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Abstract

This theoretical treatise uses the scientific literature concerning help seeking for mental illness among those with a background in the U.S. military to posit a more complex definition of military culture. The help-seeking literature is used to illustrate how hegemonic masculinity, when situated in the military field, informs the decision to seek formal treatment for mental illness among those men with a background in the U.S. military. These analyses advocate for a nuanced, multidimensional, and situated definition of U.S. military culture that emphasizes the way in which institutional structures and social relations of power intersect with individual values, beliefs, and motivations to inform and structure health-related practices.

Keywords

culture psychosocial and cultural issues mental health masculinity ideology

Introduction

Numerous publications have addressed the role of culture in mental health concerns among U.S. military and veteran populations. In these, the concept of military culture has increasingly been used to explain a number of different aspects of mental health, ranging from stressors experienced by military spouses (Watson, 2005) to alcohol misuse (Ames & Cunradi, 2004-2005). Familiarity with military culture is often described as important in the therapeutic alliance between patients and mental health care providers (Coll, Weiss, & Metal, 2013; Koenig et al., 2014), and has also been evoked in understanding “perceptions of trauma” (Weiss, Coll, & Metal, 2011) and a reluctance to seek treatment for mental illness and distress among those with a background in the U.S. military (Gibbs, Rae Olmsted, Brown, & Clinton-Sherrod, 2011; Gould et al., 2010; McFarling, D’Angelo, Drain, Gibbs, & Rae Olmsted, 2011; Weiss et al., 2011; West, Yanos, Smith, Roa, & Lysaker, 2011; Zinzow et al., 2013). The latter is particularly concerning because issues related to access to care among U.S. military veterans has recently received considerable national attention (Holland, 2014).

In much of the literature, military culture is conceptualized rather simplistically as a way of life, a common history and identity, shared values, or some combination of the latter, with authors citing a common language and traditions (Muramatsu, 2013), a shared history (i.e., the development of different branches within the U.S. military; (Catherall, 2011), and physical isolation from the mainstream population (Hall, 2013), among other things, as evidence of a separate culture among those with a background in the U.S. military.

Limitations in Current Notions of Military Culture

Although culture holds much promise as a framework to better understand beliefs and practices related to mental health among those with a U.S. military background, military culture is rarely defined in a way that resonates with anthropological or sociological conceptualizations of culture. For example, in describing military culture, scholars typically disregard primary processes of socialization, framing basic training as a process of indoctrination in which new recruits are reprogrammed (Coll et al., 2013). Such claims are inconsistent with current conceptualizations of culture that emphasize how individuals are members of multiple cultures. This literature nearly uniformly emphasizes an ethos of honor, valor, personal sacrifice, devotion to duty and mission, subjugation to the chain of command, and unit cohesion as defining characteristics of military culture (see Exum, Coll, & Weiss, 2010; Hale, 2012; Weiss et al., 2011). Defining culture solely through values and beliefs, however, neglects how structures external to the individual constrain behavior, disregarding the way in which culture is situated. Definitions of culture that privilege values and beliefs lack the multidimensionality characterizing current anthropological and sociological notions of culture and are insufficiently robust to account for health-related behaviors.

Social scientific research suggests a more complex and nuanced notion of military culture that contrasts with the way it is often framed in the literature. For instance, Ricks (1997) describes “drinking, lying, cheating, stealing, and whoring around” among active duty personnel in the U.S. Marine Corps that is at odds with the military ethos (as cited in Soeters, Winslow, & Weibull, 2006, p. 251). A recent survey on health-related behaviors further evidences the need to challenge overly simplistic notions of military culture and the military ethos as a defining characteristic of this concept. Despite the military’s attempts to instill a sense of devotion and duty to mission in recruits during basic training, this study identified that only 22.2% of active duty personnel in the U.S. military reported a strong commitment to service (Barlas, Higgins, Pfieger, & Diecker, 2013). As socialization to the institutional values of the U.S. military is far from uniform, the military ethos might not have much utility in defining military culture or illuminating beliefs and behaviors related to mental health.

Military culture thus remains an ill-defined construct whose relationship to mental health beliefs and behaviors is unclear. A more complex and nuanced notion would acknowledge that culture is negotiated and contested, recognize that individuals are bearers of multiple cultures, and be mindful of how culture is situated within and elicited via social and historical contexts. These points must be considered to better conceptualize and explicate the complex relationships between culture and health beliefs and behaviors.

Aims and Scope of the Analysis

This article builds on the literature about help seeking for mental illness to formulate a notion of military culture that is both grounded in empirical evidence and congruent with current anthropological and sociological understandings of culture. Drawing together data from studies that examine help seeking for mental illness among U.S. military personnel with studies concerned with masculinity and help seeking, then analyzing these through a Bourdieusian lens, reconfigures a definition of military culture. This article is thus not a meta-analysis or literature review, but a theoretical treatise that draws together and analyzes evidence from empirical studies completed in the United States via a particular theoretical framework. Grounding theory empirically in this way results in a more valid and compelling definition of military culture.

The analysis presented here results in a nuanced, multidimensional, and situated definition of the U.S. military as a field that contrasts with how it is often framed in the scholarly literature. This definition is nuanced because it accounts for how different experiences of socialization inform help seeking for mental illness. It is multidimensional because it is mindful of how institutional structures and social relations of power intersect with individual-level motivations, values, and beliefs to inform and structure practices related to mental health. It is situated because it acknowledges how structures and processes external to the individual constrain practices related to mental health.

Viewing Military Culture Through the Lens of Bourdieu’s Theory of Practice

Although it would be possible to use any number of epistemological frameworks for these analyses, Bourdieu’s theory of practice (1977) was chosen because it emphasizes how people constantly negotiate between their own desires and the constraints imposed on them. In the help-seeking literature, factors external to the individual emerge as salient in service members and Veterans’ decisions regarding whether or not to seek help for mental illness. It therefore seems logical that any theory of military culture must account for both individual values and beliefs as well as external structures that constrain individual choice and social processes that elicit and reward specific mental health-related practices.

According to Bourdieu, individual action is constrained by the power embedded in structured systems of social positions, or fields, defined as a “configuration of objective relations between positions” (Bourdieu & Wacquant, 1992, p. 97). These structured spaces, occupied by both persons and institutions, delineate social relations. While the notion of field accounts for objective structures, habitus and doxa pertain to subjective experience. Bourdieu defines habitus as a “socially constituted system of cognitive and motivating structures” (Bourdieu & Wacquant, 1992, p. 76) that shape personal motivations. Habitus is thus a system of embodied dispositions that arise from cognitive structures and motivations, while doxa refers to the learned and unconscious values and beliefs that inform behavior (Bourdieu, 1990). As distinguishing between habitus and doxa is rather complex for the purposes of this article, “habitus” will refer to the subjective components of culture, which is common in current iterations of practice theory.

The interplay between habitus and field, which seeks to explain how individuals engage in practices (Webb et al., 2002, as cited in McLeod, 2005), is useful in understanding help seeking for mental illness among those with military background because institutions possess enormous authority in both structuring practices and delineating social relations in the U.S. military. By emphasizing “broader structural determinants and constraints on ‘choice’” (Williams, 1995, p. 588), a framework drawn from Bourdieu’s theory permits analyses to strike a balance between factors at the individual level (i.e., values, beliefs, and motivations), and the structures and processes outside individual control that constrain help seeking. In the process of parceling institutional norms and social relations of power from individual motivations, values, and beliefs, a robust, empirically grounded definition of U.S. military culture emerges.

Describing a Military Field Through the Literature

In studies examining help seeking for mental illness among active duty military personnel in the United States, social relations within military units, and between unit members and superior officers often emerge as a critical factor in whether or not treatment for mental illness is initiated. In one recent study, for example, service members residing on base endorsed significantly more fear of being stigmatized by others for mental illness than did those residing off base (Kim, Thomas, Wilk, Castro, & Hoge, 2010). Evidence for the salience of social relations in help seeking is also supported by a study in which U.S. soldiers returning from deployment were less likely to report mental health concerns when screened along with members of their unit than when screened alone (Britt, 2000). According to research by Pietrzak, Johnson, Goldstein, Malley, and Southwick (2009), a perceived lack of unit support and cohesion can constrain treatment initiation for mental illness among U.S. National Guardsmen. This speaks specifically to the salience of social bonds within units to help seeking practice, even among active duty personnel residing off base. Such studies provide evidence that social relations among active duty military members can constrain help-seeking practices related to mental illness.

Numerous studies also underscore the authority of the institutional structure of the U.S. military to constrain help seeking for mental illness (see Williams, 1995, for a discussion of institutions and health-related practices). In a study by Gibbs et al. (2011), soldiers in the U.S. army reported concerns about how seeking help for mental illness might negatively impact service careers. These results were echoed by a study in which 53% of active duty military personnel who perceived a need for mental health treatment (but did not seek it) reported concern that seeking help would damage their careers (Barlas et al., 2013). Unlike concerns related to social stigma, unease regarding how seeking treatment for mental illness might negatively impact service careers remains both salient and constant over time, as recent longitudinal analyses among members of the U.S. Army National Guard reveal (Valenstein et al., 2014). The authority of institutional structures is evident, as well, in studies that underscore how organizational barriers such as difficulties scheduling appointments and getting leave to attend clinical visits (Hoge et al., 2004; Kim et al., 2010) constrain access to mental health treatment among active duty U.S. military personnel.

Other studies describe how social relations and institutional structures work in tandem to constrain treatment seeking, suggesting a particular field of practice in the U.S. military. Rae Olmsted et al. (2011, p. 585) identified beliefs such as “I would be seen as weak,” “My unit leadership might treat me differently,” “Members of my unit might have less confidence in me,” and “It would harm my career” among active duty respondents who met screening criteria for mental illness. Research by Porter and Johnson (1994) and Kim, Britt, Klocko, Riviere, and Adler (2011) have identified similar beliefs and concerns regarding treatment initiation. By identifying both institutions (“It would harm my career”) and social relations (“I would be seen as weak,” “Members in my unit might have less confidence in me”) as important to whether or not soldiers initiate mental health treatment, such studies suggest a military field that constrains help seeking for mental illness, most notably among active duty military personnel. These studies speak to the context in which mental health-related practices like help seeking are situated.

Accounting for Habitus: Individual Beliefs, Values, and Motivations in the U.S. Military

But does the existing literature provide enough evidence for a habitus related solely to socialization in the U.S. military? Stecker, Fortney, Hamilton, and Ajzen (2007) reported the belief among active duty military that they should be able to cope with problems without assistance salient in the decision to seek help for mental illness. In a qualitative study, True, Rigg, and Butler (2015) identified norms related to help seeking for mental illness among veterans, such as “stoicism, self-reliance, and prioritizing the needs of the unit over the needs of the individual.” Sayer et al. (2009) likewise identified numerous “treatment-discouraging beliefs” and “values and priorities that conflict with treatment-seeking” among U.S. veterans related to mental health, including “pride in self-reliance” (p. 244) that constrained treatment initiation for posttraumatic stress disorder. Although such studies identify similar cognitive and motivational structures among those with a military background, it is difficult to rule out structures and processes external to the U.S. military that might account for these beliefs. This is made apparent by the fact that both enlisted and retired members of the military possess similar treatment-discouraging beliefs, even though only the former live on base day-to-day.

Social class is one of many structures that might explain why those with a U.S. military background often share similar values and beliefs (Courtenay, 2011). The U.S. military draws liberally from the working class (Lutz, 2008), and individual values, beliefs, and motivations are structured by class (Bourdieu, 1986). Katz (1990) describes alexithymia, an emphasis on concrete actions over words, and strict conformity to ascribed roles, as components of “American working-class subculture.” Yet each of the latter has also been attributed to U.S. military culture. That class might account for similar values and beliefs among U.S. military personnel is rarely considered in the literature defining military culture.

Gender most clearly complicates attributing the values and beliefs described in the mental help seeking literature to U.S. military culture. That gender might inform and structure health was first recognized by Harrison (1978) in the 1970s, who accounted for the shorter life expectancy of men in the U.S. through gender socialization (or what Bourdieu refers to as embodiment). Subsequent research argued that disparate health-related practices, including “tobacco and alcohol use, diet, exercise, use of social support, safety practices, and efforts to prevent disease” (Mahalik, Burns, & Syzdek, 2007, p. 2201) all correlate with gender. Gender has, in fact, been described as one of the most important sociocultural factors to inform and structure health beliefs and practices (Courtenay, 2000b).

Gender socialization begins during early childhood (Cahill, 1982), long before potential recruits are eligible to enlist in the U.S. military. Socialization in the military occurs relatively late in human development, and is thus secondary (or even tertiary), occurring when other forms of socialization have already begun to be embodied and enacted. West and Zimmerman (1987) explain the salience of gender identity in relation to other, secondary forms of socialization: “We are always women or men—unless we shift into another sex category. What this means is that our identificatory displays will provide an ever-available resource for doing gender under an infinitely diverse set of circumstances” (p. 139). One such circumstance, or field, would be the U.S. military. As the U.S. military is primarily constituted by men, masculinity (rather than femininity) may be most significant and more salient than the military ethos in shaping a habitus among military personnel.

Masculinity, Field, and Seeking Help for Mental Illness

Masculinity is actively constructed and enacted within specific social and historical contexts (Kimmel & Messner, 2001); although one’s gender category usually remains stable, the way in which masculinity (or femininity) is socially and institutionally defined and enacted by individuals is highly variable and dynamic. Despite this variability, only one conceptualization of masculinity is awarded legitimacy in any given field, achieving hegemony over all others. This “hegemonic masculinity” constitutes a normative yardstick by which men are evaluated by others; a “pattern of practice” which demands that men “position themselves in relation to it” (Connell & Messerschmidt, 2005, p. 832) if they are to acquire social and symbolic capital (e.g., prestige, honor, influence).

Fields where practices consistent with hegemonic masculinity are rewarded elicit specific health-related practices from men, including a refusal to admit pain; a denial of weakness, vulnerability, and the need for help; an avoidance of practices socially defined as feminine, such as complaining or seeking help from others; emotional control (i.e., stoicism); and maintaining an appearance of being physically robust and competent in resolving problems without aid from others (Courtenay, 2000a). Fields elicit gendered practices by rewarding capital when practices are congruent with social expectations and institutional norms, and withholding capital when practices are not, such as when men seek help for mental illness. Men’s ability to communicate distress to others (Robertson, 1995) and to initiate treatment for mental illness (Courtenay, 2003; Good, Dell, & Mintz, 1989; Smith, Tran, & Thompson, 2008; Springer & Mouzon, 2011) is therefore constrained because to do so in fields that reward practices consistent with hegemonic masculinity results in a loss of capital.

Empirical studies describe similar values, beliefs, and motivations related to mental health and help seeking among men in the U.S. who embody hegemonic masculinity. For example, men who endorse values congruent with hegemonic definitions of masculinity demonstrate more negative attitudes toward formal treatment for mental illness than do others (see Berger, Levant, McMillan, Kelleher, & Sellers, 2005; Levant & Richmond, 2007; Vogel, Heimerdinger-Edwards, Hammer, & Hubbard, 2011), suggesting that they may have little motivation to seek help. Brownhill et al. (2002) argue that because popular notions of depression in the U.S. center on emotional states (i.e., feelings), men often fail to recognize symptoms of mental illness and to seek help for it. A recent meta-analysis concluded that men in the United States not only generally possess more negative attitudes toward seeking treatment for mental illness than do women, but that such attitudes may be attributed to the “ideological position that men should be tough, competitive, and emotionally inexpressive” (Nam et al., 2010, p. 114). Such studies describe gender specific values, beliefs, and motivations related to help seeking that suggest gendered habitus. This has significant implications for mental health-related beliefs and practices among U.S. military personnel, as the following analysis demonstrates.

Situating a Gendered Habitus in the Military Field

Gender achieves a heightened salience in the U.S. military, where hegemonic masculine ideals are adapted to the goal of training, controlling, and deploying large numbers of potentially unruly young men (and, recently, women; Agostino, 1998). Recruits are first introduced to the behavioral practices they will be expected to adhere to during basic training, where they learn the institutional norms and social expectations related to hypermasculinity, an exaggerated and stereotypic hegemonic masculinity (Morris, 1996). Embodying and enacting hypermasculinity results in the accrual of social and symbolic capital in the military field, such as respect from peers. It is reinforced by peers and superiors who police practices to ensure that they remain consistent with institutional norms (Morris, 1996). The institutionalization of masculinity is so complete that scholars have described the U.S. military as a “cult of masculinity” (Stewart, 1991, p. 7), noting that masculinity constitutes the “cementing principle” of this institution (Harrison, 2003, p. 75; see also Kimmel, 2000).

The military field tempers overt expressions of personal autonomy and individuality, but largely rewards health-related practices congruent with masculinity as it is institutionally and socially defined in the broader social context of the United States (i.e., refusing to admit pain; denying weakness, vulnerability, and the need for help; avoiding practices socially defined as feminine, such as complaining or seeking help from others; emotional control; and appearing both physically robust and competent in resolving problems; Woodward, 2000). Constraints on help seeking for mental illness are, in fact, particularly pronounced in fields, such as the U.S. military, that reward behaviors congruent with hegemonic ideals (Davies et al., 2000). As such, not only have many new recruits already learned how to enact gender specific values, beliefs, and motivations before enlisting in the U.S. military, but the military field reinforces that gendered habitus by eliciting hypermasculine practices.

Given all of the above, it is perhaps not surprising that men in the U.S. military endorse many of the very same beliefs about help seeking for mental illness as do civilians who embody and enact hegemonic masculinity, believing that they should be able to cope with problems without help from others (Stecker et al., 2007), and often interpreting seeking help as a weakness that conflicts with their identity (Weiss, Coll & Metal, 2011).) Support for the supposition that the military field reinforces and elicits behaviors congruent with hegemonic masculinity comes from studies that underscore the complex intersection of “traditional masculine gender role norms, relative youth, recency of distressing events, and recent experience in the social context of the military” in ambivalence toward treatment for psychological problems, and increasing dropout rates from psychotherapy among U.S. veterans (Lorber & Garcia, 2010; see similar findings in Green, Emslie, O’Neill, Hunt, & Walker, 2010; Hoge et al., 2004). The salience of hegemonic masculinity in informing a habitus related to gender and eliciting gendered mental health-related practices both within and without the U.S. military makes it difficult to discern if a veteran says, “You don’t talk about what could be deemed as emotional weakness” (Green et al., 2010, p. 1484) for fundamentally different reasons than any other man who is motivated to enact hegemonic ideals might state that, “A real man puts up with pain and doesn’t complain” (O’Brien, Hunt, & Hart, 2005, p. 508).

In summary, that U.S. military personnel, veterans, and many civilians share similar values and beliefs related to mental health and help seeking, despite the fact that their practices are situated in different fields, suggests a gendered habitus that is shared by men in the United States, who embody hegemonic ideals and learned previous to enlistment. Thus, U.S. military culture, at least insofar as help seeking is concerned, constitutes a field that hosts habitus which many recruits bring with them when they enlist.

Discussion

The U.S. military may be conceptualized as a field that elicits practices by rewarding capital to those who embody and enact a unique configuration of hegemonic masculinity adapted to the institutional goals of success in warfare. Although the military field has a strong authority in constraining help seeking practices related to mental health, individuals nevertheless bring with them to this field habitus informed through early socialization to gender, class, and race/ethnicity. This article focused on one such habitus, gender, in shaping beliefs and practices related to mental health in the U.S. military. Researchers, scholars, and clinicians would do well to acknowledge the way gender informs and structures beliefs and practices related to seeking help for mental illness in the U.S. military. If, as Saltonstall (1993) notes, “the doing of health is a form of doing gender,” the salience of gender in this respect is perhaps nowhere more certain than in this field.

The analyses in this article demonstrate how overly simplistic formulations of military culture, based in the premise that socialization in the military results in a uniform military culture, obscure diversity in the U.S. military. The notion of the U.S. military as one of many fields proposed here permits structures and processes, such as gender, social class, and race/ethnicity, to be accounted for in discussions about military culture and health behaviors, encouraging researchers and clinicians to see the U.S. military as comprised of complex individuals.

Definitions of military culture ubiquitous to the scholarly literature place an undue emphasis on the military ethos, insufficiently addressing the authority of the military field (i.e., social relations of power and institutional norms) to structure practices related to mental health. This emphasizes individual-level barriers to mental health treatment (e.g., health beliefs), obscuring external constraints on treatment initiation, despite considerable empirical evidence suggesting that the latter might be more salient than the former. The more balanced definition proposed here via an analytical framework informed through Bourdieu’s theory of practice underscores how individual choice is constrained and/or elicited within fields.

Adopting a nuanced, multidimensional, and situated notion of culture is an imperative first step toward identifying the multitude of factors that inform and structure health beliefs and practices, such as help seeking for mental illness, among those with a background in the U.S. military (see calls for cultural analyses in Hsu & Ketchen, 2013; Vogt, 2011). Defining the U.S. military as a field that hosts numerous habitus moves research closer to answering the call to integrate factors outside the individual, such as sociocultural, social network, and system-level factors (Sayer et al., 2009) into a more complex conceptual framework for exploring help seeking for mental illness in research.

The notion of U.S. military culture described here leads to intriguing questions that suggest directions for future research. For example, although women in the United States are often credited with having more positive attitudes toward seeking formal treatment for mental illness, does embeddedness in the military field, which rewards capital for hypermasculine practices, make them less likely to seek help for mental illness? How might different military fields (i.e., Marine Corps, Army, Navy, Air Force) and occupational specialties within the U.S. military inform and structure beliefs and practices related to health? Might the notion of culture proposed here help researchers better understand variation in mental health-related practices not only in the U.S. military, but among men, in general?

This article situated gendered health habitus in the military field to advance a more robust theoretical understanding of military culture in the United States. Using a Bourdieusian theoretical framework to analyze research related to help seeking for mental illness re-conceptualizes U.S. military culture in a way that is congruent with current notions of culture as a nuanced, multidimensional, and situated phenomenon. These analyses demonstrate how adopting a more complex notion of culture can inform a better understanding of health-related beliefs and practices among those with a background in the U.S. military.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The writing of this article was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, the Central Arkansas Veterans Healthcare System, and the Center for Healthcare Outcomes and Research (CeMHOR), Little Rock, Arkansas.

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A Bourdieusian Analysis of U.S. Military Culture Ground in the Mental Help-Seeking Literature

Abstract

Keywords

Introduction

Limitations in Current Notions of Military Culture

Aims and Scope of the Analysis

Viewing Military Culture Through the Lens of Bourdieu’s Theory of Practice

Describing a Military Field Through the Literature

Accounting for Habitus: Individual Beliefs, Values, and Motivations in the U.S. Military

Masculinity, Field, and Seeking Help for Mental Illness

Situating a Gendered Habitus in the Military Field

Discussion

Footnotes

Declaration of Conflicting Interests

Funding

References