Fields of Combat: Understanding PTSD Among Veterans of Iraq and Afghanistan(The Culture and Politics of Health Care Work)

"If you consider Iraq—like I do, probably twenty-nine out of thirty days—to be the pinnacle of your life, then where do you go from there? And I'm sure that a lot of veterans feel that way. To them, that was it. That was everything. So now what? They have to find something meaningful and purposeful." "When I got back from Afghanistan, there was not even so much as a briefing that said, 'Let us know if you're having problems.' There wasn't so much as a phone number. There was literally nothing." "I knew it was crazy. I was thinking, the guy on the roof's either a sniper or he's going to radio ahead. And then I thought, this is San Antonio. There's not snipers on the roof, nobody's going to blow me up here." "Whenever I look at people back here at home, I know what they're going to look like dead. I know what they look like with their brains blown out or jaws blown off or eyes pulled out. When I look at somebody I see that, to this day." —Voices of veterans interviewed in Fields of Combat 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 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.

Table of Contents:
Introduction 1. Fourth of July: A Tradition of Service in San Antonio 2. War Stories: Case Studies of Combat Deployment 3. Home Again: Early Experiences of Post-Deployment Stress 4. Of Men and Messages: How Everyday Cultural Influences Affect Living with PTSD 5. Clinical Histories: From Soldier's Heart to PTSD 6. Under Pressure: Military Socialization and Stigma 7. Embattled: The Politics of PTSD in VA Mental Health Care 8. Navigation: Identity and Social Relations in Treatment Seeking and Recovery ConclusionNotes References Index

About 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.

Review :
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) 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) 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) 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 Universitycoauthor, (Breaking Ranks: Iraq Veterans Speak Out Against the War) 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)