Beyond PTSD: Deployment Stress on a Post-9/11 Homefront
When soldiers return to the United States from the wars in Iraq and Afghanistan, they bring with them more than medals, battle stories and visible wounds. The unseen effects from their experiences – combat-stress and moral injuries, depression and suicide, substance abuse, and higher propensities to violence – ripple through the lives of combat veterans, their families, friends and wider communities for years to come. Ideally, conversations and stories ripple outward as well, about patrols and battles but also about what happened at home, about sacrifices made and costs dearly paid, stories that seek to make sense of the wars and their experiences.
The Deployment Stress Project (2008-present) chases those ripples through ongoing faculty-student collaborative, community-based research housed out of the Colorado College and in conjunction with the University of Colorado Denver. Led by anthropologists Sarah Hautzinger and Jean Scandlyn, over twenty student researchers have participated in the project (See “Researchers”).
Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI) and depression, identified as the “signature injuries” of these conflicts, have dominated public and private, individual and collective conversations around the effects of the wars. But many of the stories we need to tell cannot be confined to those directly linked to combat trauma writ small; combat stress injuries are but the most acute expression of a broader complex of stressors placed on individuals, relationships, institutions and infrastructure resulting from repeated deployments. Going “beyond PTSD,” and focusing on what we label “deployment stress” reflects how we broadened the work’s scope. We consider the Army’s internal responses to the behavioral health crisis in returning soldiers, but also explore efforts and struggles in the surrounding community, including families, local health-care and service providers, advocates, schools, police, courts, and not-for-profits across all these sectors. At the same time, we examine how processes of globalization, national military and Veterans Administration policies, and technologies of war and medicine that give the post-9/11 wars their unique character, affect soldiers’ experience upon return, as well as those in the institutions and communities that care for them.
The city of Colorado Springs, Colorado, adjacent to the nation’s second-largest Army post, Fort Carson, is the particular “homefront” that hosts this account. There is nowhere better to explore reintegration challenges than in the Pikes Peak region, where Fort Carson counts as one of the named “Centers of Excellence” for addressing PTSD, and where hundreds of programs and non-profits have sprung up to address combat veterans’ new needs and challenges. Yet the kinds of homecomings and reintegration struggles we chronicle are occurring across the United States, and will continue to unfold for decades to come. In our invoking the word “homefront” -- that already-militarized term -- readers may recognize our debt to Catherine Lutz’s seminal work Homefront: A Military City and the American 20th Century. Published in 2001 on the eve of 9/11, Lutz analyzed the relationship between Fort Bragg and the city of Fayetteville, North Carolina. This work offers a portrayal of an equally “military city,” but ours is a decidedly post-9/11 account, focused on the later years of a decade in which the world, to so many, suddenly appeared drastically, irrevocably changed.
With Fort Carson occupying some 216 square miles to the city’s south, Colorado Springs is not merely “The Best Home Town in the Army,” but also literally surrounded by additional bases. Two Air Force bases (Schriever and Peterson/NORTHCOM) flank the east, and NORAD and the Air Force Academy round out its western and northern edges. Over 25% of the Colorado Springs workforce is employed in the defense industry.[i] Despite the identification of the Colorado Springs area – along with such cities as San Diego, San Antonio, Virginia Beach, and Fayetteville – as singularly military and militarized, in an important sense this does not make them atypical American locales. Consider that the “U.S. military is far and away the country’s largest employer, leaving Wal-Mart, the Post Office, and General Motors in the dust” in providing jobs to 1.4 million service members and 700,000 civilians. In this light, military towns are just places where the degree to which “every aspect of the American way of life began to depend on, entwine with, or suffer from a massive investment in arms and armies” becomes less deeply hidden than it is in most communities around the nation.[ii]
Three singular features of the post-9/11 wars provide critical context for this study. First is the elevated ratio of 9.2 wounded service members for every service member who dies (as compared to 2.2 to 1 for all U.S. wars 1775-1991). Many more survive, and face learning to recover or cope with injuries at the same time they confront reintegration challenges. Second is the All-Volunteer Force; with the abolition of the draft in 1973, these wars are the first protracted conflicts fought by a professionalized force, and also the conditions leading to repeated tours of unprecedented number (Yingling 2010) – up to five year-long tours for regular Army personnel. It matters that many may view themselves as de facto economic (and/or regional and/or ethnic-racial) draftees. This has meant that the lives of select sectors of Americans, military and civilian alike, are intensely affected by the wars, while major sectors remain largely disengaged. As an angry father of a veteran with severe TBI and PTSD declared, “I want to understand why a country thinks it’s okay for one half of one percent to fight its wars while everybody else goes to the mall.” In this light, understanding how “community” responses shape recovery and reintegration processes requires attending to civilian-military “cross-cultural” relations, both where these are tightly enmeshed, and where they are polarized or disconnected. A third key element is the open-ended nature of the post-9/11 wars. Training “to fight the last war” may be a perennial problem, but what the military calls GWOT (the Global War on Terror) presents unique territory by any measure, in its diffuse geographical nature, particularly the low-intensity, urban conflicts in which civilians can be indistinguishable from the enemy and whose combatants may not all be aligned with a nation state. The nature of the wars – including their uncertainties and, for many, their unpopularity – shapes how combat veterans enjoin their communities, both in what is said and what remains largely unspoken.
The central component of the Deployment Stress Project is the book in progress, Beyond PTSD. The work’s titleis not meant to minimize the importance of combat stress and moral injuries as an important reflection of the costs of war. Rather, the title indicates the “both/and” strategy of the book: PTSD is one critical measure of war’s effects on soldiers and their surrounding community, but our cost-accounting narration of the effects of the wars cannot stop there. We argue that recognizing and treating PTSD is a necessary, but not sufficient, response to soldiers’ and communities’ efforts to “come back” and heal from war. PTSD needs decentering: it should not sideline attention to other injuries, Traumatic Brain Injuries in particular, or to soldiers’ resistance to medical diagnoses and treatment as the sole pathway to recovery. This text explores the many pathways that soldiers and their surrounding communities charter in response to the challenges of coming home.
The book “decenters” or moves beyond PTSD in other ways. We “decenter” the experience of war away from a single-pointed focus on the warrior-protagonist, by introducing how its effects play out in domestic settings, and how local actors become part of the story. In place of the Odyssean, epic mythology of the hero’s journey that underpins so many accounts of the aftermath of combat, we introduce the notion of war as a labyrinth that ensnares the lives of many who reside far from the battlefield. Finally, we decenter the conception that the injuries of war are primarily individual, medical issues, and instead insist on their social and collective dimensions, which are crucial to recovery, reintegration, and reconciliation with war’s impact.
Part I of the book portrays returning soldiers as they struggle to find paths “all the way home,” and especially those facing combat stress and trauma. It asks not what PTSD is, but why PTSD has become the predominant expression of the suffering of military personnel and their families at this particular historical moment. Although the symptoms of PTSD are universal biological responses to trauma, the diagnosis of PTSD is a social and symbolic process that affects how those responses are interpreted, explained, named and treated. We explore how PTSD has changed in light of new technology of weapons and military tactics, the political, economic and social characteristics of the All-Volunteer-Force and cultural conceptions and discourses of the mind and body.
Part II shifts the spotlight away from the soldier-hero to illuminate the “supporting cast”: the spouses and other family members; providers of health, social and pastoral services; and community organizations, including those engaged in protesting the wars and Army attempts to expand in the local region. How does Colorado Springs compare with other comparably sized cities that are and are not located adjacent to major military bases? How has the area’s history of actively seeking military investment affected local schools, businesses, non-profit organizations and law enforcement? We follow those intimately connected to the wars as they navigate new bureaucratic terrain in search of care and benefits, and new social and emotional “normals” that accept absence, permanent disabilities, grief and loss, and altered personalities and relationships. Finally, Part III moves into the community, exploring efforts to convene fact-to-face dialogue in varied settings, across sharp social and political divisions.
[i] Pikes Peak Quality of Life Indicators, 2011.
[ii] Lutz, Catherine. 2010. “Warmaking and the American Way of Life.” In The Insecure American, H. Gusterson and C. Besteman, eds. University of California Press: Berkeley, CA. 47, 45.
Baleria, Evelyn, RNS, CNS, CCM, Behavioral Health Center of Excellence, Colorado Springs, CO.
Bayendor, David, BA. M.A. student in Anthropology, University of Colorado Denver and Behavioral Health Specialist, U.S. Army Reserves, Denver, CO.
Bickford, Andrew, Ph.D. Assistant Professor of Anthropology and Sociology, George Mason University, Fairfax, VA.
Copeland, Jessica Giles, Ph.D. Associate Director, Partnership for Civic Engagement and Visiting Assistant Professor of Psychology, Colorado College, Colorado Springs, CO.
Cunningham, Marilyn, MA Anthropology. Former Family-Readiness Group Specialist, Fort Carson, CO; Former Instructor in Spouse Leadership Training Ft. Bliss, El Paso, TX.
Enloe, Cynthia, Ph.D. Research Professor, Departments of International Development, Community, and Environment (IDCE) and Women’s Studies, Clark University, Worcester, MA.
Finley, Erin, Ph.D. Research Health Scientist, Veterans Evidence-based Research, Dissemination & Implementation Center (VERDICT), South Texas Veterans Health Care System; Adjunct Assistant Professor, Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center, San Antonio, TX.
Lutz, Catherine, Ph.D. Thomas J. Watson, Jr. Family Professor of Anthropology and International Studies; Chair, Department of Anthropology; Research Professor, Watson Institute for International Studies, Brown University, Providence, RI.
McCormick, Jill. J.D., M.S.W. Doctoral student in Health and Behavioral Sciences, University of Colorado Denver, Denver, CO and Staff, Court Appointed Special Advocates (CASA), Colorado Springs, CO.
Nicodemus, Amber, B.S. Army spouse, resident of Colorado Springs, and founder of Cognogenesis Brrain Center in Colorado Springs, CO.
Terrio, Heidi, MD, MPH. Colonel. Former Chief of Deployment Health, Evans Army Hospital, Fort Carson, CO (until spring 2011).
Taylor, T.G., Major. Public Affairs Officer, 4-4 BCT, Fort Carson, CO (until summer 2010).