Janet Cater
Many Americans don’t realize that women in the military face exactly the same dangers as men, but Janet Cater set out to change that with a groundbreaking study of six women who lost arms and legs while serving their country.
Cater was working on a doctoral degree in rehabilitation education and research at the University of Arkansas when she heard a story on the university’s local National Public Radio affiliate about women serving their country in the military.
As the daughter, niece and mother-in-law of men in the military, Cater was intrigued as the radio reporter interviewed women about their roles in the Iraq war.
“Despite Congress saying that women could not be involved in combat, women serving in Iraq served in a combat zone,” she said. “They worked in a combat environment and lost limbs, suffered burns, and other injuries the same as male soldiers.”
When she searched the existing research literature to see what studies had been done about the effects of military combat on women warriors, she found nothing written about one of the most obvious effects – physical harm.
Cater knew she had found her dissertation topic: the psychosocial adjustment of military women to the loss of limb. She conducted in-depth interviews with six women using Skype, a software application that allows users to make free video and voice calls over the Internet. She compared their experiences to three theories of psychosocial adaptation to disability.
In addition to describing how their injuries occurred, the rehabilitation process they went through and their interaction with fellow servicemembers, these women also reported that often Americans did not readily recognize them as wounded warriors with war injuries.
“That’s an important reason I hope these women’s stories are heard – so that future female veterans receive more public support,” Cater said.
IN HARM’S WAY
Women are choosing to go to war for the United States in larger numbers than ever before. In today’s modern warfare, they are on the front lines; there is no safe zone in Iraq and Afghanistan.
Through her research, Cater learned these women are very resilient and determined to succeed in life despite the loss of one or more limbs. She interviewed five Army women who lost limbs in combat, and one who returned to active duty after losing a leg in a motorcycle accident. The public generally does not understand the jobs women are performing in the military, including serving as gunners, flying helicopters and airplanes in combat zones, leading platoons, and defusing bombs, she said.
A nation that increasingly depends on women as a vital part of the U.S. armed forces – 15 percent of total troop strength and 11 percent of the Iraq war troops deployed – must fully acknowledge their participation and their unique needs upon returning home, Cater believes.
“When I asked these women to tell me their stories, I explained that there was no published research on female military amputees,” Cater said. “They chose to participate in the hope this research would help future military women amputees. We owe that to them for the sacrifices they made.”
Cater, who also holds a master’s degree in vocational rehabilitation counseling from the university, found common themes among the female soldiers’ recovery: physical disability adjustment issues, psychosocial adjustment and coping skills, and an emerging new sense of self and life purpose. Women must adjust to a new body image in a society where women often are judged by their appearance. They frequently drew on their personal courage when going out into the community because of public attitudes toward women amputees.
“While recovering from amputation in a military environment promoted a ‘kick-butt’ attitude, they reported a positive attitude, social support, personal courage, resiliency and military training, a sense of humor, and the belief their loss had meaning most influenced their recovery,” Cater wrote.
ASSISTING VETERANS
Medical and rehabilitation professionals must respect the wishes of women, Cater said, citing the choice by two of the women she interviewed not to wear prosthetic devices. One said a body-powered prosthetic arm with levers, pulleys and hooks got in the way more than it helped. Others who used prosthetic devices chose not to wear cosmetic coverings because they considered their amputations a symbol of their sacrifice.
“I think what I learned could help others working in the rehabilitation counseling field,” Cater said. “It’s very important not to put limits on people with disabilities, not to assume they can’t do something but instead to let them try.”
After finishing her doctorate, Cater began working as a rehabilitation counselor with military veterans. Her job is to determine whether a veteran is eligible for vocational rehabilitation services. If so, the veteran completes an assessment to determine various skills and aptitudes, and she offers guidance on careers that would be suitable and where there is expected job growth.
“I do a lot of case management, staying in contact with clients to be sure they are on track with their training programs and have the supplies that they need,” she said. “It’s up to them to choose the training they want, but we provide guidance. We try to guide them away from careers unsuitable for a person with their disabilities or where there is a limited job market. They are investing years of their lives to go to school. Thus, they need a career with a future. It has been a challenge finding jobs with the economic downturn and cuts to government funding.
“It’s like being career counselors in college,” she continued. “We try to use a crystal ball but the world is changing fast. We have our clients do market research, too. One client who graduated from engineering school got a job before he graduated, as did a veteran in construction management.”
Cater has not yet worked with any amputees since taking the position about eight months ago. She sees veterans of all ages and backgrounds and a variety of disabilities. Many have typical problems resulting from injuries to legs, backs, knees and ankles. In addition to physical challenges, many of the veterans also have cognitive issues, such as post-traumatic stress disorder and traumatic brain injury.
She has heard anecdotal evidence that veteran amputees are less likely to seek vocational rehabilitation training than those with conditions such as post-traumatic stress disorder and traumatic brain injury.
“Many amputees feel like it’s no big deal,” she said. “They go to the hospital for prosthetics and continue with their lives.”
FUTURE RESEARCH
Cater published an article concerning the use of Skype for qualitative research and has an article coming out this summer in the Journal of Applied Rehabilitation Counseling. That article, written with Jerry Leach, a doctoral student in the rehabilitation program, also breaks new ground. Its topic is military sexual trauma among male and female servicemembers.
Military sexual trauma can cause mental and physical illness in both men and women. It can also influence behavior and the ability to work with others. It encompasses a range of unwanted sexual attentions within the military that range from gender harassment to sexual coercion and gang rape. The percentage of military women who have experienced military sexual trauma is more than 13 times higher than for men, but the actual number of reported cases for both men and women is about equal. She would like to learn about male amputees’ experiences in order to compare and contrast them with women’s experiences. She would also like to study the differences in psychosocial adjustment between military and civilian female amputees.
RAISING AWARENESS
More than 220,000 servicewomen have fought in the Iraq and Afghanistan wars. Casualties among women include about 150 deaths, more than 600 injured, and more than 20 experiencing traumatic amputations.
The women Cater interviewed ranged in age from 20 to 36 at the time they were wounded. Their jobs included logistics, road repair and gunner; military police platoon commander; helicopter pilot and battle captain; military police gunner; convoy platoon commander; and explosive ordnance disposal technician. Three were injured by improvised explosive devices, two by rocket-propelled grenades, and one in a motorcycle crash after which she returned to active duty. Four lost legs and the other two lost arms. One woman lost both arms above the elbow. All five women who lost limbs in combat spent a year or longer at Walter Reed Medical Center in Washington, D.C., or the Center for the Intrepid at Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas.
The military training and values instilled in the women motivated them to never give up and increased their hardiness and resiliency. They derived comfort from the fact that they had given their limbs in service to their country.
An important side lesson Cater took from her research was that servicemembers of both genders often feel unappreciated.
“These people have signed a blank check giving everything up to and including their lives,” she said. “They really appreciate it when people thank them for their service. Women are less likely to be thanked than men.”
