Doctoral Dissertation Research: Mild Traumatic Brain Injury, Medical Uncertainty, and Disability in the U.S. Military Healthcare System

University Of Washington, Seattle WA

Investigators

Abstract

The wars in Afghanistan and Iraq are characterized by an exceptionally high ratio of American troops who survive combat with injuries. It has been estimated that nearly twenty percent of surviving troops have sustained traumatic brain injuries (TBI). The vast majority of these are mild TBI, also known as concussion, the most common type of TBI and the least recognizably visible as an injury that has lasting effects. In the past twenty years the Department of Veterans Affairs (VA) and the Department of Defense have raised the profile of this otherwise "invisible injury" by connecting brain injury to troops' puzzlingly persistent memory problems, cognitive impairment, irritability and anxiety. This ethnographic study of post-9/11 TBI investigates how mild TBI is organized by clinicians, patients, and benefits specialists as a 'signature wound" of the country's most recent wars, and the effects of this emerging causal relationship between head injuries and troops' post-combat experiences. What historically-specific social processes and suppositions about the self, the body, the brain, and war-fighting are written into current constructions of mild TBI? This study uses interviews and observation to collect data about the everyday experiences and observations of three groups of people, VA patients, VA clinicians, and veterans' benefits specialists, with the aim of understanding (1) the production of scientific/medical knowledge about "invisible" forms of TBI, (2) the consequences of TBI's "invisibility", and (3) its subjective and institutional meaning as a disability. Though it is not a new injury, mild TBI's recent association with combat has positioned the military and the VA as powerful stakeholders in the negotiation of its contemporary meaning as an injury and as a cause of lasting disability. By documenting the complexities and consequences of this redefinition of concussion as a serious health risk, this study contributes to the public's understanding of one of the cultural legacies of the post-9/11 wars. This research contributes to the anthropological study of disability and medical anthropology. The research has the potential to make a contribution to the understanding of the military health care system when the use of that system has accelerated. Given the number of veterans returning from Iraq and Afghanistan with TBI, this research is timely. This research will provide much needed detail about how this disability is treated and the challenges veterans face. The results of this research will be shared with military professionals and among anthropologists interested in studies of the military and disability. The project will also provide for the training of a graduate student in anthropology.