Fields of Combat: Understanding PTSD among veterans of Iraq and Afghanistan

By Erin P. Finley

Cornell University Press, 2012. 240pp.

Finley’s portrayal of the difficulties of soldiers returning from Afghanistan and Iraq elegantly interweaves narratives and analysis. Drawing on 20 months of ethnographic fieldwork in San Antonio, Texas, involving 133 study participants (62 of which were veterans), Finley conveys her message through the construction of six narratives that “represent composites of several individuals who participated in the research” (xiii). The use of composites is a methodological technique to protect the privacy of research participants. This proves particularly important in Finley’s study given the sensitive nature of these individual’s service in the military and/or in their anxiety over receiving a diagnosis of psychological injury.  Adam, Brian, Chris, Derek, Jesse, and Tony all have unique stories to tell about what compelled them to join the military (honor, respect, bravery, hardship, aspirations for a better future), the traumas they experienced as soldiers on the front lines (constant hyper vigilance, temporary paralysis and incontinence from sheer terror, loss of friends, loss of a limb, the murder of a child), and the hardships they experienced in returning home to negotiate their new identities as war veterans. It is through these individual narratives that Finley deconstructs some of the preconceptions of PTSD symptoms and sufferers – the extreme and unanticipated violence associated with PTSD, the social isolation as a consequence, the link to specific ethnic groups, the shame experienced by PTSD sufferers and the related idea that the machismo of military culture contributes to delayed treatment and increased suffering – revealing that PTSD sufferers and symptoms are varied, diverse and intimately influenced by our culture(s). The book clearly distills various historical and contemporary views of combat-related PTSD, and examines how these perspectives and definitions are internalized and responded to. Finley notes that veterans’ personal experiences of PTSD and the cultural politics that surround and shape those experiences are interrelated: “Combat trauma (the personal) may occur during war (the political) but is unavoidably shaped by the meaning of the event to the individual (the personal), a meaning that is partly the product of a shared vocabulary for the describing experience (the cultural)” (158).

Finley’s portraits of war offer a perspective of an evolving American warrior – a civilian, turned soldier, and then veteran. It is this progression of time in service and the changing perspectives of self and illness that structures the book. The first half focuses primarily on narratives. The second half offers an analysis of the cultural, political, and historical influences shaping the experiences of PTSD in three particular cultural contexts: families, the US military, and the VA’s mental-health-care system. Rather than switching to a more removed and analytical register in this section, Finley offers a rendering of how each of her composite veterans uniquely experiences the devastating impacts of PTSD, including substance abuse, insomnia, domestic violence, distancing of friends and family, divorce, and unemployment. By drawing on their narratives, Finley not only challenges popular ideas of PTSD as incurable and permanently debilitating, but offers a hopeful outlook on how significant advancements have and continue to be made in acknowledging, understanding, and treating PTSD. True to her applied anthropology perspective, Finley closes her book with a substantial offering of recommendations. Informed by her intimate relationships with veterans, their families and health care providers, the recommendations are positioned at the levels of policy, family and community and cover both prevention and impact minimization.

Rich in descriptive detail, Finley’s text is careful, sensitive, and thoughtful. Finley transports us from picnic tables at a local Veterans of Foreign Wars post on the Fourth of July, to an army Humvee being ravaged by an IED, to the bedside of a soldier whose leg has been amputated as a result, to a college campus too overwhelming with potential hidden dangers for a PSTD sufferer to traverse, and to a Chuck E. Cheese entertainment center where a recovering veteran plays untroubled with his family.

Yet, in keeping the text narrowly focused on the experiences of her participants in San Antonio Finley omits some of the wider anthropological discussions about war, trauma and PTSD. Finley briefly mentions debates about understanding PTSD as a universal phenomenon or as a Western-derived cultural construct to explain certain types of suffering. More attention to this question as well as to the issue of the “medicalization” of trauma would be welcome. A deeper examination would have contributed nicely to the discussion of new treatment strategies: Why are these accepted by the ‘new’ breed of psychologists but rejected by older generations? Is this division in the discipline of psychology unique to San Antonio, the VA system, or is can it be generalized to psychologists treating PTSD patients elsewhere in the US and the world? Similarly, Finley’s account could have been extended to include findings on PTSD in non-US, non-military, non-contemporary contexts, perhaps broadening the relevance of her research beyond its immediate contexts: the cultures of southern Texas, the military, and men.

It is only in the conclusion that Finley shifts some attention to female veterans. More attention to women would have have been a welcome addition to this ethnography. In Iraq and Afghanistan female service members were often exposed to the same risks of mortar, rocket, and improvised explosive device attacks as their male colleagues. Women in the military are also at greater risk for what is termed ‘military sexual assault’ than their male counterparts. Another issue regarding women is the potentially more dramatic identify shift they experience in social reintegration at times resulting in greater difficulty in adjusting to the roles and social expectations of the macho-soldier and the feminine-civilian.

Finally, Finley poses the question, “Who is responsible for [the] suffering [of veterans]?” (169), but limits her answer to saying only that it is a question that will be answered differently across cultural worlds. Explaining her limited offering of discussions of the politics of the wars in Iraq and Afghanistan, Finley says that the political debates of the wars had no influence on the experiences of PTSD of her study participants. She offers little indication of how she came to this conclusion, and whether this may be unique to the San Antonio setting. I am left wondering then about the intended audience for Fields of Combat and about Finley’s decision to limit the critical potential of her analysis. A more thorough theoretical discussion, drawing upon concepts of biopolitical subject-making, for instance, would help shed light on veterans’ relationship to the state and the political positioning of their suffering.

In defense of Finley, many other scholarly anthropological works on PTSD tend to portray the individual, in part, as a victim, desperately trying to survive and make sense of what is often viewed as incomprehensible and overwhelming.  Theirs is an effort to maintain or create subjectivity in the face of dehumanizing experiences.  However, Finley demonstrates that for the veteran, despite the fact that elements of structural violence may have directed their life trajectory in the direction of joining the military, they embrace their choice and are dedicated to what they do.  Their agency is an important element in the equation. And, that the road to PTSD involves the whole of their life experience and does not simply begin with the experience of trauma.  It is the fact that they have accepted this calling in their minds that is being betrayed by their acknowledging suffering.  However, the intimate interplay between the personal and the political could have been explored to a more satisfying depth.

Nicola Bulled holds a PhD in Anthropology from the University of Connecticut as well as a Masters degree in Public Health from Boston University. She is currently a Fogarty Foundation funded Water and Health Initiative in Limpopo (WHIL) Post-doctoral Fellow with the University of Virginia’s Center for Global Health.