Female Veterans’ Experiences of Reintegrating After Military Service

This blog summarises a research review that was part of my doctorate thesis, about female veterans’ experiences of reintegration into civilian life after military service.

Not all female veterans will have had the experiences described here and not all of the experiences described are exclusive to female veterans - many of the male veterans I have worked with would relate to a lot of what is about to be described. However, women within the military and female veterans within society are a minority, from which there have been reports of feeling excluded from services set up to help male veterans. In 2012 the US Department of Veteran Affairs stated a need for a ‘gender-specific and gender-sensitive service in a system that has otherwise historically focused on treating men’.

Reviewing all of the available research on a topic allows us to see where we are at – what we currently know and where we need to go from here.

Research reviewed

After searching long and hard, I found 11 studies that asked female veterans about their experiences of reintegration after leaving the military. In total the studies included 255 female veteran participants, aged between 18 and 91. Ten studies were from the US, one from Ethiopia. I have not excluded studies from other countries – it is just that unfortunately there weren’t any.

Studies included veterans deployed in various conflicts ranging from World War 2 to Operation Enduring Freedom in Afghanistan. Studies included female veterans from all branches of the military within a range of roles.

What the studies said

In quote marks are the exact words a female veteran said to the researcher, with a number to show which study the quote came from. There is a reference list at the end. The information from the studies is arranged into six themes – which describe different aspects of the process of reintegration that the veterans described.

A Woman in a Man’s World

Almost all of the studies talked about female veterans’ experiences whilst in the military and on deployment before they went on to describe how it was when they left the military. This was because it was so relevant to understand what they had been through during their service and how some of the challenges they later faced would be related to this.

Whilst on deployment, regardless of role, female veterans experienced the ‘violence of war’ (1) similar to their male colleagues. This included high danger and high exposure to death and traumatic events throughout. Here are a couple of things veterans said that showed the level of intensity they experienced - ‘my first casualty I saw was a suicide’ (2), ‘I had the unfortunate experience of having to kill a child, an Iraqi child’ (8).

On top of the violence of war, some female veterans faced gender-specific issues which were described as feeling like they were ‘a woman in a man’s world’, ‘an outsider’ and under pressure to prove their worth (2). One veteran said they were ‘battling with my own peers…they didn’t want me to succeed’ (3). Trying to fit in was explained by one veteran as having to gain a fine balance between proving your own worth but also not standing out, as both could make you a target for bullying if you got the balance wrong. Some said they coped by developing a masculine ‘vibe’ to fit in, ‘I kind of went out of my way to be as guy-like as I could’ (3), and felt they became woman soldiers equal to men.

Some female veterans described derogatory treatment and military sexual trauma (MST) as additional challenges they contended with. Experiences they talked about ranged from ‘bullying type behaviour’ such as insinuating that they must have been promoted due to intimate relations with male superiors, to serious sexual abuse at the more extreme end. Where these incidents were formally reported, the aftermath of this could become more stressful and harder to cope with than the incident itself. This was due to being treated with scepticism and a lack of dignity, and the lasting impact it could have on their career within the military. In the Ethiopian study MST was not mentioned but derogatory treatment within the structure of the military was commonly reported, for example being told to report off duty when menstruating.

Social support from family, friends and fellow female military personnel was described as essential to help the veterans cope with these challenges. Some described forming strong relationships with other females in the military quickly, ‘you skip all of the beginning parts in the friendship and go right to being best friends’ (7). Participants also drew strength from developing themselves in line with military values and expectations, to be a ‘good person’ (1). They gained pride in themselves by building confidence, work ethic, team work and leadership skills, integrity and respect from others. Building a strong identity as an independent, competent person was important not just to fit in, but to cope with adversity.

The Immediate Aftermath

Once the veterans left the military, common features of what they experienced were struggling to come to terms with the stark change in environment and the extreme emotions they had which felt out of their control. Returning home could feel lonely and for some it felt like a traumatic loss, to add to others they had experienced in service.

It was common to have a confusing and complex mix of positive and negative emotions, ranging from joy, happiness, relief and renewed connection, to feeling guarded, fearful, distant, subdued, sad and that life was surreal. One veteran gave an example that it felt bizarre to be relaxing in a swimming pool ‘while the week before you were dodging mortars’ (6). There was a ‘lingering effect of war’ (8) which left some veterans on high alert and unable to relax. A process was used to make them vigilant, and they felt unable to reverse this. Intrusive memories of what they experienced were frequent, and often this was the first time they fully experienced personal losses they were unable to process whilst on active duty. Sleep difficulties and nightmares were frequently reported, and referred to as ‘a given’ by one (8).

Emotions were described as problematic, moving between two extremes - feeling emotionally numb vs being totally overwhelmed. Blocking emotions was a common coping strategy the veterans had learned, which had enabled them to do their job. However they were concerned about the longer term consequences of this on their relationships, ‘It made me kind of insensitive to people. I don’t show a lot of empathy. I am not very emotional anymore’ (2).

On the opposite end of the emotional spectrum and equally as destructive to relationships, veterans described uncontrolled and unpredictable outbursts of anger, anxiety, sadness and shame, ‘I get angry, like out of nowhere…from normal to ten like that [snaps fingers]’ (3). One participant described feeling like a ‘time bomb’ of barely contained emotions on the verge of explosion (3). These emotions could be so extreme that some discussed having suicidal thoughts, suicide attempts and self-harm.

Some veterans explained that in the military, showing emotion would stigmatise them as having a weak character, and the lasting effect of this was that they resisted seeking help with their emotions following service. This made the transition particularly troublesome for those with mental health difficulties and combat trauma or MST. Difficulties managing emotions led some to use avoidant coping mechanisms that they recognised were not helpful, such as excessive use of alcohol and prescription medication.

An Outsider Again in Your Own Home

Veterans talked about getting back to their home lives, including partners, children, family and friends. A central aspect of this was trying to navigate feeling disconnected from a family that had evolved in their absence, and coming home different in their emotions and habits compared to their families and their previous selves.

The significance of missing out on important events and developments whilst away was highlighted, ‘when I returned I didn’t know my kids anymore…I was gone for a year and a half and so much changed in that time’ (8). They felt unprepared for dealing with the practicalities of this, ‘everyone else gets to learn to be mom one day at a time. We come back and all of a sudden our child is on a different developmental level and we're trying to figure out how they got there, let alone what we're supposed to do next’ (5).

Intimate relationships with partners and children were affected by having been ‘toughened up by the military’ (4), ‘you have to put up this barrier. If you don’t protect yourself…you would go crazy with [being] lonely, missing somebody’ (4). It was hard to switch this off on return to home life. It was also common to feel uncomfortable with physical touch after seeing injury and death, or experiencing personal trauma such as MST. Some managed to reconnect and ease back into it over time, but for others difficulties got harder to manage.

Positive support from loved ones could help the veterans adjust. Although, some felt that sharing their troubling experiences from the military risked overburdening loved ones who had little familiarity with the military context, ‘treating people that have been blown up and all that is not that relatable of an experience to most people you meet’ (8), and some feared judgement and rejection, ‘If I tell them the truth, then I’m going to lose this person's support too’ (5).

Veterans described coping with reintegration into home life in two main ways, by making active efforts or by withdrawing socially. Each individual’s journey could understandably involve periods of both. Some adjusted by creating structure and routine in their lives, keeping occupied with practical tasks and finding work early on, ‘You sit around and you get depressed. And so, I went back to work [full time] less than 30 days after I got home’ (9). For others, difficulties were harder to overcome, leading to withdrawal. They realised that withdrawal was unhelpful, but they struggled to find the words to communicate how they felt and ask for what they needed.

‘Civvies’ and ‘Civvy’ Systems

The veterans were also required to reintegrate with civilians on a wider level and civilian systems they had to navigate on their return to civilian life. Veterans described a divide between themselves and civilians that isolated them. Even more so than in their close relationships, they felt civilians would not understand their experiences, so found it hard to trust professionals and their wider social circle with details of their experiences and emotions. It was hard for some to reconnect with previous civilian friends, due to growing apart in their life experiences and interests.

A significant irritant for many veterans was that civilians’ worries and what mattered to them seemed trivial in comparison with what they had endured and experienced. Some veterans found civilian life easier in ways, because they were not encountering the dangers of living in a war zone. But for many, civilian systems were seen as unnecessarily complex and frustrating to navigate. One veteran gave an example about going to the supermarket, ‘as a civilian, for me to shop for my family coming directly off deployment and then try to make Christmas dinner? It was a nightmare. I completely shut down…I walked outside and started crying because there were too many people, too many choices’ (4).

Some veterans found it easy to integrate into the civilian workforce, which they were surprised by. Others felt at a disadvantage due to having few transferrable skills, and physical and mental health difficulties from their service that limited their employment choices. In one study the lack of discipline and commitment in civilian colleagues compared to military was noted.

Managing finances was a major stressor, including applying for benefits, ‘that whole process, the drive up there, the evaluation, it was way worse than any of the combat situations…I dreaded having to be re-evaluated’ (7). Veterans also struggled to access the right medical care and said they were unaware of available resources, so felt that a more comprehensive and better funded reintegration programme was needed. Some veterans highlighted that community resources and organisations set up to help veterans were focused towards men, meaning they felt excluded. This was especially the case where they experienced MST from male military colleagues, as they didn’t feel safe or comfortable using a service that may include those who abused them. Feeling excluded just made veterans want to withdraw even more, with some hiding their military service and coping alone, ‘I just went into seclusion…I will deal with this on my own and it was hard. I would say that is like I hit rock bottom’ (1).

Identity: Forever Changed and Between Two Worlds

This theme is about how the veterans felt about their changing identity and purpose. Reintegration into civilian life required them to settle into a new identity as veteran-civilian, and this involved challenges they had to work through.

Some veterans felt that they were caught between two worlds, feeling forever changed and grieving the loss of their previous self. It was difficult finding a place for themselves. Some didn’t relate to the term veteran, seeing it as applying to men. Veterans in the Ethiopian study had additional cultural identity struggles, due to women being able to build respect whilst in a military role but expected to resume traditional gender roles with no political authority on their return. They struggled to accept this, ‘I wish the respect men had for women would have continued after the war…but men revealed their real personalities and attitudes about women when we returned to the city’ (10). They were expected to turn off the anger and aggression they had made good use of in their military role and act like women in a traditional sense to avoid judgement, which was difficult to adjust to.

Many veterans went from having a clearly established role and identity to experiencing at least a temporary loss in both areas. This naturally impacted on self-worth and was experienced as depressing, ‘I went from being special in my field…to being frighteningly devoid of identity’ (3), ‘you go from, "I was making a difference when I was doing this in Baghdad" to "would you like some ice to refresh that drink sir?"’ (4). It is therefore unsurprising that many veterans found themselves holding onto their previous identity, longing for the past and wanting to go back, ‘just send me back that’s how I felt, angry and frustrated’ (7). For those who had a strong military identity this stage of identity renegotiation could be particularly difficult. Some mourned the loss of their previous self and what it meant for them, ‘I mourn the loss of the days that I didn’t have to worry’ (3).

Some participants reported feeling fearful that they had been changed forever, and that they were destined to permanently experience strong uncontrollable emotions, difficulties connecting with others, and lost identity and meaning. In time though, many veterans were able to see that the strong emotions and extreme experiences they had, such as seeing tragedy and death, had changed them in both positive and negative ways.

Reflection, Reintegration & Post-Traumatic Growth

This final theme describes how over time and with reflection, the veterans in the studies gained a sense of reintegration. To achieve this they emphasised that their experiences needed to be reflected upon, processed and explained to others.

On a personal level, reflecting on the meaning of military service was important for bringing balance to the painful and more challenging experiences. Veterans reflected on their growth as people - their priorities, values, resilience, work ethic, transferrable military skills, strengths and appreciation of life, ‘to see the world is to know that life gets so much bigger than this little town we live in’ (5). This helped participants feel it ‘was worth it’ despite the consequences (5).

For some, their reflections led them to explore spirituality and religion, which was then used as a coping resource, ‘If I had not had some relationship with a higher power, knowing that somebody else is in charge of my life, I probably would be a statistic’ (9). For some, reflection helped them to find ease in accepting and feeling proud of an identity that included many components, and an ability to move between different aspects of the self, ‘I feel proud of what I did. I feel like being in the military has helped me to be a successful civilian, and I am a veteran’ (1).

Although some of the veterans in one study didn’t want to dwell on their past, generally veterans wanted to tell their story and feel accepted, ‘we go around hoping we find the person that can accept the story for what it is, or for what parts we're willing to tell’ (3). One veteran found that taking part in the research fulfilled this, ‘Talking like this felt great; I feel like I've taken a shower. I feel clean.’ (3). Others used therapy services to make sense of their emotions, ‘I couldn’t really tell you what I was angry about…luckily after time and with counselling that resolved’ (9).

Sometimes it was helpful for family members to prompt input with services, due to reluctance to ask for help, ‘She [sister] noticed what she thought was problems with PTSD. She asked me to seek some help’ (9). Some found that within healthcare it helped to see female professionals with knowledge of military issues, ‘there has to be a separation and definitely female doctors, who are highly educated on complexities of PTSD and assault and different types of stuff’ (7).

The most common and favoured way veterans reported sharing stories was to connect with other female veterans. Support from female veterans was highly valued as participants could be more open, and gained validation and normalisation of their experience by learning that others felt the same, ‘we could talk about common problems and realise we were not alone’ (6). Getting involved in these communities allowed them to gain belonging and social support, but it also allowed them to give it, which gave them a strong sense of purpose and belonging. This sense of supportive comradery could not be matched in any other context, ‘no-one else talks the language’ (11).

Much of what veterans said helped them to reintegrate links closely with the concept of Post-Traumatic Growth (PTG). This is the personal growth that happens because of the hard times we go through, rather than despite them. Getting knocked down by life’s events, struggling, withdrawing, feeling alone and unsure we will ever heal – are all part of the process of PTG in my experience (personal and in my work). In time, and when you are able to process what happened and create a bit of distance, you reflect on what going through hard times has given to you as well as what it has taken. Finding a group of people who understand what you have been through gives validation and support which supports healing. Ultimately, you start to see and appreciate the good in life, in yourself and in others, which helps give a sense of balance that we often can’t access in the earlier stages of trauma processing, where extreme emotions and reliving trauma takes all of our focus.

What’s next?

We will each have our views on what we should do with this information, and many of you will be better informed than I am about what is currently happening within the military, organisations which support female veterans and what is included in reintegration packages. However, following my research review it made sense to me to recommend the following:

Making sure resources we already have are known about and accessible

Dealing with the challenges described was easier where veterans had access to good quality social support, were able to get a job that made use of their skills and had active coping strategies that played on their strengths. There are various resources available to veterans to support access to employment, give support following MST or specific to female veterans and mental health services which are female veteran aware. Ensuring veterans who may be struggling actually know about resources available to them is important and could be part of reintegration information provided. Perhaps further research is needed into the extent female veterans know about and are accessing relevant support, and if there are barriers – what are they and how could they be worked around?

Training and information sharing

One factor that would likely help make services more accessible is wider awareness of the experiences and needs of female veterans within civilian health services and systems. It would be useful if previous military service was identified by GP’s as part of the registration process on discharge. This could facilitate conversations about mental health, trauma, and access to social support, which could help identify issues early on. Within services female veterans may access, providing training and information on female veterans’ experiences and needs could improve access to what is likely to help. For example veterans expressed a preference to see a female practitioner with understanding of female veterans’ experiences.

Tackling MST

Military sexual trauma (MST) has been recognised as a problem within the military in many countries, and one which needs to be better handled so that investigation doesn’t further traumatise people or fail to reach justice. In the UK, strategies to better tackle MST have included anonymous reporting methods, investigations of MST being separate from the person’s chain of command and support systems for personnel who are in a minority group while they are deployed.

It would be good to see data on anonymous reporting and outcomes of investigations which are kept separate from the chain of command – which can be compared to data and outcomes prior to the changes. It would also be useful to hear thoughts from those who have used the reporting process and who have been supported as part of a minority group whilst deployed. All of this could help us to know if the situation is improving.

Female veteran support & post-traumatic growth

The review of research highlights that many female veterans may have no-one they feel they can talk to who gets what they have been through, except for other female veterans. This indicates that peer support groups with other female veterans would be a useful source of support and validation, as well as providing a space where they can tell their story and process what they have been through. Whether groups be formal or informal, promoting aspects of post-traumatic growth would likely be helpful, such as encouraging reflection on what they have gained through military service, coping with hardship and trauma.

Any addition of female veteran groups to health services or veteran organisations is of limited value unless it is widely known about. Promoting through channels such as GP services, within reintegration packages and social media pages for veterans may be a good start. If forming a coherent and balanced narrative is associated with coping, reintegration and personal growth - providing space and resources to do this early on may help avoid some of the spiralling down into withdrawal and hitting rock bottom that some veterans described. This kind of early intervention would need to be trialled and reviewed to determine the impact it could have – currently we can only guess.

More research

Review findings highlight that reintegration can be a complex process with many aspects, where experiences during military service have an ongoing impact on female veterans’ lives. It was great to have had 11 studies to review, however more studies from different countries would likely be useful to strengthen the evidence-base and argument for forming services and developing interventions to help female veterans with reintegration difficulties.

Credit to my cat Lol for ‘helping’ me arrange the data

References

1.     Burkhart, L., & Hogan, N. (2015). Being a female veteran: A grounded theory of coping with transitions. Social Work in Mental Health, 13(2), 108-127. DOI: 10.1080/15332985.2013.870102

2.     Conard, P., & Scott‐Tilley, D. (2015). The lived experience of female veterans deployed to the gulf war II. Nursing Forum, 50(4), 228-240. DOI: 10.1111/nuf.12097

3.     Demers, A. (2013). From death to life: Female veterans, identity negotiation, and reintegration into society. Journal of Humanistic Psychology, 53(4), 489-515. DOI: 10.1177/0022167812472395

4.     Kelly, P., Berkel, L., & Nilsson, J. (2014). Post deployment reintegration experiences of female soldiers from National Guard and reserve units in the United States. Nursing Research, 63(5), 346-356. DOI: 10.1097/NNR.0000000000000051

5.     Leslie, L., & Koblinsky, S. (2017). Returning to civilian life: Family reintegration challenges and resilience of women veterans of the Iraq and Afghanistan wars. Journal of Family Social Work, 20(2), 106-123. DOI: 10.1080/10522158.2017.1279577

6.     Maiocco, G., & Smith, M. (2016). The experience of women veterans coming back from war. Archives of Psychiatric Nursing, 30(3), 393-399. DOI: 10.1016/j.apnu.2016.01.008

7.     Mankowski, M., Haskell, S., Brandt, C., & Mattocks, K. (2015). Social support throughout the deployment cycle for women veterans returning from Iraq and Afghanistan. Social Work in Health Care, 54(4), 287-306. DOI: 10.1080/00981389.2014.990130

8.     Mattocks, K., Haskell, S., Krebs, E., Justice, A., Yano, E., & Brandt, C. (2012). Women at war: Understanding how women veterans cope with combat and military sexual trauma. Social Science & Medicine, 74(4), 537-545. DOI: 10.1016/j.socscimed.2011.10.039

9.     Maung, J., Nilsson, J., Berkel, L., & Kelly, P. (2017). Women in the National Guard: Coping and barriers to care. Journal of Counseling & Development, 95(1), 67-76. DOI: 10.1002/jcad.12118

10.   Negewo–Oda, B., & White, A. (2011). Identity transformation and reintegration among Ethiopian women war veterans: A feminist analysis. Journal of Feminist Family Therapy, 23(3-4), 163-187. DOI: 10.1080/08952833.2011.604536

11.   Suter, E., Lamb, E., Marko, M., & Tye-Williams, S. (2006). Female veterans' identity construction, maintenance, and reproduction. Women and Language, 29(1), 10.