EXPERT ANALYSIS FROM THE INSTITUTE ON PSYCHIATRIC SERVICES

WASHINGTON (FRONTLINE MEDICAL NEWS) – The role of ostracism in overall poor health outcomes in service personnel is a growing concern, according to a panel of military experts.

“Think about the primary mechanism of suicide in kids who are bullied: It’s ostracism,” Kate McGraw, PhD, said in an interview at the American Psychiatric Association’s Institute on Psychiatric Services. Dr. McGraw is the interim director of the Deployment Health Clinical Center, a Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

She cited a study that used imaging to measure how, when a person feels cut out of a group, the dorsal anterior cingulate cortex – the same region of the brain associated with sensing physical pain – is seen to light up in that person’s brain. “If we really feel physical pain when we’re ostracized, does that impact immunology? Does that impact our ability to function? Does it contribute to onset of PTSD and depression, or impact other behaviors?” Dr. McGraw said while speaking on a panel dedicated to the health issues faced by women in combat.

Although the literature is scant at this point because the effects of being left out are “common sense,” said Dr. McGraw, “we need to take it seriously.”

While ostracism as a clinical term doesn’t actually exist and direct data on its impact are not numerous, its inherent psychological risks include suicide, depression, and trauma, according to another of the panelists, Jacqueline Garrick, acting director of the Defense Suicide Prevention Office in the Department of Defense.

Dr. McGraw defined ostracism as group behavior “designed to isolate or deprive another individual of being part of that group.”

Women in the military are particularly at risk for ostracism simply because they tend to be outnumbered by their male counterparts in a combat unit, according to Dr. McGraw. This, combined with a wariness of women after sexual assault awareness education, can exacerbate the segregation.

Ms. Garrick said there is a growing awareness across all branches of the armed forces that men in the service “walk away from that kind of training and figure, ‘Just stay away from women because they’re gonna get you in trouble.’ ”

Add to the mix the separation from the male group that female biology can sometimes cause, whether due to menstrual cycles or toilet needs, Ms. Garrick said. This can widen the gap.

Additionally, service personnel – men or women – who report sexual assault are at risk of being isolated or can suffer retaliation, despite there being antiharassment and antibullying policies in place.

In the interview, Dr. McGraw said she recommends assessing the level of social support a serviceman or servicewoman has by asking directly: “How included do you feel in your group?” She also suggested looking for evidence of ostracism such as the patient endorsing a sense that they do not belong, or being friendless.

If a clinician suspects that a person who says “I am stressed” actually means, “My feelings are hurt,” Dr. McGraw suggested going deeper: Seek clues as to whether the person is experiencing ostracism either covertly, such as being bullied in private, or overtly such as not being given information that ends up making the person appear foolish or unprepared for a task.

“Ask some very pointed questions, such as ‘Are people behaving toward you in a certain way?’ and ‘Do you feel targeted?’ ”

The challenge, she said, is to maintain what is known as “military bearing” – essentially, cultivated stoicism, while also admitting that one’s functionality is suffering because of having been isolated. A dialogue between patient and clinician about being ostracized can lead to helping the person develop strategies for coping with its effects, such as making the commanding officer aware of what is happening.

“Most military personnel are not going to say their feelings are hurt, but they can address the behavior,” Dr. McGraw said.

Although Dr. McGraw admitted when asked that reporting the behavior to a superior could result in further ostracism, she said she has faith in the power of leadership to evoke cultural change. “In a military environment, if the leaders are aware of what is happening, and they take steps to mitigate or eliminate it as a unit, then they can create a healthier environment in the unit, improving morale and esprit de corps.”

None of the presenters had any relevant financial disclosures and said their presentations represented their own opinions, not those of the U.S. Armed Forces.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

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