Editor’s Note: As part of the Center for Deployment Psychology’s ongoing mission to provide high-quality education on military- and deployment-related psychology, we are proud to present our latest “Guest Perspective.” Intermittently, we will be presenting blogs by esteemed guests and subject matter experts from outside the CDP. This allows us to offer more insight and opinions on a variety of topics of interest to behavioral health providers.
As these blog entries are written by outside authors, one important disclaimer: all of the opinions and ideas expressed in them are strictly those of the author alone and should not be taken as those of the CDP, Uniformed University of the Health Sciences (USUHS), or the Department of Defense (DoD).
That being said, we’re very happy to offer a platform where we can feature these individuals and the information they have to share. We’d like to make this an ongoing dialogue. If you have questions, remarks, or would like more information on a topic, please feel free to leave comments below or on our Facebook page, and we’ll pass them along to the author.
By Deloria Wilson, Ph.D.
Like many, my understanding of culture grew through my experiences over time. I grew up as a Hispanic woman in a predominantly Hispanic part of Texas. When I went away to a school in the North, I quickly learned I was different than many there. Nearly every interaction was a cross-cultural one. It made me stronger, took me out of my comfort zone, and taught me that adaptation was necessary, not just for survival, but to be successful. It also gave me a whole new respect for a wider and more diverse world.
Fast forward a few years, I was preparing to finish my graduate degree. My grandfather, great-uncles, and uncles all served in the military, although it was not talked about very much. Serving was a part of who my family was, not just something we did. I was near the end of my graduate program when I learned about the military’s psychology internship programs and decided to apply for one with the Air Force. My grandfather was proud of me when I earned my graduate degree, but what he talked about the most was how I was an officer in the United States Air Force once I entered the military as an Air Force resident (intern) in July 1999. No one in our family had earned a degree, but no other member of our family had been an officer, and that seemed to matter the most to him.
Initiation into military life began as soon as I got off the bus for commissioned officer training. Despite the shock of moving from the academic to military world, I immediately felt like I had joined something bigger and was contributing to my family’s legacy. I enjoyed the structure, heritage, and camaraderie I experienced in my tight-knit flight. I felt proud when my grandfather was there in his tuxedo to participate in the ritual dining out and grog bowl when I graduated officer training I belonged to the Air Force culture and we are all one…or so I thought.
I soon realized I didn’t know much about the non-medical Air Force. Most of what I learned came from the interaction with my patients. Later during that internship year, I was on a rotation on the training side of our base. I quickly learned that my initiation into the military was quite a bit different than the majority of our Airmen. They had a lot more rules and significantly less freedom. Those poor Air Force trainees were afraid of me because of my rank of captain, but the best kept secret was that I only had a few more weeks of experience than they did! My lesson learned was that the medical side of the house was a lot different than the “real” Air Force, as I was often told.
The next important event in my journey was taking a rotation at a small base. I was able to work within my area of interest, aviation psychology. I had chosen my mentor specifically because of this. He was also an ethnic minority and he taught me how to carry myself in the Air Force world outside the “ivory tower” of the medical world. I spent my time observing not just what pilots did, but how they spoke to each other and what they valued. I was soon able to make recommendations that were honest, but also within the context of their role in the larger Air Force and in the job that they had worked hard to obtain. Every interaction either with a patient, the commander, or experiencing hypoxia in the altitude chamber helped me understand and serve the community. It gave me credibility and their trust. The lesson I learned was how important it was to experience as much as possible about their daily life.
I eventually left the Air Force, but never left working with the military. My first job out of the military was with the Center for Deployment Psychology (CDP) when it was being formed. Understanding military culture in the broadest sense was an important theme in everything we taught and something I had taken for granted. After the CDP, I worked briefly for the Army to develop resilience training. Those of you who have worked in more than one service, understand each one has its own culture, whether you are medical or not. Because of the nature of my work with the Army, I also worked with civilian law enforcement on occasion. Working within the Army culture and subsequent exposure to the law enforcement community was another important layer in my cultural education and preparation for what I am doing now.
My current role is to assist Air Force Security Forces to develop their own internally driven performance optimization/resilience program. I facilitate the development of a cohesive model, integrate it into existing training and venues and serve as a liaison with bridging AF force medical care. My hope is to empower and provide the community with what it needs to develop and support Security Forces members.
I cannot completely capture all my lessons learned in this blog, so I will only offer only two more observations on my cultural journey.
Observation 1: Approach with Humility and Respect, NOT Cookies
This observation addresses our myopic belief that we have all the answers because of our training and expertise. I know we don’t mean to do this because we are caring people and want to help. However, how often do we involve direct and sustained input from the communities we are trying to help? More often than not, we expect them to adapt to our medical delivery system and language. I believe this contributes to the continuing stigma for seeking mental health assistance and programs being off target or underutilized.
It’s easy to think we are humble, but the truth emerges when we interact with others. Are we willing to get down and dirty and just be who we are? Or do we feel the need to prove that what we offer is priceless? It’s a fine balance between humility and confidence. Not enough confidence, then your worth is doubted. Too much confidence, without humility, and you come off as arrogant. Many military subcultures are very team-oriented and you have to prove yourself as willing to listen and learn from their perspective before they let you in as a guest team member. I learned that if you are humble “learner,” then they will give you the benefit of the doubt and some time to “get it.” However, if you come across as arrogant, you will be dealt with politely, but quickly marginalized. Funny thing is, you may not even know when it is happening.
Everyone has their own indicators for humility. I believe it comes from a sense of passion to empower others, and an understanding that learning is a lifetime endeavor. Being humble comes in many forms. For me and my work for the Air Force Security Forces, I was willing to show my own vulnerabilities by getting out in the field and letting them teach me their craft at any hour, day or night (e.g. weapons firing, trekking through the mud). I wasn’t as bad as I (or they?) expected, but these experiences still provided some good laughs at my expense. In turn, they taught me who they were and what was important to them. I view the Security Forces members on my team as equal partners and because we are learning from each other, we can contribute together, and that gives them ownership.
I have seen too many providers who thought that just because they work in a certain military community, such special operations that they were a part of that cultural group when nothing could be further from the truth. I worked with a person who thought she was superior because she knew how to be technically correct “from the science side of the house.” They knew the research and disputed minor facts such as whether something was a hormone vs. neurotransmitter. It was important for her to show they were the expert and that minute details were more important than the big picture of what we were trying to achieve. Unfortunately, this person did not understand how to effectively communicate in a culturally appropriate way and therefore never fit in with the group. She struggled both in training and translating resilience and performance science in a way that made sense to them. What use is science if it cannot be translated?
Observation 2: Translate Science in Their Terms
The second observation focuses on the difficult task of translating science to a specific culture (including sub-cultures) of the military. I don’t think we ever get taught how to practically do this, but it is something we must do.
The approach I take it to culturally adapt existing models and research in resilience and human performance. The trick is using terminology and concepts that fit into that specific culture’s existing structures. For example, after learning a sufficient amount of the Security Forces’ language and customs, I put together some human performance concepts tested them out with a small audience, and made adjustments based on feedback. We went through several iterations, but even that was not enough. I needed them to show me the best way to apply and integrate the concepts human performance I was trying to convey. The initial humbling experience of going out to the field, putting on gear and firing a weapon helped me tailor examples to those that were already familiar to members of the Security Forces. For instance, I learned to describe how tactical breathing can be used in the context of active shooter training and the ways that a Security Forces member’s gear impacts his or her ability to use this technique while under stress. This translation process was very challenging; I had discovered I needed the Security Forces members to help me do my job so it benefited them and their unique circumstances.
I have had many requests from other mental health professionals who want our curriculum or our model so they can use it. What they don’t understand is that the process of working together with members from the Security Forces to make sense of how the science applies to them and their unique sub-culture is more important than the content. Cultural integration ensures the sustainability and credibility of the community’s efforts toward their goal.
I know I am not saying anything new, but I have been surprised at how often we continually make the same mistakes with our top-down approach, and unintentionally distance ourselves from the unique cultures we serve. If we really want to reduce stigma and address the needs of our military members, then we need to start listening to them. This requires humility on our end as well as the willingness to work with them to translate our knowledge of psychological principles and relevant research findings into something that fits within their cultural ethos and resonates with their mission.
Learning to build bridges takes time. If you are on that journey keep at it! If you are just starting or struggling, then keep at it! If you haven’t started then I ask what are you waiting for? Change happens through culture, and if we mean to help facilitate change, then we have to become builders.
Deloria Wilson, Ph.D., is a contractor working with Air Force Security Forces personnel. She earned her Bachelor of Arts in psychology from the University of Notre Dame and her doctorate in Educational and Counseling Psychology from the University of Missouri. She served in the United States Air Force for 7 years as a staff psychologist. She was director of a learning and development center, Alcohol Drug Abuse Prevention and Treatment program manager, deputy flight commander, and consultant to flying training squadrons and aerospace medicine in matters of airsickness management and performance improvement. She was a Deployment Behavioral Health Psychologist with the Center for Deployment Psychology (CDP), which trains civilian personnel to work with military members in providing effective treatments. She provided consultation to civilian law enforcement to educate response teams on working with military members and understanding parallels to military culture. Dr. Wilson helped to stand up the education and training division at the Warrior Resiliency Program where she helped develop training for psychologists on issues of resiliency. Her current efforts include helping AF Security Forces develop a culturally centric performance optimization platform to deliberately forge and sustain Security Forces Defenders throughout their careers.