Page 59 - JSOM Spring 2018

In that year and the year after, rates of suicide in the Army and of resilience in SF in Q-course candidates reported effect sizes
other branches of service eclipsed any in history. 17-19 In addi- in small ranges (e.g. a one-point increase in self-reported re-
tion to high rates of suicide, adverse mental health outcomes silience increased the odds of candidates’ training success by
in Soldiers remain elevated despite mandatory military resil- only 3.3%). That study did not demonstrate any protec-
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ience programs such as Battlemind, Comprehensive Soldier tive factor of resilience in SF or SOF populations, nor has any
Fitness (now also “and Family Fitness”), Military Resilience other, to our knowledge.
Training, and other initiatives. Conceptual analysis of resil-
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ience in SOF military populations is absent in the literature, No literature we found examined resilience of SOF in opera-
to our knowledge. As discussed later in this article, examina- tional units, nor were any studies found investigating resilience
tion of resilience programs throughout the military reveal a in SOF spouses or families; no published concept analysis of
dearth of theoretical and/or conceptual frameworks guiding resilience we reviewed was SOF specific. Although Soldier
their development and implementation. Evidentiary chasms suicides are reported throughout the literature, the underly-
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in examining resilience in SOF and their families prevent iden- ing concept of resilience remains wholly unexamined. Lack of
tifying mechanisms that mitigate or influence negative effects examination of resilience as a concept is concerning, because
of war on SOF and their families. throughout the reviewed literature, investigators consistently
infer that resilience is influential in preventing suicide and as-
In 2016, SOF died in combat at rates higher than that of con- sociated adverse mental health outcomes.
ventional troops; this was touted as an historical first and at-
tributed to political hesitation to put more troops on the front Definitions of Resilience in the Military
line. Previously, elite SOF composed a smaller percentage of Within the opening summary of an extensive report on re-
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troops injured and killed in combat; in 2016, SOF comprised silience throughout the American military, commissioned
83% of fatalities. Though SOF risks of death are consistently by the US Department of Defense (DoD), researchers cited
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heightened in comparison with their conventional forces col- specific difficulties in defining resilience because of vast vari-
leagues, military suicide researchers such as Nock et al. assert ances within the literature, particularly because of the cultural
SOF suicidality is extremely low and attribute their calcula- contexts of the military, and recommended policymakers spe-
tions of almost-zero SOF suicides to SOF “high levels of re- cifically define resilience to ensure clear programmatic guid-
silience.” Despite claims that high resilience reduces suicide ance. Over the last decade, the DoD implemented force-wide
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symptomology, Nock et al. and co-investigators of the Army programs to increase resilience, such as Comprehensive Sol-
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Study to Assess Risk and Resilience in Service members cited dier Fitness, Master Resilience Training, and the US Army’s
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studies to bolster their assertions of SOF hyperresilience, al- Ready and Resilient strategic plan. The US Army, composing
though those cited studies never analyzed the concept of resil- the largest element of combat-arms ground forces, even has a
ience nor studied SOF resilience. Resiliency Directorate, an iteration borne of a previous pro-
gram called Battlemind training. 20
No literature we reviewed rigorously quantified SOF resilience
nor reliably calculated SOF suicidality as specifically associ- Despite the presence of a force-wide Resiliency Directorate and
ated factors. The Ursano et al. 2017 study of military suicide researchers’ explicit recommendations that the military define
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included Special Forces (SF) participants, and resumed the resilience within their population, resilience doctrinal and pro-
SOF hyperresilience narrative that selection for SF anoints one grammatic guidance have not defined resilience for their target
with the chrism of resilience. Following that, when comparing population. Within 85 pages of the Army’s Leadership Guide
SF with combat medics, investigators did not indicate knowl- for building personal readiness and resilience, a definition of
edge that SF has medics, and SF participants only composed resilience is not found, nor is resilience analyzed conceptually.
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approximately 1.2% of participants. Though the investiga- Within 186 pages of a commissioned research report on resil-
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tors inferred SF had higher resilience, no use of specific sta- ience in the military, resilience is defined once by its diction-
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tistical models is found in the article by which resilience is ary definition: “the capability of a strained body to recover
quantified, nor are covariate influences on suicide calculated its size and shape after deformation caused especially by com-
for SF and comparative participant groups, nor was verbiage pressive stress . . . an ability to recover from or adjust easily
found addressing controls for grossly unequal sample sizes. to misfortune or change” and is not defined contextually for
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Yet, the authors concluded SF suicidality is borne of resilience the military. Lead investigators studying military resilience
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derived from SF’s “rigorous selection, intense training, strong note, in particular, the lack of a universal definition of resil-
unit cohesion, or psychological and biological characteris- ience despite the presence of terms accepted as synonymous,
tics.” Articles cited to support those claims were retrieved such as hardiness and adaptability. Lack of accepted common
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and reviewed; none actually quantified resilience in SOF be- definitions, in addition to the various fields of psychology and
yond measuring associated biobehavioral constructs, nor was clinical sciences that have used resilience in research, warrant
resilience measured with psychometric instruments in SF or a revised and updated conceptual analysis of resilience with
SOF study populations. methods enabling contextual analysis for military populations.
Studies of resilience in SOF were limited to predicting SF Methods: Concept Analysis
qualification course (i.e., Q course) candidates’ success on the
basis of operationalized resilience. One article about mili- Literature Retrieval and Analysis
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tary suicide misappropriated a previous publication on SOF Rodgers’ method of conceptual analysis is descriptive and in-
clinicians’ philosophy of care to support the authors’ state- ductive, meaning the current existence of the concept in ques-
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ments that the “ethic of stoicism in Special Operations cul- tion is clarified by analyzing the evolution of that concept and
ture” imbues SOF with hyperresilience to effects of traumatic examining consensus agreement from interdisciplinary sources
stress. Despite claims of SOF hyperresilience, the one study of evidence. Within this inherently inductive method, evidence
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