In the Journals

Anthropology Goes Public in the VA — A special issue of the Annals of Anthropological Practice

VA coverThe current issue of the Annals of Anthropological Practice is a special issue, entitled, “Anthropology Goes Public in the VA.” Guest-edited by Karen Besterman-Dahan and Alison Hamilton, the issue contains seven articles organized thematically around discussions of what it means to be an anthropologist in the VA, the kinds of interventions anthropologists are making, and the often marginalized groups with whom they work. In addition, the issue has an introduction by Elisa J. Sobo and an afterword by Sarah S. Ono and Samantha L. Solimeo. Articles and abstracts are below. Enjoy!

Anthropologists in the VA: A Generative Force
Elisa J. Sobo

Practicing anthropology within the Veterans Health Administration of the Department of Veterans Affairs (VA) has, until recently, received little serious consideration as a respectable career option for anthropology postgraduates. But times are changing. Anthropologists employed by the VA are responsible for some of the most important and actionable anthropologically informed health research today. Far from being a marginal pursuit, VA anthropology is in fact a generative force for medical anthropology and, indeed, the discipline as a whole.

Practicing Anthropology in the VA

Observers Observed: Exploring the Practice of Anthropology in the  VA
Megan B. McCullough, Bridget Hahm, and Sarah Ono

From our position as publicly funded anthropologists in the Veterans Affairs, we discuss how anthropological research on Veterans health care offers an opportunity to critically engage with ideas about what constitutes public anthropology. As public sector anthropologists, we are conducting theoretically and ethnographically innovative work. In this chapter, we discuss the implications of this work in regard to anthropological theory and practice.

Anthropologist and Government Employee: A Description of Career Paths to Becoming an Applied Anthropologist with the U.S. Department of Veteran Affairs
Gemmae M. Fix

The U.S. government is the largest employer of anthropologists, with an increasing presence in the Department of Veteran Affairs (VA). However, there has been limited discussion of the path from graduate school to an applied career. This article describes the motivations and trajectories of anthropologists employed by VA. Interviewees described their VA work as embodying the principles of anthropology and the ability to see the results of their work as deeply gratifying.

Empowering Veterans

The Role of Social Networks for Veterans with Spinal Cord Injury in Obtaining Employment
Bridget A. Cotner, Jennie Keleher, Danielle R. O’Connor, John K. Trainor, and Lisa Ottomanelli

The purpose of this article is to demonstrate the use of ethnographic methods to explore the types of social support provided to Veterans with spinal cord injuries (SCIs) who are participating in an employment program. Interview data with Veterans and their social support members along with employment narratives written after a job was secured are used to document the types of support provided to Veterans with SCI to facilitate obtaining and maintaining employment. The impact of social support on mental and physical health is well documented in the literature; however, there is a need for research on the influence of social support on employment. As applied in VA spinal cord care, the “individual placement and support (IPS)” model of supported employment for vocational rehabilitation integrates vocational services into clinical treatment, and includes social support members in the pursuit of employment goals. Guided by theories of social capital, the types of social support provided to Veterans were classified into three types: instrumental, informational, and emotional. Analysis of data showed that for all Veterans with SCI, some form of social support was needed to aid in finding and maintaining employment, demonstrating the need for evidence-based supported employment (EBSE) services in the VA spinal cord system of care.

Evaluating Secure Messaging from the Veteran Perspective: Informing the Adoption and Sustained Use of a Patient-Driven Communication Platform
Jolie N. Haun, Jason D. Lind, Stephanie L. Shimada, and Steven R. Simon

Secure messaging (SM) is a secured asynchronous electronic e-mail system within the Veterans Health Administration web-based patient portal, My Health eVet. This electronic tool is part of a national transformation initiative to create new models of care to support patient-provider communication and promote self-care management. SM is designed to empower patients to communicate with their providers, but to date little research has evaluated Veterans’ perspectives on using SM as a communication tool. This article provides an overview of a qualitative mixed-methods study with 33 Veterans who opted-in to use SM. We used a combination of in-depth interviews, user-testing, three-month review of secondary SM data, and three-month follow-up phone interviews to understand Veterans’ experiences using SM. Synthesizing these data, we identified high- and low-volume users and characterized their reasons for using or not using SM. These profiles illustrate the Veteran perspective, enabling clinicians, administrators, and other stakeholders to understand how to adapt marketing and educational strategies and make system changes to promote and facilitate Veteran adoption and sustained use of SM as a communication tool.

Empowering Veterans with PTSD in the Recovery Era: Advancing Dialogue and Integrating Services
Erin P. Finley

As highly effective treatments for posttraumatic stress disorder (PTSD) become increasingly available, how will the VA (Department of Veterans Affairs) and other public institutions navigate complex questions around appropriate services for Veterans with PTSD? This and related questions will be examined in this article in light of epidemiological, clinical, and ethnographic data on combat PTSD in the 21st century.

Working with Veterans at the Margins

Gendered Social Roots of Homelessness among Women Veterans
Alison B. Hamilton, Donna L. Washington, and Jessica L. Zuchowski

Homelessness is one of the most challenging issues facing U.S. Veterans and those who serve Veterans. While the overall number of homeless Veterans is declining, the number of homeless women Veterans is increasing, with little clarity as to why. In previous work, we have examined pathways to homelessness among women Veterans, with a focus on proximal pathways, that is, how women perceived themselves to have become homeless at the time of the study. In this paper, we dig deeper into the roots of homelessness, specifically into the social institutional roots of homelessness. We examine women’s focus group conversations about entering and experiencing the military, particularly with regard to the common occurrence of sexual violence and trauma before and during military service. Drawing on anthropological concepts, we conceptualize trauma at both an individual level as embodied in women’s lived experiences, as well as at a collective, gendered level. Gendered traumatic experiences can accumulate over time, creating or reinforcing vulnerable pathways. For women Veterans, gender and the military are both social institutions that may act in combination to create gendered social roots of homelessness that are particular to women, and that may be relevant to the gender difference in prevalence of homelessness among Veterans.

“You Never Heard Jesus Say To Make Sure You Take Time Out for Yourself”: Military Chaplains and the Stigma of Mental Illness
Karen Besterman-Dahan, Jason D. Lind, and Theresa Crocker

The wars in Iraq and Afghanistan have taken a toll on military chaplains (MCs) who often return from deployment with high levels of stress, yet are expected to counsel on a daily basis without decompression of their own, potentially exacerbating any personal trauma. MC with posttraumatic stress disorder (PTSD) who have had deployments abridged due to their positive PTSD screen have reported shame due to leaving service members in their unit in danger while they went to safety. Many MCs report compassion fatigue, PTSD, reintegration issues, and adverse effects to their personal energy, motivation, and mental and spiritual well-being postdeployment, related to stressors from deployment and combat exposure. Only 23–40 percent of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) service members with a psychiatric disorder seek mental health care, citing stigma as a primary barrier. For MCs, stigma is compounded by a culture in which military health care providers, including MCs, are encouraged to deny their own needs to provide the necessary support to beneficiaries. This paper reviews a pilot study, which explored the impact of operational stress on the psychosocial health and reintegration of MCs, focusing on findings related to mental health and stigma within the military chaplaincy.

Negotiating Domains of Patient Dignity in VA Spinal Cord Injury Units: Perspectives from Interdisciplinary Care Teams and Veterans
Jason D. Lind, Gail Powell-Cope, Margeaux A. Chavez, Marsha Fraser, and Jeffrey Harrow

Patient dignity is a significant concern among inpatient Veterans with spinal cord injuries (SCIs) because they may lack physical control over their bodies and thus rely on others for a variety of specialized needs, including mobility, personal care, wound care, bowel and bladder care, and rehabilitation, among others. This study examines the complexities of providing and negotiating dignified care in the context of interdisciplinary care teams in SCI, and the challenges Veterans with SCI face maintaining dignity in the context of limited independence. Based on a mixed methods approach that included in-depth interviews, observations, and pile sorting at six Veterans Health Administration (VA) SCI units, the goal of this study was to explore ways in which dignity was defined, negotiated, and conferred during patient and provider interactions. Study results have immediate value to VA leadership, VA providers, and Veterans by calling attention to the ways in which the concept of patient dignity can be integrated into clinical practice on SCI units. This study provides a methodological framework to capture complex interactions among interdisciplinary care teams and patients, and offers a significant contribution to our understanding of how patient and provider interactions are conferred and negotiated.

The Intersections of Gender and Power in Women Veterans’ Experiences of Substance Use and VA Care
Ann M. Cheney, Audrey Dunn, Brenda M. Booth, Libby Frith, and Geoffrey M. Curran

In this article, we show that the Veterans Health Administration (VA), similar to military organizations, is a gendered organization where women Veterans’ experiences are embedded in and shaped by gender inequalities and structures of power. Based on an in-depth analysis of women Veterans’ substance use histories and VA treatment seeking experiences, we illustrate how gender power dynamics are (re)produced and maintained through everyday social interactions and organizational practices and processes that render women Veterans both visible and invisible: visible as sexual objects and invisible as suffering subjects. By retelling the illness and treatment experiences of women Veterans with trauma histories and co-occurring substance use and mental health disorders—a highly stigmatized population of Veterans—we highlight the importance of giving voice to their concerns when developing policies and programs to address the unique health care needs of women Veterans.

Afterword: Public Sector Anthropologists and New Directions for a Public Anthropology
Sarah S. Ono and Samantha L. Solimeo

In this final contribution in the edited volume on anthropologists working in the Veterans Health Administration within the Department of Veterans Affairs (VA), the authors reflect on how developments in recent years have brought us to this moment in time from the “insider” perspective of VA anthropologists. These collected papers provide ethnographic evidence for the innovative ways in which anthropologists employed in the public sector constitute a public anthropology that is theoretically informed, actionable, and cognizant of its role in the production of authoritative knowledge. The “afterword” makes connections between the chapters, with their varied topics, and addresses how this volume points to new destinations for engaged and ethical research in the growing field of public sector anthropology.

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