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

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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.

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References

  • 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.

    Book  Google Scholar 

  • American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Arlington, VA: American Psychiatric Association.

    Book  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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 

  • Bowers, Leonard. 2003. The Social Nature of Mental Illness. New York: Routledge.

    Book  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Bury, Michael. 1991. The Sociology of Chronic Illness: A Review of Research and Prospects. Sociology of Health & Illness, 13, 451-468.

    Article  Google Scholar 

  • Cantor, Chris. 2009. Post-Traumatic Stress Disorder: Evolutionary Perspectives. Australian & New Zealand Journal of Psychiatry, 43(11), 1038-1048.

    Article  Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Conrad, Peter. 1987. The Experience of Illness: Recent and New Directions. Research in the Sociology of Health Care, 6, 1-31.

    Google Scholar 

  • Conrad, Peter. 1992. Medicalization and Social Control. Annual review of Sociology, 18(1), 209-232.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Courtwright, David T. 1982. Dark Paradise: Opiate Addiction in America before 1940. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • 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.

  • Department of Veterans Affairs. 2013. Federal Benefits for Veterans, Dependents and Survivors. Washington, D.C.: U.S. Government Printing Office.

    Google Scholar 

  • Eisenberg, Leon. 1977. Disease and Illness: Distinctions between Professional and Popular Ideas of Sickness. Culture, Medicine and Psychiatry, 1, 9-23.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Fassin, Didier, and Richard Rechtman 2009 The Empire of Trauma. Trans. Rachel Gomme. Princeton, NJ: Princeton University Press.

  • Finley, Erin P. 2011 Fields of Combat: Understanding PTSD among Veterans of Iraq and Afghanistan. Cornell University Press, Ithaca, NY.

    Google Scholar 

  • Foucault, Michel. 1965. Madness and civilization: A history of insanity in the age of reason. New York: Random House.

    Google Scholar 

  • 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.

    Chapter  Google Scholar 

  • 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 

  • Goffman, Erving. 1959. The Presentation of Self in Everyday Life. New York, NY: Doubleday.

    Google Scholar 

  • Goffman, Erving. 1963. Stigma: Notes on the Management of Spoiled Identity. New York: Simon and Schuster.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Hacking, Ian. 1999. The Social Construction of What? Cambridge, MA: Harvard University Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Heckathorn, Douglas D. 1997. Respondent-Driven Sampling: A New Approach to the Study of Hidden Populations. Social Problems, 44(2), 174-199.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • Horwitz, Allan V. 2002. Creating Mental Illness. Chicago: University of Chicago Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • Katz, Jack. 2001. From How to Why: On Luminous Description and Causal Inference in Ethnography (Part I). Ethnography, 2, 443–473.

    Article  Google Scholar 

  • Kelly, Michael P., and Field, David. 1996. Medical Sociology, Chronic Illness and the Body. Sociology of Health & Illness, 18, 241-257.

    Article  Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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.

    Article  Google Scholar 

  • Link, Bruce G., and Jo C. Phelan. 2001. Conceptualizing Stigma. Annual Review of Sociology, 27(1), 363-385.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Maguen, Shira, and Brett Litz. 2012. Moral Injury in Veterans of War. PTSD Research Quarterly, 23, 1–6.

    Google Scholar 

  • Martin, Emily. 2007. Bipolar Expeditions: Mania and Depression in American Culture: Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Martin, Emily. 2010. Self-Making and the Brain. Subjectivity, 3(4), 366-381.

    Article  Google Scholar 

  • Mattingly, Cheryl 1998 Healing Dramas and Clinical Plots: The Narrative Structure of Experience (Vol. 7). Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Miles, Matthew B., and A. Michael Huberman. 1994. Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage Publications, Inc.

    Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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 

  • Scott, Wilbur J. 1990. PTSD in DSM-III: A Case in the Politics of Diagnosis and Disease. Social Problems, 373, 294-310.

    Article  Google Scholar 

  • Shay, Jonathan. 2002. Odysseus in America. New York: Scribner.

    Google Scholar 

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

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Stewart, David W., Prem N. Shamdasani, and Dennis W. Rook. 2007. Focus groups: Theory and Practice (2nd ed.). Thousand Oaks, CA: Sage Publications, Inc.

    Book  Google Scholar 

  • Summerfield, Derek. 2001. The Invention of Post-Traumatic Stress Disorder and The Social Usefulness of a Psychiatric Category. Bmj 322, 95-98.

    Article  Google Scholar 

  • Szasz, Thomas S. 1960. The Myth of Mental Illness. American Psychologist, 15(2), 113.

    Article  Google Scholar 

  • 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 

  • Lawrence A. Tritle. 2002. From Melos to My Lai: A Study in Violence, Culture and Social Survival. New York: Routledge.

    Google Scholar 

  • Vasterling, Jennifer J., and Chris R. Brewin (Eds.). 2005. Neuropsychology of PTSD: Biological, Cognitive, and Clinical Perspectives. New York: Guilford Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Walker, Michael T. 2016. The Social Construction of Mental Illness and Its Implications for Neuroplasticity. London: Lexington Books.

    Google Scholar 

  • Watters, Ethan. 2010. Crazy Like Us: The Globalization of the American Psyche. New York: Simon and Schuster.

    Google Scholar 

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

    Book  Google Scholar 

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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.

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  1. National Development and Research Institutes, 71 W. 23rd St. 4th Fl, New York, NY, USA

    Luther Elliott, Alexander S. Bennett & Andrew Golub

  2. Department of Anthropology and Sociology, Earlham College, 331 Landrum Bolling Center, Richmond, IN, 47374, USA

    Kelly Szott

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  1. Luther Elliott
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Correspondence to Luther Elliott.

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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.

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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.

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Elliott, L., Bennett, A.S., Szott, K. et al. Competing Constructivisms: The Negotiation of PTSD and Related Stigma Among Post-9/11 Veterans in New York City. Cult Med Psychiatry 42, 778–799 (2018). https://doi.org/10.1007/s11013-018-9586-7

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