Signature Wounds: The Untold Story of the Military's Mental Health Crisis

by David Kieran

Overview

The surprising story of the Army’s efforts to combat PTSD and traumatic brain injury
The wars in Iraq and Afghanistan have taken a tremendous toll on the mental health of our troops. In 2005, then-Senator Barack Obama took to the Senate floor to tell his colleagues that “many of our injured soldiers are returning from Iraq with traumatic brain injury,” which doctors were calling the “signature wound” of the Iraq War. Alarming stories of veterans taking their own lives raised a host of vital questions: Why hadn’t the military been better prepared to treat post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI)? Why were troops being denied care and sent back to Iraq? Why weren’t the Army and the VA doing more to address these issues?
Drawing on previously unreleased documents and oral histories, David Kieran tells the broad and nuanced story of the Army’s efforts to understand and address these issues, challenging the popular media view that the Iraq War was mismanaged by a callous military unwilling to address the human toll of the wars. The story of mental health during this war is the story of how different groups—soldiers, veterans and their families, anti-war politicians, researchers and clinicians, and military leaders—approached these issues from different perspectives and with different agendas. It is the story of how the advancement of medical knowledge moves at a different pace than the needs of an Army at war, and it is the story of how medical conditions intersect with larger political questions about militarism and foreign policy.
This book shows how PTSD, TBI, and suicide became the signature wounds of the wars in Iraq and Afghanistan, how they prompted change within the Army itself, and how mental health became a factor in the debates about the impact of these conflicts on US culture.

Product Details

ISBN-13:	9781479824007
Publisher:	New York University Press
Publication date:	11/21/2023
Sold by:	Barnes & Noble
Format:	eBook
Pages:	410
File size:	985 KB

About the Author

David Kieran is Assistant Professor of History and Director of the American Studies concentration at Washington&Jefferson College. He is the author of Forever Vietnam: How a Divisive War Changed American Public Memory, and editor of The War of My Generation: Youth Culture and the War on Terror.

Table of Contents

Introduction: "These Unseen Wounds Cut Deep" 1

1 "At the Time People Hadn't Been Asking Those Sorts of Questions": Army Mental Health Research between Vietnam and Iraq 17

2 "The Psychiatric Cost of Sending Young Men and Women to War": Mental Health as Crisis and Enigma amid Growing Opposition to the Iraq War 42

3 "Callous Disregard of Veterans' Rights Is of a Piece with the Administration's Entire Approach to War": Veteran Suicide and Anti-war Sentiment 77

4 "The Culture of the Army Wasn't Ready": Stigma, Access, and the Politics of Organizational Change 110

5 "Military Families Are Quietly Coming Apart at the Seams": Managing Family Mental Health and Critiquing the Iraq War 148

6 "The Limited Science of the Brain": Traumatic Brain Injury and Scientific Uncertainty during Wartime 175

7 "Leaders Can Once Again Determine the Kind of Culture the Army Is Building": Active-Duty Suicide and Anxiety over Army Culture 214

8 "The Challenge to the VA Is Execution and Implementation": VA Suicide Prevention in a Moment of Mistrust 248

Conclusion: "They Will Start to Bring the ... Lessons That They Learned Back into Their Communities" 281

Acknowledgments 299

Notes 303

Index 385

About the Author 000

Editorial Reviews

"An impressive work on a vitally important, yet understudied topic that is both illuminating and compelling. For an American society still grappling with the multifaceted problems of endless war, this is an extraordinarily relevant book that deserves a wide readership."

Chapman University Gregory A. Daddis

"One comes away from Signature Wounds with a healthy respect for the military's attempts to understand and manage [PTSD and TBI], and an even greater contempt for the armchair hawks most responsible for creating them."

New York Review of Books

"Because David Kieran is so fair-minded, his analysis of the mentalhealth crisis in the U.S. military is devastating and persuasive.Signature Wounds provides a judicious, yet stunning, rebuke to a culturethat incessantly reminds us to support our troops yet acquiesces toendless wars that expose them to levels of psychological trauma nomental health program could possibly prevent or adequately treat."

author of Patriots: The Vietnam War Remembered Christian G. Appy

"A significant contribution to understanding the long-term human costs and consequences of the wars in Iraq and Afghanistan. Afoundational work in this field."

University of Warwick Susan Carruthers

"As new military threats emerge and the nature of conflict continues to change exponentially, it is critical to properly plan mental health programs to prepare and support defense personnel to protect against the physical, mental, ethical and spiritual traumas and dilemmas they may face. As Kieran argues, it is also important to weigh carefully and consider under what circumstances we as a country will engage in conflict at such significant costs. We cannot sidestep this complex mental illness IED staring at us in the room."

Journal of Military and Veterans' Health

"A significant contribution to understanding the long-term human costs and consequences of the wars in Iraq and Afghanistan. Afoundational work in this field."

Universityof Warwick Susan Carruthers

"The first comprehensive history of the military mental health crises of the Iraq and Afghanistan Wars. While Kieran finds both successes and failures along the way, his larger argument leads us beyond policy judgements — Kieran reveals how military mental health was itself the terrain of battle in the late twentieth and early twenty-first century. This book is essential reading for historians, policy makers, and members of the US military."- Jennifer Mittlestadt, Rutgers University

"A significant contribution to understanding the long-term human costs and consequences of the wars in Iraq and Afghanistan. A foundational work in this field."- Susan Carruthers, University of Warwick

“Because David Kieran is so fair-minded, his analysis of the mental health crisis in the U.S. military is devastating and persuasive. Signature Wounds provides a judicious, yet stunning, rebuke to a culture that incessantly reminds us to “support our troops” yet acquiesces to endless wars that expose them to levels of psychological trauma no mental health program could possibly prevent or adequately treat.”- Christian G. Appy, author of Patriots: The Vietnam War Remembered from All Sides

"An impressive work on a vitally important, yet understudied topic that is both illuminating and compelling. For an American society still grappling with the multifaceted problems of “endless war,” this is an extraordinarily relevant book that deserves a wide readership.”- Gregory A. Daddis, Chapman University

"A challenge to conventional wisdom about the military ignoring PTSD, traumatic brain injury and suicide among troops who have served in Iraq and Afghanistan. [Kieran] takes readers inside the medical arm of military services and civilian government bureaucracies showing how dedicated researchers and administrators trying to reach consensus about how to treat - and perhaps even prevent - serious mental damage and suicide...an intriguing study."- Kirkus Reviews

From the Publisher

2019-02-03

A challenge to conventional wisdom about the military ignoring PTSD, traumatic brain injury, and suicide among troops who have served in Iraq and Afghanistan.

Kieran (History, American Studies/Washington & Jefferson Coll.; Forever Vietnam: How a Divisive War Changed American Public Memory, 2014, etc.) never denies the seriousness of PTSD, TBI, and suicide among active and discharged veterans. However, he contends that critics of the military and federal bureaucracy often downplay the complexities of understanding the problems and finding effective solutions. In fact, he contends, implacable anti-war critics have unfairly used the psychological injuries for political ends. "In a climate in which anti-war sentiment was often dismissed with assertions that critics were not supporting the troops," writes Kieran, "pointing out how the wars were harming those troops facilitated broader policy critiques." Before the wars in Iraq and Afghanistan, research about PTSD, TBI, and suicide was based on the premise that deployments would be brief and that the same troops would not be ordered to return to the same war zones multiple times. When the nature of war changed, the military and the Veterans Administration had to recalibrate their policies and their research to react to new realities. As the author points out, those recalibrations take time and don't usually conform to the urgent needs of combat veterans. Kieran's research takes readers inside the medical arm of military services and civilian government bureaucracies, showing dedicated researchers and administrators trying to reach consensus about how to treat—and perhaps even prevent—serious mental damage and suicide. The author stresses that the disagreements about how to proceed derive from compassionate advocates relying on science-based research. Kieran rejects the commonly held belief that those in charge of warfare are dismissive of effective treatments for veterans. Throughout, the author provides memorable individual case studies. Much of the book, however, relies on dense academic research and a scholarly writing style, so general readers will need to pay close attention to digest the author's arguments.

An intriguing study for students of military culture and mental health.

Kirkus Reviews