Assignment: Diverse Populations in the Military, 6212 wk-2
As you explore the various cultures within the military, you may wonder how some of the differences affect the overall culture of the military. How do these differences influence the identity, roles, stressors, and needs of military personnel? The military has evolved over many years to include a rich ethnically and culturally diverse population. This diversity has led the military to break down stereotypes and create a new norm for working as a team despite individual differences.
In this Assignment, you analyze how distinct cultures can contribute to the larger military culture.
The Assignment:
In addition to the resources given this week, find in the Walden Library at least one additional piece of peer-reviewed research that helps to identify two distinct populations within military culture. However, do not choose the same culture that you chose for the Discussion.
In a 3- to 4-page paper:
Describe some characteristics of the population.
Describe how you would approach those cultures as a military social worker.
Identify strengths and challenges associated with this culture within the military.
Describe specific social work skills you would need to help clients within these populations.
Explain the importance of knowing how this population fits within the military culture.
Learning Resource Required Readings
Rubin, A., Weiss, E. L., & Coll, J. E. (Eds.). (2013). Handbook of military social work. Hoboken, NJ: John Wiley & Sons.
Chapter 2, Military Culture and Diversity (pp. 2136)
Understanding Cultural Humility Through the Lens of a
Military Culture
Margaret Lane
Abstract: The authors background for over the past 20 years has been working with the
military veteran population and active duty military members in the Veterans Administration
(VA). Her practice has comprised many components of VA health care, including medical and
behavioral health. Regardless of which facet of care her practice has led her to, one element has
always been the driving focus for her to convey to those who do not primarily work with
veteransthe understanding and recognition of veterans and military members as a separate
cultural identity. This narrative seeks to create a space for exploration and understanding of the
differences between civilian cultures and military cultures by utilizing a cultural humility
framework. The authors overall aim is to inform and recognize military cultural differences
through the lens of a shared, collectivistic, and militaristic cultural enmeshment, thus increasing
present cultural competency and linguistic knowledge beyond categorical denotations and
moving toward continued cultural learning and true expression that lead to deeper implications.
Providers perceptions of their own cultural humility play a vital role in understanding and
treating military members. It is in the understanding of military structure, language, commitment
to their unit, service to their country, and how military members embrace honor and service, that
true cultural humility begins to form (Tschaepe, 2018). The author believes it is vital that the
military populations are recognized not only for their specialized services in protecting their
country, but also for their unique and distinct culture that comprises the United States military
community.
Keywords: military culture, cultural humility, civilian culture, cultural identity
My background for over the past 20 years has been working with our military veteran population
and active duty military members in the Veterans Administration (VA). My practice has
comprised many components of VA health care, including medical and behavioral health.
Regardless of which facet of care my practice has led me to, one element has always been the
driving focus for me to convey to those who do not primarily work with veterans the
understanding and recognition of veterans and military members as a separate cultural identity.
Early in my career, I found the military philosophy to be markedly separate and distinct from its
civilian counterpart and comprised of multiple factors and values that define how military
members live their lives as part of the United States military (Cunha & Curran, 2013). Military
values define how military members live their lives and include both written and unwritten
principles (Cunha & Curran, 2013). These principles include concepts such as unit cohesion
through the success of the unit, the desire to never break trust among fellow members, the
promise to never leave a man on the battlefield (this extends to all walks of life, such as never
leaving your buddy at a bar), and control over emotions (Cunha & Curran, 2013). I was faced
with the tenacity of military protocol, which promotes strong character, morale, and welfare of
the military unit. This tenacity transcends military language through the use of terminology that
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Understanding Cultural Humility Through the Lens of a Military Culture
protects the military members psyche, but to those outside of this military culture, language can
easily be taken out of context (Cunha & Curran, 2013). From my experiences, I found there
needs to be a narrative that utilizes a cultural humility framework to create a space for
exploration and understanding of the differences between civilian cultures and military cultures.
My overall aim is to inform and recognize military cultural differences through the lens of a
shared, collectivistic, and militaristic cultural enmeshment, thus increasing present cultural
competency and linguistic knowledge beyond categorical denotations and moving toward
continued cultural learning and true expression that lead to deeper implications.
A brief understanding of VA medical and health care policies from which the VA operates is
critical to understanding military populations and receipt of health care services. I quickly
learned the military community is much different from civilian communities regarding how they
provide care for discharged military personnel harmed either physically or mentally while
fulfilling active duty requirements. When military personnel transition from active duty to
inactive duty, members may become eligible for benefits that civilian populations may not
necessarily understand, which can inadvertently create areas of marginalization. In his
discussion of a strengths-based approach to health care, Saleebey (2002) indicated that it is
becoming increasingly clear that emotions have a profound effect on wellness and health (p.
15).
Disability ratings and service connections are two terms that help define the medical and
behavioral health care that military members and veterans are given throughout their mission
and upon mission completion (Budahn, 2011). Service connection is a rating that determines the
percentage of monies or services given to the veteran, which is evaluated by and based on the
veterans disability or health impairments (Budahn, 2011). Service connection is a classification
rating system in which compensation and benefits are determined. Each tier and class bring with
them the definition and types of services and needs for which veterans will be eligible and
treated within the VA health care system (Budahn, 2011). A Class IV rating is considered one of
the highest eligibility and reimbursed categories a veteran can receive from injuries and
disabilities incurred through service to the United States (Budahn, 2011).
Any physical or mental complications incurred while the soldier was serving a military tour
potentiates the need for a disability rating. Disability allotments to the discharged veteran can
occur through a monthly compensation check and can be as minimum as 0% service connection
(health care eligibility but no monthly check) to 100% service connection, which can pay a
disabled veteran a monthly tax-free salary (Budahn, 2011). Along with a monthly income,
veterans become eligible for medical care and prescriptions with zero co-pays, eye exams, dental
benefits (for some), and housing reimbursements for handicap accessibility, along with many
other eligibilities (Budahn, 2011).
I was proud to be a part of the Veterans Health Administration (VHA), one of the largest
integrated health care systems that serves over nine million veterans enrolled in their system
(U.S. Department of Veterans Affairs, n.d.). However, not all military populations are treated at
VHA facilities (U.S. Department of Veterans Affairs, n.d.). For many health care providers who,
like me, are civilians without any prior experience with military service members, immersion in
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this culture adds a layer of complexity in a population very different from a civilian population
(Goff, Crow, Reisbig, & Hamilton, 2007). Military populations comprise approximately seven
percent of the total population, with close to 93 percent of the military population being part of a
multigenerational military family (Atuel & Castro, 2018). Although there is recognition and
appreciation for the job military members perform, I find there is a gap between civilian
populations and military populations, which creates a lack of cultural awareness about military
members as a distinct minority and culture (Atuel & Castro, 2018). For example, when active
duty military members or veterans seek any type of health care service, the military member will
test the trustworthiness of the provider (Atuel & Castro, 2018). Service members will ask
questions relating to trust through questions such as, Have you served? or Are you a
veteran? (Atuel & Castro, 2018, p. 75). Cultural humility within the military health care field
recognizes power imbalances and the need for reflection (Foronda et al., 2018). If I, as a health
care provider, am not culturally aware of military culture, the dialogue of understanding
disintegrates, ending any possibility of a therapeutic alignment with the member (Tschaepe,
2018).
Military culture can be defined as an active process of constructing shared meaning and is
represented through shared ideas, beliefs, attitudes, teamwork, trust, uniformity, anonymity, and
an environment that acknowledges that the units goals are always placed ahead of an individual
members goals (Foronda et al., 2018). My experience found that the military culture and
collectivistic framework was entrenched in each member as part of a cohesive whole. Within
military communities, military life provides a structured lifestyle through rules, guidelines, and
expectations that frame members adherence to core values determined via the branch of service
(Cunha & Curran, 2013). In comparison, my civilian culture is more individualistic with codes
of conduct set by Western standards. Cunha & Curran (2013) describe the differences between
civilian and military cultures using a job frame of reference. In military communities, a military
members job becomes their identity among their peers, their units, and their military branchit
is who they are. In civilian cultures, jobs are what people do to earn money and are not
necessarily attached to their identity. Missions within military cultures in comparison to civilian
cultures come with expectations of high performance and dependency on the unit for survival,
and any absence from your job could endanger your units safety or have far deeper implications
(Blazer, 2007; Koenig, 2007; Peteet, 2007).
With my behavioral health background, and from working with the returning veterans, I see
military members often viewing society differently upon returning home. This view can manifest
and create personal conflict for the veteran as well as his or her family, friends, and caregivers. I
find behavioral health providers, as well as medical providers, need to be aware of these views
by using cultural humility to benefit both the military members and their families. Cultural
competency/awareness are terms that are frequently used in the health care field and encompass
definitions that include concepts such as minority group knowledge and self-awareness of our
own attitudes and feelings (Foronda et al., 2018).
Cultural humility is a lifelong immersion in a bi-directional commitment to self-reflection and
self-critique focused on the process of mutually re-addressing and re-defining imbalances of
power dynamics when interacting cross-culturally (Foronda et al., 2018). American culture
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constructs fit this definition through a popular cultural lens that binds masses of diverse people
in an amalgamated identityviewing conglomerates of people through a lens of similar
customs, beliefs, and social norms (McAdams, 2014). However, it is erroneous to amalgamate
military service members and veterans into the construct of American culture (McAdams, 2014).
I can attest that the attention to cultural awareness and diversity without the inclusion of cultural
humility when working with military personnel brings into question common understandings of
social constructs and clinical terminology used in civilian populations and the relatability of that
terminology to military personnel (Hinojosa & Hinojosa, 2011; Oztrk, Bozkurt, Durmus,
Deveci, & Sengezer, 2006).
In a military cultural setting, military personnel reflect the social constructs and governing
bodies that define and make up a militaristic hierarchy and the creed of a Warriors Ethos
(Hinojosa & Hinojosa, 2011; Oztrk et al., 2006). Lack of military cultural knowledge can lead
to viewing variables about military culture as superordinate, leading to interpretation of cultural-,
racial-, or ethnic-group variances as minority-group deficits or majority-group strengths
independent of embedded social, organizational, and pedagogical processes which negate the
institutional context and function of cultural and historical circumstance (Brannan, Esler, &
Anders Strindberg, 2001; Merlan, 2005). I find that the lack of military cultural humility and
awareness creates areas of miscommunication when using common terminology to describe
behavioral characteristics of military members, affecting understanding for both the military
member and the provider with the potential to miss critical or necessary information (Goff et al.,
2007; Hoge, Auchterlonie, & Milliken, 2006; Knox, 2017).
Examining a cultural humility framework within military populations extends understanding of
culture when compared to cultural competence. Cultural humility incorporates a lifelong
commitment to self-evaluation and critical reflection of our knowledge and to recognizing power
imbalances (Foronda et al., 2018). Cultural humility commits to continual learning in a world
that has power imbalances (Foronda et al., 2018). For example, from my experience working
with veterans, the sustained presence of American military personnel over the past decade in
Iraq and Afghanistan has created an atmosphere of persistent high risk, increased potential for
mental health challenges, and increased exposure to missed communication encounters due to
not understanding military culture (Currie, Day, & Kelloway, 2011).
In some ways, modern war can be considered a condition of captivity, as military service
members describe their experiences of active duty as being always on and the recognition that
they are not free to quit and return home (Adler, Huffman, Bliese, & Castro, 2005; Hutchinson
& Banks-Williams, 2006; Reeves, Parker, & Konkle-Parker, 2005). Their mission requires a
continued presence of military personnel in Iraq and Afghanistan, which is a 24-hour continuous
danger zone with no front line that separates troops from the enemy (Hoge et al., 2006). Warfare
tactics have shifted and become more ambiguous and intangible. Blurred boundaries between
war and safety make it impossible to separate innocent civilians and enemies (Hoge et al., 2006).
These blurred boundaries shift the conventional way of conceptualizing war from the perspective
of the location of the enemy or targets in a latitudinal and longitudinal perspective, but this shift
doesnt always equate and match with how the provider views war (Ettlinger & Bosco, 2004).
Loss of a clear demarcated front line, terrorist networks, and the expansion of the war challenge
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military perceptions of sense of place and sense of time during military missions, thus increasing
reliance and adherence to strict military protocols within military culture (Currie et al., 2011;
Ettlinger & Bosco, 2004). Military culture and training design protect military members from,
mitigate, and lessen the effects of war by fostering interdependence, teamwork, a greater bond,
and greater trust with fellow military members (King, King, Gudanowski, & Vreven, 1995). By
using a cultural humility framework in recognizing this culture, I am constantly aware of an
ever-evolving and ever-changing lens through which I provide care.
I have learned that military culture, when viewed through its own cultural humility lens, can
assist in the greater understanding of primary factors, many of which are based in military
experience that aids practitioners in having real conversations with military members (Helmer et
al., 2007; Resnik, Gray, & Borgia, 2011). Military philosophy differs from civilian philosophy in
relation to how service members make decisions, whether in combat or not; how they overcome
adversity and challenges; and how they conduct themselves (Cunha & Curran, 2013). What must
not be forgotten when working toward a cultural humility framework in understanding military
populationsone that I continually strive foris the notion that behaviors, attitudes, emotions,
and actions of military personnel all serve within a symbiotic relationship to protect military
units (Hoge & Castro, 2012). We as practitioners and civilian providers must recognize our
responsibility and therapeutic obligation to meet military members where they are within their
military culture.
Unit cohesion, considered necessary for survival during military conflicts, is a cultural element
not frequently embedded in a civilian provider when considering military members challenges
(Hinojosa & Hinojosa, 2011). Traumatic events and circumstances experienced by military units
serve to bind and tie military service members together (Hinojosa & Hinojosa, 2011). These
bonds created among fellow military members and units are defined by military members as
surrogate families; these cultural bonds develop during war or adversity and can increase
transitional stress on a military members reintegration process into civilian life (Chappelle &
Lumley, 2006; Figley, 2005; Hoge, Terhakopian, Castro, Messer, & Engel, 2007; Solomon &
Mikulincer, 2006; Taft, Schumm, Panuzio, & Proctor, 2008). I have come to learn and
understand that at discharge from being an active military member, demobilization serves as a
prelude to a break-up of the military members family, ultimately ending the camaraderie and
intimacy of shared war experiences (Atuel & Castro, 2018; Hinojosa & Hinojosa, 2011).
I continually examine militaristic phenomena through a cultural humility framework, which
includes associating culture within military structure development and involves the exploration
of many domains (such as ethnicity, occupation, gender role, spirituality, and social and peer
negotiations) through the lens of military collective processes of individual and group
categorization and re-categorization of group membership (Oyserman, Coon, & Kemmelmeier,
2002). Military members cultural identity process begins with their military branch, rank, job
title, and duty. Race, ethnicity, or other parameters traditionally used to separate and define
civilian populations are not at the core of a military troop and unit (Oyserman et al., 2002).
Understanding military culture and the therapeutic processes when working within this culture
when military cultural humility has not been taken into consideration can compromise services
and impede the therapeutic relationship (Bowling & Sherman, 2008; Goff et al., 2007). For
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example, when I work with military members, it is important to understand military
organizational structure and hierarchies of power (Hoge & Castro, 2012). Military culture in
comparison to civilian cultures lies within power structures according to rank and job title (Hoge
& Castro, 2012). Military members follow a hierarchy of authority with the military command
recognized as the decision makers. In military culture, the commanding officer of the service
member stays involved in their lives on and off duty (Cunha & Curran, 2013). Medication
choices, treatment choices, and intervention modalities must be cleared and understood through
the members chain of command. Military members are never off duty. They can be called to
action at a moments notice with the expectation of continual mission readiness (Atuel & Castro,
2018). It is imperative that I always recognize the cultural organizational frame in which the
military member functions. Without military cultural awareness, I can unknowingly create areas
of misperception when using common civilian terminology to describe behavioral
characteristics, such as mission readiness, and I could jeopardize the military members ability to
serve if treatment modalities do not follow military protocols (Goff et al., 2007; Hoge et al.,
2006; Knox, Conwell, & Caine, 2004). This misperception in terminology can potentiate critical
outcomes, especially if mission readiness is viewed as less important by the provider (Goff et al.,
2007; Knox et al., 2004; Spelman, Hunt, Seal, & Burgo-Black, 2012).
Mission readiness is a military cultural norm that continuously ties service members to a military
identity, thus usurping other cultural constructs, such as race, religion, or gender (Bowling &
Sherman, 2008). Conformity to the military structure and an organizational cultural group, plus a
military identity embedded within the military organizational culture and a military chain of
command, are the cultural cornerstones for military members (Atuel & Castro, 2018).
My practice of including military culture and the multidimensional aspects of formal and
informal processes must include a cultural humility framework for conceptualization when
working with military members (Fugas, Meli, & Silva, 2011; Hard, Recchia, & Tversky, 2011;
Hoge et al., 2006; Miller, 1999; Tschaepe, 2018). Health care providers consider normative
behavior and the understanding of social norms as one of the critical aspects in the navigation of
the social world (Hard et al., 2011). The construct identified and used in measuring the social
world and acceptable behavior is termed social norms (Fugas et al., 2011). In a civilian world,
popular culture creates the social norm. In military culture, the mental and physical health of a
military member is dependent on group and normative factors of cultural safety (military social
norms) (Hoge et al., 2006; Tschaepe, 2018). These factors are defined within the military context
and, thus, represent a set of descriptive and injunctive values that follow military cultural norms
(Fugas et al., 2011; Hoge et al., 2006). Military protective instincts designed to mitigate danger
flow through a continuum of diminishing and intensifying reactions to perceived threats as the
military member transitions into a civilian culture; they are not cognizant of everyday factors
considered normal in a civilian world but present real threats to a military members perception
(King et al., 1995).
As an example, an active duty military member is gearing up for his fourth deployment. He
comes in to see his mental health care provider or physician before meeting up with his unit and
with his wife. Immediately, the health care provider starts to notice behaviors that are both subtle
and elusive. The health care provider observes the simple everyday process of the military
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member choosing a chair. The military member enters the examination room, immediately
surveys his surroundings, and checks for exits from the room and the position of all the furniture.
The significance of this illustration is paramount; the military member chooses the chair facing
the door closest to the exit (Carlsten & Hunt, 2007). When the health care provider questions the
military member as to why he chose that chair, he responds that it was because he could observe
the door (Carlsten & Hunt, 2007). In military culture and from within a cultural humility
framework, choice of chair is a protective process brought about by survival mechanisms
ingrained while in a military culture (Carlsten & Hunt, 2007; Hutcheson & Adams, 2007).
Conceptualization of chair choice as a protective instinct in the civilian world is irrelevant. In a
military environment, failure to recognize potential threats may endanger ones life and the life
of ones unit (Carlsten & Hunt, 2007; Hoge et al., 2006; Hutcheson & Adams, 2007).
Additionally, utilizing a cultural humility framework and a military cultural understanding
allows the provider and the members spouse to understand the connection of driving a vehicle
in terms of a survival mechanism that is instilled during military training. I have found that in
counseling military members and their partners, bringing them to a mutual understanding of how
each other feels and reacts in situations such as driving a vehicle can bring greater healing within
the relationship. Improvised Explosive Devices (IED) are another example of something that can
trigger culturally ingrained protective instinctsand the perceived and real threat they bring to
troops livesand this must be recognized through a cultural humility framework (Hoge et al.,
2006). My example briefly illuminates the need for recognizing and defining hypervigilance
through the act of driving a vehicle. A military member is driving down the street with his
spouse and family. Suddenly, without warning, he is driving down the center of the road at the
top speed. His spouse, who is sitting beside him, does not understand the moment and what is
happening and perceives the moment from a different perspectivea civilian one. The military
members spouse immediately becomes anxious and shouts and pleads for him to pull over or
slow the vehicle and go back into their lane. Her fear is coming from the perspective of an
accident. The military members fear is coming from the perspective of fear as well, but his fear
is due to hypervigilance and a triggered experienced while driving. When the provider questions
the service member regarding this incident, the service member reports seeing a white plastic
bag float across the road (any item that appears in the visual driving field can become a life or
death moment) (Atuel & Castro, 2018; Hoge et al., 2006; Hoge et al., 2007). The very
mechanism that keeps the military member and his unit safe during a war is the same one that, in
a civilian world, can put the military member and his family in danger.
Empowerment and recognition of power imbalances are more likely to occur when utilizing a
cultural humility framework. The providers perceptions and processing of their own cultural
humility play a vital role in understanding and treating military members. True cultural humility
begins to form only when the practitioner understands the following: military structure and
language, service members commitment to their unit and service to their country, and how
military members embrace honor and service (Tschaepe, 2018). I believe it is vital that we
recognize military populations not only for their specialized services in protecting our country,
but also for the unique and distinct culture that comprises the United States military community.
It is in the recognition and centralization of a cultural humility framework when working with
military cultures that a positive cultural understanding can begin.
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