The Cost of Medical Stigmas for Military Families

Editor's Note: This article contains discussion of suicidal ideation.

Jennifer Barnhill is a columnist for Military.com writing about military families.

"I delayed getting [my son] treatment," said Elizabeth Rotenberry, the spouse and caregiver of a wounded warrior.

Rotenberry, knowing the stigma in the military community surrounding mental health issues, was worried about how seeking help might harm her son Kristopher's future.

Kris was in sixth grade when his father was struck by an improvised explosive device in 2011, resulting in a traumatic brain injury and triggering PTSD, factors that led him to being honorably discharged after 14 years of service as a Marine Corps gunnery sergeant.

Just 11 years old, Kris felt compelled to take on the role of caregiver, something he shares in common with 2.3 million military children whose parents have been wounded or injured as a result of their military service.

Elizabeth, trying to carry on in typical military-spouse fashion by taking care of four children and a husband with an unfamiliar diagnosis, could see the signs that Kris was struggling. But she thought, "If I can survive deployments, and I can bring up the kids on my own, I can fix this."

Thoughts of suicide began to plague Kris within a year of his father's injury.

"I was anxious all the time. I was stressed out all the time," said Kris. "I thought it'd be better if I wasn't here." Luckily, his mother entered his too-quiet room to check on him during his suicide attempt.

In the seven years since Kris' suicide attempt, the Rotenberry family has done everything they can to get help. He received mental health care and the family was open about their experiences, sharing with military and civilian media outlets in order to raise awareness of the impacts of service on military families, including working with the Elizabeth Dole Foundation's "Hidden Heroes" program. Despite what Kris, now 19, has experienced, he wants to continue to serve his country. But it may be that his military career is already over.

"There's no one else on the planet who wants to be a Marine more than I do," said Kris. When Kris entered a recruiting office in November 2022, he was told he would be at boot camp by February. That has not happened.

Instead, he was later told by the Navy's medical review board that he was not medically eligible to serve due to a "history of obsessive-compulsive disorder, depressive disorder, anxiety disorder, suicidality" and for corrective chest surgery performed when he was a child. A civilian doctor serving the family reviewed Kris' medical history and wrote in a letter to the Marine Corps that the conditions mentioned would not prevent Kris from serving, as they "did not appear to reach the level of clinical significance and impairment in functioning associated with a diagnosis." He was denied the ability to apply for a waiver.

"The fact that they're hung up on anxiety, that I had when I was like 11 and 12, is incredibly frustrating," said Kris. While he understands the military's desire to review his records to ensure he is fit for duty, he believes that its decision doesn't seem to recognize that his was an acute mental health crisis and not an underlying issue.

The Defense Department has recognized the impact of military family caregiving, encourages military families to seek care for their mental health and offers programming to support those with medical and educational needs. However, the DoD doesn't seem to know what to do with those help-seeking military kids once they try to enlist. Decades of help-discouraging behavior and outdated medical policies have fueled a pervasive stigma that impacts military medical decision-making and says: If you have a medical condition, hide it.

The Future of the Force

The Rotenberrys' decision to delay seeking care for their military child may be more prevalent than one would hope.

According to the National Military Family Association's (NMFA) Military Teen Experience 2023 report, 40% of teens reported low mental well-being, up from 28% the previous year. Children with a wounded, ill or injured parent were 2.5 times more likely to report low mental well-being. Eight percent of those who needed mental health care did not receive it because they did not tell their parents. And 5% said their parents were "unwilling" or "unable" to get them the care they needed.

If military stigma says "hide your medical condition," it may be that military kids are increasingly unable to do so. MHS Genesis is an electronic medical records system that the DoD adopted in 2021. The system stands to streamline the military medical experience, improving continuity of care for service members and families. However, a byproduct of the system is military children's medical records are fully accessible to recruiters, something that was not available to the generations currently serving.

Many with disqualifying medical conditions have been serving honorably, but undiagnosed, for decades, because the military medical recruiting standards are stricter than the standards to remain in the military.

According to the National Institute of Mental Health (NIMH), 19% of adults may have an anxiety disorder. In 2019, the Air Force documented "341 cases since 1 Jan 2015 with a diagnosis of an anxiety-related disorder. Of these, 168 (49%) were disqualified." This number represents less than 1% of Air Force personnel, far below the NIMH estimate, meaning there are likely many airmen experiencing anxiety who do not report their symptoms.

These disparities could be attributed to a rigorous medical screening process that holds a would-be recruit to a higher medical standard than those currently serving. But it is impossible to know whether these numbers reflect a successful medical review process or a stigmatized culture that tells those with a condition not to self-identify, or a combination of both.

"There's the fear of coming to get seen," said an active-duty physician with the Navy who was granted anonymity because they were not authorized to speak to the press in their official capacity. The doctor shared that this fear impacts some sailors' decision to self-identify symptoms, for fear it could be disqualifying. In this way, military doctors have to navigate a more complex "do no harm" landscape, understanding that patients may not self-disclose, because either they are unaware of their condition or they may withhold symptoms for fear of losing their jobs and therefore their financial stability. And these stigmas have already been passed down to the next generation.

How Stigmas Impact Decision-making

Christian Campbell-Carrigg grew up surrounded by the military. His great-grandfather served in the Air Force during Vietnam as a mechanic, his grandfathers served and his dad is currently serving in the Army. He is one of the 33% of young Americans who have an immediate family member in the military.

"It was always a dream or aspiration of mine to become a pilot," said Campbell-Carrigg. He was on track to achieving his goals and enrolled in an ROTC class at Louisiana State University, where he studied engineering. But everything changed when his younger sister, who suffers from a rare condition, had a stroke that nearly killed her.

"My dad was definitely seeing that I was struggling with anxiety, and he was pushing me towards seeking some help," said Campbell-Carrigg. "I knew that taking anxiety medication could affect me getting into the Air Force and so I just kept pushing and pushing and pushing to try not to take it, trying to work through it, but ended up getting to the point where I didn't end up eating for a week."

Campbell-Carrigg ultimately got the help and medication he needed, and things started to turn around for him and his sister. But rather than continue in his ROTC program, knowing he would need to jump through hoops to get a medical waiver that may not be approved, he mourned his situation and moved forward. His desire to serve led him to pursue an internship on Capitol Hill, where he says his anxiety diagnosis was understood and accepted.

Younger generations are getting diagnosed with anxiety and developmental disabilities like ADHD and autism at higher rates than ever before. The same generation of military kids have been raised by service members who may no longer feel the need to hide their PTSD or TBI symptoms from loved ones. While some like Rotenberry will continue to pursue service despite the obstacles, others like Campbell-Carrigg allow their familiarity with military stigmas to preemptively influence their decision-making.

My own daughter also wants to serve, but like 25% of her peers, she struggled with anxiety during the pandemic. In getting her the help she needed, we documented conditions that could disqualify her from serving her country. Now we must decide whether we should steer her away from her dream of service to avoid future disappointment.

When military families like mine hear of stories like the Campbell-Carriggs or Rotenberrys, we internalize them. We hear about those serving with disqualifying conditions and wonder if getting our child a waiver is possible. We want to set realistic expectations and protect our children from heartbreak so we discourage service preemptively.

"My dad is both the reason I want to be in the Marines and the reason I can't be a Marine," said Kris Rotenberry, matter-of-factly. He's not resentful, just resigned to continue fighting his way into the Marine Corps while his parents cheer him on from the sidelines.

The 988 Suicide and Crisis Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a trained listener, call 988.

A Military Veterans in Journalism grant helped fund research for this article.