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From warfare to welfare: a comparative study of how combat trauma is internalized and institutionalized

Final Report Summary - COMBATTRAUMA (From warfare to welfare: a comparative study of how combat trauma is internalized and institutionalized)

This project was an anthropological study of military mental health and mental health care conducted in four countries: the United States, the United Kingdom, the Netherlands, and Israel. The core method was ethnography, an immersion method used to gain insights into how research subjects interpret their own experience and act in different environments. Ethnography was also chosen to build trust and probe sensitive issues relating to mental illness and military service that often go under the radar of surveys. Research was conducted at three societal levels: living with trauma, treating trauma, and institutionalizing trauma.

The result was a holistic and up-close portrait of soldiers’ and veterans’ lives, their mental health problems, and help-seeking. By accompanying subjects in everyday activities and through repeat contacts, the researchers gained understanding of some of the struggles an often misunderstood group faces. These include coping with lingering psychosocial effects of violence, but also other life problems arising during the transition to civilian life. Research with clinicians shed light on their clinical reasoning as well as the considerable pressures they face, and how they respond to them.

The research is being disseminated via a variety of scholarly and other forums. The team delivered 48 talks to diverse audiences, composed of academics, stakeholders (including veterans, military personnel, and mental health clinicians), and the general public. Some team members also initiated collaborations with external institutions or academics. For example, in consultation with the Veterans Institute of the Netherlands, Roy Gigengack undertook a project that built Dutch research capacity on veterans’ position in society, and experimented with “apprenticeship models” of research. The team convened three international conference panels, one at the European Research Group on Military and Society (ERGOMAS) 2017 conference in Athens (Greece), and a double panel at the 2018 European Association of Social Anthropology conference in Stockholm (Sweden). It also hosted an international conference at the Van Leer Institute in Jerusalem (Israel) in April 2018 with the participation of officials from the Ministry of Rehabilitation for Veterans.

Overall, the project’s multi-sited approach showed that service-related mental illness is a dynamic condition that unfolds within changing social, moral and expert environments. For example, whether illness is linked to military service is often contested. Many research subjects experienced problems with trust, bureaucratic conflicts, or moral dissonance during assessment or treatment that contributed to barriers to care. Others rejected help as they sought to distance themselves from those whom they viewed as taking advantage of the system. The project also yielded insights into the conditions that support healing and connection, both within and outwith formal health care.

These findings are significant because much prior mental health research has standardized disease objects that can be measured and treated across context. In contrast, this project has shown significant differences in illness experiences between nations and health care systems. It demonstrated the need for more interventions and policies that are tailored to specific groups and that take into account how institutional practices affect illness and help-seeking.

The project also advanced social science studies of mental health by examining relationships between terror and trauma, that is, between historical forms of warfare and illness. During the War on Terror some soldiers faced tactics that could put them at risk of developing traumatic illness. At the same time soldiers’ actions during combat came under more forensic scrutiny as militaries tried to “win hearts and minds” or address wars’ legitimacy problems. Militaries too were held more accountable for fulfilling a duty of care to the armed forces community. In these conditions military mental health came to have a political life beyond the clinic. Soldiers and veterans brought claims against militaries and governments, whilst mental illness could be used for judicial or administrative purposes, such as explaining violence or managing workplace conflicts. This project contributed a political ecology of trauma that shows how it is shaped by the institutions that govern military lives.