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.

David Kieran is Assistant Professor of History and Director of the American Studies concentration at Washington & Jefferson College. He is the author of Forever Vietnam: How a Divisive War Changed American Public Memory, and editor of The War of My Generation: Youth Culture and the War on Terror.

One comes away from Signature Wounds with a healthy respect for the military's attempts to understand and manage [PTSD and TBI], and an even greater contempt for the armchair hawks most responsible for creating them.

A significant contribution to understanding the long-term human costs and consequences of the wars in Iraq and Afghanistan. Afoundational work in this field.

An impressive work on a vitally important, yet understudied topic that is both illuminating and compelling. For an American society still grappling with the multifaceted problems of endless war, this is an extraordinarily relevant book that deserves a wide readership.

A challenge to conventional wisdom about the military ignoring PTSD, traumatic brain injury and suicide among troops who have served in Iraq and Afghanistan. [Kieran] takes readers inside the medical arm of military services and civilian government bureaucracies showing how dedicated researchers and administrators trying to reach consensus about how to treat - and perhaps even prevent - serious mental damage and suicide...an intriguing study.

Because David Kieran is so fair-minded, his analysis of the mentalhealth crisis in the U.S. military is devastating and persuasive.Signature Wounds provides a judicious, yet stunning, rebuke to a culturethat incessantly reminds us to support our troops yet acquiesces toendless wars that expose them to levels of psychological trauma nomental health program could possibly prevent or adequately treat.