UC San Diego

This dissertation research follows the development of Virtual Iraq, a virtual reality system designed to assist clinicians conducting a prolonged exposure therapy among military service members diagnosed with post-traumatic stress disorder. Research was conducted using a mixed methods approach, employing both textual analysis and multi-sited ethnography, following the system from the designers' computer screens to public demos to clinicians' offices. I argue that in remediating therapy through a VR system, Virtual Iraq not only impacts therapeutic practice, but also impacts cultural conceptions of therapy. The system's resemblance to video games has provided a justification for its development by suggesting that it will help to destigmatize therapy and thereby attract young male "digital generation" service members from the to seek mental health care for PTSD. However, it was not designed for play: rather, the system uses multimedia representations of war to enhance an empirically supported psychotherapy. The inventors had to negotiate competing concerns to design, research, and promote a tool clinicians will accept that also makes therapy look "cool" enough to garner popular support and military funding. Not actually a game, Virtual Iraq has been made to perform as game-like in order to create a cultural place for it as a tool for transforming the public image of therapy to conform to concepts of military masculinity--a performance sometimes at odds with medical legitimacy. The development of VR exposure therapy (VRET) is therefore a site wherein issues of medical legitimacy, militarized masculinity, and technological innovation are negotiated. As the first large-scale clinical trial of VRET began in April 2011, the project charts the development of a technological practice that may fundamentally change psychotherapy. As a biography of a technology in the making, this is the first major investigation of clinical VR from a cultural perspective, providing historical, ethnographic, and discursive insight into a young field that has the potential to affect how thousands of people receive mental health care, as well as the kind of care they expect