Review of the Wounded Troops and Partners: Supporting Intimate Relationships Conference
Last week the Center of Excellence for Sexual Health hosted a one day conference in Washington called “Wounded Troops and Partners: Supporting Intimate Relationships.” The conference was meant to address the lack of services for wounded service members and their families that address sexual health. This lack isn’t unique among those who have acquired a physical or psychiatric disability as a result of combat; sexual health information and services for people living with physical, psychological, and developmental disabilities have never been as good as those for the non-disabled population (and that’s not exactly a high bar).
But a war is a special case. As the organizers of this conference are well aware, there was a significant increase in sexual information and services in response to the needs of service members returning from Vietnam. They argue that now, more than ever, military and civilian health systems need to offer sexual health services to their patients.
The conference was billed as one of a kind and it truly was. It brought together big names in U.S. public health including two former Surgeons General, the direct of HHS on Disability, VA providers, some of the top disability and sex professionals from across the country. It also included service members and their partners to talk about their personal experiences around sexuality and combat, and Lee Woodruff whose husband Bob was wounded and acquired a traumatic brain injury while covering the war for ABC.
I highly recommend watching some or all of the conference, which you can do here courtesy of the web cast at Kaisernetwork.org. As is often the case when you get a group of people together who share a passion that is usually hidden and tied to shame, many of the speakers offered deeply personal stories and each presenter left us with an important piece of a story we’re just beginning to tell.
I thought I’d also share some of my responses to what was said. In the interests of full disclosure I should also mention that I volunteered as part of the planning committee, and like everyone, I got the free pen at registration.
Big Picture Health Disparities
Both of the former Surgeons General who spoke made passionate and persuasive arguments for the need to understand all disparities in the provision of health services (and the inevitable disparities in the health that result) as interrelated. Dr. Carmona, who spoke so eloquently about both his professional and personal experience with the military health care system, pointed out that we need to work harder to offer services that address not just physical health needs but mental health needs. He pointed out that before Iraq and Afghanistan only one in five people needing mental health services in the U.S. were getting them. That’s the baseline we’re working with. In the end of his opening remarks Dr. David Satcher whose organization sponsored and put on the conference offered a powerful quote from Kay Redfield Jamison who, writing about our collective response to mental health needs, wrote that "the breach between what we know and what we do is lethal."
Mental Health and Sexual Health
Several speakers addressed the connection between mental health and sexual health, both in the specifics of how mental illness and conditions such as PTSD impact our sexuality, but also to highlight the fact that most of the discussion around disability and sexuality is about physical disability. Even though relatively speaking, we don’t talk about sex and disability a lot, there is in fact quite a lot of research and resources around spinal cord injury and sexuality. There’s much less about mental illness and sexuality, and this is something many presenters pointed out will have to change.
Dignity
It’s sometimes difficult for people who haven’t been through the health care system with a seriously ill or injured person to imagine the multiple ways that being a patient or someone labeled with a disability translates into loss of basic rights, and how the loss of those rights can lead to a loss of dignity. Lee Woodruff talked about how hard it was to see her husband in the hospital, not only in such bad shape from his injuries, but, as she put it, bereft of the basic dignities afforded to most people outside of a hospital setting. She recalled how her husband’s hospital gown was forever open or hiked up exposing his genitals to anyone near enough to see, and how painful this was for her (thinking also of how he would feel if he hadn’t been in a medically induced coma). She found a solution with an organization which makes accessible clothing for wounded service members and provides them free of charge.
There was something about this story that raised a flag for me. I thought of people I know who will never have privacy. People who will always require others to be there at their most private, naked, and raw moments. When we tie dignity to a specific privilege, for example being able to be fully clothed in front of strangers, instead of to the larger human rights we all share, for example autonomy, we inadvertently marginalize people who don’t have the same privileges we do. I’m not suggesting that in this case Woodruff should have learned to “be okay” with the nudity. I’d probably do the exact thing she did. Instead, when talking about it afterward I think we need to think about the people we leave behind.
Personal Stories
The conference was originally set up to have the experts on some panels and then “first person stories” on others. One of the greatest surprises of the day was the extent to which lines between “expert” and “regular person” were blurred. Many of the experts shared deeply personal stories, particularly powerful was Dr. Richard Carmona’s sharing of his experience as a family member with the military health system when his son needed services. And of course the so-called regular people offered invaluable expertise for the service providers in the audience. I have to say this usually happens during conferences on sex and disability. It’s so rare to get a group of people together who are all passionate and willing to talk, that when you do, a little magic always happens.
Invisible Wounds
Several of the speakers, vets, and partners talked about “invisible wounds”. In the context of combat injuries the invisible wounds were usually psychological ones, including PTSD, and also traumatic brain injury which, when it’s “mild” can be completely invisible (great quote from one of the presenters: “a traumatic brain injury is only mild when it doesn’t happen to you”). But I felt a subtext in the room which acknowledged that anyone who is in combat is going to come back with some invisible wounds as a result of what they’ve seen and experienced. Several of the speakers called for more attention to be paid to the wounds that we don’t see, and how to treat them.
Interestingly one woman in the audience addressed this issue from a different angle. She raised her hand and asked who in the room was thinking of peace? Her point, I think, was that these wounds are there because we’re sending people to war and one way to preventatively treat those wounds would be not to send soldiers to war. Given that both the Department of Defense and the VA were well represented in the room, her comments didn’t get very far. But I was glad someone raised it.
Sex, Eventually
As is often the case when we come together to talk about sex and disability, it took a while to get to the actual sex part. Of course talking about intimacy and relationships is as important as talking about sexual behaviors, but, as Dr. Linda Mona pointed out during her presentation on the psychological aspects of healthy sexual relationships, what a lot of people want to know is how they can do it. If this had been a conference primarily for people living with disabilities the lack of nuts and bolts may have been a bigger issue. But seeing as how this was first and foremost a venue for raising awareness and building support the gentle entry into the field was probably wise.
Humor
If you’ve been around people who have been blown up or whose bodies are falling apart one way or another you can quickly become accustomed to laughing about things that most people think of as the end of the world. And you get the difference between laughing about something or with someone and laughing at them. In a conference environment it’s hard to know how this will go over. A vet gets on stage and talks about his ear falling off at the wrong time and the well meaning audience is silent, meantime he’s cracking up. Some speakers addressed this directly and others just led by example, but the importance of humor was mentioned throughout the day. Using humor to get through the difficult transition from hospital to rehab to home, using humor to adjust to life with a disability, and using humor to share experiences with others. There’s also something to be said for the times we have to laugh because what we’re dealing with is just so bizarre and unexpected.
Questions For Next Time
Of course in one day there is so much that doesn’t get said. I know the organizers made an effort to include individuals who identify as gay and lesbian in the day but due to circumstances beyond their control that didn’t happen. It was nice that a few of the speakers made an effort to talk the fact that neither we, nor our service members, are all heterosexual (it would have been nicer if more had).
We also need to come up with a way of addressing these issues for and with people who are not in relationships. Most of the conversations about personal experience came from people in loving committed relationships. So many people, particularly people living with disabilities, pain, and chronic illness, don’t have partners, and we know these people fair far worse as they move through the health care system.
Being in a room that was so overtly political (with actual politicians and plenty of government employees present) meant a few major omissions that felt strange. No one was talking about how government policies like don’t-ask-don’t-tell and the current administration’s eight year war on sex negatively impacts the sexual health and overall health of service members. As well, no one was talking openly about how the current health care system is failing many service members. Everyone was okay saying that things could get better, but it did sort of feel like if we don’t admit how bad things are we may not create enough change. I know these silences are political, and I understand them, but it still felt strange and I want to think about how these conversations might happen next time.
Overall this was an excellent conference and a landmark event in the move towards greater inclusion of sexual health both inside the health care system and specifically within the rehabilitation system.
Read more – USA Today: Is sex over? Badly hurt vets talk intimacy
Related:
Sexual Health Issues for Post-Combat Soldiers
B.J. and Abby Jackson Building a Sexual Life Together after Combat
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