Moved to 1/13/22, 3:15-4:45 pm Experiences of Institutional Betrayal and Institutional Courage Among Veterans Exposed to Airborne Hazards

Research has found that among individuals who have experienced psychological trauma, and then perceived that they were harmed by an institution that was supposed to protect them, there are increased rates of dissociation, anxiety, interpersonal problems, and other trauma-related outcomes (Smith & Freyd, 2013). This phenomenon, known as institutional betrayal, has been explored among survivors of sexual assault, childhood sexual abuse, and intergenerational trauma. The current project sought to explore the concept among Veterans exposed to airborne hazards (e.g., pollution, particulate matter, burning refuse). Our team coded verbatim transcripts of interviews with Veterans (N=14; which included a semi-structured initial interview and subsequent member checking) and interview debriefing with project staff which included discussion of a priori knowledge derived from clinical training, practice, and the literature.

Initial themes from Veterans suggest diverse views of the concept of institutional betrayal; experiences of perceived harm from across military, civilian, and health care settings; perceptions of harm resulting from inconsistencies between and within organizations; perceptions of failure resulting from individual decisions and systemic factors; time and financial burdens associated with institutional barriers; and descriptions of discrimination related to race, gender, and sexual minority status. Health care-related themes include inefficiencies in the health care system; severity, chronicity, and progression of symptoms; concerns about mortality; tension between subjective symptoms and objective medical evidence; strain in patient-provider relationships; perception of being dismissed by health care systems despite high levels of health care utilization; and examples of positive experiences of being validated and helped. Access to Veteran disability benefits is a prominent theme, including the perception of benefits as a form of validation of Veterans’ lived experiences. Veterans described their own persistence, self-advocacy, information seeking, peer networks, spirituality, and perception that they are at times viewed as a threat or a problem. Veterans provided diverse views and examples of institutional courage. Findings highlight that experiences of perceived betrayal across the lifespan are relevant to Veterans’ views of themselves, their illnesses, their health care, and their ongoing engagement with institutions. Increased awareness of the concepts of institutional betrayal and institutional courage may allow health care providers to address unmet psychosocial needs of Veterans and promote institutional courage in the organizations in which they work.