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Culture, Medicine, and Psychiatry

, Volume 42, Issue 4, pp 778–799 | Cite as

Competing Constructivisms: The Negotiation of PTSD and Related Stigma Among Post-9/11 Veterans in New York City

  • Luther ElliottEmail author
  • Alexander S. Bennett
  • Kelly Szott
  • Andrew Golub
Original Paper
  • 201 Downloads

Abstract

Posttraumatic stress disorder (PTSD) stands as a form of psychopathology that straddles moral and psychiatric domains. Grounded in discrete instances of trauma, PTSD represents an etiological outlier in an era of increased attention to the genetics of mental illness and a prime location for social constructivist analyses of mental illness. This examination of PTSD narratives—as voiced in qualitative interviews and focus groups with 50 veterans of the recent Iraq and Afghanistan wars living in New York City—attends to the processes through which veterans conceive and navigate PTSD symptoms and diagnoses. In so doing we highlight the social constructivist positions undertaken by veterans themselves as they varyingly challenge and internalize symptomology in dialogue with psychiatric definitions and the stigma associated with PTSD. Findings demonstrate the rejection of classic psychopathological etiology—in brain disease, for example—by many veterans as well as the complex balancing of benefit and stigma that veterans undertake when making decisions about presenting to psychiatric clinicians. Drawing on veterans’ accounts, we argue for greater cultural specificity in characterizing the diagnosis-seeking behavior of trauma survivors and a greater appreciation for the contradictions and compromise related to both acceptance and rejection of a mental health diagnosis.

Keywords

Post-traumatic stress Social construction Military veterans 

Notes

Funding

This research was supported by Grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA; R01 AA020178) and the National Institute on Drug Abuse (NIDA; R01 DA036754-01A1). Points of view expressed in this paper do not necessarily represent the official position of the U.S. Government, NIAAA, NIDA, or NDRI.

Compliance with Ethical Standards

Conflict of interest

None of the authors has received any research grants or other forms of funding or support other than those listed above. All four authors declare that they have no conflicts of interest.

Ethical Approval

This article does not contain any procedures with animals performed by any of the authors. All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study and all study.

References

  1. Acosta, Joie D., Amariah Becker, Jennifer L. Cerully, Michael P. Fisher, Laurie T. Martin, Raffaele Vardavas, Mary E. Slaugher, and Terry L. Schell. 2014. Mental health stigma in the military. Santa Monica, CA: RAND Corporation.CrossRefGoogle Scholar
  2. American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Arlington, VA: American Psychiatric Association.CrossRefGoogle Scholar
  3. Andreasen, Nancy C. 1995. Posttraumatic Stress Disorder: Psychology, Biology, and the Manichaean Warfare Between False Dichotomies. The American Journal of Psychiatry, 152(7), 963-965.CrossRefGoogle Scholar
  4. Andrews, Bernice, Chris R. Brewin, Rosanna Philpott, and Lorna Stewart. 2007. Delayed Onset Posttraumatic Stress Disorder: A Systematic Review of the Evidence. The American Journal of Psychiatry, 164, 1319-1326.CrossRefGoogle Scholar
  5. Bell, S. E. 2000. Experiencing Illness in/and Narrative. In C. E. Bird, P. Conrad, & A. M. Freemont (Eds.), Handbook of Medical Sociology (5th ed., pp. 184–199). Saddle River, NJ: Prentice Hall.Google Scholar
  6. Bennett, Alex S., Luther Elliott, and Andrew Golub. 2013. Opioid and Other Substance Misuse, Overdose Risk, and the Potential for Prevention among a Sample of OEF/OIF Veterans in New York City. Substance use & misuse, 48(10), 894-907.CrossRefGoogle Scholar
  7. Bergen-Cico, Dessa K. 2012. War and Drugs: The Role of Military Conflict in the Development of Substance Abuse. Boulder, CO: Paradigm Publishers.Google Scholar
  8. Bowers, Leonard. 2003. The Social Nature of Mental Illness. New York: Routledge.CrossRefGoogle Scholar
  9. Bremner, J. Douglas. 2006. The Relationship Between Cognitive And Brain Changes in Posttraumatic Stress Disorder. Annals of the New York Academy of Sciences, 1071(1), 80-86.CrossRefGoogle Scholar
  10. Bremner, J. Douglas, Bernet Elzinga, Christian Schmahl, and Eric Vermetten. 2007. Structural and Functional Plasticity of the Human Brain in Posttraumatic Stress Disorder. Progress in Brain Research, 167, 171-186.CrossRefGoogle Scholar
  11. Buckley, Todd C., Edward B. Blanchard, and Edward J. Hickling. 1996. A Prospective Examination of Delayed Onset PTSD Secondary to Motor Vehicle Accidents. Journal of Abnormal Psychology, 105, 617-625.CrossRefGoogle Scholar
  12. Bury, Michael. 1991. The Sociology of Chronic Illness: A Review of Research and Prospects. Sociology of Health & Illness, 13, 451-468.CrossRefGoogle Scholar
  13. Cantor, Chris. 2009. Post-Traumatic Stress Disorder: Evolutionary Perspectives. Australian & New Zealand Journal of Psychiatry, 43(11), 1038-1048.CrossRefGoogle Scholar
  14. Charmaz, Kathy. 1999. Discoveries’ of Self in Illness. In K. Charmaz & D. A. Paternitri (Eds.), Health, Illness, And Healing: Society, Social Context, And Self: An Anthology (pp. 72-82). Los Angeles, CA: Roxbury Publishing Company.Google Scholar
  15. Charmaz, Kathy. 2000. Grounded theory: Objectivist and Constructivist Methods. In N. K. Denzin & Y. Lincoln (Eds.), The Sage Handbook of Qualitative Research (pp. 509-535). Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
  16. Clarke, Adele E., Janet K. Shim, Laura Mamo, Jennifer R. Fosket, and Jennifer R. Fishman 2003 Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine. American Sociological Review, 68(2), 161-194.CrossRefGoogle Scholar
  17. Cohen, Beth E., Kris Gima, Daniel Bertenthal, Sue Kim, Charles R. Marmar, and Karen H. Seal. 2010. Mental Health Diagnoses and Utilization of VA Non-Mental Health Medical Services Among Returning Iraq And Afghanistan Veterans. Journal of General Internal Medicine, 25, 18-24.CrossRefGoogle Scholar
  18. Conrad, Peter. 1987. The Experience of Illness: Recent and New Directions. Research in the Sociology of Health Care, 6, 1-31.Google Scholar
  19. Conrad, Peter. 1992. Medicalization and Social Control. Annual review of Sociology, 18(1), 209-232.CrossRefGoogle Scholar
  20. Conrad, Peter, and Kristin K. Barker. 2010. The Social Construction of Illness: Key Insights and Policy Implications. Journal of Health and Social Behavior, 51, S67-S79.CrossRefGoogle Scholar
  21. Courtwright, David T. 1982. Dark Paradise: Opiate Addiction in America before 1940. Cambridge, MA: Harvard University Press.Google Scholar
  22. Department of Veterans Affairs 2012 DSM-5 Diagnostic Criteria for PTSD Released, https://www.ptsd.va.gov/professional/ptsd-overview/dsm5_criteria_ptsd.asp. Accessed 21 May.
  23. Department of Veterans Affairs. 2013. Federal Benefits for Veterans, Dependents and Survivors. Washington, D.C.: U.S. Government Printing Office.Google Scholar
  24. Eisenberg, Leon. 1977. Disease and Illness: Distinctions between Professional and Popular Ideas of Sickness. Culture, Medicine and Psychiatry, 1, 9-23.CrossRefGoogle Scholar
  25. Elhai, Jon D., Kenneth J. Ruggiero, B Christopher Frueh, Jean C. Beckham, Paul B. Gold, Michelle E. Feldman. 2002. The Infrequency-Posttraumatic Stress Disorder Scale (Fptsd) for the MMPI-2: Development and Initial Validation with Veterans Presenting with Combat-Related PTSD. Journal of Personality Assessment, 79(3), 531-549.CrossRefGoogle Scholar
  26. Elliott, Luther, Andrew Golub, Alex S. Bennett, and Honoria Guarino 2015a PTSD and Cannabis-Related Coping Among Recent Veterans in New York City. Contemporary Drug Problems 42(1):60–76.CrossRefGoogle Scholar
  27. Elliott, Luther, Andrew Golub, Matthew Price, and Alex S. Bennett 2015b More than Just a Game? Combat-Themed Gaming Among Recent Veterans with Posttraumatic Stress Disorder. Games for Health Journal 4(4):271–277.CrossRefGoogle Scholar
  28. Fassin, Didier, and Richard Rechtman 2009 The Empire of Trauma. Trans. Rachel Gomme. Princeton, NJ: Princeton University Press.Google Scholar
  29. Finley, Erin P. 2011 Fields of Combat: Understanding PTSD among Veterans of Iraq and Afghanistan. Cornell University Press, Ithaca, NY.Google Scholar
  30. Foucault, Michel. 1965. Madness and civilization: A history of insanity in the age of reason. New York: Random House.Google Scholar
  31. Gaines, A. D. (1991). Cultural Constructivism: Sickness Histories and the Understanding of Ethnomedicines beyond Critical Medical Anthropologies. In Beatrix Pleiderer and Gilles Bibeau (Eds.), Anthropologies of Medicine (pp. 221-258). Weisbaden, GBR: Vieweg und Sohns.CrossRefGoogle Scholar
  32. Glaser, Barney G. and Anselm L. Strauss. 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research. New York, NY: Aldine De Gruyter.Google Scholar
  33. Goffman, Erving. 1959. The Presentation of Self in Everyday Life. New York, NY: Doubleday.Google Scholar
  34. Goffman, Erving. 1963. Stigma: Notes on the Management of Spoiled Identity. New York: Simon and Schuster.Google Scholar
  35. Golub, Andrew, and Alex S. Bennett. 2014. Substance Use Over the Military–Veteran Life Course: An Analysis of a Sample of OEF/OIF Veterans Returning to Low-Income Predominately Minority Communities. Addictive behaviors, 39(2), 449-454.CrossRefGoogle Scholar
  36. Golub, Andrew, Peter Vazan, Alex S. Bennett, and Hilary J. Liberty. 2013. Unmet Need for Treatment of Substance Use Disorders and Serious Psychological Distress Among Veterans: A Nationwide Analysis Using the NSDUH. Military medicine, 178(1), 107-114.CrossRefGoogle Scholar
  37. Grubaugh, Anouk L., Kathryn M. Magruder, Angela E. Waldrop, Jon D. Elhai, Rebecca G. Knapp, and B. Christopher Frueh. 2005. Subthreshold PTSD in Primary Care: Prevalence, Psychiatric Disorders, Healthcare Use, and Functional Status. Journal of Nervous & Mental Disease, 193, 658-664.CrossRefGoogle Scholar
  38. Hacking, Ian. 1999. The Social Construction of What? Cambridge, MA: Harvard University Press.Google Scholar
  39. Hall, Ryan C.W., and Richard C.W. Hall. 2007. Detection of Malingered PTSD: An Overview of Clinical, Psychometric, and Physiological Assessment: Where Do We Stand? Journal of Forensic Sciences, 52(3), 717-725.CrossRefGoogle Scholar
  40. Heckathorn, Douglas D. 1997. Respondent-Driven Sampling: A New Approach to the Study of Hidden Populations. Social Problems, 44(2), 174-199.CrossRefGoogle Scholar
  41. Heckathorn, Douglas D. 2002. Respondent-Driven Sampling II: Deriving Valid Population Estimates from Chain-Referral Samples of Hidden Populations. Social Problems, 49(1), 11-34.CrossRefGoogle Scholar
  42. Hoge, Charles W. 2010. Once a Warrior Always a Warrior: Navigating the Transition from Combat to Home—Including Combat Stress, PTSD and mTBI. Guilford, CT: GPP Life.Google Scholar
  43. 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, 13-22.CrossRefGoogle Scholar
  44. Horwitz, Allan V. 2002. Creating Mental Illness. Chicago: University of Chicago Press.Google Scholar
  45. Jakupcak, Matthew, Daniel Conybeare, Lori Phelps, Stephen Hunt, Hollie A. Holmes, Bradford Felker, and Miles E. McFall. 2007. Anger, Hostility, and Aggression Among Iraq and Afghanistan War Veterans Reporting PTSD and Subthreshold PTSD. Journal of Traumatic Stress, 20, 945-954.CrossRefGoogle Scholar
  46. Jenkins, Janis H. 2004. Schizophrenia as a Paradigm Case for Understanding Fundamental Human Processes. In J. H. Jenkins & R. J. Barrett (Eds.), Schizophrenia, Culture, and Subjectivity (pp. 29-61). Cambridge UK: Cambridge U Press.Google Scholar
  47. Katz, Jack. 2001. From How to Why: On Luminous Description and Causal Inference in Ethnography (Part I). Ethnography, 2, 443–473.CrossRefGoogle Scholar
  48. Kelly, Michael P., and Field, David. 1996. Medical Sociology, Chronic Illness and the Body. Sociology of Health & Illness, 18, 241-257.CrossRefGoogle Scholar
  49. Kleinman, A. (1980). Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. Berkeley, CA: University of California Press.Google Scholar
  50. Kleinman, Arthur, Leon Eisenberg, and Byron Good. 2006. Culture, Illness and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research. Focus: The Journal of Lifelong Learning in Psychiatry, 4, 140-149.Google Scholar
  51. Kulka, Richard A., William E. Schlenger, John A. Fairbank, Richard L. Hough, Kathleen B. Jordan, Charles R. Marmar, and Daniel S. Weiss. 1990. Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. Philadelphia, PA: Brunner/Mazel.Google Scholar
  52. Link, Bruce G., Elmer L. Struening, Michael Rahav, Jo C. Phelan, and Larry Nuttbrock. 1997. On Stigma and its Consequences: Evidence from a Longitudinal Study of Men with Dual Diagnoses of Mental Illness and Substance Abuse. Journal of Health and Social Behavior, 38, 177-190.CrossRefGoogle Scholar
  53. Link, Bruce G., and Jo C. Phelan. 2001. Conceptualizing Stigma. Annual Review of Sociology, 27(1), 363-385.CrossRefGoogle Scholar
  54. Litz, Brett, 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.CrossRefGoogle Scholar
  55. Maguen, Shira, and Brett Litz. 2012. Moral Injury in Veterans of War. PTSD Research Quarterly, 23, 1–6.Google Scholar
  56. Martin, Emily. 2007. Bipolar Expeditions: Mania and Depression in American Culture: Princeton, NJ: Princeton University Press.Google Scholar
  57. Martin, Emily. 2010. Self-Making and the Brain. Subjectivity, 3(4), 366-381.CrossRefGoogle Scholar
  58. Mattingly, Cheryl 1998 Healing Dramas and Clinical Plots: The Narrative Structure of Experience (Vol. 7). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  59. McNally, Richard J., and B. Christopher Frueh. 2013. Why are Iraq and Afghanistan War Veterans Seeking PTSD Disability Compensation at Unprecedented Rates? Journal of Anxiety Disorders, 27(5), 520-526.CrossRefGoogle Scholar
  60. Mehta, Sheila, and Amerigo Farina. 1997. Is Being “Sick” Really Better? Effect of the Disease View of Mental Disorder on Stigma. Journal of Social and Clinical Psychology, 16(4), 405-419.CrossRefGoogle Scholar
  61. Miles, Matthew B., and A. Michael Huberman. 1994. Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
  62. Nutt, David J., and Andrea L Malizia. 2004. Structural and Functional Brain Changes in Posttraumatic Stress Disorder. The Journal of Clinical Psychiatry, 65(suppl 1), 11-17.Google Scholar
  63. Pietrzak, Robert H., Douglas C. Johnson, Marc B. Goldstein, James C. Malley, and Steven M. Southwick. 2009. Perceived Stigma and Barriers to Mental Health Care Utilization Among OEF-OIF Veterans. Psychiatric Services, 60, 1118-1122.CrossRefGoogle Scholar
  64. Resnick, Phillip J., Sara West, and Joshua W. Payne. 1997. Malingering of Posttraumatic Disorders. In: Richard Rogers (ed.) Clinical Assessment of Malingering and Deception, 2nd edn., pp. 130-152. New York: Guilford.Google Scholar
  65. Scott, Wilbur J. 1990. PTSD in DSM-III: A Case in the Politics of Diagnosis and Disease. Social Problems, 373, 294-310.CrossRefGoogle Scholar
  66. Shay, Jonathan. 2002. Odysseus in America. New York: Scribner.Google Scholar
  67. Shay, Jonathan. 2010. Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Simon and Schuster.Google Scholar
  68. Spoont, Michelle R., Nina Sayer, Greta Friedemann-Sanchez, Louise E. Parker, Maureen Murdoch, and Christine Chiros. 2009. From Trauma to PTSD: Beliefs About Sensations, Symptoms, and Mental Illness. Qualitative Health Research, 19, 1456-1465.CrossRefGoogle Scholar
  69. Stewart, David W., Prem N. Shamdasani, and Dennis W. Rook. 2007. Focus groups: Theory and Practice (2nd ed.). Thousand Oaks, CA: Sage Publications, Inc.CrossRefGoogle Scholar
  70. Summerfield, Derek. 2001. The Invention of Post-Traumatic Stress Disorder and The Social Usefulness of a Psychiatric Category. Bmj 322, 95-98.CrossRefGoogle Scholar
  71. Szasz, Thomas S. 1960. The Myth of Mental Illness. American Psychologist, 15(2), 113.CrossRefGoogle Scholar
  72. Tanielian, Terri, and Lisa H. Jaycox (Eds.). 2008. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Center.Google Scholar
  73. Lawrence A. Tritle. 2002. From Melos to My Lai: A Study in Violence, Culture and Social Survival. New York: Routledge.Google Scholar
  74. Vasterling, Jennifer J., and Chris R. Brewin (Eds.). 2005. Neuropsychology of PTSD: Biological, Cognitive, and Clinical Perspectives. New York: Guilford Press.Google Scholar
  75. Vazan, Peter, Andrew Golub, and Alex S. Bennett. 2015. PTSD, Depression, Daily Stressors, and Treatment Pathways Among Urban Veterans. Military Behavioral Health, 3(2), 108-115.CrossRefGoogle Scholar
  76. Walker, Michael T. 2016. The Social Construction of Mental Illness and Its Implications for Neuroplasticity. London: Lexington Books.Google Scholar
  77. Watters, Ethan. 2010. Crazy Like Us: The Globalization of the American Psyche. New York: Simon and Schuster.Google Scholar
  78. Young, Allan. 1997. The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton, NJ: Princeton University Press.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.National Development and Research InstitutesNew YorkUSA
  2. 2.Department of Anthropology and SociologyEarlham CollegeRichmondUSA

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