Doctoral Dissertation Research: Mild Traumatic Brain Injury, Medical Uncertainty, and Disability in the U.S. Military Healthcare System

阿富汗和伊拉克战争的特点是，美军在战斗中受伤幸存的比例非常高。据估计，近20%的幸存士兵遭受了创伤性脑损伤（TBI）。其中绝大多数是轻度TBI，也称为脑震荡，是最常见的TBI类型，也是最难识别的具有持久影响的损伤。在过去的二十年里，退伍军人事务部（VA）和国防部通过将脑损伤与部队令人困惑的持续记忆问题，认知障碍，易怒和焦虑联系起来，提高了这种“无形伤害”的形象。这项对9/11后TBI的人种学研究调查了临床医生，患者和福利专家如何将轻度TBI组织为该国最近战争的“标志性伤口”，以及这种新兴的因果关系的影响头部受伤和部队的战后经历。关于自我、身体、大脑和战争的哪些特定的历史社会过程和假设被写入了当前轻度TBI的结构中？本研究使用访谈和观察来收集关于三组人的日常经历和观察的数据，VA患者，VA临床医生和退伍军人福利专家，目的是了解（1）关于TBI“不可见”形式的科学/医学知识的产生，（2）TBI“不可见”的后果，以及（3）其作为残疾的主观和制度意义。虽然这不是一种新的伤害，但轻度TBI最近与战斗的联系使军队和退伍军人管理局成为谈判其当代意义的强大利益相关者，作为一种伤害和持久残疾的原因。通过记录脑震荡作为一种严重的健康风险的重新定义的复杂性和后果，这项研究有助于公众对后9/11战争的文化遗产之一的理解。这项研究有助于残疾和医学人类学的人类学研究。这项研究有可能为军事医疗保健系统的使用加速时，该系统的理解作出贡献。考虑到从伊拉克和阿富汗返回的TBI退伍军人的数量，这项研究是及时的。这项研究将提供有关如何治疗这种残疾以及退伍军人面临的挑战的详细信息。这项研究的结果将与军事专业人员和对军事和残疾研究感兴趣的人类学家分享。该项目还将为一名人类学研究生提供培训。

The wars in Afghanistan and Iraq are characterized by an exceptionally high ratio of American troops who survive combat with injuries. It has been estimated that nearly twenty percent of surviving troops have sustained traumatic brain injuries (TBI). The vast majority of these are mild TBI, also known as concussion, the most common type of TBI and the least recognizably visible as an injury that has lasting effects. In the past twenty years the Department of Veterans Affairs (VA) and the Department of Defense have raised the profile of this otherwise "invisible injury" by connecting brain injury to troops' puzzlingly persistent memory problems, cognitive impairment, irritability and anxiety. This ethnographic study of post-9/11 TBI investigates how mild TBI is organized by clinicians, patients, and benefits specialists as a 'signature wound" of the country's most recent wars, and the effects of this emerging causal relationship between head injuries and troops' post-combat experiences. What historically-specific social processes and suppositions about the self, the body, the brain, and war-fighting are written into current constructions of mild TBI? This study uses interviews and observation to collect data about the everyday experiences and observations of three groups of people, VA patients, VA clinicians, and veterans' benefits specialists, with the aim of understanding (1) the production of scientific/medical knowledge about "invisible" forms of TBI, (2) the consequences of TBI's "invisibility", and (3) its subjective and institutional meaning as a disability. Though it is not a new injury, mild TBI's recent association with combat has positioned the military and the VA as powerful stakeholders in the negotiation of its contemporary meaning as an injury and as a cause of lasting disability. By documenting the complexities and consequences of this redefinition of concussion as a serious health risk, this study contributes to the public's understanding of one of the cultural legacies of the post-9/11 wars.This research contributes to the anthropological study of disability and medical anthropology. The research has the potential to make a contribution to the understanding of the military health care system when the use of that system has accelerated. Given the number of veterans returning from Iraq and Afghanistan with TBI, this research is timely. This research will provide much needed detail about how this disability is treated and the challenges veterans face. The results of this research will be shared with military professionals and among anthropologists interested in studies of the military and disability. The project will also provide for the training of a graduate student in anthropology.