Pulse
Tailhook's Legacy
Nearly one in four women veterans has experienced military sexual trauma. These and other women veterans can now get counseling and medical care at VA clinics just for them.
Debra Thilgen knew that the fallout from the 1991 Navy Tailhook incident would prompt female veterans to come forward with their own stories of sexual harassment and assault during their service. But she didn’t expect the response she saw five years ago when she started doing outreach on women’s health and military sexual trauma for Veterans Affairs (VA) medical centers in Minnesota and surrounding states—especially from women who had served in World War II.
“I couldn’t believe the number of people who had never told anyone before,” says Thilgen, a registered nurse and the women veteran program manager.
Military sexual trauma (MST) is defined as sexual harassment that is perceived as threatening or physical assault of a sexual nature that occurred while the victim was in the military. And it’s a key issue being addressed at the Women Veterans Comprehensive Health Center in Minneapolis.
Thilgen and Linda Van Egeren, Ph.D., a clinical psychologist at the Minneapolis VA who treats MST and the post-traumatic stress disorder (PTSD) that often goes along with it, credit public exposure of the problem as the reason why women are stepping forward years later. “It’s hard enough to talk about it now, but it was nearly impossible to talk about it then,” Van Egeren says. “So many of these women have lived with their secret—what had happened to them—and have never really revealed it to anyone.”
A Man’s Problem, Too
Following hearings before the Senate Veterans Affairs Committee in 1992, during which poignant stories of sexual harassment and assault of women veterans came to light, Congress mandated the U.S. Department of Veterans Affairs to provide health care services to women veterans who experienced sexual assault and harassment during active duty.
About the same time, Congress provided grants to establish four health care centers for women veterans, one of which is in Minneapolis (there are now eight). “The idea was to have a comprehensive approach to the health of women veterans. It’s a one-stop shopping model,” says Angeliki Georgopoulos, M.D., director of the Minneapolis center. Georgopoulos explains that the women’s clinic is in an area of the VA medical center that’s separate from where men are treated. It offers primary care as well as mental health services—especially for treatment of MST
and PTSD (see “Care for Women Vets,” p.12).
Care for Women Vets
Women have played a role in nearly every U.S. military conflict since the American Revolution, during which some went so far as to disguise themselves as men in order to serve on the battlefield. As the nature of war changed, so have the duties of the women soldiers—and so have the casualties they suffer in the line of duty.
“We used to have a designated frontline, and women were working in health care or a clerical capacity,” says Debra Thilgen, R.N., the Minneapolis Veterans Affairs (VA) Medical Center’s women veteran program manager. “We never used to have women flying combat aircraft, manning missiles, serving on ships, or driving convoys through landmines. Now it’s very common for women to be doing that.”
Consequently, women are suffering the same types of combat-related injuries as men. “There are two types of patients coming back from Iraq,” says VA endocrinologist Angeliki Georgopoulos, M.D. “Those who are seriously disabled or have injuries that need long-term treatment … and those needing outpatient care. Those patients are pretty much healthy but may have PTSD and sexual trauma issues.”
Georgopoulos directs the Women Veterans Comprehensive Health Center at the Minneapolis VA. The center, created in 1993, is one of eight comprehensive centers in the United States offering primary and maternity care, infertility treatment, nutritional counseling, and mental health and other services. Thilgen says the center, which draws on experts from throughout the VA Medical Center, provides primary care for approximately 2,000 women veterans and specialty care for another 1,000 in a region that includes Minnesota, North and South Dakota, western Wisconsin, Iowa, and Nebraska. Care is available to female veterans who have service-related disabilities or fall below a certain income level.
According to the U.S. Department of Veterans Affairs, the number of women veterans in the United States increased by 33.3 percent, from 1.2 million to 1.6 million, between 1990 and 2000. Women currently represent approximately 15 percent of the active-duty military, 23 percent of the reserve force, and 7 percent of the veteran population. By 2010, women will account for approximately 10 percent of the veteran population.—K.K.
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In 1999, the VA began requiring that all veterans be screened for MST when they come to a VA hospital or clinic for care. A national survey of more than 3,600 women who use the VA found that 23 percent reported a history of sexual assault and 55 percent reported sexual harassment while on active duty. According to the VA’s 2002 national MST surveillance data from some 1.7 million patients, about 22 percent of women and 1 percent of men indicated they had experienced MST. (In terms of raw numbers, more than half of all VA patients who report MST are men simply because there are 20 times more men than women in the VA system.)
Thilgen says the military has made progress in the way it addresses MST. In addition to acknowledging that sexual harassment and assault happen and training physicians and other providers to screen for it, the VA offers counseling to any veteran who has experienced MST and wants help. “Back in World War II, women who went on active duty were discharged without any benefits at the end of their service,” Thilgen says. “So even if they wanted to talk with someone about what they experienced, these women couldn’t get care.”
The fact that veterans of the wars in Iraq and Afghanistan may come home having suffered MST while in combat makes their cases that much more complicated. “Not only have they experienced sexual trauma, but they’re in a foreign country and they’re in a combat situation,” Van Egeren says. “So you can imagine the impact of that is far greater than in circumstances where it’s happening here in the States.”
Warning Signs
But will those returning veterans, many of whom are National Guard or Reserve members who will get their health care in their communities, rather than at the VA, get screened for MST? Probably not, says Maureen Murdoch, M.D., M.P.H., clinical investigator with the Center for Chronic Disease Outcomes Research at the Minneapolis VA. Murdoch explains that most physicians in the community don’t even know if their patients have served in the armed forces, much less whether they might suffer from MST. “Very, very few clinicians in the community routinely screen for veteran status. I don’t think that it occurs to them that they have women veterans in their clinic,” she says, adding that about one out of every 100 women seen by primary care physicians in the community will be a veteran. “Physicians need to know that MST is a common thing associated with adverse psychiatric conditions and some adverse medical conditions.”
Murdoch, who became interested in MST around the time of Tailhook, conducted a study of women veterans hospitalized at the Minneapolis VA or who received outpatient care there from 1992 to 1993 and found that those who reported sexual harassment while in the military were more than twice as likely to report a history of anxiety or depression. Other studies have associated MST with an increased risk of heart attack, breast cancer, asthma, suicide attempts, and alcohol and/or other drug abuse.
A VA-developed guide to help physicians understand MST mentions that survivors of MST are more likely to experience chronic low-back pain, headaches, pelvic pain, sexual dysfunction, menstrual abnormalities, reproductive difficulties, diarrhea, indigestion, nausea, difficulty swallowing, chronic fatigue, and heart palpitations. The guide is available at www.va.gov/vhi.
Although physicians in the community aren’t obliged to treat MST, they can refer patients to Van Egeren, who can connect them with free counseling services from the VA. And that’s been beneficial to veterans of both recent and earlier wars. Van Egeren says that once veterans begin to talk about their MST, many things start to make more sense to them. “Like why they make certain decisions or have difficulty going to their granddaughter’s soccer game because they have trouble being in a crowd and didn’t know why,” she says, adding, “To think about having this secret all those years.”—Kim Kiser