Last week I was honored to represent the American Sociological Association (ASA) at a Coalition for National Science Funding (CSNF) exhibition on Capitol Hill. The annual event gives lawmakers a chance to see the impact of research funded by the National Science Foundation (NSF). I received a Dissertation Improvement Grant from NSF, which helped me expand the scope and strength of my dissertation research. When asked to be part of this event, I asked myself “what does Congress need to know about today’s wounded veterans?” A few thoughts came to mind, but I kept coming back to the divergent experiences of visibly and invisibly injured veterans.
We tend to think of “wounded warriors” as one monolithic group: veterans who were wounded in combat while serving in Iraq and Afghanistan. By definition, this is true. But by any measurement of meaningful experience, this masks an essential defining feature of a wounded veteran’s trajectory: injury visibility. Veterans with physical, visible injuries and veterans with invisible injuries (mental or physical) find that their experiences differ in three key ways: (1) timeline of recovery, (2) claim to “wounded warrior” status, (3) living as a “wounded warrior.”
These differences are best illustrated by comparing the individual stories of wounded veterans, and I’ve pulled two representative cases from my dissertation research. Names and identifying information have been altered to protect the confidentiality of my participants.
Meet Marcus: a 28-year old Marine Corps veteran who lost his leg in Afghanistan. Marcus enlisted in the Marine Corps out of high school, eager to serve his country in the wake of 9/11 and ready to get out of the impoverished neighborhood he grew up in. Upon completing boot camp and his initial training, he deployed to Iraq where he saw pretty heavy combat. He returned to Iraq again, twice, eventually working to close down operations in the area. It was his fourth deployment to Afghanistan where he stepped on the IED that took his leg and badly scared his other leg. He was medically evacuated out of the country to Germany, and woke up in Bethesda, Maryland a couple weeks later. After arriving in Maryland he became part of the Wounded Warrior Battalion, the Marine Corps rehabilitation program for severely wounded, injured, or ill Marines. He worked through his recovery, and started using prosthetic limbs 6 months after his injury. During his second year of recovery he decided to return to active-duty, and began working again. After a year on active-duty, Marcus decided to medically retire. He was feeling unfulfilled by his new role in the military and wanting to find work that wasn’t so hard on his body. At the time I interviewed him he was out of the military and looking to pursue his college education.
Meet Brian: a 35-year old Marine Corps veteran who has PTSD and chronic pain. Brian joined the Marine Corps a few years after 9/11 because he needed a change in his life and wanted to go to war. Once he was in, he found that he loved military service and wanted to say for a career. On his first and second deployments to Iraq he worked in casualty evacuation, and frequently witnessed the trauma of servicemembers who were critically and gravely wounded in combat. The things he saw on his second deployment in particular stuck with him, but he suppressed it because he was at war–he felt there was no room for breaking down. He described his third deployment to Iraq as frustratingly uneventful, and his fourth deployment to Iraq was shorter than usual, only 4 months. At this point, three years after his 2nd deployment, Brian began realizing that he needed to seek help for his mental health. He felt his productivity slipping at work and friends encouraged him to see a mental health professional. After being in therapy for a while, Brian received PCS orders and moved to a new base. At his new command he faced backlash for his mental health issues, leaders accused him of “malingering” and “faking” his issues. When he wasn’t deployed, Brian had been using alcohol to cope with his symptoms (like nightmares)–he described drinking as his “crutch.” Once he stopped drinking, he had a major panic attack, which led to his hospitalization. Brian was assigned to the Wounded Warrior Battalion and spent 1.5 years in recovery before being medically retired from the Marine Corps. Brian is currently volunteering with several local organizations that serve post-9/11 wounded veterans.
The most immediate difference in Brian and Marcus’ stories is the chronological timeline of recovery: for Marcus, the injury necessitated a quick and prompt entrance into the medical recovery space, but for Brian it was a slow and simmering recognition process until his problems became unavoidable. Servicemembers with apparent physical injuries are immediately ushered in to the medical system and the (service branch specific DoD) wounded warrior recovery program. The Iraq and Afghanistan wars tested the DoD hospitals, and the military medical system has been built-up and revamped over the last 15 years. These hospitals provide some of the best life-saving medical care and rehabilitation in the country. Visibly injured veterans often describe recovery as a “teamwork” effort where everyone pushes each other to get up on their prosthetic legs, walk further today, or start running. Physical rehabilitation lends itself to this competitive military environment, but it is hard for invisibly injured veterans to feel the same camaraderie as they recover, ‘high five I didn’t have a panic attack today!’ or ‘my pain level is down to a 4 today’ isn’t a celebrated milestone in the same way that walking on prosthetic legs can be.
Recovery for invisible injuries is a far more isolating experience. Brian’s initial path to recovery was long and windy: taking almost 4 years to come to the point where he was forced into the Wounded Warrior Battalion and medical retirement. Brian’s story is typical of invisibly injured veterans, they often spend months or years working before realizing their injuries or seeking help. Despite a greater awareness of invisible injuries and more advanced screenings for military personnel, the path to recovery is rarely straightforward or immediate for these wounded veterans. In fact, a new GAO report shows that wounded troops are often discharged for behaviors related to PTSD, TBI or other invisible injuries; this is a symptom of the complicated and varied nature of these invisible injuries. PTSD will not present the same way with every person (symptoms will vary), and external factors (such as a parent dying or the birth of a child) can trigger mental health issues like PTSD or depression that is related to combat exposure. Wounded veterans with invisible injuries usually do not have a straight path to care: injury to recovery to life post-injury. It’s an obvious difference between these types of injuries, but usually overlooked in the larger “wounded warrior” narrative.
Another difference illustrated by the experiences of these wounded veterans is the claim to their status as “wounded warrior.” Marcus has a prosthetic limb and some scarring on his other leg, a very visible injury. Veterans like Marcus have never had the legitimacy of their injuries or their status as a “wounded warrior” questioned. No one tells him his leg ‘actually isn’t that bad’ or ‘that it’s temporary’ or ‘maybe he’s just trying to get out of work.’ In fact, many wounded veterans report meeting civilian amputees who say they are constantly mistaken for “wounded warriors.” Have the right ‘look’ of a wounded veteran? You are given the benefit of the doubt about your potential status from others.
Veterans with invisible injuries, however, are contested members of the wounded veteran community. They are continually under a veil of suspicion until proven otherwise, and in some cases, they may never emerge as a full-fledged member. In Brian’s case, his leaders and peers accused him of “malingering” — a discharge status that has become a historically-rooted way to stigmatize someone in the military, accusing them of falsifying health-related reasons they can’t do their job. Brian, and other invisibly injured veterans, constantly face questions of whether their injuries are ‘real’ or as severe as they say they are, or if they are just reaching for the status of “wounded warrior.” With every new organization, medical doctor (yes, medical doctor), or veteran/peer an invisibly injured veteran meets, there is a looming question in the back of their minds, “will they believe me?”, because most invisibly-injured veterans have experienced not being believed by someone.
The last difference I want to highlight is the significance of the “wounded warrior” construct in the day to day lives of wounded veterans. After their injury and after their recovery, visibly injured veterans like Marcus can find it hard to move on because they are constantly reminded they are “wounded warriors.” From the ‘thank you for your service’ comments to strangers buying dinner to the simple stares and glances: it is hard to forget your status as a wounded veteran when everyone around you reacts to you as a “wounded warrior.” Wounded warriors with visible injuries, especially those who fit the stereotype of a wounded warrior (amputee with prosthetic limbs, wheelchair, or burn scars) have a hard time escaping their status as a “wounded warrior.” Even during my interview with Marcus at a local coffee shop, someone came up to thank him as we were talking. Marcus himself described how it’s hard to stay focused and move foward in that kind of environment:
“For me it’s been really challenging to try and to stay focused [on raising awareness] because you are like a rock star when you go see those places and people – tons of people come up to you and tell you, “Thank you for your service.” And they give you lots of really cool things. You’ll get really nice t-shirts…or they’ll pay for you to go to an event, you’ll have nice meals, or stay in a nice hotel…”
In this sense, invisibly injured veterans have an advantage, something that they told me they expressively enjoy about the nature of their injuries. Their status as a “wounded warrior” isn’t immediately apparent so it doesn’t dominate or cloud the way others see them. They can choose when to reveal their status as a wounded veteran, and most of the time they opt to not disclose that information to others. Many avoid the subject entirely. Invisibly injured veterans can escape the constant loop of being a “wounded warrior”, which allows them to establish their life outside of the military and veteran communities (if they choose) and root their identity elsewhere. Brian however has a service dog, one of the only ways that invisibly injured veterans are identifiable in public, giving them a parallel experience to their visibly injured counterparts. Service dogs attract a lot of attention in public, a lot. While it’s a useful tool for wounded veterans, it can also create new problems–especially for the invisibly injured.
What I hope our lawmakers (and future DoD and VA leaders) can truly consider is that the wounded veteran experience is not “one-size-fits-all.” The nature of different injuries and whether it is visible to others dramatically changes the trajectory and day-to-day experiences of these veterans. For the post-9/11 generation of veterans, the media likes to use “invisible injuries” and “signature wounds of war”, they have become the new buzzwords. But rarely do we stop to think about the unique challenges and obstacles for each group as they return from war wounded and come to find their new life in recovery. After 15 years of war, we’ve learned a lot as a nation about medical care and systems of recovery, and we’ve made great strides–but we still have a long way to go to support invisibly injured veterans in identifying, diagnosing, and taking their claims of injury seriously. We also need to recognize that all wounded veterans, visibly injured or not, want to be seen as more than their military service and more than their wounds. Next time you read about “wounded warriors” I hope you consider the variety of experiences encapsulated by that one phrase.