Understanding Post-Traumatic Stress Disorder among Veterans of Iraq and Afghanistan

484 Pages·2009·2.54 MB·English

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Signature:
__________________________ ____________________
Erin P. Finley Date
Fields of Combat:
Understanding Post-Traumatic Stress Disorder among
Veterans of Iraq and Afghanistan

By
Erin P. Finley
Doctor of Philosophy

Anthropology

___________________________________________________________
Peter J. Brown, Ph.D.
Advisor

___________________________________________________________
Melvin Konner, M.D., Ph.D.
Committee Member

___________________________________________________________
Don Seeman, Ph.D.
Committee Member

_____________________________________________________________
Carol Worthman, Ph.D.
Committee Member

Accepted:

__________________________________________________________
Lisa A. Tedesco, Ph.D.
Dean of the Graduate School

______________________________
Date
Fields of Combat:
Understanding Post-Traumatic Stress Disorder among
Veterans of Iraq and Afghanistan

By

Erin P. Finley
B.A., Emory University 1999
M.P.H., Emory University, 2006
M.A., Emory University, 2007

Advisor: Peter J. Brown, Ph.D.

An abstract of
A dissertation submitted to the Faculty of the Graduate School of Emory University
in partial fulfillment of the requirements for the degree of
Doctor of Philosophy
in Anthropology
2009
Abstract

Fields of Combat:
Understanding Post-Traumatic Stress Disorder among
Veterans of Iraq and Afghanistan
By Erin P. Finley

Post-Traumatic Stress Disorder (PTSD) has received increasing attention as one
of the “signature wounds” of the U.S. wars in Iraq and Afghanistan, with more than
75,000 returning veterans newly diagnosed since 2002. Epidemiological and clinical
accounts of the disorder have struggled to understand how social and cultural factors
may influence veterans’ vulnerability to developing PTSD after combat exposure, while
anthropological explorations of PTSD have told us little about the personal experience of
PTSD, tending to focus instead on a critique of the diagnosis’ status as an authoritative
biomedical category. The present study addressed these gaps by using both
ethnographic and epidemiologic methods to investigate how recent male veterans and
their families understand and respond to post-deployment stress and PTSD. Findings
consider veterans’ experiences of post-deployment stress in the context of key social
and cultural variables such as Mexican-American and Euro-American ethnicity, family
relations and masculine gender roles, and amid wider understandings of PTSD in clinical
and media accounts of the disorder. Living with a diagnosis of PTSD turns out to require
navigating multiple and often contradictory fields of social meaning simultaneously,
with implications for how veterans make decisions vital to their experience of illness –
including coping strategies and efforts toward care-seeking and meaning-making.
Retrospectively following veterans across a trajectory of cultural environments and life
course events, this dissertation explores how social relations, political economy, and lay
and professional notions of illness and gender help to shape veterans’ vulnerability and
resilience as they work to create post-war lives, often amid profound distress.
Fields of Combat:
Understanding Post-Traumatic Stress Disorder among
Veterans of Iraq and Afghanistan

By

Erin P. Finley
B.A., Emory University 1999
M.P.H., Emory University, 2006
M.A., Emory University, 2007

Advisor: Peter J. Brown, Ph.D.

A dissertation submitted to the Faculty of the Graduate School of Emory University
in partial fulfillment of the requirements for the degree of
Doctor of Philosophy
in Anthropology
2009
Acknowledgments

This doctoral program, this research, and this dissertation would have been far less
without the inspiration, encouragement, and regular infusions of courage and joy provided by
Sarah Barks, Ryan Brown, Alexa Dietrich, Brandon Kohrt, Jennifer Kuzara, Brandie Littlefield, and
Jed Stevenson. It was Sarah Willen who provided the Eureka moment over lunch one day, when
she asked – having listened to me complain about troubles with an earlier research plan – “Why
aren’t you looking at soldiers from Iraq?” Tricia Fogarty, Michelle Parsons, Elizabeth Milewicz,
and Daniel Lende all read and provided invaluable feedback on early drafts of material that
became part of the dissertation, as did participants in a 2008 Cornell workshop on
medicalization in post-conflict societies hosted by Stefan Senders and Chip Gagnon.
The research could not have been completed without financial support from the
National Science Foundation and the Emory Center for Myth and Ritual in American Life
(MARIAL). Deborah Winslow, Sybil Bridges, and Sally Pattison-Cisna made the grants process
navigable. Bradd Shore and the Marialistas, including Marshall Duke and Robyn Fivush,
provided important intellectual and methodological insights and critiques along the way. The
nurses and other staff of the Frederic C. Bartter General Clinical Research Center in San Antonio
led me through the process of setting up the clinical portion of the study. Sharon Pryor and
Terri Barnett, in particular, were patient, wise, and kept a wonderful sense of humor
throughout. The South Texas Veterans Health Care System provided a home for this research,
and Matthew Jeffreys and Steve Holliday both played a key role in putting all the necessary
pieces together. Michael Parchman, Polly Noel, Mary Jo Pugh, and Laural Copeland, all of the
Veterans Evidence-Based Research Dissemination and Implementation Center (VERDICT), gave
me space and the motivation to work through the last half of the writing, and have kept my eyes
focused on the promise of future research whenever I got bogged down in the minutiae of the
present.
The Emory University Department of Anthropology has been my scholarly home for
many years, and its faculty and staff deserve my thanks for continual support - financial, moral
and otherwise. Svea Closser was my rock through the writing of the dissertation, doggedly
reading every chapter at least once and cutting through excess and obfuscation with an unerring
eye (what remains is entirely my fault). Carol Worthman, Mel Konner, and Don Seeman were
educators and mentors throughout, and made me grateful to have a committee who gave so
generously to the process. I still marvel at my good fortune in getting to work for so many years
with Peter J. Brown, my advisor and favorite role model. His accumulated knowledge and
intellectual curiosity are matched only by his great and wonderful humanity.
My father Dale and sister Christine are the best possible cheerleaders, day after day
after year after year, and I can’t imagine life without them or the rest of my beautiful, big-
hearted family (Cheryl, Kathy, Archie, Shelby, Nanny, Nampy, Grandma, Grandpa, Diane and all
of you, I love you so much). I am so blessed to have you all in my life.
Hector, my work and life would be so much less without you. Thank you.
This dissertation is dedicated to my mother.
Table of Contents

Preface 1

Part I: The Journey Begins -- Personal Histories of Service and Stress
Chapter One: Gearing Up 7
A Tradition of Service in San Antonio
Chapter Two: War Stories 41
Case Studies of Combat Deployment
Chapter Three: Home Again 86
Post-Deployment Stress, Changing Social Relations, and Risk Factors for PTSD

Part II: Crisis and Response -- PTSD in Three Cultural Environments
Chapter Four: Of Men and Messages 133
Ethnicity, Life Goals, and Family Support
Chapter Five: Under Pressure 183
Military Socialization and Stigma
Chapter Six: Embattled 222
The Clinic, Part I: The Politics of PTSD in VA Mental Health Care
Chapter Seven: Center of the Storm 265
The Clinic, Part II: Therapeutic Interactions
Part III: Navigation -- Deriving a Path for Life and Illness
Chapter Eight: Ambivalence 290
PTSD and Perspectives on Veterans in Contemporary America
Chapter Nine: Maps 347
Social Experience and Illness Narratives in Treatment-Seeking and Recovery
Chapter Ten: Conclusion 396
Recommendations for a Focus on Resilience

Appendices
i. Appendix A: Theoretical Underpinnings 428
ii. Appendix B: Glossary of Abbreviations 449
iii. Appendix C: List of Tables and Figures 451