Driven by the timeline of the recent US conflicts in Iraq and Afghanistan, the current moment in clinical medicine at Veterans Affairs (VA) hospitals offers an important, circumscribed setting for evaluating both the effects of contemporary US warfare on soldiers and society, as well as personal, biomedical, and bureaucratic efforts to understand and manage these effects within veterans’ lives and on broader social publics. This qualitative study thus evaluates how veterans and VA clinicians at a Midwestern VA Health Care System understand the experiences of mild traumatic brain injuries and post-traumatic stress disorder --the two signature injuries of recent US conflicts -- in relation to an intensification of clinical and scientific surveillance of veterans and these traumatic conditions. This project utilizes ethnographic methodologies to triangulate analyses of a) participant-observation in VA clinical spaces where veterans receive physical and mental health care; b) analysis of the professional micro-practices, clinical sensibilities, and bureaucratic processes revealed in veteran medical records; c) in-depth interviews with veterans and VA clinicians regarding each’s understanding of PTSD and mTBI, and their efforts to manage each; as well as d) emergent biomedical and neuroscientific knowledge and discourses about both diagnoses during these wars.

In ethnographically characterizing the meanings and subjectivitiesthat veterans and clinicians assign each diagnosis, this project provides insightinto the forms of subjectivities and citizenships that clinical practices andbiomedical knowledges facilitate and impede in veterans’ interactions with thestate and negotiation of their traumatic injuries. As such, it tests the degreeto which emergent VA biomedical knowledges and practices contribute to novelmodes of citizenship as predicted by Foucauldian theories of biopower. This qualitative analysis also permits investigation of other forms of citizenship that disabled veterans enact vis-a-vis the state, and the alternative knowledges,experiences, and social forces that might contribute to them. Thus, this studycontributes broader understandings of the subjectivities that are both presentand possible for a population that has long been the subject of intense stateand medical scrutiny.  

By documenting the VA’s bureaucratic model of care and everyday practices that include medical evaluations, diagnosis, and clinical communications, I also characterize the US government’s response to the signature injuries of its recent wars, while simultaneously analyzing the cultural work enacted by the VA. This project suggests that a core function of the VA is to demonstrate a moral performance of care, and that central goals of this performance aim to shape the meaning of war-acquired mTBIs for both the veteran and broader public. Far from the abdication or failure to provide care depicted in popular media and cultural forms, this project reveals the extent to which the VA’s management of war-acquired injuries functions as an intensive, highly orchestrated performance and means of domesticating and mitigating the effects of war when they are brought home. In this way, the medical management of these wars’ signature injuries reflects a politics of care that promotes particular logics of state governance, citizenship, and state responsibility in the management of injured veterans and broader consequences of war. When combined with analysis of biopower’s theoretical relevance to understanding veterans’ on-the-ground experiences with these traumatic injuries, this descriptive analysis of how the state operates through the VA to manage the effects of contemporary warfare advances social scientific understandings of the nature of biopower itself, and its ability to be simultaneously productive and destructive, adaptive and fragile.