While at War, Female Soldiers Fight to Belong

http://www.nytimes.com/2015/05/25/health/while-at-war-female-soldiers-fight-to-belong.html

Version 0 of 1.

The day’s work was in full swing, the men in the platoon needed a break, and one of them began imitating his leader’s style of walking. Head down, elbows flapping, legs flying forward, he soon had the other soldiers laughing and calling out modifications:

Swing your arms out more!

No, really throw your legs out!

Don’t forget to look like you’re about to punch somebody!

The “rhino walk,” they called it, and it was a way to ease the tension of long days in southern Kandahar Province. The platoon leader loved it, too, at first. “I thought the rhino walk was funny, and totally true; they got me,” Lt. Courtney Wilson, who served in Afghanistan in 2010 and 2011, said in a recent interview.

But by the time she was in her bunk, she wondered. “Was it just being funny, or were they getting exasperated with me? That was the hard part,” she said. “I started feeling a little like it was me versus them. I was worried the men didn’t like me. I wasn’t sure if they were making me one of the guys, or completely disrespecting and making fun of me.”

In the months to come, that sense of exclusion would deepen into depression. Halfway through her deployment, she sent an email to a friend at home saying she was determined not to kill herself.

One of the biggest adjustments the United States military attempted during the Iraq and Afghanistan wars was cultural: the integration of women into an intensely male world. Women made up about 15 percent of the force during these two wars, compared with 7 percent in the Persian Gulf war of 1991, and they saw more combat in greater numbers than ever before.

Yet even though women distinguished themselves as leaders and enlisted soldiers, many of them describe struggling with feeling they do not quite belong. For men, the bonds of unconditional love among fellow combatants — that lifeblood of male military culture — are sustaining. But in dozens of interviews with women who served, they often said such deep emotional sustenance eluded them.

“It’s not a fair comparison to say the deployment is more or less stressful based on gender; it’s stressful for everyone,” said Lisbeth Prifogle, a supply officer who was attached to Marine Aircraft Group 16 in Al Asad, Iraq, in 2005. “But there are a whole bunch of little things you have to deal with that men don’t even think about, because it’s their world.”

The psychic distress is measurable. More than 38 percent of women report depressive symptoms after deployment, compared with about 32 percent of men, according to a study published by the Journal of General Internal Medicine. Women are 10 times more likely than men to have reported serious sexual harassment. Suicide has been an enormous issue across the military, particularly for white men. But Army data show that the suicide rate for female soldiers tripled during deployment, to 14 per 100,000 from 4 per 100,000 back home — unlike the rate for men, which rose more modestly.

“Clearly these data beg us to account for why there’s this apparent surge in felt hopelessness and alienation among so many women service members during deployment,” said Dr. Loree K. Sutton, a retired brigadier general, a psychiatrist and the commissioner of the New York City Mayor’s Office of Veterans’ Affairs. “This is a critical endeavor, and it’s got to go beyond individual factors and look at group dynamics.”

Any self-doubts Lieutenant Wilson had about deployment were buried in a stampede of forward motion.

She arrived in Afghanistan on April 1, 2010, landing at Kandahar Airfield — a dusty, chaotic staging area, swarming with convoys and contractors. “It reminds me of those postapocalyptic towns in ‘The Terminator’ and ‘The Matrix,’” she wrote in an email to a friend back home.

Soon she was leading a platoon in the 864th Engineer Battalion on projects outside the wire, in the Kandahar region and beyond. Her team moved heavy equipment; built security towers, barriers and fences; shored up roads and buildings; and leveled terrain for construction crews.

“You try moving 40-foot flatbeds full of equipment through those narrow dirt streets full of mud buildings without ruining anyone’s house,” said Lt. Nicholas LaPonte, who later inherited her job. Running the platoon, he said, “means you’re up 20 hours a day, you’re planning missions, you’re on the move all the time.”

Lieutenant Wilson was hooked. Like many young people, she had enlisted to prove herself to be a player in the world’s biggest live-action drama. “To be able to say, when I’m 40 or 50, ‘I did this, I did something very cool,’” she said. “I guess secretly I always wanted to be a badass.”

Growing up in suburban Boston, the daughter of business consultants, she was forever competing with her older brother. “Fierce, fearless, driven — like a young, blond version of myself,” said her mother, Debbie Depp Wilson. “You give her a goal and she plays to win.”

After graduating from Phillips Exeter Academy, a preparatory school, she attended the women’s college Wellesley and majored in English, with a minor in psychology. There, she joined the Reserve Officers Training Corps.

She graduated first in the R.O.T.C. cadet class from the Paul Revere Battalion. “When she decided to officially enlist, I interrogated her,” said her father, David Wilson. “Are you sure you really want to do this? Why? She said it was the people. She said: ‘They have my values. They stand for something.’”

On missions in Afghanistan, Lieutenant Wilson projected determination. Her soldiers worked to exhaustion, without complaint. “I’m biased, of course, but I don’t think there’s a better platoon out there,” she emailed a friend at home.

She also learned how to handle the rich girl comments: “So what, I’m here just like you.”

But soon the “rhino walk” ribbing started, and her self-doubt, dormant in the initial rush of deployment, stirred.

As social scientists have sought to understand the increased rates of depression and suicide among enlisted women, they have looked at research on other groups at the margins of a culture, whether blacks in the Ivy League, whites attending a nonwhite high school — or women in male professions. And they have found that the mental costs borne by those in the minority are similar.

Members of such groups tend to report as many insults and bad days as members of the dominant culture. But compared with the majority, they feel far less secure.

“Every bad thing that happens, they interpret it as a sign that they don’t belong,” said Gregory M. Walton, an assistant professor of psychology at Stanford University. That uncertainty is likely to become especially predictive of mental trouble during deployment, he added, “when the unit becomes all-encompassing, the social network contracts.”

A research team led by Amy Street of the National Center for PTSD and V.A. Boston Healthcare System, and Ronald Kessler of Harvard University has ransacked Army data for factors that might explain the spike in suicide rates. In the journal Psychological Medicine, the team in March ruled out some of the most plausible explanations: Women did not enter the Army with more psychological problems than men. Reported sexual assaults did not explain the elevated rate. And the proportion of women in a given unit did not seem to matter. The search for answers continues.

Researchers are now asking how much “all those little things” — the differences inherent in being on the margins of a culture — affect a person’s mood, especially under the stress of combat.

One of the little things, in Lieutenant Wilson’s case, nearly led to starvation.

The rhino-walk comments prompted a psychological retreat. She never doubted her ability, and neither did anyone else. “Lieutenant Wilson is a model officer whom I would trust with the most difficult mission,” her company commander wrote in September of 2010.

But she was less certain she inspired affection. “Courtney doesn’t have that laid-back humor a lot of guys have, so she’d get teased and didn’t know how to shrug it off,” said Lieutenant LaPonte, who became a close friend. “She took everything personally.”

Perhaps no more so than when a couple of soldiers cracked that she looked fat.

It was a bad joke, at best; a distance runner, she worked out whenever she could. Still, it got under her skin. “I was living on carrots and water,” she said. “I was down to 122 pounds, so skinny you could see my clavicle. It was crazy, but I felt I had to prove something to them.”

Female veterans said in interviews that the expectations for male soldiers were clear: Do your part, keep your head, cover your buddy’s back — and you’re in.

In contrast, the women said, they got mixed messages. The Army bans most jewelry and makeup yet is institutionally protective toward women, at least out in the field. “You’re treated like a girl, and yet you can’t really be a woman — that’s the feeling,” Lieutenant Wilson said.

Mixed into this odd displacement were ever-present sexual undercurrents. Many women said that at night, on base, they would not go to the bathroom without an escort. Lieutenant Wilson said a noncommissioned officer in her unit continually made sexual jokes that made her so anxious she thought about reporting him. She decided against it, but the threat lingered.

In fact, almost any consorting with a male soldier was enough to feed an appetite for gossip that rivaled high school, veterans said. “What made it unbearable were the moments you felt you couldn’t socialize or bond with the men after a hard day — they were mostly hard days — because of the rumors that would fly,” said Susanne Rossignol, who served in Baiji, Iraq, in 2004 and 2005.

Many women said forming close, collegial ties with fellow soldiers was not easy. “It’s such a tricky thing to navigate; you have to learn to approach guys like a sister, not as a potential romantic partner,” said Anne, a woman who served two tours in Iraq and wanted her full name omitted because she is currently on active duty. “When you do that, they’ll do anything for you. But so many females coming into the Army, they’re so young, they don’t understand how to do that.”

Some female soldiers found companionship with other serving women. “I was lucky,” said Elizabeth Verardo, who flew Apache helicopters and served two tours in Afghanistan. “I had a group of women of my same rank. We were close and hung out all the time.”

Many women had nothing of the kind, either because of a scarcity of women in their unit, or because of the vagaries of service — different schedules, ranks and jobs. “The number of other women in the unit is one way to get at social isolation, but it’s not the crispest measure,” Dr. Street said. “There are factors that it doesn’t account for.”

Lieutenant Wilson had three good friends in Afghanistan — Lieutenant LaPonte; Lt. Elissa Adams, now a captain; and Capt. Michael L. Fortune — but they were stationed at different bases and crossed her path only occasionally. She felt so cut off that she counted the days between those visits.

“Whenever I was on the same location she was, I would stop in and we would talk about what was going on,” Captain Fortune said in an email. Lieutenant Wilson’s main problem, he added, was that “she overthought every encounter she had with others.”

“She would question if people liked her and if they respected her,” he said.

After one especially long stretch, she wrote a friend at home, “I just cannot connect. It’s like there is this 12-inch-thick sheet of glass separating me from the rest of humanity. I see people, and I hear muffled sounds and everything, but none of them can reach me.”

One low point came one night in November of 2010 when mortars rocked her base in Kandahar. Even as she squeezed into a cramped bunker with dozens of other soldiers, she felt no adrenaline rush, no fear, no concern for herself. She had gone dead empty.

“All around me, guys were calling home, calling other soldiers, checking on people to see if they were O.K.,” Lieutenant Wilson said. “I was just standing there, numb, thinking, ‘O.K., maybe now is when I die … hmm, that’s interesting.’

“I didn’t care whether I lived or died.”

Out of the bunker, out of Afghanistan, Lieutenant Wilson began suffering panic attacks, bursts of anxiety that squeezed her throat. “It got to where I couldn’t breathe, like I was close to blacking out,” she said.

Jack Daniel’s and Coke blunted the anxiety, but the relief did not last. She tried biofeedback, prayer, meditation and psychiatric medications. Finally, reluctantly, she began regular talk therapy with a psychologist at the Fort Hood military base in Texas.

“She really struggled to connect with other people, and in part it’s because she was trying to be someone she was not,” Roger Belisle, a clinical psychologist at Fort Hood’s Resilience and Restoration Center, said in a phone interview.

That type of person — high expectations, tough on others, tougher on oneself, averse to asking for help — is a well-worn military role that is hard enough to fill for men. For women, it is an invitation to isolation, psychiatrists said. The best fighters are fierce, but they have a deep well of support from buddies.

“It creates a kind of bond between members, a love that transcends anything you’ve ever known,” David H. Marlowe, the founder of the Army’s behavioral health unit, who died last year, once said. “You come to the absolute belief that the noblest and most important thing you can do is die for the others.”

Like Lieutenant Wilson, many women in the military did not have that kind of love — at least when they were deployed. “It’s like, I got all the downside of serving in the Army and none of the upside, the camaraderie,” Lieutenant Wilson said.

Out of the service, she is now in close contact with her friends, her parents and her brother. Whenever her mood wavers, she phones one of them — “therapy time,” she calls it. In a final session, her therapist, Dr. Belisle, asked: What is your passion, right now?

“Travel,” she answered.

“Then do it.”

In August last year, Lieutenant Wilson finished her contract with the Army. On Oct. 29, after visiting with her brother and parents, she flew to Madrid.

She was determined to visit India and Africa, before returning. Or not.

This time the mission was open-ended, and the goals much harder to measure.