Skip to main content

Advertisement

SpringerLink
Log in

Conflicting Notions on Violence and PTSD in the Military: Institutional and Personal Narratives of Combat-Related Illness

  • Original Paper
  • Published:
Culture, Medicine, and Psychiatry Aims and scope Submit manuscript

Abstract

Research indicates that soldiers struggling with PTSD under-utilize mental health care. Quantitative studies of barriers to care point to the importance of soldiers’ beliefs about mental health and mental health interventions in their care-seeking behavior, yet these studies still struggle to understand the particular beliefs involved and the ways they impact care-seeking behavior. This preliminary study makes a start in examining these questions through qualitative literature analysis. It maps out dominant messages surrounding PTSD in military mental health interventions, and explores how they can both shape and conflict with soldiers’ personal notions. It does so by analyzing these messages and notions as institutional and personal (illness) narratives. Institutional military PTSD-narratives, which draw on mainstream scientific and clinical models, appear to communicate contradictory notions on the meanings of violence and its psychological consequences, often without acknowledging these contradictions. As such, these narratives seem to shape struggles of soldiers, both within themselves and with the military institution. The identified conflicts indicate, contrary to the individualizing and decontextualizing focus of dominant PTSD-understandings, that soldiers’ struggles also have social and moral dimensions. This has important implications for both research into PTSD-interventions and understandings of PTSD as such.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. See also e.g., http://www.ptsd.va.gov/apps/AboutFace/questions--what-ptsd-is.html [A website of the US Veteran Affairs National Center for Posttraumatic Stress Disorder]; http://www.pdhealth.mil/wot/fact_sheet2.asp [A website of the US DoD Deployment Health Clinical Center]. (Accessed at 08-04-2015).

  2. To be sure, cognitive behavioral therapies do not simply aim to restore pre-deployment cognitive schemes. They may aim to help altering cognitive schemes. But the premise of, for instance, exposure therapy is still that soldiers’ thoughts and behaviors are changeable interpretations of the world rather than ‘knowledge.’

References

  • Adler, Amy B., Roos Delahaij, Suzanne M. Bailey, Carlo Van den Berge, Merle Parmak, Barend van Tussenbroek, José M. Puente, Sandra Landratova, Pavel Kral, Guenter Kreim, Deirdre Rietdijk, Dennis McGurk, Carl A. Castro 2013 NATO Survey of Mental Health Training in Army Recruits. Military Medicine 178(7):760–766.

    Article  Google Scholar 

  • American Psychiatric Association 2013 The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM 5. Arlington, VA: American Psychiatric Association.

    Google Scholar 

  • Ben-Zeev, Dror, Patrick W. Corrigan, Thomas W. Britt, and Linda Langford 2012 Stigma of Mental Illness and Service Use in the Military. Journal of Mental Health 21(3): 264–273.

  • Boermans, Sylvie, Roos Delahaij, Hans Korteling, and Martin Euwema 2012 High-Risk Environments: Towards a Strength-Based Approach within the Military. In International Handbook of Workplace Trauma Support. Rick Hughes, Andrew Kinder, and Cary L. Cooper, eds., pp. 313–322. John Wiley & Sons.

  • Bouma, Kaya, Charlotte Waaijers, and Leonie Sellies 2014 “Je Bent Veilig Terug, Waar Zeik Je Nog Over” [“You Are Back Safely, What Are You Nagging About”]. Volkskrant, April 26.

  • Bourke, Joanna 1998 Disciplining the Emotions: Fear, Psychiatry and the Second World War. In War, Medicine and Modernity. Roger Cooter, Mark Harrison, and Steve Sturdy, eds., pp. 225–238. Thrupp, Stroud: Sutton Publishing.

    Google Scholar 

  • Cardona, Robert Andrew, and Elspeth Cameron Ritchie 2007 US Military Enlisted Accession Mental Health Screening: History and Current Practice. Military Medicine 172(1): 31–35.

    Article  Google Scholar 

  • Casey, George W. 2011 Comprehensive Soldier Fitness: A Vision for Psychological Resilience in the U.S. Army. American Psychologist 66(1): 1–3.

  • Cohn, Joseph, Gershon Weltman, Raj Ratwani, Don Chartrand, and Rollin McCraty 2010 Stress Inoculation through Cognitive and Biofeedback Training. Arlington, VA: Office of Naval Research.

    Google Scholar 

  • Dehue, Trudy 2011 “Ik Maak Drukte Want Ik Ben Een Druktemaker”. De Medicalisering van “Ongewenst Gedrag”. [‘I Make Trouble Because I Am a Troublemaker’. The Medicalization of “Unwanted” Behavior’.]. De Groene Amsterdammer, November 3: 30–33.

  • Difede, JoAnn, Megan Olden, and Judith Cukor 2014 Evidence-Based Treatment of Post-Traumatic Stress Disorder. Annual Review of Medicine 65: 319–332.

    Article  Google Scholar 

  • Eidelson, Roy, Marc Pilisuk, and Stephen Soldz 2011 The Dark Side of Comprehensive Soldier Fitness. American Psychologist 66(7): 643– 644.

    Article  Google Scholar 

  • Fassin, Didier, and Richard Rechtman 2009 The Empire of Trauma: An Inquiry Into the Condition of Victimhood. Princeton, N.J.: Princeton University Press.

    Google Scholar 

  • Faust, David, and Richard A. Miner 1986 The Empiricist and His New Clothes: DSM-III in Perspective. The American Journal of Psychiatry 143(8): 962–967.

    Article  Google Scholar 

  • Finley, Erin P. 2009 Fields of Combat: Understanding PTSD Among Veterans of Iraq and Afghanistan [Ph.D. dissertation]. Department of Anthropology, Emory University.

  • Good, Byron J. 1994 Illness Representations in Medical Anthropology: A Reading of the Field. In Medicine, Rationality and Experience: An Anthropological Perspective. B. J. Good, ed., pp. 25–64. Cambridge University Press.

  • Hautzinger, Sarah, and Jean Scandlyn 2013 Beyond Post-Traumatic Stress: Homefront Struggles with the Wars on Terror. Walnut Creek, CA: Left Coast Press.

    Google Scholar 

  • Herman, David, Manfred Jan, and Marie-Laure Ryan 2005 Routledge Encyclopedia of Narrative Theory. New York: Routledge.

    Google Scholar 

  • Hoge, Charles W., Carl A. Castro, Stephen C. Messer, Dennis McGurk, Dave I. Cotting, and Robert L. Koffman 2004 Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. New England Journal of Medicine 351(1): 13–22.

    Article  Google Scholar 

  • Hooyer, Katinka 2012 Going AWOL: Alternative Responses to PTSD Stigma in the US Military. Field Notes 4(1): 106–128.

    Google Scholar 

  • Hull, Alastair M. 2002 Neuroimaging Findings in Post-Traumatic Stress Disorder Systematic Review. The British Journal of Psychiatry 181: 102–110.

    Article  Google Scholar 

  • Iversen, Amy C., Lauren van Staden, Jamie H. Hughes, Neil Greenberg, Matthew Hotopf, Roberto J. Rona, Graham Thornicroft, Simon Wessely, and Nicola T. Fear 2011 The Stigma of Mental Health Problems and Other Barriers to Care in the UK Armed Forces. BMC Health Services Research 11(31): 1–10.

    Google Scholar 

  • Jones, Edgar, K. C. Hyams, and Simon Wessely 2003 Review: Screening for Vulnerability to Psychological Disorders in the Military: An Historical Survey. Journal of Medical Screening 10(1): 40–46.

    Article  Google Scholar 

  • Jones, Edgar, and Simon Wessely 2007 A Paradigm Shift in the Conceptualization of Psychological Trauma in the 20th Century. Journal of Anxiety Disorders 21(2): 164–175.

    Article  Google Scholar 

  • De Jong, Joop T.V.M. 2005 Commentary: Deconstructing Critiques on the Internationalization of PTSD. Culture, Medicine and Psychiatry 29(3): 361–370.

    Article  Google Scholar 

  • Kamp, Ellen, and Olaf Binsch 2012 Serious Gaming and Bio Physiology as a “Way In” for Resilience Training. Paper Presented at the 54th International Military Testing Association Conference, Dubrovnik, Croatia, November 5-9.

  • Kienzler, Hanna 2008 Debating War-Trauma and Post-Traumatic Stress Disorder (PTSD) in an Interdisciplinary Arena. Social Science & Medicine 67(2): 218–227.

    Article  Google Scholar 

  • Kim, Paul Y., Jeffrey Thomas, Joshua Wilk, Carl Castro, and Charles Hoge 2010 Stigma, Barriers to Care, and Use of Mental Health Services Among Active Duty and National Guard Soldiers After Combat. Psychiatric Services 61(6): 582–588.

    Article  Google Scholar 

  • Kleinman, Arthur, K. 1988 The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books.

    Google Scholar 

  • Lifton, Robert J. 2005 Home from the War: Learning from Vietnam Veterans. New York: Other Press.

    Google Scholar 

  • Litz, Brett T., Nathan Stein, Eileen Delaney, Leslie Lebowitz, William P. Nash, Caroline Silva,and Shira Maguen 2009 Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy. Clinical Psychology Review 29(8): 695–706.

    Article  Google Scholar 

  • MacLeish, Kenneth T. 2013 Making War at Fort Hood: Life and Uncertainty in a Military Community. Princeton, N.J.: Princeton University Press.

    Google Scholar 

  • Martens, Wil, and Ad Zijlmans 2003 Psychological Support Pre- During and Post-Deployment. Amersfoort: Dutch Department of Defense.

    Google Scholar 

  • Mattingly, Cheryl. 1994 The Concept of Therapeutic ‘Emplotment’. Social Science & Medicine 38(6): 811- 822.

    Article  Google Scholar 

  • Meichenbaum, Donald 2011 Resilience-Building as a Means to Prevent PTSD and Related Adjustment Problems in Military Personnel. In Treating PTSD in Military Personnel: A Clinical Handbook. Bret A. Moore and Walter E. Penk, eds. Pp. 325–344. New York: Guilford Press.

    Google Scholar 

  • MGGZ 2008 De Overgang van Uitzendgebied naar Thuis [The Transition from the Deployment Area to Home] [Instruction Guide]. CDC/BGGZ/MGGZ/Zorglijn Uitzendingen, Dutch Department of Defense.

  • Morse, Stephen J. 2008 Vice, Disorder, Conduct, and Culpability. Philosophy, Psychiatry, & Psychology 15(1): 47–49.

    Article  Google Scholar 

  • Mulligan, Kathleen, Nicola T Fear, Norman Jones, Helen Alvarez, Lisa Hull, Ulrike Naumann, Simon Wessely, and Neil Greenberg 2012 Postdeployment Battlemind Training for the U.K. Armed Forces: A Cluster Randomized Controlled Trial. Journal of Consulting and Clinical Psychology 80(3): 331–341.

  • Mulligan, K., N. T. Fear, N. Jones, S. Wessely, and N. Greenberg 2011 Psycho-Educational Interventions Designed to Prevent Deployment-Related Psychological Ill-Health in Armed Forces Personnel: A Review. Psychological Medicine 41(4): 673–686.

    Article  Google Scholar 

  • Nash, William P., Caroline Silva, and Brett Litz 2009 The Historic Origins of Military and Veteran Mental Health Stigma and the Stress Injury Model as a Means to Reduce It. Psychiatric Annals 39(8): 789–794.

    Article  Google Scholar 

  • Nesse, Randolph, and Dan Stein 2012 Towards a Genuinely Medical Model for Psychiatric Nosology. BMC Medicine 10(5): 1–9.

    Google Scholar 

  • Perilla, Julia L., Fran H. Norris, and Evelyn A. Lavizzo 2002 Ethnicity, Culture, and Disaster Response: Identifying and Explaining Ethnic Differences in PTSD Six Months After Hurricane Andrew. Journal of Social and Clinical Psychology 21(1): 20–45.

    Article  Google Scholar 

  • Pilgrim, David 2011 The Hegemony of Cognitive-Behaviour Therapy in Modern Mental Health Care. Health Sociology Review 20(2): 120–132.

    Article  Google Scholar 

  • Radden, Jennifer 1994 Recent Criticism of Psychiatric Nosology: A Review. Philosophy, Psychiatry, & Psychology 1(3): 193–200.

    Google Scholar 

  • Robins, Richard, W., Samuel Gosling D., and Kenneth Craik H. 1999 An Empirical Analysis of Trends in Psychology. American Psychologist 54(2): 117–128.

  • Rona, Roberto J., Kenneth C. Hyams, and Simon Wessely 2005 Screening for Psychological Illness in Military Personnel. Jama 293(10): 1257–1260.

    Article  Google Scholar 

  • RTO 2000 Officer Selection. Papers Presented at the RTO Human Factors and Medicine Panel, Montery, USA, November 9-11.

  • Schipholt, Ingrid L.E. 2007 Sommigen Voelen Nu Nog Niks, Anderen Huilen [Some Still Feel Nothing, Others Cry]. Medisch Contact 19: 816–818.

    Google Scholar 

  • Scott, Wilbur J. 1990 PTSD in DSM-III: A Case in the Politics of Diagnosis and Disease. Social Problems 37: 294–310.

    Article  Google Scholar 

  • Sharpley, J. G., N. T. Fear, N. Greenberg, M. Jones, and S. Wessely 2008 Pre-Deployment Stress Briefing: Does It Have an Effect? Occupational Medicine 58(1): 30–34.

    Article  Google Scholar 

  • Shay, Jonathan 2010 Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Simon and Schuster.

  • Steenkamp, Maria M., William P. Nash, and Brett T. Litz 2013 Post-Traumatic Stress Disorder. Review of the Comprehensive Soldier Fitness Program. American Journal of Preventive Medicine 44(5): 507–512.

  • Stein, Dan J, Soraya Seedat, Amy Iversen, and Simon Wessely 2007 Post-Traumatic Stress Disorder: Medicine and Politics. The Lancet 369(9556): 139– 144.

    Article  Google Scholar 

  • Sturken, Marita 1998 The Remembering of Forgetting: Recovered Memory and the Question of Experience. Social Text(57): 103–125.

  • Suarez, Eliana Barrios 2013 Trauma in Global Contexts: Integrating Local Practices and Socio-Cultural Meanings into New Explanatory Frameworks of Trauma. International Social Work 6: 1–13.

    Google Scholar 

  • Summerfield, Derek 1999 A Critique of Seven Assumptions Behind Psychological Trauma Programmes in War- Affected Areas. Social Science & Medicine 48(10): 1449–1462.

    Article  Google Scholar 

  • Summerfield, Derek 2000 War and Mental Health: A Brief Overview. British Medical Journal 321(7255): 232– 235.

    Article  Google Scholar 

  • Vermetten, Eric, Greenberg, Neil, Boeschoten, Manon, Delahaije, Roos, Jetly, Rakesh, Castro, Carl, and McFarlane, Alexander 2014 Deployment-Related Mental Health Support: Comparative Analysis of NATO and Allied ISAF Partners. European Journal of Psychotraumatology 5.

  • Wool, Zoë H. 2012 On Movement: The Matter of US Soldiers’ Being After Combat. Ethnos 78(3): 403– 433.

    Article  Google Scholar 

  • Wool, Zoë Hamilton 2011 Emergent Ordinaries at Walter Reed Army Medical Center: An Ethnography of Extra/Ordinary Encounter. Toronto: University of Toronto.

    Google Scholar 

  • WRAIR Land Combat Study Team 2006 Battlemind Training I: Transitioning from Deployment to Home [Instruction Guide]. http://www.ptsd.ne.gov/pdfs/WRAIR-battlemind-training-Brochure.pdf, accessed February 20, 2015.

  • Yehuda, Rachel 1999 Biological Factors Associated With Susceptibility to Posttraumatic Stress Disorder. Canadian Journal of Psychiatry 44: 34–39.

    Google Scholar 

  • Yehuda, Rachel, and Linda M. Bierer 2007 Transgenerational Transmission of Cortisol and PTSD Risk. Progress in Brain Research 167: 121–135.

    Article  Google Scholar 

  • Young, Allan 1997 The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton, N.J.: Princeton University Press.

    Book  Google Scholar 

  • Zaidi, Lisa Y., and David W. Foy 1994 Childhood Abuse Experiences and Combat-Related PTSD. Journal of Traumatic Stress 7(1): 33–42.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Military Management Studies, Faculty of Military Sciences, Netherlands Defence Academy, Breda, The Netherlands

    Tine Molendijk, Eric-Hans Kramer & Désirée Verweij

Authors
  1. Tine Molendijk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric-Hans Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Désirée Verweij
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tine Molendijk.

Ethics declarations

Conflict of interest

Tine Molendijk declares that she has no conflict of interest. Eric-Hans Kramer declares that he has no conflict of interest. Désirée Verweij declares that she has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Molendijk, T., Kramer, EH. & Verweij, D. Conflicting Notions on Violence and PTSD in the Military: Institutional and Personal Narratives of Combat-Related Illness. Cult Med Psychiatry 40, 338–360 (2016). https://doi.org/10.1007/s11013-015-9469-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11013-015-9469-0

Keywords

Search

Navigation