Dichotomy of PTSD Symptoms in Male and Female Veterans

1. Abstract

Post-Traumatic Stress Disorder (PTSD) in war veterans is often described in a way that is seen as male-centric wherein male veterans are depicted as struggling with substance abuse, homelessness, unemployment, and who perpetrate domestic violence. PTSD is less often associated with women, who often experience additional personal struggles on top of those struggles that are typical of war. My research question states, “How do Women who have served in the U.S. military experience PTSD after War?” In order to answer this question, I will be conducting research on accounts from male and female soldiers who have served in Iraq/Afghanistan as well as in the Vietnam War. I am choosing to use Iraq/Afghanistan and the Vietnam War, because both wars are fought for different reasons. The independent variables I will be using are the soldier’s gender (male or female) and their assigned role within a given conflict (nurse or active combat). My dependent variables are the symptoms of PTSD a soldier accrues after deployment. In conclusion, both women who served as a nurse and in active combat in Afghanistan did not suffer from significant symptoms of PTSD from their gender and role in the war like the women who served in those same roles in Vietnam. Both men that served in active combat in both Iraq and Vietnam had positive effects on the first and second hypothesis. This is most likely due to prevailing masculine ideals that cause men to feel like they need to repress their PTSD symptoms to be seen as worthy fighters/war heroes, which, in turn, causes a buildup of these emotions that present themselves in externalized ways post-deployment.

1. Introduction

Post-Traumatic Stress Disorder (PTSD) in war veterans is often described in a way that is seen as male-centric wherein male veterans are depicted as struggling with substance abuse, homelessness, unemployment, and who perpetrate domestic violence. PTSD is less often associated with women, who often experience additional personal struggles on top of those struggles that are typical of war, such as having a greater likelihood of experiencing rape and sexual violence. This lack of representation of women in the category of veteran PTSD is harmful, because the struggles that women face during wartime are often brushed to the side and ignored, due to the fact that women are less likely to serve in active combat roles than male soldiers. If PTSD in war veterans stems from traumatic events- like witnessing a fellow soldier get killed by the enemies, or being forced to kill innocent civilians- it will often be used by reporting outlets. This favorability for gore-based PTSD marginalizes many women and their experiences within wartime roles that can also evoke trauma. My research seeks to answer the question, “How do women who have served in the U.S. military experience PTSD after war?” This research question seeks to demonstrate how men’s and women’s wartime experiences become factors that affect the type and severity of their PTSD that they garner post-deployment.
The research conducted for this study is important for current scholarship, because it highlights the severity of PTSD that women experience that often goes unnoticed. As I have examined sources that research topics similar to my own, never before have I seen researchers compare and contrast singular, autobiographical accounts from male and female war veterans on PTSD. Most previous research focuses on the “victim and survivor” rhetoric, wherein female soldiers are limited to their stories. For example, Jelke and Henry’s “Between fatigue and silence: The challenges of conducting research on sexual violence in conflict” discusses the aspect of research fatigue, and how a plethora of sources will repeatedly ask women about their traumas during the war and over-report on their traumas, without taking their post-war emotional states and PTSD symptoms into account. Taking this limited approach used by numerous sources into account, I hope to get beneath the surface of these female soldiers’ stories, and look deeper at how these events and the roles these women played in war has affected them in terms of emotional states and PTSD symptoms, as well as how these mental-aspects compare to those of male soldiers. For this study, I will be researching personal accounts from veterans in the form of a small-N study over a large-N approach to give weight to individual experiences had by male and female U.S. soldiers who served in Vietnam and Iraq/Afghanistan.

1. Literature Review

My first source is entitled “‘Before the War, I Was a Man’: men and masculinities in the Eastern Democratic Republic of Congo.” This article discusses how Humanitarian Organizations fail to recognize the dichotomy between “gendered issues” and “women issues,” and therefore, do not work for social change for men who have experienced gender-based violence. The author homes in on authoritative masculinities in the conflict zone of the North Kivu province in the Eastern Democratic Republic of Congo. Research shows that as men try to enact dominant masculine ideals onto themselves- like becoming the breadwinner and the head of the family- political and economic institutions within society will put substantial pressure onto them to uphold these ideals. Moreover, female household members, no matter how financially independent they may be, also place pressure on their men to support them and to lead their household. This often leads to men experiencing a sense of failure, as war-related traumas from being an active combat soldier play a role in discouraging men from being productive and keeping a lucrative job post-war to provide for their family. Failure then further leads to unhealthy outlets being used by men to assert dominance through violence (namely towards women). This piece inspires my hypotheses because it provides an instance wherein men’s PTSD stems from the extreme dominant masculine ideals put onto them by society, (i.e. from being coerced to fight in active combat roles) and the failure to reach masculine standards, while women are obtaining PTSD through the violence they experience from the men who take unhealthy outlets to assert their masculinity.
This article contributes to my paper by listing the different types of experiences that women and children have in a time of war that contributes to the types of traumas they may experience post-war. The author says, “In addition to rape, women and children are subjected to other forms of sexual and gender-based violence, such as sexual slavery, domestic violence, economic poverty, and structural discrimination (e.g. poor access to education and political participation)” (Lwambo, 2013). Furthermore, the article contributes to my paper by explicitly stating that men need gender-specific care when it comes to tending to their psychological needs as well as their socioeconomic needs, that cannot be assuaged with programs geared towards women. With the absence of these programs, men are more likely to have uncontrolled symptoms of PTSD post-war.
While this article contributes to my research paper, it also poses some limitations. The study conducted in this paper is limited to civilian folk that are situated in diverse geographic regions and who hold diverse jobs. Each individual is described as having, “Variations in the degree of military presence and armed conflict, infrastructure, development, and geopolitical constellations” (Lwambo, 2013). This poses limitations to my research, because not all individuals studied have the same amount of time and involvement in the military, and so it would be hard to equally compare the PTSD experienced by men and women post-deployment.
Chapter 17 of The Palgrave International Handbook of Gender and the Military entitled, “Gender, Mental Health, and the Military” assesses popular discourses of military heroism, sacrifice, victimization, and recruitment coercion to understand personnel with mental health problems. These discourses are found to be heavily interconnected with gender, using emotional restraint, control, strength, and masculinity tactics. Mental health difficulties that arise from military distress raise questions about the capacity of men and women to live up to heroic standards while they serve, bringing aspects of vulnerability and emotion into attention and causing soldiers to suppress and “overcome” their strong emotions. Media coverage that seeks to describe the experiences of PTSD of Western military personnel that served in Iraq and Afghanistan reinforce and reflect gendered-discourses of heroism and victimization as it applies diversely to men and women. All in all, this chapter “explores the relationship between militaries and mental health through a gendered lens, highlighting the interactions between the military as a gendered institution, gendered identities and the gendering of mental illness” (Cornish, 2017). This piece inspires my hypotheses, by providing an in-depth, gendered approach to mental illness within military institutions, with gender being understood as the ideas of masculinity and femininity through which we make sense of people, roles, organizations and behaviors.
My research builds upon the dichotomy between diagnoses with regards to mental disorders in men and women. The author says, “Although varying with class and race, broadly speaking, women are more likely to be diagnosed with internalizing disorders such as depression, anxiety and panic attacks, whilst men are more likely to be diagnosed with externalizing disorders such as antisocial personality disorders, anger/violence-based disorders, and substance abuse or dependence (Cornish, 2017). This contributes to my hypotheses, because it provides a gender-specific diagnosis for mental health in men and women, which could influence how their PTSD post-deployment presents itself. For example, women will likely have more internalized PTSD in the form of panic attacks from nightmares about sexual violence during war, while men will likely have more externalized PTSD in the form of domestic violence, alcoholism, outward anger and substance abuse. Moreover, this piece explains how women are more likely than men to seek professional help to treat their mental illnesses, due to the prevailing stigma that asking for help and depending on others emasculates men and proves that they aren’t able to control their emotions, which is a pertinent task for being a “military hero.” This provides insights into why male and female PTSD experiences are different. While women have higher rates of PTSD than men due to not only war-related traumas, but also due to the gender-specific experiences they have during war, they might be more likely to get it under control to a greater extent than men, which is a reason why men are more likely to be depicted as violent, unemployed, and substance-dependent post-war.
This piece focuses on external factors outside of the war setting that can contribute to the vulnerability of male and female soldiers and their symptoms of PTSD, such as childhood traumas. However, it does not address my research question, because my research question and hypotheses require accounts of PTSD that are strictly based on military exposure and how a soldier’s role within a war contributes to their PTSD symptoms. Considering external factors complicates my research and brings in doubt about the origin of soldier’s PTSD.
In “A War of One’s Own- Understanding the Gender Gap in Support for War,” the author discusses the gender gap in support of going to war, and how the root causes of a particular war matters. Scholars know little about the particular causes for this gap, however the authors were able to propose two hypotheses: (1) “The gender gap in support for war will decrease when the primary object of the war is humanitarian as opposed to economic/strategic” and (2) “The gender gap in support for war will decrease when the proposed military operation receives multilateral support” (Brooks and Valentino, 2011). Using two made-up countries in their controlled experiment involving U.S. adults, they found that when the U.S. needed to send troops for humanitarian causes and the U.N. approved of it, women were more likely to support going to war. In contrast, they found that when the U.S. needed to send troops for economic/strategic objectives and when the U.N. did not necessarily support it, men were more likely to support going to war. This reading inspires my hypotheses development and contributes to my research, in that the root causes for a war (and whether more men or more women support going to war in certain circumstances) can influence different gendered experiences during the war that could lead to specific kinds and severities of PTSD post-war.
However, this piece fails to discuss the aftermath of both humanitarian and economic/strategic wars, and how they may invoke PTSD in both men and women. One aspect that satisfies my research is the explanation of the gender gap in support of war that discusses empathy and how women are more likely to be empathetic. This provides one solid explanation as to why women may have different symptoms/expressions of PTSD than men, as they may feel more empathetic of the people being killed and injured in these atrocities.
Chapter 7 of a book entitled Maneuvers: The international politics of militarizing women’s lives presents the theory that adding women to the military inherently militarizes them, and pushes them to engage in violent acts that they wouldn’t otherwise engage in (Woodward and Duncanson, 2017). The theory is premised on critiquing the liberal idea of inclusion, and how most equal rights activists would not push back against inclusion within an institution. Moreover, it presents the idea that the militarization of women in war can be lopsided, and that not all women realize that they are being maneuvered to support something. This reading inspires my research question and hypotheses because it proposes the idea of women feeling empowered being linked to committing violent acts in combat roles to “prove their strengths” in a male-dominated sphere, which can affect how they experience PTSD post-deployment. This is due to the fact that they have been brainwashed to see violence and strength as empowering through propaganda (i.e. Rosie the Riveter), women’s rights movements, and the patriarchy which puts an exuberant amount of pressure on women to prove they’re worthy of fighting in a male-dominated institution like the military.
This reading contributes to the framework of standpoint feminism, which states that not all women are the same and may have different perspectives, backgrounds, and norms. Bringing these different perspectives, backgrounds and norms into a war setting while under the pressure to be aggressive can evoke PTSD in different ways (Enloe, 2000). For example, a woman who comes from a background of violence in the home and child abuse may be more likely to experience heightened PTSD after war, due to the experiences they have in regards to war atrocities that evoke old feelings of uneasiness they felt as a child. A limitation and unanswered question is how men are maneuvered to support violence in war, and how that influences their PTSD after the war. This will be explored later as well.
“Anti-War Movements, From Vietnam to Today” discusses the year 1968, which was seen as the most deadly year of the Vietnam War with massive atrocities. It was also the height of the anti-war protest movement in the United States (Engler, 2018). The first major protests began in 1964 and quickly gained momentum after that: universities held “teach-ins,” and act of civil disobedience became more widespread with the burning of draft cards and sit-ins taking place on the Pentagon steps, at draft induction centers, as well as on the railroad tracks that transported soldiers to war. Eventually, the anti-war movement forced the U.S. to sign a peace treaty, withdraw its remaining forces, and end the draft in the beginning of 1973. Today, anti-war protests seem less dramatic and less visible than they were in the past. Following the attacks of September 11th, President Bush had American forces invade Afghanistan in order to overthrow the dangerous Taliban that was running the Afghani government at the time. In late 2002, Bush pushed the invasion of Iraq as well, claiming that Iraqi Dictator Saddam Hussein possessed “weapons of mass destruction.” Both quickly sparked anti-war protests, wherein protesters claimed that the invasions were mistakes and actually increased the prestige of these terrorist organizations (Engler, 2018).
This piece provides insight into how inhumane certain wars were regarded at the time of their occurrence due to the correlation to the high number of atrocities occurring, which could’ve contributed to a soldier’s PTSD post-deployment. Although this piece lacks accounts from soldiers that were deployed in those wars, this piece contributes a potential insight into which soldiers may have accumulated more heightened symptoms of PTSD. Since the Vietnam War sparked the most massive amounts of protests in the history of anti-war protests, I will predict that those soldiers experienced the most gruesome and frequent atrocities and thus they have the most heightened symptoms of PTSD.

1. Theory/Hypotheses

As mentioned above, my research question states, “How do women who have served in the U.S. military experience PTSD after war?” In order to answer this question, I will be conducting research on accounts from male and female soldiers who have served in Iraq/Afghanistan as well as in the Vietnam War. I am choosing to use Iraq/Afghanistan and the Vietnam War, because both wars were fought for different reasons. The Vietnam War was fought to combat communism, and is seen as a war fought for strategic means, which appeals more to male interests. On the other hand, Iraq/Afghanistan was fought to combat terrorism, which is seen as a more humanitarian cause as the goal was to keep both American and Afghani/Iraqi citizens safe from terrorist regimes like the Taliban, which appeals more to female interests (Brooks and Valentino, 2011). Therefore, using Vietnam and Iraq/Afghanistan is sufficient for measuring how wars fought in men’s interests as well as in women’s interests affects the wartime experiences of both male and female soldiers (especially female soldiers, as they are more likely to experience the costs of war). I expect that the three different wars will provide differences in PTSD in both male and female soldiers due to the differing motivations behind all three wars, as well as the differences in protest-patterns each war experienced, as mentioned earlier in the piece (Vietnam experienced more wide-spread and heightened protests while Iraq/Afghanistan experienced more quicker-forming protests).
The independent variables I will be using are the soldiers’ gender (male or female) and their assigned role within a given conflict. My dependent variables are the symptoms of PTSD a soldier accrues after deployment. These two variables are related, because in a war-setting that is brewing with masculinity and violence-oriented ideals, your gender, role, and exposure to violence can play a large role in how your mental wellbeing and overall life experiences will pan out after the war is over and for many years to follow. The frameworks that undergird the relationship between my two variables are the feminist anti-war theory and the consensus-orientation hypothesis, which are both found in the “A War of One’s Own” reading. Political feminism presents the feminist anti-war theory, which states that wars may be fought for men’s interests, and thus its costs fall most disproportionately on society’s most vulnerable members, which are women and children (Brooks and Valentino, 2011). This enhances my framework, because it provides a dichotomy of gender differences in post-war PTSD and in wartime experiences of men and women, which speaks to how women can experience backlash and symptoms of PTSD from a war being fought in men’s interest. The consensus-orientation hypothesis provides the framework for how men and women relate to their social groups within their roles during the war. Women place greater value on group relationships than men do and are more likely to favor cooperation and compromise within groups over aggression as a means of settling disagreements. With women often being excluded from group cohesion and support systems when in active combat roles, their PTSD post-war could be greatly enhanced, as they most likely did not have a great wartime experience when it came to having strong support systems.
My hypotheses are as follows:
H1: If a soldier is of a certain gender, then they will have experiences particular to their gender that contribute to their PTSD post-deployment.
H2: A soldier that performs a specific role in a war will acquire PTSD symptoms post-deployment that stem from their experiences while serving in that particular role.
Some critiques that others may have for these theories would most likely be based around the question of whether PTSD in soldiers is related to their role and gender experiences during the war, or if they have had earlier traumas in their childhood years that the war itself re-surfaces when they’re deployment time is over. As chapter 17 of The Palgrave International Handbook of Gender and the Military- “Gender, Mental Health, and the Military” discusses, childhood experiences can influence how an individual responds to/mentally processes traumatic events during the war. For example, if someone was sexually assaulted as a child, they may have an increased traumatic response if they are sexually assaulted during a war, due to the fact that they are “reliving” that moment from their childhood. Therefore, an alternative hypothesis could be:
AH: If a soldier experienced childhood traumas that may include sexual violence and physical violence, then they will experience PTSD from war-related events that perpetuate the re-memorization of these childhood traumas.
This alternative hypothesis, while compelling, is harder to connect to my dependent variable than my independent variables of gender/war role, because it is difficult to connect an event unrelated to war and a person’s upbringing to a trauma after war. It would be hard to prove wrong, but, for the purposes of this research paper, I am solely looking at how war-related events (that consider a soldier’s gender and role) directly affect a soldier’s mental well-being after war. If an instance does arise where a soldier mentions childhood trauma, I will include it in my description, but will not use it to prove or disprove my hypotheses.

1. Research Design

As mentioned above, I am comparing men’s and women’s experiences during wartime that influence their PTSD post-deployment. In regards to my independent variable, women have additional struggles on top of war-related struggles such as increased sexual violence/rape incidents, having to prove themselves more as fighters, as well as not having the strong support system that male soldiers have with each other as the majority gender in combat, which is why being of the female gender influences PTSD. On the other hand, men are expected to be strong leaders that are naturally violent and militarized in nature. Individuals in active combat roles are more likely to experience gory deaths and are more likely to be required to engage in perpetrating these gory deaths, which can lead to PTSD. Non-active combat roles in war (specifically, being a nurse) are more likely to deal with remains and wounded soldiers post-combat, and can thus experience PTSD in a different nature than those in active combat.
My dependent variable will be measured in a qualitative manner, and will seek to spot out the symptoms of PTSD a certain soldier has acquired, and how they deal with those symptoms. For example, I will look for aspects such as whether a soldier has acquired mental health services; if their PTSD presents itself in certain triggers, flashbacks, dreams, and suicidal ideations; if their PTSD/triggers affect their social life in regards to unemployment and relationships; and if they show signs of other mental disorders (i.e. depression and anxiety) and sudden behavioral changes like mood swings, irritability or sudden rage/anger and violent tendencies. I will also be looking to see the extent to which certain soldiers within a given study “cope” with their PTSD in the form of using alcohol or drugs. I’m using these particular variables, because the most recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) characterizes PTSD and the symptoms it contains across four symptom clusters: Intrusions (flashbacks, nightmares, physical reactivity, triggers), Avoidance (not leaving the house, not seeing other individuals/making relationships, or not being productive in order to avoid possible traumatic triggers), Negative alterations in cognition or mood (mood swings, suicidal ideation), and Alterations in arousal and reactivity (increased anxiety, anger, rage, irritability) (Armour, Fried, Deserno, Tsai and Pietrzak, 2016). The symptom clusters of PTSD incorporate the variables I am using in my dependent variable to measure PTSD in individuals based on their role and gender.
Furthermore, I will be looking to see if individuals acquired mental health services, because of the prediction I stated earlier in my literature review, wherein I said that since men seek professional mental help at a much lower rate than women due to the stigma of seeking help being “emasculating,” they’re more likely to have prolonged PTSD symptoms because they’re less likely to get help to assuage the symptoms (Cornish, 2017). I will see if the veteran soldiers apart of my personal account studies have developed other mental disorders post-deployment- like depression and anxiety- because oftentimes symptom clusters of PTSD tend to be in high comorbidity with other mental health disorders (Armour, Fried, Deserno, Tsai and Pietrzak, 2016). Lastly, I will be looking to see if veteran soldiers use drugs or alcohol to cope with PTSD, which will be an indicator of the severity of PTSD within the individual. The comorbid presentation of PTSD and Substance Use Disorders (SUDs) is very common, and in comparison to patients diagnosed with either disorder alone, PTSD/SUD patients often report greater functional impairment and experience poorer treatment outcomes, including treatment failure and dropout (McCauley, Killeen, Gros, Brady and Back, 2012). This approach provides a variety of symptoms that can vary depending on gendered and role-related experiences during war. Women with their often-subordinate statuses and men with their greater likelihood of active combat roles may experience these PTSD symptoms in different ways and at different rates of severity. This approach doesn’t consider any outside factors that may contribute to PTSD, but directly links traumatic events that are experienced and subordinate/masculinized statuses in war to deteriorated mental health post-deployment.
A limitation of this approach is that a soldier’s gender or role may not have a direct correlation with the traumas they experience that contribute to their PTSD. Although the types and amount of traumatic exposures a soldier witnesses usually depends on their role in the war or their gender, a soldier could randomly come across a traumatic/triggering incident during the war that is not influenced by these aspects. A traumatic event a soldier witnesses may not be in the context of active combat, working in a hospital for soldiers, being involved in the cleanup process in the aftermath of a battle, or any other role-related exposures. For example, soldiers may witness another fellow soldier kill themselves, which is not considered a role or gender-related witnessed atrocity. Another limitation is that PTSD in women post-deployment is under-reported, and so it can be hard to look into deep accounts from women soldiers about their PTSD and how it affects their life as well as how they cope with it. It is also difficult to find literature that provides direct comparisons of gender-based differences in PTSD post-deployment, and researchers often focus more on womens’ traumas than their mental health states when writing research literature on war.
My research design will involve personal accounts of both men and women U.S. soldiers of various roles who have served in Iraq/Afghanistan or the Vietnam War. The study will include accounts from 6 soldiers: 2 females and 1 male that served in each conflict. Each women soldier in each study will have different roles: 1 in an active combat role and 1 in a nursing role (I could not find any significant autobiographical accounts from male nurses who served in the Vietnam War and in Iraq/Afghanistan, so I decided to only use male veterans who served in active combat roles). I will look for autobiographical/biographical accounts, as well as interviews with soldiers from both conflicts, and take into account the independent variables (the soldier’s gender and role in the war), and evaluate their state of mental health based on their experiences related to their gender and role in the war. I will be using a qualitative form of measurement that speaks to my research question/hypotheses, in that I will take into account the PTSD symptoms that each veteran explicitly says they have, and see if it ties in with my independent variables. Then, I will be indicating whether the soldier’s gender and/or role in the war was deemed statistically significant for the study, in that it is seen as a direct cause of the PTSD symptoms in the dependent variable, as per my hypotheses. Statistical significance of my independent variables for gender can be determined based on if the soldier expresses that he/she experienced harassment that is gender-specific that contributed to their PTSD symptoms (i.e. subordination and sexual harassment for females, and masculine ideals being a source of contention for males). Statistical significance for war roles can be determined based on if a particular soldier experienced atrocities that are specific to the role they were in that contributed to their PTSD symptoms (i.e. battlefield deaths and committing atrocities for active combat roles and dying/dead soldiers for nurses). These measurements for my variables will be discussed in my conclusion section.
My two conflict studies (U.S. soldiers that served in Iraq/Afghanistan and U.S. soldiers that served in the Vietnam War) are similar, because both conflicts were long and contained numerous deaths and atrocities. Vietnam spanned 20 years between 1955 and 1975, the U.S.’s involvement in Afghanistan continued into its 13th year in 2014, and Iraq spanned 2003-2011 (Rockett, 2015). Over 58,000 U.S. soldiers died in the Vietnam War, while over 6,000 U.S. soldiers died in Iraq/Afghanistan, which provides lots of instances of atrocities that could’ve been PTSD-inducing for soldiers (Rockett, 2015).

1. Research Findings

Vietnam War- My first personal account is from a veteran named Sheila Procella from Texas, who joined the U.S. Air Force at the tail end of the Vietnam War in 1974. At the time of the Vietnam War, only 3% of servicemembers were women, and so Sheila describes her work environment as filled with non-stop, gender-based harassment (Casey, 2017). She recalls the daily routine of sexual comments, gestures, and inappropriate grabbings by male soldiers. Moreover, one of her superiors discreetly informed her that she could not advance in her role in the war without having sex with him. At the time of her serving, reporting your superior for sexual harassment and assault was bad for your career, so she never spoke about it to anyone. She kept telling herself that she would be ok, but she was not. After her deployment ended, she found herself dependent on alcohol and drugs. Eventually, she began to associate her feelings of deep depression, anxiety, and frequent panic attacks to the harassments and assaults she experienced from male soldiers during her time in active combat (Casey, 2017). Sheila also experienced childhood sexual abuse (which will not be associated with the measurements of this study, as it is not war-related) and was diagnosed with Military Sexual Trauma (MST) and PTSD in 2014. Today, she has a 70% disability rating from the Department of Veteran Affairs, and did not go into detail about obtaining mental health services.
My next personal account is from U.S. veteran Lynda Van Devanter of the Vietnam War, who served as an army surgical nurse in the 71st Evacuation Hospital in Pleiku, South Vietnam from 1969-1970. The constant gore, noise, and fatigue of war followed her home, and she began to have recurring nightmares of one of her patients, a teenage soldier whose face had been blown off (Oliver, 2002). She discusses how her and the other fellow nurses would frequently engage in drugs, sex, and alcohol during the war in order to be able to handle what they were dealing with on the operating table. Lynda went on to publish a book entitled “Home Before Morning,” wherein she recounts all of the horrors she experienced as a nurse in the war. She talks about her post-deployment life, and how she suffered from a drinking problem, homelessness, unemployment, flashbacks, nightmares, an unstable personal life with regards to relationships, and extreme emotional distress. Lynda describes how drinking helped her to sleep peacefully at night without having nightmares, and how that is why many soldiers fall into alcoholism after war (Oliver, 2002). She eventually acquired mental health services, but it took her a long time to be able to discuss Vietnam with her therapist. Her therapist entitled her PTSD program “Walking through Vietnam,” wherein she learned to write down her experiences to cope. Writing helped her work through her feelings, and she eventually wrote her book and became the founding executive director of the Women’s Project of the Vietnam Veterans of America from 1979-1984, wherein she testified in front of Congress and other governmental bodies on behalf of the over 7,000 women Vietnam veterans until her death in 2002.
My next veteran is a male veteran of the Vietnam war, William Maxwell Barner, who served in the U.S. Army overseas from 1966-1968. Following his service, he was unable to control his anger and had difficulty keeping a job, and after almost 40 years since combat, he was diagnosed with PTSD (Barner, 2001). Immediately after deployment, he went back to college and graduated on an academic scholarship. At that time, nobody knew how he was suffering mentally with extreme anger and assumed the schooling took his mind off of the war atrocities he experienced in active combat. After college, he went through a plethora of jobs, and was continuously fired due to his lack of emotion and cruelty towards co-workers and clients, whom he had unstable relationships with (Barner, 2001). It wasn’t until 2006 that William went to the Veterans’ Affairs Office to report his emotional distress from the war that was directly related to his role as an Army soldier in active combat. William expresses that he never got into drugs or alcohol, but strictly expressed his emotional distress through anger, isolation, and repression through his constant focus on work. Much of his PTSD symptoms came about from guilt of his role in war after he experienced the first dead body his troop caused six months after his deployment and he realized that the Army was trying to hide the atrocities they were causing from the soldiers. He also acquired these PTSD symptoms from his ability to live in more optimal conditions than other troops, and from his disconnect to the human costs of war. The VA office eventually deemed William as 100% mentally disabled for the rest of his life, and prescribed him 25 different kinds of pills to keep his emotions under control (Barner, 2001). On top of severe PTSD, other mental disorders he was diagnosed with include anxiety, depression, and obstructive sleep apnea. Upon receiving these diagnoses, William refused to accept them, and expressed that only “weak people” suffered from PTSD and other mental disorders. After a few years, he realized that “the ones diagnosed with PTSD are the good ones who care” (Barner, 2001). Today, William devotes his life to helping other troubled veterans and youth.
Afghanistan/Iraq
The next veteran account is from Jamie Fox, who served in the U.S. Air Force in the Afghan War. Growing up in a military family and on a military base, Jamie had a fairly easy transition into combat. She expresses that she had a strong sense of group cohesion and support, and that her fellow troop members in the military did not care about her ranking or her gender (Ward, 2019). Her highest rank was as a Staff Sergeant and she served from 2007-2016 all throughout the Middle East. She served particularly in Afghanistan from 2011-2012. Jamie comes from an Indian Reservation entitled Fort Belknap in Montana, which had a lot of maternalistic beliefs and made sure that Jamie was always taken care of, which demonstrates how she had a strong support system of relationships that helped her cope through the difficult times (Ward, 2019). When she returned to Olympia, Washington after deployment, she became dependent on cigarettes to deal with the stress of reality and to deal with the feelings of missing Afghanistan. After acquiring mental health services, she found outlets to help her relieve the stress from being back in “the real world,” which includes listening to music and training future soldiers in Air Force boot camps. Jamie’s case is much different from the expected accounts of women in combat, because she highly enjoyed the experience and the group cohesion that came along with it. Her mental symptoms were not deemed severe enough to qualify for a PTSD diagnosis.
The next Veteran account comes from Patty Justice, who served in Operation Enduring Freedom in the U.S. Army Nurses Corp in Afghanistan. She talks about how the American females who were serving in Afghanistan had to watch themselves around the Afghani and the Muslim men because they didn’t believe that women should be armed and in any military roles. The women soldiers were told to never look at the Afghani/Muslim men, because there the women were seen as subordinates (C-SPAN, 2014). As a nurse, Patty had to operate on a lot of men, which included Afghani civilians, and many of the Afghani men she treated got angry when she would touch them even though it was a part of her role as a nurse in the war. During her time as a nurse in Afghanistan, she witnessed Afghanis being beheaded for helping Americans, multiple explosions perpetrated by the Taliban and was even severely injured in an explosion that blew her into a brick wall. She expressed that she felt a strong sense of group cohesion within her unit, which consisted of guys and girls, and talked about how they helped her out when she got severely injured in an explosion. Once she got home from deployment, Patty resumed normal life, got a job at the trauma center in Atlanta Medical Center, and is still in the reserves today. While she showed signs in the interview of emotional distress while recounting her traumatic memories (through crying and freezing up) she never needed to acquire mental health services and never had mental symptoms severe enough to qualify for a PTSD diagnosis.
The last veteran in my study is named Carlos Huerta who served in the U.S. Army during the Iraq War. He was diagnosed with PTSD by Army doctors in 2004, and was in disbelief. Feeling like he needed to remain as masculinized as possible to get through the traumas of war, Carlos told himself that he needed to remain tough and push on. When he returned home in September 2010, he experienced a sudden panic attack in the middle of the night that jolted him awake. He was recounting instances where he witnessed people kill themselves, when he had to tell little kids that their mom or dad wasn’t coming home, and when he had the brains of a little Iraqi kid who got caught in an IED all over his uniform. He got out of bed and paced around, his chest tight and restricting his breathing. He almost called the hospital, but decided not to because the soldier in him told him to stick it out (Huerta, 2012). He finally called the doctor when he thought he was having a heart attack, because he said he believed that having a heart attack was honorable, while having PTSD was not. When the doctors told him he needed to get mentally evaluated, he immediately got worried that the Army would find out and that they would label him as “broken.” He decided to not make any close relationships with anyone- even his kids- in fear that he may have to leave them again one day to go back into combat. While in combat, he and his combat buddies were reluctant to seek mental help in fear that it would affect their assignments and promotions. He now fears that he is a burden to his family, and still constantly sees images of the war whenever he shuts his eyes at night. Carlos is now getting professional mental help, so that he can officially “come home from war” (Huerta, 2012).

1. Conclusion

After reviewing the 6 diverse case studies from both sets of conflicts, there were a lot of unique findings for each individual. The first case study of Sheila Procella positively affects my first hypothesis and has no effect on my second hypothesis. Sheila expresses that her PTSD symptoms and comorbidities are directly related to the gender-based harassment and assault she faced from male soldiers during her time in active combat. In terms of my second hypothesis, there were no provided accounts of how her role and experiences in the Air Force sector contributed to her symptoms of PTSD, so I concluded that there were no findings to either prove or disprove that hypothesis. Something to consider for this case is the frameworks I laid out that connected my independent and dependent variables: feminist anti-war theory and consensus orientation. Since we can conclude that the Vietnam War was fought for strategic means to combat communism and protect democracy around the world, it is likely that the war was fought more within a male’s interest, and so some of the costs of war fell disproportionately onto female soldiers. This could explain why Sheila experienced gender-based violence during this particular war. In addition to feminist anti-war theory, consensus orientation provides a plausible explanation for gender-based violence against women. Since only 3% of servicewomen at the time of the Vietnam War were women, Sheila was entering a “boy’s club” and was most likely one of the only females in her unit full of men. Therefore, she was easily a subject of subordination and sexual harassment in this male-dominated and male-run military sphere. As mentioned above, there was no mention of mental health services acquired for Sheila.
The second case of Lynda Van Devanter had no effect on the first hypothesis, but positively affects the second hypothesis. Her gender did not have an effect on the PTSD she experienced post-deployment, as she did not experience subordination or sexual harassment (both men and women nurses engaged in consensual sexual acts as a trauma response). However, her specific role as a nurse did directly affect her symptoms of PTSD post-deployment, because she explicitly states that treating and operating on severely injured and gore-ridden soldiers directly contributed to her symptoms of PTSD. The Vietnam War, as stated in Engler’s “Anti-War Movements” piece garnered the highest amount of anti-war protests in U.S. history due to the inhumaneness and massive atrocities that accompanied the war. Dealing with these atrocities first-hand as a deployed nurse, Lynda states that she had to be intoxicated or had to engage in sexual acts to be able to calm her nerves enough to treat these atrocity-ridden patients. As stated earlier, she eventually acquired mental health services, and learned to cope with her PTSD symptoms through writing.
The third case of William Maxwell Barner had a positive effect on the first hypothesis as well as on the second hypothesis. His gender contributed to aspects of his PTSD symptoms post-deployment, because he originally had the masculinized notion that only “weak” people were diagnosed with PTSD, which made receiving the diagnosis difficult for him. Men in war are hypermasculinized and feel as though they cannot exude any qualities that would deem them as “weak.” Therefore, male soldiers often repress and brush off their mental diagnoses. This sense of failure that comes along with not “upholding manhood” in military heroism, and from being seen as a “failure” often detracts men from holding jobs and keeping a productive life post-combat (as mentioned in the “Before the War, I Was a Man” reading). Furthermore, in the “Gender, Mental Health, and the Military” reading, the author explains how men are more likely to be diagnosed with externalizing disorders, which explains why William experienced a lot of anger that kept him from maintaining professional relationships and jobs. William’s case also had a positive effect on the second hypothesis because his role in the Army helped contribute to his anger and other symptoms of PTSD post-deployment. Once he realized what his role really was and saw the atrocities he helped cause, he felt the need to disconnect from the human costs of war and to look at the Vietnamese as the enemies, which later caused his symptoms of PTSD and guilt. As mentioned earlier, he did acquire mental health services and became a counselor for other troubled veterans and youth.
The fourth case of Jamie Fox negatively affected both the first and second hypotheses. Jamie’s case negatively affected the first hypothesis, because she expressed that she felt a strong sense of group cohesion with both her male and female troop members, and she was able to advance to the prestige rank of Staff Sergeant, which proves that she was not subordinated or harassed because of her gender. Her case also has a negative effect on the second hypothesis, because she did not mention any PTSD symptoms that arose from her role in the war, and didn’t have significant mental symptoms to qualify for a PTSD diagnosis. Furthermore, she expresses how she actually missed the life she had deployed overseas with her daily routine and her troop mates, and experienced anxiety due to the fact that she had to return to “real life” back home. She did acquire mental health services, and, as mentioned before, learned to cope with her anxiety through music and through training future soldiers.
The fifth case of Patty Justice also had a negative effect on both the first and second hypotheses. Although Patty experienced some gender discrimination from Afghani men, she expressed how she felt a strong sense of group cohesion among her nursing unit with both the guys and girls, and how they looked out for her after she was severely injured in an explosion. Besides general emotional distress post-deployment, Patty did not show signs of PTSD from her role, and thus did not affect my second hypothesis. She did not mention if she acquired mental health services, but did go on to live a productive and successful life despite the traumatic events she witnessed during the war as a nurse.
The sixth and last case of Carlos Huerta had a positive effect on both the first and second hypotheses. When diagnosed with PTSD, Carlos felt a sense of disbelief and feared that his diagnosis would be used against him when promotions were being given out. Carlos, as a former soldier who felt the need to keep himself masculinized in order to be seen as an Army hero, repressed his PTSD symptoms. When he returned home, however, he suffered from a plethora of PTSD symptoms as listed in the previous section. He is now working to acclimate to regular life again through his mental health services.
In conclusion, both women who served as a nurse and in active combat in Afghanistan did not suffer from significant symptoms of PTSD- or even qualified for a diagnosis- from their gender and role in the war like the women who served in those same roles in Vietnam. I believe that this is due to my framework analysis using feminist anti-war theory and consensus orientation because Vietnam is seen to be fought for predominantly male interests, which often leads to the negative effects falling onto women and children (i.e. increased violence, harassment/assault, and subordination). Moreover, women in active combat roles only made up a small portion of service members, and so relating to and finding group cohesion with the soldiers in a particular unit was nearly impossible for women at the time of Vietnam. Vietnam was also seen as a war with massive amounts of atrocities that garnered the most amount of protests in U.S. history, as mentioned in “Anti-War Movements, From Vietnam to Today” reading, which could also explain why PTSD symptoms could be seen as heightened for women who served in Vietnam as opposed to the women who served in Afghanistan. Lastly, both men that served in active combat in both Iraq and Vietnam had positive effects on the first and second hypothesis. This is most likely due to prevailing masculine ideals that cause men to feel like they need to repress their PTSD symptoms to be seen as worthy fighters/war heroes, which, in turn, causes a buildup of these emotions that present themselves in externalized ways post-deployment through anger, panic attacks, and sometimes violence. These masculine ideals could also provide an explanation as to why I couldn’t find a significant amount of accounts from male soldiers who served as nurses, because nursing is seen as nurturing and therefore “feminine.” Men may be more likely to be on the front lines, wherein they witness atrocities occur first-hand more often than women, however women are affected in their own ways that are unique to their roles and gender as well.

1. References

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