Gay Mental Healthcare Providers and Patients in the Military : Personal Experiences and Clinical Care

This volume tells the history of homosexuality in the United States military beginning in 1986, when the issue first came to the forefront of social consciousness. Each chapter is written through the eyes of gay mental healthcare providers, covering how to steadily adapt and learn to treat veterans struggling with the traumas associated with the stigma of homosexuality in service. Topics include the “Don’t-Ask-Don’t-Tell” (DADT) policy, its repeal in 2011, and addresses the current trends and challenges. Unlike any other professional book, this text includes the personal stories of gay military mental healthcare providers, as well as gay civilian clinicians who have worked with the military population in various segments in history. These accounts offer invaluable support for medical professionals working with this demographic. Chapters cover the various psychological damage service personnel encounter as it uniquely pertains to those struggling with the stigma of LGBTQ rights. Chapters include clinical pearls for particular psychiatric concerns, lessons learned for the future, and hard-earned successes as stigmas and perceptions evolved over time. __Gay Mental Healthcare Providers and Patients in the Military__ is an excellent resource for psychiatrists, psychologists, social workers, policymakers, and all professionals who are interested in LGBTQ rights in the context of veteran psychiatry. Foreword 5 References 7 Contents 8 Contributors 10 Part I: Background and Introduction 12 1: Introduction 13 Purpose 14 Background 15 The Early Years 15 Recent Years 16 Conclusion 17 References 17 2: Risk and Resilience: A Review of the Health Literature of Veterans Who Identify as LGBT 18 Terms, Definitions, and Their Limitations 19 The Decision to Serve 20 Life Under Anti-LGBT Policies 22 Diversity Among Military Service Members 23 Military and Veteran Families 24 Research on the Health and Mental Health of Sexual and Gender Minority Veterans 24 Historical Significance of the Minority Stress Model 25 Person and Environment: Resilience Among Service Members and Veterans 26 Resilience Under DADT 28 Conclusion 29 References 29 3: “I Can Finally Be Me...Why Did It Take So Long?” A History of US Military Policy Regarding Sexual and Gender Minority Service 34 Andrew’s Story 34 Revolutionary War to Operation Desert Storm (1775–1992) 35 “Don’t Ask, Don’t Tell” (1993–2010) 37 DADT Repeal and Open Transgender Service (2010–Present) 38 Department of Defense Instruction 1300.28 40 Conclusion 41 References 42 Part II: Personal Experiences 44 4: The Reservist Perspective: Service Before and During “Don’t Ask, Don’t Tell” 45 The Reserve Forces Prior to Desert Shield 45 Becoming Part of the Reserves 46 Life in the Reserve Forces 47 Romance in the Reserves 48 The Impact of Deployment 48 Service in the Reserves Following Desert Storm 49 The Impact of Increasing Societal Tolerance 50 Decision Process on Continuing in the Service 50 The Last Few Months of Service 52 Don’t Ask, Don’t Tell 53 5: Being Discharged Under Don’t Ask, Don’t Tell 55 Joining the Military 55 Reconciling Joining the Military with Being LGBT 55 Being “Outed” 56 Military Issues About Being Gay 57 Separation 57 Leaving the Air Force 58 In Retrospect, What Would I Have Done Differently? 58 Working for the Military as a Civilian 59 6: A Gay Psychologist’s Account of Serving in the Army Reserves and National Guard During Don’t Ask, Don’t Tell 60 Before Joining the Army 60 Pre-deployment 61 In-Country 62 Welcome Home 63 The Career After 64 Round Two 64 Home Again 65 Conclusion 66 7: Does Anybody Have Anything They Want to Say? 67 Deployment 68 West Point 69 Residency 69 “Coming Out” 70 Finally “Gay” and in the Army 71 Lessons Learned 72 Clinical Work 73 A New Generation: 5 Years Post-DADT 74 Residual Effects 75 Conclusions 75 References 76 8: “Family”: Surviving the Don’t Ask, Don’t Tell Years 77 Making Friends to Make Do 77 Early Years 78 Outing Myself 79 The End of DADT 81 9: Here/Queer/Used to It: An Account of a Post-Don’t Ask, Don’t Tell Mental Health Provider 84 Arriving 84 Private Past Experience 86 On Training 87 The Struggle 90 Onward and Upward 91 Conclusion 93 References 94 Part III: Clinical Lessons Learned 95 10: Ward 52: A Haven for HIV-Positive Military Personnel 96 History of Ward 52 97 Structure of Ward 52 98 Research 99 Benefits of Ward 52 99 Dr. Hicks’ Perspective 99 Case 1 100 Case 2 100 Case 3 101 Course of Care 101 Case 4 101 Informing Partners 101 Case 5 102 Case 6 102 Case 7 102 Policy Issues 102 Case 8 103 Dr. Tulin’s Perspective 104 Conclusion 105 References 106 11: Creating Safe Spaces: Best Practices for Clinicians Working with Sexual and Gender Minority Military Service Members and Veterans 107 Accessing Care 108 Creating Safer Space in Healthcare for Military Personnel and Veterans 108 Policies Addressing Healthcare Needs 109 Guidance for Initial Clinical Interactions and Rapport Building 110 Sexual Health 113 Guidance in Assessing for Strengths, Resilience, and Resistance 114 Clinical Assessments of Sexual and Gender Minority Veterans’ Years Prior to the Military 114 Clinical Assessments of Sexual and Gender Minority Veterans: During Military Service 115 Clinical Assessments of Sexual and Gender Minority Veterans: Post-military Discharge 115 Integrating Military and Veteran Sources of Strength and Resilience in Treatment 116 The Life-Span Approach 117 Fostering Posttraumatic Growth Through Encouraging Social Support 118 Support Groups 118 Veterans Service Organizations 119 Supporting Military Families 119 Fostering Posttraumatic Growth Through Clinical Practice 119 Conclusion 120 References 120 12: Treating LGBT Veterans with Substance Use Disorders: A Gay Psychiatrist’s Experience 126 Post-traumatic Stress Disorder as Comorbid 127 Other Comorbid Conditions 127 Case Studies 128 Case 1: VJ 128 Importance of Therapeutic Alliance 129 Attention to Internalized Homophobia 129 Case 2: BR 129 Empathy 130 Therapist’s Self-Disclosure 130 Case 3: SL 131 Anxiety and Gifts 132 Treatment for SUD 133 Challenges for LGBT Therapists 133 Women Veterans 134 Transgendered Veterans 134 Conclusion 134 References 135 Further Reading 139 13: “At Least ‘Shipmate’ Is a Gender-Neutral Insult”: A Military Psychiatrist’s Introduction to Transgender Military Service 140 Andrew’s Story 140 A Military Psychiatrists’ Introduction to Transgender Military Service 143 Starting from Scratch: Knowledge Gaps in Transgender Physical and Mental Health 143 The Military and Military Culture as Total Institutions 145 Self-Determination Theory 146 Minority Stress Model in the Military Context 148 External Minority Stresses 148 Internal Minority Stresses 148 Putting It All Together 149 References 150 14: Ethical Issues Regarding LGBT and Intersex Service Members 153 Lesbian, Gay, and Bisexual Service Members 154 Historical Precedents 154 Ethical Questions for Lesbian, Gay, and Bisexual Service Members Now 155 Lesbian, Gay, and Bisexual Couples Wanting Children 156 Prescribing PrEP 156 Transgender Service Members 157 Eliciting and Maintaining Transpersons’ Trust 157 Medical Needs About Which Providers Should Know 159 Ethical Questions that Arise When Psychiatrists Have Two Roles: Treating and Preapproving Hormones and Surgery 159 Providers Acting as Transgender Persons’ Advocates 160 Intersex Children and Adults 161 Complete Androgen Insensitivity Syndrome (CAIS) 161 Children 162 Adults 162 Whether and When to Perform Genital Surgery 162 Conclusion 163 References 163 Index 165 Front Matter ....Pages i-xii Front Matter ....Pages 1-1 Introduction (Elspeth Cameron Ritchie)....Pages 3-7 Risk and Resilience: A Review of the Health Literature of Veterans Who Identify as LGBT (Heliana Ramirez, Katharine Bloeser)....Pages 9-24 “I Can Finally Be Me...Why Did It Take So Long?” A History of US Military Policy Regarding Sexual and Gender Minority Service ( Anonymous)....Pages 25-34 Front Matter ....Pages 35-35 The Reservist Perspective: Service Before and During “Don’t Ask, Don’t Tell” (James R. Batterson)....Pages 37-46 Being Discharged Under Don’t Ask, Don’t Tell (Martin Chin)....Pages 47-51 A Gay Psychologist’s Account of Serving in the Army Reserves and National Guard During Don’t Ask, Don’t Tell (Clifford Trott)....Pages 53-59 Does Anybody Have Anything They Want to Say? (Joseph E. Wise)....Pages 61-70 “Family”: Surviving the Don’t Ask, Don’t Tell Years (Monica Ormeno)....Pages 71-77 Here/Queer/Used to It: An Account of a Post-Don’t Ask, Don’t Tell Mental Health Provider (Jackson Taylor)....Pages 79-89 Front Matter ....Pages 91-91 Ward 52: A Haven for HIV-Positive Military Personnel (Daniel W. Hicks, Steven J. Tulin)....Pages 93-103 Creating Safe Spaces: Best Practices for Clinicians Working with Sexual and Gender Minority Military Service Members and Veterans (Heliana Ramirez, Katharine Bloeser)....Pages 105-123 Treating LGBT Veterans with Substance Use Disorders: A Gay Psychiatrist’s Experience (Bruce S. Hill)....Pages 125-138 “At Least ‘Shipmate’ Is a Gender-Neutral Insult”: A Military Psychiatrist’s Introduction to Transgender Military Service ( Anonymous)....Pages 139-151 Ethical Issues Regarding LGBT and Intersex Service Members (Edmund G. Howe III)....Pages 153-164 Back Matter ....Pages 165-169 "This volume tells the history of homosexuality in the United States military beginning in 1986, when the issue first came to the forefront of social consciousness. Each chapter is written through the eyes of gay mental healthcare providers, covering how to steadily adapt and learn to treat veterans struggling with the traumas associated with the stigma of homosexuality in service. Topics include the "Don't-Ask-Don't-Tell" (DADT) policy, its repeal in 2011, and addresses the current trends and challenges. Unlike any other professional book, this text includes the personal stories of gay military mental healthcare providers, as well as gay civilian clinicians who have worked with the military population in various segments in history. These accounts offer invaluable support for medical professionals working with this demographic. Chapters cover the various psychological damage service personnel encounter as it uniquely pertains to those struggling with the stigma of LGBTQ rights. Chapters include clinical pearls for particular psychiatric concerns, lessons learned for the future, and hard-earned successes as stigmas and perceptions evolved over time. Gay Mental Healthcare Providers and Patients in the Military is an excellent resource for psychiatrists, psychologists, social workers, policymakers, and all professionals who are interested in LGBTQ rights in the context of veteran psychiatry." -- Prové de l'editor Annotation This volume tells the history of homosexuality in the United States military beginning in 1986, when the issue first came to the forefront of social consciousness. Each chapter is written through the eyes of gay mental healthcare providers, covering how to steadily adapt and learn to treat veterans struggling with the traumas associated with the stigma of homosexuality in service. Topics include the "Don't-Ask-Don't-Tell" (DADT) policy, its repeal in 2011, and addresses the current trends and challenges. Unlike any other professional book, this text includes the personal stories of gay military mental healthcare providers, as well as gay civilian clinicians who have worked with the military population in various segments in history. These accounts offer invaluable support for medical professionals working with this demographic. Chapters cover the various psychological damage service personnel encounter as it uniquely pertains to those struggling with the stigma of LGBTQ rights. Chapters include clinical pearls for particular psychiatric concerns, lessons learned for the future, and hard-earned successes as stigmas and perceptions evolved over time. Gay Mental Healthcare Providers and Patients in the Military is an excellent resource for psychiatrists, psychologists, social workers, policymakers, and all professionals who are interested in LGBTQ rights in the context of veteran psychiatry