UCSF

The U.S.-led wars in Afghanistan and Iraq have resulted in thousands of servicemembers and veterans diagnosed with PTSD or suffering from PTSD symptoms. As a result, PTSD has emerged as a salient social problem in the military context. This study is a social-historical qualitative study of war related PTSD during a decade of U.S-led war in Afghanistan and Iraq (2001-2012). Through in-depth interviews, participant observation, and extensive document analysis, I examine how public officials, veterans' advocacy groups, and researchers working in the U.S. military context have constructed PTSD and the policies addressing it. I emphasize issues and policies concerning diagnosis, treatment, and disability compensation, which are significant loci of action for veterans' advocates, public officials, and researchers.

My findings first highlight that despite PTSD's long-standing codification as a mental disorder, the diagnosis is a controversial one whose legitimacy is at times disputed, particularly in U.S. military contexts. These disputes manifest not in questions about whether PTSD exists, but in queries and statements about how many individuals are, or should be, diagnosed with PTSD; the struggle is over prevalence rates. Second, I argue that various cultural meanings associated with PTSD--particularly perceptions of its "true" prevalence, high economic cost, and negative impact on military manpower--have shaped PTSD policy. Specifically, economic and military manpower implications have compounded concerns about prevalence and led some public officials and researchers to challenge the disorder's clinical validity as well as its diagnostic tools, procedures, and systems, and to frame PTSD as a clinical state which is often induced or falsified because of the prospect of "secondary gains" such as VA benefits. Finally, I focus on the range of veterans' advocate responses to and grievances about a lack of appropriate prevention, diagnosis, and treatment of PTSD. I argue that there exists a widespread channeling of veterans' advocacy efforts into health and mental health issues and postulate that this biomedicalization of advocacy funnels otherwise radical activity into collective action focused on VA benefits. This research builds upon sociological scholarship, most notably theories of the social construction of mental illness and social movements in health.