Signature Wounds

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.

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.

Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments -- many involving prolonged exposure to combat-related stress over multiple rotations -- may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with these three conditions among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of our study, which should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org. Data collection for this study began in April 2007and concluded in January 2008. Specific activities included a critical reviewof the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of service members and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well asutilization of and barriers to care; a review of existing programs to treat service members and veterans with the three conditions; focus groups withmilitary service members and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions overtime. Among our recommendations is that effective treatments documented in the scientific literature -- evidence-based care -- are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or majordepression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.

Atlas of Conducted Electrical Weapon Wounds and Forensic Analysis provides a comprehensive publication on the subject of Conducted Electrical Weapon (CEW) wounds and signature markings created by this class of weapon. This volume will serve as a very useful resource for all professions tasked with assisting persons that have allegedly been subjected to a CEW exposure. The volume provides an introduction to basic CEW technology and the types of CEWs currently available. It also serves as a comprehensive pictorial atlas of signature markings that CEW exposures make in the immediate and more remote post-exposure periods. Also, it discusses the ability of forensic specialty examinations of the CEW itself to aid in the determination of whether the alleged CEW exposure is consistent with the objective evidence and the subjective statements. Finally, this text addresses the important and growing area of factitious CEW markings that will be useful for consideration by investigators and litigators. Atlas of Conducted Electrical Weapon Wounds and Forensic Analysis provides an objective atlas of evidence for reference that will benefit those professionals who often must make diagnostic, treatment or legal judgments on these cases including Emergency and Primary-Care Physicians, Medical Examiners, Forensic Pathologists, Coroners, Law Enforcement Investigators, and Attorneys.

This volume explores culture-bound syndromes, defined as a pattern of symptoms (mental, physical, and/or relational) experienced only by members of a specific cultural group and recognized as a disorder by members of those groups, and their coverage in popular culture. Encompassing a wide range of popular culture genres and mediums – from film and TV to literature, graphic novels, and anime – the chapters offer a dynamic mix of approaches to analyze how popular culture has engaged with specific culture-bound syndromes such as hwabyung, hikikomori, taijin kyofusho, zou huo ru mo, sati, amok, Cuban hysteria, voodoo death, and others. Spanning a global and interdisciplinary remit, this first-of-its-kind anthology will allow scholars and students of popular culture, media and film studies, comparative literature, medical humanities, cultural psychiatry, and philosophy to explore simultaneously a diversity of popular cultures and culturally rooted mental health disorders.

The country’s wars in Iraq and Afghanistan, its interventions around the world, and its global military presence make war, the military, and militarism defining features of contemporary American life. The armed services and the wars they fight shape all aspects of life—from the formation of racial and gendered identities to debates over environmental and immigration policy. Warfare and the military are ubiquitous in popular culture. At War offers short, accessible essays addressing the central issues in the new military history—ranging from diplomacy and the history of imperialism to the environmental issues that war raises and the ways that war shapes and is shaped by discourses of identity, to questions of who serves in the U.S. military and why and how U.S. wars have been represented in the media and in popular culture.

Wounds, Flesh and Metaphor in Seventeenth-Century England explores the theme of physical and symbolic woundedness in mid-seventeenth century English literature. This book demonstrates the ways in which writers attempted to represent the politically and religiously fractured state of the time and re-imagined the nation through language and metaphor in the process. By examining the creative permutations of the wound metaphor, Covington argues for the centrality of the charged imagery, and language itself, in shaping the self-representations of an age.