Tuesday, June 2, 2009
While there have been perhaps twenty recently published books on the issue of sexual assault of men and/or boys, few books dedicate time to discuss the effects of sexual assault on men in the military. To date, I have been unable to find any books dedicated solely to the research, study and discussion of sexually assaulted males in the military. Michael Scarce utilizes six pages in his book on “Male on Male Rape” to discuss male rape in the military, while Mezey and King barely brush the issue on two pages of their book “Male Victims of Sexual Assault”. In Scare’s text, he discusses (from page 44 to 49) Military Organizations, and noted that the results of male rape in the military (shame, denial, abuse of power over others) are similar to result of rape in a male prison population. Scarce tells the story of a writer who once wrote about the secrecy enforced concerning a same-sex rape at a military base at Fort Jackson in 1965, and highlights the continuation ongoing military ‘cover-ups’ when it comes to the crime. This ‘highlight’ may underscore why so little has been written on this issue.
The secrecy, the shame, the necessity to wear the appearance of ultimate ‘masculinity’ among fellow soldiers has kept this problem hidden away from public view all too well. Both books do little to shed light on the issue of male rape and sexual violence in the military. Meezy and King bring up a study done in 1984, which was based in a psychiatric outpatient clinic, and in which the researcher documented mood disturbances, problems with peer relationships and suspicion/uneasiness among people in 13 men who reported suffering sexual assault in the military.
A 1995 military Sexual Harassment Survey study done by the Defense Department found 30 percent of men in the armed forces reported received "unwanted sexual attention". Historically, although women are reported as suffering greater incidents of sexual assault/abuse, there are many pockets of information that remain obscure in this area, and therefore the numbers of sexually violent incidents towards men emphasized this concept in their April 2005 article titled ‘Sexual Assault Among Male Veterans’, by stating that research has shown that as many as 1.3% of veterans have experienced an adult sexual assault. When combining this information with the knowledge that men are less likely to report incidents of rape/sexual assault, the number merits attention. And yet, between the DoD, and the medical/scientific communities of the military, the issue still remains largely ignored.
Findings of the DoD Mental Health Task Force Survey were released in 2007. It is critical in this process to understand that the survey of military personnel in Iraq showed that 1/3 of military personnel polled believe it is OK to torture other human beings in order to save a fellow soldier's life. Approximately 40 percent of Marines and 55 percent of Soldiers stated that they would consider reporting a member of their unit for killing or wounding an innocent civilian. It is inconceivable that approximately half of troops polled stated they would not consider reporting these crimes, yet the numbers speak for themselves. In addition, the report showed that about 10 percent of over 1,300 Soldiers/450 Marines surveyed admitted that they had committed violence towards civilians and/or damaged property unnecessarily. These figures are important to understand, because they give insight in to general attitudes and beliefs that are prevalent among military members in combat, and may assist with understanding both perpetrator mind-sets, victimology of military members and reasons for underreporting of assaults.
Violence within the military services presents in several ways. From sexual assault, to workplace violence, to homicide and suicide…military personnel are often their own worst enemies in the face of a radically changing world. It is necessary, therefore to discover and implement methods that will stabilize military forces internally. The United States is generally seen around the world as a leader in International Affairs. However, nations around the globe must feel confident that the U.S. military forces have enough honor, integrity and fortitude to lead the way in the face of the worlds’ most difficult situations. It is important that they are secure in the knowledge that U.S. forces are present to prevent violence and atrocities, not to contribute to them.
Interestingly, the 2005 DoD Survey on Health Related Behaviors report showed that almost half of the total population of military personnel surveyed suffered from some type of physical and/or sexual abuse. Those surveyed stated that the greatest majority of abuse occurred before the age of 18 (39%) . The combination of the following factors contribute to military personnel’s' violence upon each other, violence upon non-combatants, unethical violence toward the enemy, and violence upon themselves. Factors include: past history of abuse of many service members, young age and inexperience in the military; introduction to new surroundings/environment (often threatening); exposure to various situations of violence and fear of loss of loved ones, personal injury and/or death.
There are approximately 1.4 million active-duty uniformed personnel currently serving within the four military branches of the U.S. Department of Defense. Over 50-60% of U.S. Military personnel are composed of individuals who are 25 years old or younger. This age group is similar to age groups found predominantly at Colleges and Universities across the country. Because the U.S. military ranks parallel these age groups, the rates of sexual assault are noted to be similar to university institutions.
Surveys of college men attending a variety of college/university campuses demonstrate sobering figures when questioned about sexual assault. In his article, LaVant discusses a study done in 1987 found that 77.6% of college women experienced some sort of unwanted sexual aggression, and 14% suffered from unwanted sexual intercourse. In comparison, 57.3% of college men had suffered from unwanted sexual aggression, and 7.1% suffered from unwanted sexual intercourse.
In one research report from Abbey et al, it stated: “Depending on the precise questions asked and the universities sampled, up to 15% of college men reported that they perpetrated an act that met standard legal definitions of attempted or completed rape and up to 57% indicated that they perpetrated some form of sexual assault”. Similar studies have not been done in the military population, but it is suspected that statistics would be comparable since the age groups are similar.
Occurrences of the crime of sexual assault in the military are multi-factorial, and can be divided into primary contributing factors and secondary contributing factors. Primary factors include: history of sexual abuse and particular personality traits of both victims and perpetrators. Secondary factors include: environment, substance abuse of alcohol and other drugs, and exposure to violence.
Recent research of males who committed sex crimes support an association between childhood abuse and rape perpetration, thus demonstrating that perpetrators of sexual assault are often prior victims of abuse as children. The determinant toward becoming either a victim or an abuser as an adult seems to be dependent on a variety of circumstances and personality traits. Personalities that tend toward an anti-social personality disorder in conjunction with a history of childhood sexual abuse demonstrate an increased risk of becoming a perpetrator.
Secondary contributing factors have been shown to greatly influence violent behavior. Alcohol, a drug that alters mental inhibitions and perceptions, facilitates both the potential to commit a sexual crime and to be a victim of it. A person who has ingested alcohol, and who has a history of sexual abuse in addition to an anti-social personality disorder, has a much greater risk of becoming violent and/or committing crimes of sexual assault/abuse. Although some forms of sexual assault/abuse may not be physically violent, it is important to remember that sex crimes are primarily related to a perpetrator’s feeling of anger and need for power. It is these motivations that serve as the catalyst for the offender committing sex crimes.
Victims of sexual assault as adults have been shown on many occasions to be victims of abuse or assault earlier in life. LaVant states that young people who witness, or who are victims, of violent or aggressive acts are more likely to perpetrate or become victims of substance abuse and/or aggression later in adolescence and adulthood. In addition, there is a strong association between alcohol consumption and sexual behavior. LaVant lists several studies which perpetration of unwanted sexual intercourse on both men and women on college campuses included the use of alcohol. On average, 55% of men who perpetrated sexual assault reported being intoxicated, while 29% reported being ‘mildly buzzed’.
A study involving females, who were prior victims of child sexual abuse, showed that if they drank alcoholic beverages, and were subsequently exposed to a threat or force, their tendency was to become more placid and malleable to the external threat. While alcohol is not a causative factor of sexual assault, it allows for the perpetrator to more easily commit the crime, and victims to more easily succumb. Alcohol renders individuals who are already susceptible to abuse, even more vulnerable than if alcohol were not a part of the equation. Unfortunately, I was unable to uncover similar studies done in males, however it may be that their responses would be similar.
Current figures on military sexual assault have recently been released from the DoD SAPR Office demonstrating the prevalence of Sexual Assault in the Military. In 2007, there were a total of 1,020 victims of sexual assault. Of those, there were 90 cases of male on male sexual violence, 9 cases of female on male assaults, and 15 cases of assaults on males where the gender of the perpetrator was listed as ‘unknown’. While it may seem as if the numbers pale in comparison to the listed number of 1247 male on female assaults , it is important to remember that typically men far underreport cases, and that even with the number disparity, men also deserve compassionate quality care.
For U.S. military members, access to care after a sexual assault has sometimes been difficult, as there are few official points of entry for sexual assault care other than existing Emergency Rooms at Medical Treatment Facilities (MTF’s). Often these facilities may not have an assigned point of contact, or a health care provider assigned as a sexual assault examiner “on-call”, in order to administer sexual assault care. Many medical personnel also frequently, and inaccurately, assume that victims of sexual assault should have their examinations performed in the Emergency Department (ED) by an Emergency Physician. However, and a majority ED physicians and nurses agree, the ED environment does not allow for exclusive attention of emergency room nurses and providers to attend to victims of sexual assault (unofficial poll of Navy MTF’s, 2004).
Sexual assault exams are complex and time-consuming, sometimes taking up to 8 hours to complete. Personnel that begin the examination process have to be cognizant of the “chain of custody” which requires the examiner to stay with the evidence at all times unless it is officially signed off to law enforcement or other approved personnel. Some exams involve diverse psychosocial issues requiring consults and referrals. Additionally, the examiner may later have to testify in court as an expert witness.
In the operational theatre, a there are a few medical personnel who are known to possess skills for thoroughly performing a sexual assault forensic medical examination utilizing techniques such as forensic photography and colposcopic magnification, in addition to utilizing the sexual assault exam kit. Most providers are taught how to perform examinations only on women. In addition, the challenges of operating in an austere environment with small military units, and the potential demands of immediate mobility of that unit, minimize the ability for sexual assault examiners to access specialized equipment, such as a colposcope for enhanced visualization of genital trauma, in order to perform a thorough exam.
The continuing occurrence of sexual assaults in the military, particularly during times of critical military operations, has demonstrated to the DoD a need for increased training of military personnel regarding sexual assault prevention, and for military medical personnel to provide improved response to, and forensic care of, sexual assault victims. The U.S. military has acknowledged that the provision of care for these victims is not only essential, but critical to the welfare of all military personnel, and therefore crucial to our country's welfare, by initiating inspections and surveys of sexual assault issues through Joint Task Forces, by developing Directive Type Memorandums to direct the Services to provide training for sexual assault responders, to provide options for confidential reporting, and to provide standardized avenues for victims to access needed services through Sexual Assault Response Coordinators (SARC’s) and Victim Advocates.
In the United States, many civilian rape crisis centers and hospitals are utilized as either a primary or secondary site for nearby military installations to refer sexual assault cases to. In the past, there has been disorganization, difficulty, and sometimes misunderstandings, regarding sexual assault care and the existing abilities of military personnel to care for their own sexual assault victims. Current U.S. military collaboration with civilian rape crisis centers, and civilian sexual assault examiners, has facilitated relationships that continue to show the benefits for both groups of personnel. Working together on these issues has promoted better training of military medical personnel and improved forensic care for U.S. soldiers and sailors, but further work is still in progress. Some of the programs that currently exist are pockets of excellence that will enhance military and civilian partnerships in the future.
The need to identify military health care specialists with training in Sexual Assault Examination techniques should be a priority within the armed services medical communities. Statistics from the Pentagon, and the study released by the Joint Task Force on Sexual Assault confirm this information. It is to the benefit of the military that personnel are both trained and learn to identify resources in Sexual Assault specialty care in order to provide optimal care to all genders of military victims of sexual assault, particularly in areas overseas and on deployment.
The military has struggled hard over the past 5 years to meet the challenges of improving its response to victims of sexual assault, and in developing better sexual assault prevention methods. Currently, the military medical response to care for sexual assault victims and suspects is fraught with difficulties and misunderstandings. However, it should be evident to those that examine the work that the Department of Defense has accomplished in the past five years, that many of the recent changes within the military regarding sexual assault issues, are a direct result of a high level of commitment by senior personnel to provide a quality standard of care for all sexual assault victims, and that the process of this positive change is continually evolving. There are many challenges ahead for all of the military Services, and the changes that need to take place to improve victim care will continue to occur with the patience, dedication and understanding of both those that working hard to create increased positive change and those that are waiting for it to occur. One of the greatest barriers to breach in this area is the barrier of gender preconceptions and misunderstandings in relation to sexual assault care.
Because of the limited amount of research published in the area of sexual violence toward military males, I propose that further research on sexual assault in the military, in regard to both male and female genders, be considered. While the Veteran’s Administration has provided some highly useful information, both quantitative and qualitative data are lacking in this area within the active duty military population. It is only with scrutiny at what is presently occurring in the ranks, and in correspondence with research on historical accounts that the military can hope to adequately address the future and prevent these crimes. It is only with awareness and dedication that it will succeed.
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Since the subject of violence as a public health issue is near and dear to my heart, and since I haven't seen it dealt with on a significant scale, or addressed adequately in programs and policies, I've decided to approach the subject with a blog page. It's my hope that the blog will spur some interest in others to consider the significance of violence issues in the public health arena, and perhaps even lead some to the understanding that violence is one of the primary sources (if not the main primary source) of all disease in the world. The following excerpt comes from a paper I wrote earlier in the year, and is placed here as an "Introduction" to addressing violence as a Public Health issue.
The Centers of Disease Control and Prevention (CDC) has only recently recognized the problem of violence as a significant Public Health issue. From criminal incidents such as sexual assault, domestic violence, homicide and suicide; medical providers, and other members within the healthcare system sometimes find themselves caught in between the two worlds of medicine and law. Medical providers who address cases related to violence frequently devote long hours of medical service towards these patients because of the complexity of the care they become involved in, however there are few resources available for them to turn to. Although medical providers frequently encounter aspects of violence in their daily patient care routines, issues related to violence remain inadequately addressed within national and state Public Health policy, and therefore efficiency and efficacy of violence prevention programs are suboptimal.
In 1979, the Carter Administration’s U.S. Surgeon General Julius B. Richmond identified violent behavior as a key public health priority . In the year 1980, the CDC made a particular effort to study the patterns of violence, and their efforts grew into a national program aimed at reducing the death and disability of violence associated injuries in the workplace. In 1992, the CDC established the National Center for Injury Prevention and Control (NCIPC) with the purpose of having it serve as the lead federal organization for violence prevention. Currently, the Division of Violence Prevention (DVP) serves as one of three divisions within NCIPC.
The main mission of the Division of Violence Prevention is to prevent both injuries and deaths that result from violence, and its goal is to do this by stopping violence before it begins. The DVP feels this can be done by: utilizing database systems to monitor all violence-related injuries; researching factors that put individuals and communities at risk and/or factors that protect them from violence; and assessing, planning, implementing violence programs as well as evaluating the effectiveness of those programs.
While the CDC has begun to develop programs and policy that link violence programs together, and has begun pooling its resources; individual U.S. states, other federal programs and the Department of Defense (DoD) have yet to recognize the benefits redesigning the structure of their violence prevention programs. Independent silos of violence prevention exist in the health care arena, and many of these silos of prevention are structured around the social services/psychology programs instead of Public Health programs. By developing state and federal programs that address violence overall, and by utilizing shared education and training, staffing, policy, and database resources, there can be maximum efficiency and efficacy within the system.
Violence issues most frequently encountered in the medical system include the following: Sexual Assault; Domestic Violence; Adult Assault; Child Sexual and/or; Physical Abuse; Trafficking of Persons; Workplace Violence; Gang Violence; Hate Crimes; Stalking; Suicide and Homicide.
Each one of the issues listed has an independently financed state and/or federal program dedicated to it, and each of these programs is housed in its own independent public health office.
The existence of violence within the United States is a significant health problem that affects people in all stages of life, from infants to the elderly. As an example, in 2005, there were 18,124 deaths from homicide as well as 32,637 from incidents of suicide. It is important to understand that violence unravels and deteriorates communities as well as individuals, by reducing productivity, disrupting social services and decreasing the value of local property. In addition, survivors of violence suffer permanent physical and emotional scars, and many have a greater need of counseling services, as well suffer as an increased risk of future violence, homicide and suicide incidents.
In developing an understanding of these issues, it is up to Public Health to address the problem of violence, to gather data, to assess its origins and impacts, and to consider appropriate responses via programs and interventions related to violence. Until Public Health begins to lead the way in violence prevention and response in communities, efforts to combat violence and to reduce its effects will remain largely inefficient and ineffective.
Centers for Disease Control (CDC) (2008) Public Health Approach to Violence Prevention. Retrieved on 16 January, 2009 from: http://www.cdc.gov/ncipc/dvp/PublicHealthApproachTo_ViolencePrevention.htm
Centers for Disease Control (CDC) (2008) Violence Prevention at CDC. Retrieved on 16 January, 2009 from: http://www.cdc.gov/ncipc/dvp/prevention_at_CDC.htm