context: Stemming from Hill ($1949$), originally focusing on fathers.

• Ambiguous Absence: The family feels the psychological presence of the service member despite their actual physical absence during deployment.

• Ambiguous Presence: The family experiences psychological distance and absence from the member after they return home, despite their physical presence.

• Reunion Dynamics: Succesfully negotiating one reunion builds patterns for more effective future reunions.

PTSD and Stigma in the Australian Defence Force (ADF)

• Mental Health Statistics (Department of Defence, 2010):     - Lifetime risk of mental health disorders: ADF is $\sim 54\%$, civilians are $\sim 49\%$.     - Anxiety disorders are the most common ADF mental health condition.     - PTSD Prevalence: Approximately $8\%$ of ADF personnel (compared to $5\%$ general population).     - Gender Differences in PTSD: ADF males at $8.1\%$ versus general population males at $4.6\%$.

• PTSD Diagnosis (DSM-5-TR): Symptoms must last for more than one month, cause distress, and include:     - Exposure to death, serious injury, or sexual violence (direct, witnessed, or indirect/learning about it affecting loved ones).     - Re-experiencing (flashbacks, nightmares, memories).     - Avoidance (suppression of thoughts or avoiding reminders).     - Negative thoughts/feelings and heightened arousal (hypervigilance, self-blame, irritability, difficulty sleeping).

• Comorbidity: PTSD often co-occurs with depression, anxiety, and substance abuse disorder.

• Barriers to Treatment and Stigma:     - Treatments like Cognitive Behavioural Therapy (CBT), Eye Movement Desensitisation and Reprocessing (EMDR), and Prolonged Exposure (PE) are effective.     - Stigma Definition (Goffman, 1963): Negative perception of a person because their characteristics differ from (or are seen as inferior to) social/cultural norms.     - Military Culture Impact: Culture of strength, self-reliance, and self-sacrifice leads to fears of being seen as weak or incompetent (Bale, $2014$).     - Prevalence of Shame: Over $80\%$ of veterans express shame regarding mental health concerns. Some are told to "harden up" or "suck it up."

• Addressing Stigma: Early treatment reduces duration and negative impact. Australia utilizes resources like the "Dents in the Soul" PTSD awareness video to combat ingrained stigma.