Fields of Combat: Understanding PTSD Among Veterans of Iraq and Afghanistan

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Overview

For many of the 1.6 million U.S. service members who have served in Iraq and Afghanistan since 2001, the trip home is only the beginning of a longer journey. Many undergo an awkward period of readjustment to civilian life after long deployments. Some veterans may find themselves drinking too much, unable to sleep or waking from unspeakable dreams, lashing out at friends and loved ones. Over time, some will struggle so profoundly that they eventually are diagnosed with post-traumatic stress Disorder (PTSD).

Both heartbreaking and hopeful, Fields of Combat tells the story of how American veterans and their families navigate the return home. Following a group of veterans and their their personal stories of war, trauma, and recovery, Erin P. Finley illustrates the devastating impact PTSD can have on veterans and their families. Finley sensitively explores issues of substance abuse, failed relationships, domestic violence, and even suicide and also challenges popular ideas of PTSD as incurable and permanently debilitating.

Drawing on rich, often searing ethnographic material, Finley examines the cultural, political, and historical influences that shape individual experiences of PTSD and how its sufferers are perceived by the military, medical personnel, and society at large. Despite widespread media coverage and public controversy over the military's response to wounded and traumatized service members, debate continues over how best to provide treatment and compensation for service-related disabilities. Meanwhile, new and highly effective treatments are revolutionizing how the Department of Veterans Affairs (VA) provides trauma care, redefining the way PTSD itself is understood in the process. Carefully and compassionately untangling each of these conflicts, Fields of Combat reveals the very real implications they have for veterans living with PTSD and offers recommendations to improve how we care for this vulnerable but resilient population.

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Editorial Reviews

Library Journal
In this anthropological survey, Finley (Univ. of Texas Health Ctr.) studies the process by which veterans of current conflicts define and seek treatment for combat-induced post-traumatic stress disorder (PTSD). Because she also seeks to illuminate military culture, she looks at how families cope with returning relatives who now seem like strangers; delves into the history of the Veterans Administration medical system, whose employees are struggling to treat a flood of new patients with limited resources; and chronicles how mental health professionals have defined the problems of veterans, from "soldier's heart" through combat fatigue to today's struggles to define PTSD (and, hence, to decide who gets treatment). VERDICT This book isn't intended as a guide for sufferers. Readers concerned with themselves or loved ones would be better served by Glen Schiraldi's The Post-Traumatic Stress Workbook or similar titles. There's not much new here, but scholars and general readers will get a comprehensive look at the subject from many viewpoints.—Mary Ann Hughes, Shelton, WA
From the Publisher

"Fields of Combat is highly recommended for leaders, persons providing direct care and ancillary services, and administrators involved in the care of active duty or retired service members, as well as for clinicians who work with veterans in community settings. It will be a valuable resource for family members to assist them in understanding and working with loved ones experiencing combat-related PTSD."—JAMA

"Erin P. Finley creates a compelling account of how to understand PTSD and how to help treat those who suffer from it. . . . She mixes historical accounts of PTSD as a medical illness with the current understandings of its causes, signs, and evidence-based treatment. . . . Finley gives us hope and several well thought-out recommendations for preventing and minimizing combat PTSD."—Kevin M. Bond, Military Review (November-December 2011)

"Finley offers a well-researched and reasoned contribution that explores how the social environments veterans come from and return to when not deployed shape their PTSD experience. The book weaves together empirical research findings with lengthy case studies that show the experience of PTSD across time. This book's most important aspect is the understanding it conveys that PTSD is not only a psychiatric condition, but a socially mediated one as well, shaped by the ways in which the Veterans Affairs health system interacts with and compensates' veterans. Finley's richly textured ethnography demonstrates the many factors that influence the readjustment struggles of returning veterans. She closes the book with a helpful and practical set of suggestions that give it an edge on other works on the topic, many of which fail to treat the issues with Finley's depth and insight. . . . Summing Up: Highly recommended."—Choice (January 2012)

"Finley studies the process by which veterans of current conflicts define and seek treatment for combat-induced PTSD. Because she also seeks to illuminate military culture, she looks at how families cope with returning relatives who now seem like strangers; delves into the history of the Veterans Administration medical system, whose employees are struggling to treat a flood of new patients with limited resources; and chronicles how mental health professionals have defined the problems of veterans, from "soldier's heart" through combat fatigue to today’s struggles to define PTSD (and, hence, to decide who gets treatment). . . . A comprehensive look at the subject from many viewpoints."—Library Journal (11 March 2011)

"This is the first major ethnography of PTSD among veterans of America's most recent wars.In Fields of Combat, Erin P. Finley deftly weaves the experiences of these young men and women who have participated in the invasions and occupations of Iraq and Afghanistan into a larger fabric of the U.S. military enterprise, including the clinical responses to a health crisis in treatment and prevention of debilitating traumas of war. How Americans, civilian and military alike, respond to these veterans says as much about the mental health of U.S. society as about them."—Matthew Gutmann, Brown University, coauthor, Breaking Ranks: Iraq Veterans Speak Out Against the War

"Fields of Combat documents the PTSD experience as it is lived by veterans of the Iraq War. In presenting the range of responses to PTSD, Erin P. Finley shows how they can be inflected by gender, ethnicity, and personal background. Anger, violence, and alcohol abuse emerge as major themes."—Dr. Devon E. Hinton, Massachusetts General Hospital and Harvard Medical School

"Most of what we have learned about the personal costs of wartime trauma comes from veterans' experiences in post-Vietnam America. Things are different now. The wars in Iraq and Afghanistan are different, the injuries are often different, and the homeland's attitude to its veterans is different. Fields of Combat is an anthropologist's inquiry into the lives of a new generation of traumatized veterans and the people and institutions to which they have returned. Post-traumatic stress disorder is widely presumed to be a unitary and fully understood phenomenon. Erin P. Finley's engrossing ethnography corrects this profoundly mistaken view."—Allan Young, McGill University

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Product Details

Meet the Author

Erin P. Finley is a medical anthropologist and Investigator at the Veterans Evidence-Based Research Dissemination and Implementation Center (VERDICT), Department of Veterans Affairs Medical Center, San Antonio, Texas, and an Adjunct Assistant Professor in the Division of Clinical Epidemiology, Department of Medicine, at the University of Texas Health Science Center, San Antonio.

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Table of Contents

Acknowledgments ix

List of Abbreviations xi

List of Characters xiii

Introduction 1

1 Fourth of July: A Tradition of Service in San Antonio 12

2 War Stories: Case Studies of Combat Deployment 22

3 Home Again: Early Experiences of Post-Deployment Stress 51

4 Of Men and Messages: How Everyday Cultural Influences Affect Living with PTSD 73

5 Clinical Histories: From Soldier's Heart to PTSD 89

6 Under Pressure: Military Socialization and Stigma 99

7 Embattled: The Politics of PTSD in VA Mental Health Care 113

8 Navigation: Identity and Social Relations in Treatment Seeking and Recovery 135

Conclusion 158

Notes 181

References 199

Index 217

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