stigma and barriers to care - Uniformed Services University of the ...

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Stigma and Barriers to Care — Caring for Those Exposed to War, Disaster and Terrorism
on warriors and their families. One deals with suicide. One deals with a warrior
who is left behind by his unit and how that affects not just him but also his fellow
service members. We have been taking this around the country and we are hoping
to take it around the world. We have amazing actors who perform the readings of
the plays. They are not staged. There is nothing fancy about it. It is just the words
and the performance. It is like the approach of using drama as a method of getting
communities to talk and to be able to talk openly about these issues.
Following the play there is typically a panel of individuals up on the stage to
get the conversation going. Then we open it up so that the audience, and these are
usually service members, family members, sometimes doctors, chaplains, and other
professionals, can share how this relates to their experience. It is an innovative and
powerful technique. You can learn more about it at Theaterofwar.com or Google
Philoctetes project.
DR. ENGEL: One fundamental view I have that makes Theater of War important
is that, although there is a large proportion of people in the military who are not
seeking care, many of those people do believe that they have a problem. It leads
me to think that we must not be offering the right thing for them to engage. What
we currently have to offer is either a pill that affects your brain in some fashion or
talking to a stranger about intimate things. That does not appeal to a large portion
of people. I like Charles Hoge’s view that you wonder who is crazy sometimes.
Perhaps we should reformulate the way we are thinking and try to offer things
that work that are outside the box. Sometimes we do not know if these things will
work. Certainly Theater of War is among those. But, anecdotally, as we go around
the United States with Theater of War we see communities engaged, we see people
respond. It creates a teachable moment where you can provide literature about
where they can go for care. Often it is not the people who have issues that are the
ones most affected by this. It is the ones who have a loved one at home or in their
neighborhood who they know needs some assistance. They are able to learn ways
that they can help them. I also think that these are ways that we can reach a larger
proportion of people who have needs. When we do not know what the therapeutic
effects of these things are, I think we are obligated to study them further. We have
to expand our notion of what is therapeutic.
DR. HOLLOWAY: Charles Hoge commented on the blame culture. I want to
raise the issue that such cognitive activity, along with its overall accompanying
emotional consequences, is frequently supported by society as a delusion that we
really do have control in these circumstances. One of the large delusions is that when
you enter into these deadly quarrels, in which people are actively killing each other
in a chaotic and violent environment, certain things can be done and that they will
come out in a fixed way. We have seen people plan wars with those assumptions
with some disastrous results. The consequence for the individual is to carry the
blame and guilt in the psychotherapeutic range. My point is that social structure and
cultural assumptions sometimes operate to produce what is in fact undistinguishable
from delusional thinking. Nonetheless, it is very hard to get people to give that up
because it allows them to avoid the thing that people said made them so anxious:
uncertainty about the future.
DR. URSANO: This addresses some of the comments Bruce Link and Bernice
Pescosolido were making about what motivates stigmatizing and, in this case, what
motivates is for the larger society to have a sense of control over a series of events.