If you are a veteran, with a family, and would like to participate in the study of ways to overcome stress by restorying, please contact David M. Boje, Ph.D. at davidboje@gmail.com. We are now creating a waiting list to participate in the study. All participation is confidential.

Welcome to the Leviathan of Institutions profiting from Stress Disorder, Junk Science, While Increasing rate of Suicides

David M. Boje, Ph.D. January 1, 2014; Revised April 9, 2014

Pharmaceutical industry and psychiatry have actually implemented Post Traumatic Stress medication treatments into a permanent Disorder-pathology that actually increased, rather than decreased the numbers of military (& civilian) suicides since 2002.

 

My sense is the living story is an aliveness that is being overshadowed, crowded out of awareness-domination of the grand narratives of macho-soldier, medication-only path to health, tough it out and never seek help, and the permanent Lifetime Disorder Label (PTSD) as Professor Gerald W. Vest calls it. The restorying process is a super powerful approach to healing when combined with the Psychocalisthenics exercises Gerry Vest and/or the Vipassana meditation that Febna Caven is doing here in Las Cruces, New Mexico.

As an organizational scholar, I am sensitized to the ways the pharmaceutical industry is profiting form the Life Time Disorder Label, PTSD. Somehow US society, its medical establishment has bought into the name game, naming post-deployment stress a Disorder. Millions of dollars are spent by the government funders on university research that is making matters worse. 22 veteran suicides a day, which is 8030 a year, and 56,210 in seven years, which is more than we lost in combat during that period. What is most relevant to organizational scholars, is the rate of suicide is increasing, and one possible reason is the medication approach, the labeling stress, anxiety, a Life Time Disorder is making it all profitable for the meds industry, but a tragic loss of life to the world. A related critical organizational assessment concerns the junk science associated with the Diagnostic and Statistical Manual of Mental Disorders (DSM). There are scores of empirical studies challenging the validity and reliability of the DSM PTSD, PSD, and anxiety protocols. Yet, they continue to be in widespread use in hospitals, VA, the military at large. The problem is a Leviathan of institutions that are increasing rates of suicides, and then blaming the victims of these meds, and DSM industries.

We need to stop blaming the victims of traumatic events. We need to stop stigmatizing stress in and out of the military. The result of stigmatizing, and pathologizing stress into a permanent disorder, is no one is going for help. People are gaming the typical survey tests, and say anything to get out and get on with their leave. The tragedy is people game the system of assessment of stress, then would rather commit suicide than seek help for stress, and face the social stigma. There is also a stigma placed on troops returning from deplooyment. Many people retrun from deployment and are just fine. So much storytelling of veterans with stress, that universities and employers are highly sensitized by this media storytelling. It seems to me that those of us doing organizational storytelling, can draw attention to the commodification of stress, how it 'blames the victims' and is sold by the media outlests as a disorder by various institutions, from universities, pharmaceutical, to errant counselors, to neuroscience laboratories, and so on. There is a veritable Leviathan of institutions commodifying stress disorder. Meanwhile the ways of training in coping with stress, goes wanting. Can we use storytelling theory and methods to help veterans to reclaim an authentic self from Leviathan?

Introduction

Before deconstructing DSM, the complete scientific lack of validity of PTSD, and that ways Leviathan of pharaceutical industries profits from pathologizing PTSD into something meds, cognitive behavioral modification, and reliving a signular trauma event (aka desensitization), let's look at what is possible if we do what I call 'embodied restorying.' Embodied Restorying, combines a routine of breath and meditation exercies with restorying PTSD into what it is, a blame game used by media and phraceutical industries for enormous profits.

PART I: The Good News! There is an alternative to Blaming & Eploiting the Victim

Develop an understanding of the 'materiality of PTSD' pathologizing, and stigmatizing and how it manifests in a profitable pharmecetucial industry. Enough junk science (Rappoport, 2014):

" There are no defining physical tests for any of the 300 so-called mental disorders. All diagnoses are based on arbitrary clusters or menus of human behavior. The drugs are harmful, dangerous, toxic. Some of them induce violence. Suicide, homicide. Some of the drugs cause brain damage."

People are buying into the DSM claims: Stress is a reaction to both high-magnitude traumatic events and events of low-magnitude. High-magnitude traumatic events in the DMS-IV Diagnostic Criteria for PTSD:

1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

2. The person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

Low-magnitude trauma events can also show all the symptoms of stess. This includes low-magnitide events such as: "nontraumatic deaths, serious illness, a spouse's affair, and repeated episodes of bullying, intimidation, or uncontrollable stress at work" and "victims of talking.... repeated harassing telephone calls, E-mails, letters, or other material; are constantly watched and followed; and have their homes broken into and their property damaged" (Brewin, 2003: 48).

Something important has happened to stess. It has morphed from the above DMS Medical pathology-category of diagnosis of reaction to trauma events, into a cultural expectation, a media trope. The result is people with authentic need for stress are mixed together with the new fashion, a social desirability to have a coming-home war-story of all the stress symptoms that one saw in the latest war movie, or TV news report. Click here

Stress has become a cultural identity-marker in post-empire America, aka, Leviathan.

Is it true that there are no alternatives to the pathologizing, the over-medication-for-profit?

At http://peaceaware.com I list a number of meditation approaches that do not involve medication or cognitive behavior mod, or reliving the so-called single trauma event.

"The more we develop this awareness the more illuminating and alive it becomes for us. Thoughts no longer distract us; we can remain open, clear and balanced. This penetrative, open quality is like the sunlight that shines forth in all directions. When we do not take positions, the door to enlightenment is completely open, and we understand quite naturally what is called "universal" mind, infinity, or genuine understanding" (Tibetan Meditation by Tarthang Tulku, p. 77)

Jerry Vest, LISW/LMT Injured Warrior and Family Integrative and Holistic Health Practitioner,  Emeritus Professor, NMSU;  premier US Army Warrior Restoration & Resilience Center (R & R Center), Ft. Bliss, TX; see vita at http://www.encore.org/user/geraldvestcomcastnet; newslog;

Come and join us in the Las Cruces, WSMR and El Paso Areas 

Workout & Support Groups--Jerry's Health Studio--with warriors, vets, advocates and others interested, followed by a Gestalt Training Session with Strategic Breathing and Mindfulness are introduced with our health practices: Kath States,  Kum Nye, Psychocalisthenics, Progressive Relaxation, Mindfulness, Acupuncture, Massage, Yoga, Drumming and other Meditations while maintaining a daily health routine. (Contact: 575.524.2379)

- instructors teach you how to do the series of 23 movement/breathing exercises to promote vital energy and release stress.

Jerry Vest, LISW/LMT Holistic & Integrative Health
249.JPG
Joining Nature is a Health Experience-Join Us

PCALS - Psychocalisthenics® (PCals) can be done easily at home, needs little space and no equipment

Below, Integration Breath short intro is next

Below A few exercies demonstration; Declan Rothwell teacher showing and performing the art of Pcals

Below - a complete work out you can do at home


 

PART II: STRESS IS STORYTELLING GONE WILD, A GAME OF BLAMING THE VICTIM!.

TRUTH ABOUT PTSD RESEARCH AND THEORY

The pharmaceutical industry and psychiatry have actually implemented the PTSD med treatments in ways that have increased, rather than decreased the numbers of military (& civilian) suicides.

I think the major thing we are facing is how the narrative of stigma in American culture leads our service men and women into denial, so that they dare not avail themselves of even the most basic skill training courses, much less enter therapy. The ignorant stigmatization and pathologizing of stress by the mental health industry, the journalistic media, the university, etc.

NPR tape of the lack of validity and reliablity of the stress tests used before and after deployment.

Despite the many studies deconstructing the validity of PTSD measurements, including the sacred DSM categoreis, soldiers and the general public continue to be subjected to 'junk science.' The National Institute of Health, and its DSM protocol, says PTSD consists of three things:

1. Re-experiencing an event via flashbacks and nightmares

2. Avodidance via depressiong, guilt and staying away form certain places that are reminders

3. Hyperarousal resulting in insomnia, angry outbursts, and feeling always on the edge.

See for example Washtington Post.TV; PBS This Emotional Life 2010; University of Washington panel 2009 on meds and treatment options;

The proponents of PTSD argue that it affects 7.5 million americans. Further the advocates for a PTSD diagnosis assert that there are few alternative treatments to talk-therapy and of course, medications from the pharaceutical industry, administered forever to contain PTSD.

What is the result?

Post-Traumatic Stress becomes labeled a 'disorder,' a 'pathology' that has no effective treatment beyond cognitive behavior modification, reliving the singular trauma event, and of course medications from the pharaceutical industry.

We do a disservice to veterans, by inferring from paper and pencil tests of PTSD, with highly questionable validity, and a naive public takes the media storytelling hype as valid, in order to paint all veterans with one grand narrative of flashback, etc. is an even greater disservice.

Veterans are gaming the PTSD paper and pencil tests, in order to avoid the public stigma promoted by the media, and by propenents of PTSD as a pathology.

With the immense stigma against anything to do with therapy in the U.S. particularly among the military warriors, few people have the courage to apply for services, and most have to apply twice, and have to be tough enough to face the stigma. They take the route of self-endangerment, or outright suicide. How many marriages wrecked, how much anger passed along to children. What is the total cost of the way society stigmatizes caring for veterans and their families?

I think it is import to face these facts. People get their ideas of how to handle military combat stress from the movies. Is it accurate? The military relies on Hollywood cooperation, to access archives of warships and equipment, so that movies can shape popular culture. This is a long-standing propaganda narrative co-production. It manipulates the public’s viewpoint about how to cope with stress (Robb, 2004).

PART III: THE HIDDEN ENEMY

Welcome Home our Vets and Families with Health Services and Beware of "The Hidden Enemy"! "In early 2013, the official website of the United States Department of Defense announced the startling statistic that the number of military suicides in 2012 had far exceeded the total of those killed in battle – an average of nearly one a day. A month later came an even more sobering statistic from the U.S. Department of Veterans Affairs: veteran suicide was running at 22 a day – about 8000 a year" (source: The Hidden Enemy). Actually is 22 a day, which 8,030 a year, and in 7 years, that 56,210 each year.

SEE VIDEO - The Hidden Enemy

Summary - the military is being destroyed from within by a dangerous enemy,"the soaring rates of psychiatric drug prescribing since 2003"... "And in psychiatry, diagnoses of psychological disorders such as PTSD, personality disorder and social anxiety disorder are almost inevitably followed by the prescription of at least one psychiatric drug." What are the business implications, the capitalist complicity? "In the face of these grim military suicide statistics, more and more money is being lavished on psychiatry: the U.S. Pentagon now spends $2 billion a year on mental health alone. The Veterans Administration’s mental health budget has skyrocketed from less than $3 billion in 2007 to nearly $7 billion in 2014—all while conditions continue to worsen." In short, the US pharacetuical industry is drugging the military for profit. There is a psychiatric pop-a-pill “quick-fix” mentality being sold in the marketing.

 

PART IV: SUICIDE AND THE REAL ENEMY WITHIN

"From 2001 to 2009, the Army’s suicide rate increased more than 150% while orders for psychiatric drugs rose 76% over the same period. These soaring statistics cannot be attributed to the horrors of war, as 85% of military suicide victims had never even seen combat" ... "These chemical compounds, however, can produce harmful consequences, and accumulating evidence shows that the ever-increasing use of psychiatric drugs may be fueling an epidemic of military suicides and unexplained deaths." (CCHR.org).

As of April 8 2014 -- "Over 125 meetings with Congress, the VA, the Pentagon and the White House. We mobilized the community at our National Day of Action where we planted 1,892 American flags on the National Mall to represent the veterans we have lost to suicide just this year alone" Suicide Prevention for America’s Veterans (SAV) Act, a sweeping new IAVA-crafted bill aimed at combating suicide).

On the planet Earth there are one millions suicides a year. "In America, suicide rates are higher in less populated, less wealthy areas" (source).

In the US, 22 suicides a day are by veterans. Of the 22 about 1 of these is active duty, and others are young men and women one to three years after filing DD214. Do the math: 8030 veteran suicides a year. That is more veterans than died in combat in all the years of Iraq and Afghanistan. Something is wrong when more soldiers fall in suicide than in combat. "The number of young veterans committing suicide nationally spiked dramatically from 2009 to 2011" (Kuta, 2014: 1). Kuta goes on to report "Suicides among 18- to 29-year-old male veterans increased from 40.3 per 100,000 in 2009 to 57.9 per 100,000 in 2011. Among 18- to 24-year-olds, that rate increased by more than 70 percent, from 46.1 to 79.1 per 100,000 veterans" (ibid: 1). For some reason, 2012 was the deadliest suicide year on record for U.S. forces.

There is something wrong. In just one year, 8,030 veteran suicides is more than died in combat in Afghanistan war between 2001-2014. One year of veteran suicides is about double the Iraq war casualties between 2003 and 2011. The total war casualties of War on Terror is 50,897 between 2001 and 2014. That means at 8,030 veterans suicides a year, in 7 years, the number of suicides is 56,210, which is about how many soldiers died in combat in Vietnam, and is more than all the war dead since Vietnam

What does it mean? In civilian U.S. population more people now die of suicide than in car accidents. To me it means, that U.S. society is on the decline. According to Center for Disease Control and Prevention, in 2010 there were 33,687 deaths from motor vehicle crashes and 38,364 suicides (source). There were 38,364 suicides in 2010 in the United States--an average of 105 each day (source).

In sum, of 105 suicides a day in U.S., 22 are veterans, and one of these is active duty military.

PART V: What is stigma?

Stigma can be defined as negative stereotypes about seeking mental health help, social status loss in the military from being labeled with a stress disorder, and discrimination related to a particular perception of difference of a solder who is macho, and one needing help with stress, anger, depression, and so forth (Link & Phelan, 2001; Goffman, 1963; Hoge et al., 2004; Wahl, 1999). According to National Council on Disabilities, there are three kinds of stigma:

1. Public Stigma: public (mis)perceptions of individuals with mental illnesses. Soldiers do not want to be perceived as weak, or blamed for theeir problems. The public has a general fear of stress among the military, since Vietnam days.

2. Self Stigma: veteran internalizes the public stigma (such as from depictions of soldiers in movies) and does not want to feel weak, ashamed or embarrassed.

3. Structural Stigma: institutional policies or practices that unnecessarily restrict opportunities to veterans to achieve help and health. For example, going for help, at one time, meant a barrier to promotion; military leaders at one time would blame the soldier for not being tough enough to handle stress problems.

What is structural stigma? For example, 46% of employers in a 2010 survey by Society of Human Resorce Management said "PTSD or other mental health issues were challenges in hiring employees with military experience." Results of a 2011 survey of 831 39% of the hiring managers are "less favorable" toward hiring military personnel when considering war-related psychological disorders." (Health Today).

There is good news.  Soldiers, sailors, airmen, Marines, Coast Guard, Reserve, veterans and their family members, the military is changing. "Suicides across the military have dropped by more than 22 percent this year, defense officials said, amid an array of new programs targeting what the Defense Department calls an epidemic that took more service members' lives last year than the war in Afghanistan did during that same period... Each of the military services has seen the total go down this year, ranging from an 11 percent dip in the Marine Corps to a 28 percent drop for the Navy. The Air Force had a 21 percent decline, while Army totals fell by 24 percent" (Fox News 2013). The structural stigma is getting attention. They are on quest to really eliminate stigma of seeking help for stress. For example, during a visit to a Fort Bliss, Texas, treatment center designed to help troops with post-traumatic stress disorder, Secretary of Defense Robert Gates announced a policy change:

"The most important thing for us now is to get the word out, as far as we can, to every man and woman in uniform to let them know about this change, to let them know the efforts that are underway to remove the stigma, and to encourage them to seek help when they are in the theater or when they return from the theater" (PBS).

"Fearing for their careers, many service members keep quiet about their mental health problems—and their silent suffering is taking a toll on our military readiness. In response, the Defense Department has begun fighting stigma on several front" (Dingfelder, 2009: 52). For example, the "Defense Department recently revised its security clearance questionnaire so that people who seek mental health care for combat-related reasons do not have to report it" (ibid.: 52).  The military has a new anti-stigma campaign called "Real Warriors. Real Battles. Real Strength." Stress is a material condition. In Canada, it is openly discussed as toxic occupational, a material work-related hazard (PBS). Canada wants to remove the barrier for its veterans getting care.

The problems is despite the DOD efforts, in U.S. popular culture , the stigma about stress, or any mental health care, is still very strong.

What is relation of Stigma and Stress? Stress is a well-known contributor to suicide-risk. Most research, treatment, and intervention blames the victim of stress for any and all stress. What is missing in the research is eliminating the cultural stigma associated with stress. Without a coherent storytelling of the causes of the stess condition (without specific aetiology), the veteran can find no valid reason for it except the 'clinical syndrome' materialized in the test itself as a category or a dimension called stess, that veteran can only express stess in terms of storytelling the historical or mythical explanation, or spiritually, about being haunted by a memory. Ironically, the dominant therapy approach to stess treatment in the military and for veterans who have left it, is to relive the memory again and again, wild facing their fear, by going into situations that prompt the 'syndrome' in everyday life. Since stess overlaps with lots of other categories and/or dimensions such as depression, anxiety, etc., the veteran (and I would suspect their psychiatrist or psychologist) does not know what is being treated whatsoever.

What is relation between Stigma and the Movies about Stress?

There are blogs devoted to stess in Vietnam era war movies:

There is a website where you can rank order movies about stress in military, in secret service, etc. Click here to rank the movies. This site adds Patton and Taxi Driver to the list of movies about stressed out veterans.

What is going wrong with Traditional Stress Psychology? In my view,traditional stress psychology is doing harm to veterans and families. Why? Stress psychology continues to blame the victim within U.S. society that itself stereotypes veterans in the movies as damaged characters (Rambo, First Blood, Taxi Driver, Deer Hunter, Apocalypse Now, etc.). The cultural narrative (trope) has the expected plot element of the flashback by the veteran. The recommended cure by stress psychology is more flashback to desensitize the event-memory. Try getting a job after your recruiter watches Rambo or Deer Hunter?

Does traditional stress psychology wound warriors? Does this positive stress psychology movement help where traditional stress psychology has failed?

Both the old and the new stress psychology save lives. Does traditional stress psychology stereotype, label, stigmatize veterans? Is the new approach getting beyond the old stigma?

There are still soldiers unwilling to put ‘veteran’ on their employment application. There are still veterans not participating with either the old or the new stress psychology.

Here is a summary of my Top ten concerns:
1. Traditional stress psychologists deproblematize the material history of stress in U.S.A. Into a totalizing ‘grand narrative’ (Lyotard, 1979) and hence what I call a thousand ‘living stories’ of the lifeworld of veteran and family are backgrounded, marginalized, or dismissed as irrelevant to the psychology of stress.
2. Traditional stress psychologists use and authorize what Michel Foucault (Birth of the Clinic; Madness & Civilization; Technologies of Self; Discipline & Punish) calls ‘technologies of power’ to effect power and domination of one culture over many others in ways that is not ethically answerable for ethnocide, genocide, and proceeds to blame the victim.
3. Traditional stress psychology’s DSM categories legitimate the pharmaceutical companies to medicalize stress among veterans and their families.
4. Traditional stress psychology is a way of ‘science’ that objectifies veteran and family violence through practices of cultural domination and the systemic destruction of ethnic and Native family.
5. Traditional stress psychology lacks relevance to real-life material life world of veteran and family in spaces, times, and material conditions of the military, and U.S.A. Life worlds.
6. Traditional stress psychology banishes the spiritual, all things metaphysical, and any soul wounds to another pathological category, while pretending to study cultural differences.
7. Traditional stress psychology is a means by which white male categories of stress become that basis for understanding cross-cultural differences in stress and violence in schools, families, business, universities, and the military-industrial-pharmaseutical complex.
8. Traditional stress psychology colonizes ethnic, racial, and Native American identities with a ‘white’ subjectivity of stress diagnosis and treatment.
9. Traditional stress psychologists disempower veteran’s agency to be historical, cross-cultural, and spiritual.
10. Traditional stress psychology inflicts more wounds on warriors, and their families, with each category of diagnosis, intervention, and stigmatization of stereotyped identity work.

In sum traditional stress psychology is a danger to health because it continues a neocolonialism masquerading as ‘objective science’ with disastrous results.

Positive stress psychology also masquerades as objective, acultural, universalistic science. It does succeed in moving out of the duality of you have stress or you don’t, into a multi-dimensional approach that includes family, spirituality, animals, fitness, and so forth.

The veteran is forced by traditional stress psychologists to abandon ethnic and cross-cultural beliefs and adopt the Judeo-Crhistian worldview of stress. To what extent is the new approach to stress psychology more open to more kinds of spirituality, more cultures, more alternative healing approaches?
Once the traditional stress psychologists diagnoses and stereotypes a veteran and family with stress problems, that stress-identity is carried forward into civilian life, into university, into non-military careers. Is this the case for positive stress psychology?

There are cross-cultural differences, in suicides. 73% of all suicide deaths are white males.

U.S. Suicide Statistics (2001)source
Further Breakdown by Gender / Ethnicity
    Rate Per Group        # of Suicides   100,000

White Male.........22,328........19.5

White Female ........5,382.........4.6

Nonwhite Male ........2,344........9.3

Nonwhite Female ......568.........2.1

Black Male .............1,627.........9.2

Black Female.............330.........1.7

Hispanic.................1,850.........5.0

I come bearing gifts. I propose an alternative to traditional stress psychology. It is called ‘embodied restorying’ in support of veterans and their families. It is cross-cultural, it is ethnic, and Native, spiritual, involves horses (groundwork( and it problematizes the traditional stress psychology Cartesian ‘cut’ and ‘separation’ of subjectivity and objectivity. Rather, in embodied restorying, history, cross-culture, technologies of self, the hegemony of a science that tries to universalize stress as acultural, ahistorical, and proceeds to blame the victim — all that is ripe for deconstruction.

"With so much attention, understandably, on the disorder, few researchers have asked soldiers about positive changes they might have experienced” Source: http://www.nytimes.com/2012/03/25/magazine/post-traumatic-stresss-surprisingly-positive-flip-side.html?pagewanted=2&_r=0

Embodied restorying is a way to work through the dominant grand narrative of traditional stress psychology, and understanding its hegemonic project, deconstruct its power and influence, in-order-to find liberation by reclaiming Little Wow Moments of exception to the grand narrative of stress, reconnect with spirit, fin ways to do soul healing. Traditional tress psychology continues its colonial and neocolonial project, and its exported wholesale to the Third world. It is unimaginative, and as the science spread it is replicated in psychology research full of stress stereotype and stigma. In the words of Duran and Duran (1995: 26) “clinical psychology is extremely narrow-minded” and “based on a utilitarian worldview” of whatever works. “Of the traditional concepts, soul loss may be the most difficult for the Western worldview to accept” (ibid.: 20).

PART VI: Enter the Positive Psychology Movement

Fortunately, the military is begin to face the stigma of stress in its forces head on. Why? Veterans who seek help are less apt to commit suicide. 22 veterans a day commit suicide. Of these only one is active military. Do the math. 22 times 365 is 8030. In seven years, its 56,214 which is more than Iraq and Afghanistan or about number of troops dying in combat in Vietnam.Most of the veterans who commit suicide, are out of the military, one to three years, and have not sought help because of media stereotypes in U.S. Films, news reports, magazine, articles, and in what they have heard about stress psychology. What the military is using lately is Global Assessment Tool 2.0. has social, emotional, physical, family, and spiritual dimensions. http://csf2.army.mil/downloads/ArmyFitOne-Pager.pdf

Five ways to Cope with Stress in the New Military (source Army Military site; or Fort Bliss Bugle)

Physical - Weekly exercise can protect your brain from the
aging process and delay the onset of neurodegenerative
disease. Hence, not only does exercise improve and maintain
your physical health, it can improve and maintain your
psychological health!

Social - Effective communication with peers and leaders
requires effort and practice. Remember to use the IDEAL
model when you are faced with a challenge or conflict.

Spiritual - Some would contend that interacting with
animals builds the spirit. Research in the human-animal
bond support the idea that animals make us more human.
Spending time with your pet is probably good for both of
You!

Emotional - The brain and nervous system respond best
when given structure. Creating a routine for an important
task can focus the brain and body on the necessary steps to
achieving success, while lowering counterproductive levels
of stress that inhibit emotional balance.

Family - When they can’t solve problems on their own,
resilient families reach out for help by turning to extended
family, friends, neighbors, community services and/or
Counseling.

"In less than two years — without a single pilot or study — the program has been rolled out to the Army’s one million solders. Every soldier takes the General Assessment Tool, a 105-question survey, which asks soldiers to respond to statements like, “In uncertain times I usually expect the best” (Cornum would score high on this), or “If something can go wrong for me, it usually will.” Depending on how soldiers score, they are prompted to complete online training in any of the program’s five key areas: physical, emotional, social, family and spiritual (which could mean either religious faith or personal reflection). The Master Resilience Trainer program, part of this larger effort, is supposed to turn the noncommissioned officers closest to young soldiers into teachers of positive psychology” source

"The traditional view of trauma was bifurcated: you either got P.T.S.D. or you were fine. Researchers today have a messier perspective. It is normal to have problems following trauma. You should lose sleep, have terrible images replay in your head, be racked by guilt or fear. Some people suffer these normal post-trauma reactions to one degree or another and recover, returning to a relatively normal state within weeks or months of the event. Others appear unchanged at first, only to react months or even years later. The majority of these people also recover” source.

The military is moving away from traditional stress psychology of PTSD and moving to flip it to PTSG - Researchers have found evidence of post-traumatic growth in cultures across the globe (Israel, Turkey, etc.). PTSG is using animals, storytelling, and confronting the old stigmas.
Definition: Master Resilience Training (MRT)

Download and Read 3 MRT stories.

1. First story

2. Second story

3. Third story

PART VII: Welcome to Leviathan!

Leviathan is the name Thomas Hobbes (1651) gave to the swarm of institutions that are the State. Now Leviathan has gone global, and with it stress has morphed from something haunting veterans and abused women, to the daily malady of all those living in global capitalism. Leviathan recruits heroes to fight its global wars. However, there is heightened perceptions of community-based stigma in U.S. culture that is a barrier to treatment for the stress of combat theatres (Stotzer, Whealin, & Darden, 2012: 2).

The authentic self of the veteran is haunted by many inauthentic selves, many of them part of the commodification of stress and depression instruments, treatments, insurance claims, etc.

Meanwhile, poplular culture engages in stigma-production. Popular culture has taken up the cause of Leviathn, creating narratives of the veteran's character, as victim. A veteran, according to the movies of popular culture must narrate the requisite stress symptoms, report vivid flashbacks, in order to get veteran's benefits. Stress is now what Lyotard calls a 'grand narrative' that institutions create and perpetuate, and veterans must emulate.

Veterans across the U.S. enter America's Wounded Warrior Outreach Program. Some are coming back from multiple deployments, and redeployments. They are ready to head for home. They find considerable stigma about getting help for stress, when they return to stateside. A study of Native American and Latino veterans identified several barriers to VA services: 85 percent felt “VA care-givers know little about ethnic cultures," and 79 percent felt that “VA care-givers have problems talking with ethnic veterans" (Nugent et al. 2000). 

Meanwhile, in this blaming the victim culture, the structural flaws perpetuating stress without relief assault the authentic self of the veteran, who faves barriers to treatment, or gets no treatment at all, except that which blames the victim, for any and all veteran distress. I propose a new approach to Restorying as a way to help the veteran reclaim their authentic self, and do battle amongst all the inauthentic cultural ways of stress is being created, narrated, and perpetuated by Leviathan.

PART VIII: Diagnostic and Statistical Manual of Mental Disorders

There is now so much stigma around the words 'stress' and 'anxiety' and especially 'PTSD' that our veterans on active duty and those seperated from the military do not go for services. Veterans returning from deployment, game the PTSD tests to avoid being detained, stigmatized, and/or losing rank or assignment.

PTSD has been changing as a frame over the decades. This is reflected in how PTSD is defined differently in the Diagnostic and Statistical Manual of Mental Disorders (known as DSM).

DSM Timeline of changes show that DSM keeps changing the PTSD-frame, and in 1968 removes it altogether. The PTSD-frame literally tries to protect itself from anomalies and exceptions, and the PTSD-frame tries to maximize its scope by discarding irregular data, discarding exceptions, etc. (for more on Frame Theory, please see Manfred, 1997). Here is a summary of the key changes to the PTSD-frame:

DSM-I (1952) "stress reaction" to combat, fire, earthquake, explosions (an inclusion of 1943 Technical Bulletin Medical 203, battle fatigue in WWII)

DSM-II (1968) dropping 'gross stress reaction' so there was no longer a diagnosis of war/battle fatigue; this meant that returning Vietnam War veterans had no diagnostic-frame available

DSM-III (1980) PTSD is included after 10 year political campaigning by a group of veterans known as Vietnam Veteran Against the War (VVAW), and psychiatrists Jay Lifton and Chiam Shatan

DSM-IV (1994) PTSD is changed as more and more exceptions, anomalies, contradictions, and even contrary cases emerge that the PTSD-frame cannot account for; Click for DSM-IV criteria for PTSD; result "Defining Criterion F as having both clinically significant psychological distress and functional impairment lowered the diagnostic threshold to a greater degree than did either distress or impairment alone" (see article)

DSM-V (2013) PTSD-frame changes once again, since the DSM-IV re-framing of PTSD is still not able to stem the tidal wave on frame-contradictions; The change is from a diagnostic to a dimensional approach and "The DSM-5 chapter on anxiety disorder no longer includes obsessive-compulsive disorder (which is included with the obsessive-compulsive and related disorders) or posttraumatic stress disorder and acute stress disorder (which is included with the trauma- and stressor-related disorders). However, the sequential order of these chapters in DSM-5 reflects the close relationships among them" (see APA summary of changes); Results of this most recent frame-change, "Females showed significantly higher DSM-5 PTSD rates and rates of endorsement of almost all DSM-5 PTSD criteria. Significant gender differences emerged in almost half of PTSD symptomatological criteria with women reporting higher rates in 8 of them, while men in only one (a new symptom in DSM-5: reckless or self-destructive behavior)" (see article).

DSM-V addressed PTSD as an anxiety disorder;

In DSM-IV, PTSD is restricted to exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following 4 scenarios, in which the individual:

• directly experiences the traumatic event;

• witnesses the traumatic event in person;

• learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or

• experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related).

 

In CONCLUSION: The problem, of course is the PTSD-frame is invludenced by media, pictures, TV and movies, so that veterans seeking PTSD benefits and treatments must mimick the symptoms in the cultural trope to satisfy the political, pharmeceutical, and medical framing of what constitutes PTSD in any given decade of DSM changes. Meanwhile, viable alternatives to the dominant med and therapy treatment protocols go begging. And sources of stressors outside the PTSD-frame are marginalized, untreated, not subject to insurance medical claims, etc.

DSM-5

2013
DSM-5
Thirteen workgroups worked a full 10 years before the publication of the DSM-5 in May, 2013.

 

Meanwhile an entire industry has flourshed between 1980 and 2014 that makes stress the total responsiblity of the victims of stress.

Diagnostic and Statistical Manual of Mental Disorders (DSM) is a manual that teams of experts in various field publish. The Apermican Psychological Association has been piad $30 million for its manuals. That are used to do diagnosis, design treatments, and decide on insurance payments and government benifit payouts. Meanwhile there is so much stigma attached to stress that few are seeking effective treatment.

The most hghly stigmatized stress of all stress, is PTSD. It is now so convoluted and unreliable that the Mental Health Association questions its validity and its reliablity as a measuring instrument, as a diagnosis, and its treatments are now equally suspect.

Stress came into being in DSM-I as anxiety disorder. It changed somewhat in DSM-II. PTSD came into being in the manual called DSM-III (1980) and has been redeployed differently in DSM-V (2013). A key difference is that DSM-III treats PTSD as an entity (aka category), whereas DSM-V treats PTSD as dimensions. Another difference is that test/diagnostic items in DSM-III have gone missing in action in DSM-V. As a dimensional approach to PTSD, DSM-V does not posit a threshold of PTSD, such as low-magnitude versus high-magnitude PTSD. I will argue below that PTSD has been dematerialized between DSM-III and DSM-IV, and that this dematerializtion is an example of organizational storytelling.

" Previous editions of DSM used a strictly categorical model requiring a clinician to determine that a disorder was present or absent. The dimensional approach, which allows a clinician more latitude to assess the severity of a condition and does not imply a concrete threshold between “normality” and a disorder, is now incorporated via select diagnoses” ... "To ensure DSM-5 is not overly disruptive to clinical practice, its spectrum measures are compatible with categorical definitions” (American Psychiatry Association, book publishing organization)

Does PTSD have any construct validity? Does the validity of inferences that observations or measurement tools of PTSD actually represent or measure the construct being investigated? Could it be that PTSD is a dimensional-multiplicity, not one PTSD entity? PTSD has become a spectrum of categories or is it dimensions (that answer depends upon if you subscribe to DSM-III categories or DSM-V dimensions) from reaction to loss of a parent or child, cancer, change, etc. to bullying in the school yard up to reactions combat, torture, etc.

WHAT IS HAPPENING TO PTSD BETWEEN DSM-III (1980) AND DSM-V (2013)?

My question to you, is if PTSD is different in DSM-V (published on May 18, 2013) than it was in DSM-III (1980 version) and since the framing-construct is being challenged so widely on validity issues, for its overlap with other psychiatric categories, then should we expand our inquiry to include sampling the wider population than just the military, so we can sort out this morphing of PTSD?

Further, as organizational storytelling scholars, if PTSD-framing has morphed into a multiplicity of entities, and is no longer, and perhaps never was a unitary construct or category, then it would seem that we need to study the entire communication processes of organizations, how PTSD-frame gets created by institutions, then foisted on the unsuspecting veterans, and their families. If the statistics are accurate, then 94% of the veteran’s diagnosed with PTSD are seeking compensation, which encourages exaggeration of the storytelling by veterans as well as insurance companies, therapists, etc. in order to get compensated.

PTSD is the most controversial 'disorder' of all disorders in DSM

If PTSD is as Shepard (2001) says everything from "surviving Auschwitz and that of being told rude jokes at work” is not the whole PTSD construct just nonsense to begin with? If PTSD is a social constructivism, and not a biological or a psychiatric mental disorder, then we are studying a phenomenon that is what I am calling, Leviathan. Spitzer & Wakefield (2007: 233) also wrote, "Since its introduction into DSM-III in 1980, no other DSM diagnosis, with the exception of Dissociative Identity Disorder... has generated so much controversy in the field as to the boundaries of the disorder, diagnostic criteria, central assumptions, clinical utility, and prevalence in various populations." Could it be as Wakefield and Horwitz (2007) that institutions advancing PTSD transformed normal sorrow of combat veterans into various stress and depressive disorders? Derek Summerfield in his book review of Rosen & Frueh (2010) concludes, "It is ironic that research spurred by the introduction of posttraumatic stress disorder (PTSD) has come to challenge almost every aspect of the construct’s originating assumptions.” See Derek Summerfield's book review. Summerfield adds, "Rosen notes that normal and even expected reactions to a traumatic experience, such as anger or uncertainties about the future, can now be referred to as ‘symptoms’, and that this labelling is encouraged by such terms as ‘sub-syndromal’, ‘sub-threshold’, ‘partial’ and (my favorite) ‘delayed-onset’ PTSD.” (Ibid).

PTSD plays a spectacle role in the courtroom, and in the entire compensation industry. 94% of U.S. Veterans are seeking compensation for the U.S. Department of Veterans Affairs. Is there incentive to spin the storytelling of PTSD, play the role, so that, what academics think it PTSD, is actually a negotiation to get institutions to pay compensation, disability, give benefits?

AGENTIAL CUTS AND Stress

There is another important question. What if stress actually is an ontological entity? Where if instead of blaming the victims of stress, we actually made it OK for veterans to get some effective help?

The conflated storytelling about stress is used to succeed in getting Veteran's Benefits. But this only muddies the water. The stigma increases. And what if what we take-for-granted about stess, its flashbacks, with all the coming home from war movies,has rematerialized stess into a cultural trope?

Here is my materialism storytelling take on it. Stess (& depression) is how various institutions from the VA, the military, insurance companies, DSM manual publishers have carved the construct 'stress' storytelling by making 'agential cuts.' Karen Barad (2003: 815) gives this extended definition and discussion of 'agential cut':

"A specific intra-action (involving a specific material configuration of the 'apparatus of observation') enacts an agential cut… in contrast to the Cartesian cut---an inherent distinction---between subject and object… effecting a separation between 'subject' and 'object.' ..."

The category/dimension of stess does not preexist the relationship to some particular population. That relationship is made into an 'abstract relata' as it DSM carves it out in the agential cuts by the experts creating it. DSM manuals and their writers, and the associations and publishers distributing them --- enact what Barad (2003: 815) calls "agential separability." Stress gets externalized from the relationship of the authors of 'stress instruments and protocols,' and the veterans and others, that supposedly, allegedly, have stress. Barad (ibid) adds "The notion of agential separability is of fundamental importance, for in the absence of a classical ontological condition of exteriority between observer and observed it provides the condition of a possibility of objectivity." In other words, the ontological condition of stress is harder to reach since the relation between observer and observed is severed.

Here is the kicker:

"Moreover, the agential cut enacts a local causal structure local "components' of a phenomenon in the marking of the 'measuring agencies; ('effect') by the 'measured object' ('cause')' Hence the notion of intra-actions constitutes a reworking of the traditional notion of causality" (Ibid, p. 815).

Stress as category or dimension of DSM manual, enacts the local causal structure, particularly in DSM-V in the veteran, in the 'measured object' of reliving trauma memory, as 'cause' of the disorder. The intra-actions between storytelling PTSD by the clinicians and the materiality of PTSD in the body of the veteran is reworked in DSM-V. The traditional not of causality of PTSD, is war, violence, assault, battery by somebody or some institution caused the trauma in the body, DSM-III called PTSD. The point of the agential cutting going on it to make sure that institutions blame the victims of war for PTSD, the victims of abuse for PTSD, and never ever blame the institutions for violence and trauma.

PART IX: WELCOME TO THE LEVIATHAN OF STRESS CREATION FOR PROFIT

Leviathan is Thomas Hobbes (1651) word for a hoard of institutions. A hoard of institutions from psychiatry, DSM, military, university, psychology, political, etc. are complicit in materializing the storytelling and the embodiment of stress in many populations. From an organizational storytelling standpoint, for me, this means that there is a materialization, dematerialization, and rematerialization cycle of stess.

Various institutions are creating processes that materialize stess as a construct, as a disorder, as a treatment , and a label for such a variety of anxieties, physiologies, memory loops, etc. that the whole construct of stess is quite absurd.

The dematerialization of PTSD can be studied in the ways DSM-V dematerialized aspects of stress important to the the DSM-III architects. It would be interesting to pin down what questions in the stress diagnosis (& treatment) dematerialized (were edited out of the test) between DSM-III and DSM-V.

There is a rematerialization process going on among the various institutions and academic disciplines that are concerned with forms of stress. Elements (test items, traits) in what constitutes stess are being rematerialized. I notice for example, in the online DSM-V tests for anxiety disorder, which is supposedly highly correlated to stess indicator-instruments, that in anxiety disorder the core assumptions are physiological, and the test questions are about anxiety being embodied. Compare these sort of embodiment test items to how stress in DSM-V is even more disembodied than it was in DSM-III. In sum, the organizational storytelling of stress has changed since stress was introduced in DSM-I and PTSD in DSM-III in 1980, and been rematerialized as more disembodied than ever in DSM-V.

What are the implications of this shift in organizational storytelling of stess for our interdisciplinary study? For me, it is that the ways of restorying stess involve materialization, dematerialization, and rematerialization processes of many different organizations. The Quantum Restorying and the equine skill training of stress management training by my colleagues and I. We proposing both skill training approaches are about embodiment, stress embodied in the body, and the stress defined by culture, by Leviathan, in ways that brings profit to stress-drug distributors, stress therapists, stress researchers. We may be better served with an stess/anxiety disorder measurement pre and post to such interventions that gets at embodiment than with the DSM-V test which is completely disembodied, about reliving memory of trauma, and that affecting behavior (withdrawing from the social and from intimacy, such as in the cognitive-behavior approach to stess).

One of the dematerializations is DSM-III took a categorical approach to determining PTSD, so for example, a veteran had low-magnitude or high-magnitude, or even delayed-reaction PTSD. However, "To ensure DSM-5 is not overly disruptive to clinical practice, its spectrum measures are compatible with categorical definitions” (See online text).

You can see the materialization/dematerialization/rematerialization in the academic storytelling about PTSD. Is PTSD a categorical entity or a dimensional range? PTSD can be constructed as categorical clinical entities and/or as a range of specifiers, such as “mild,” “moderate,” and “severe,” which introduce a dimensional aspect (Stein online text). Stein concludes "A potential disadvantage of categorical approaches is that they may encourage reification and oversimplification of complex entities with multiple overt symptoms and underlying mechanisms. A dimensional perspective allows for a more fine-grained approach, but also has significant potential disadvantages. It is useful to employ categorical and dimensional approaches in tandem, in both clinical and research settings.”


Spitzer, First, and Wakefield (2007:233-241) conclude in a special issue of the Journal of Anxiety Disorders:

there are "critical issues and core assumptions that underlie the diagnostic construct of posttraumatic stress disorder. Rather than addressing specific points raised in these papers, we consider the issues and their implications for redefining PTSD and associated disorders in the DSM-V. Specific proposals are advanced to tighten definitional criteria for traumatic events and posttraumatic symptoms. We believe the more stringent criteria express the intent of the PTSD category and will promote more effective research on whether that intent was legitimate or based on misconceptions.”

NEW MEASUREMENT NEEDED: STRESS in STORYTELLING AND its MANUFACTURE IN LEVIATHAN

Finally, we would like you to put aside the way stess is diagnosed, and how popular culture (TV, news stories, books, etc.) portray you as victim of stress. Rather, we ask you to tell the authentic story of stess itself. This is not reliving the trauma events, or their memories, rather we are asking you to just tell the story of your home-coming, and ways you were expected to have stess.   

Findings of Stress Research are Contrary to the Most Recommended Treatment for Veterans

Stress affects the lives of millions of people who have encountered war, domestic violence, rape, major illnesses, loss of a spouse or child, natural disasters, and other traumatic events. Anyone including children can contract stess. One of the problems is that stess as a medically defined condition has been given a very generalized definition in the media, in popular culture, in the movies, TV shows, and news reporting. And in popular culture soldiers are expected to tough it out, man-up, and never seek help, never go for therapy, be one of those that culture stigmatizes. It is stigma by popular culture, and lets med everybody, pharmecutical industry that is at the root of stress.

When the war fought is justified and legitimate, then no stess is expected. The most recommended treatment is 1. UNOFFICIALLY: Don't report it, you will never be promoted. Leave it out of all your storytelling.

If the war is unjustified, did not go as the State planned it, or otherwise questionable, then, as with Vietnam, the returning veteran is expected to have stess, to tell it in the home-coming story, to report the usual symptoms. The the second most recommended treatment is prescribed: Repeated reliving of the trauma event, its flashbacks, so as to desensitize the effect of the trauma.

Does this make sense? That the occurrence of stess, including PTSD (whatever that is today, in the latest DSM) is a matter of the popularity of the war itself, not the trauma events? Click here.

The main therapy recommended is problematic. How does reliving a trauma memory help overcome the effects?

"Rather than these reactions naturally fading over the course of time Field suggests that they are kept alive by the litigation in which patients may be involved, the succession of legal and medical reports, and the anticipation of having to appear in court, constantly refreshes the memories and the unpleasant emotions that accompany them" (Brewin, 2003: 30).

Add to this the media keeps alive the expectation and anticipation that returning veterans include all the usual symptoms in the coming-home story.

Effects of Any Previous Exposure to Trauma


"Subjects who reported any previous trauma were significantly more likely to experience PTSD from the index trauma than were subjects who had no previous exposure to trauma"  (Breslaeu et al, 1999).

This is important because many of the U.S. Department of Veterans Affairs, tests such as PTSD Coach, assume PTSD is just the result of a single trauma event, and experienced only in the past year.

 

  ptsd coach

    PTSD Coach This mobile app is to help you learn about and cope with the symptoms related to PTSD that commonly occur following trauma. It includes Tools for screening and tracking your symptoms.

    It is quite amazing, that a software app, a virtual 'PTSD coach' is there for veterans to cope with the usual symptoms.

 

PART X: More Background on Leviathan

Leviathan is a book by Thomas Hobbes (1651). Leviathan is the name Hobbes gave to the institutions of his day. In my view, PTSD is not just a stress disorder, it is a condition of Leviathan. Stress is a product sold and distributed by Leviathan, a global network of Institution bodies producing its conception, instrumentation, and treatment modalities.

1) Stress inhabits living bodies in material ways (biochemical, phsicio-biologic, psychic-memory-neurology). And stess inhabits the expected storytelling of those with traumas experiences. Finally, living bodies work for Leviathan, all the particular institutions of a society, and expect a certain trauma story to be told about flashbacks, fits of rage while driving, a burst of anger at a store clerk, etc.


2) Srtess is embodied in the Leviathan of military, State, University, Medicine, and other institutions (family, academic, clinical, pharmaceutical, neuroscience, etc.) all co-producing stess in veteran bodies in relation to other bodies with and without the syndrome of stess. This is my reading of Samantha Frost who develops a new materialism reading of Thomas Hobbes’ Leviathan.


3) Stress is embodied in the habit and disciplinary material/knowledge practices of military industrial complex, and formations of late modern capitalism where stress is recast as agentic singularity of veteran’s errant memory work.  This is a Foucauldian reading of new materialism


4) Stress is materialized in ‘observing instruments’ and ‘observing apparatuses as well as in treatment protocols, the agential cuts of Cartesians and of vital materialisms (Deleuze, Merleau-Ponty, Barad, Bennett, etc.).

5) Stress embodies the human spirit that haunts veterans, families, the military, social sciences of diagnosis (instrument production & measurement), and clinical treatments. 

Leviathan is embodied, in the “thinking-body” as Hobbes calls it, in the actions of VA, Medicine, University, Legislature, all that ongoing movement away from the very material object of the Veteran’s memory. Leviathan’s appetite and aversion feeds off the sensemaking of the veteran’s body, and in the family of the veteran.

The tragic result is the veteran takes the Self as cause of the experience of trauma and its action, meanwhile the VA treatment amplifies aversion and appetite, while holding veteran ac/countable in ac/counts of autonomous self-agency. Click here.

 

Figure 1: Leviathan-Veteran Cyclic-Antenarrative of PTSD-Fear

Without an identifiable why and what, then Leviathan for the veteran remains an absent referent, closed in the recurring cyclic-antenarrative of apprehension without object, anticipation, leading to aversion, the absent-Leviathan-referent hides, increasing appetite for veteran to relive and re-enliven fear itself, as the dominant conventional treatment modality.

 

Next Steps: Restorying Stress

We (Boje, Rosile, Hacker, England Kennedy, & Flora, 2013) propose to combine quantitative and qualitative methods in a comparative evaluation of two skill-training approaches (restorying and equine groundwork).  Both are retheorized and re-methoded as posthumanist quantum restorying. We believe it is important to treat both the veteran with PTSD and the family in posthumanist quantum restorying ways.

More about restorying stress Click Here.

We will study them in combination to assess the relative and combined efficacy in stess, both treating the family unit, and the mattering/materialization of stress. However the efficacy of our own, and other approaches depend upon the discursive/material influence of many different institutional narratives and observational apparatuses of stress/anxiety and so forth.

If you are a veteran, with a family, and would like to participate in the study please contact David M. Boje, Ph.D. at davidboje@gmail.com. We are now creating a waiting list to participate in the study. All participation is confidential. We are not affiliated with any military or veterans' institutions.

REFERENCES

Boje, D. M. (2013). Quantum Restorying of the PTSD Leviathan: Posthumanist, Critical New Materialisms of Wider Agentic-Trauma of Military and Civilian Bodis. Proceedings of the 3rd Annual Quantum Storytelling Conference, December 15-17, 2013, Las Cruces New Mexico. Click here for pre-publication pdf session handout for conference

Boje, D. M.; Rosile, G. A.; Hacker, K. L.; England Kennedy, E. S.; Flora, J. (2013). Combining restorying and equine-assisted skills training in counselor communication designed to help soldiers and their families recover from traumatic stress. Interdisciplinary grant approved for funding by NMSU Office for Research, Dec 9th.

Bowser, Betty Ann. (2010). ‘New PTSD Treatment Rules for Vets Come Too Late for Some.’ Health (July 12) on line.  http://www.pbs.org/newshour/rundown/2010/07/new-ptsd-treatment-rules-for-vets-come-too-late-for-some.html

Breslau, Naomi, et al. (1999). "Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma."American Journal of Psychiatry 156.6: 902-907.

Brewin, Chris R. (2003). Posttraumatic Stress Disorder: Malady or Myth? New Haven/London: Yale University Press.

Coole, Diana; Frost, Samantha (Eds.). 2010. New materialisms: Ontology, agency, and politics. Duke University Press.

Cook, Deborah. 2006. "Adorno’s critical materialism." Philosophy & social criticism 32.6: 719-737.

Dingfelder, Sadie F. (2009). The military's war on stigma. Monitor Staff, Vol 40, No. 6: page 52. http://www.apa.org/monitor/2009/06/stigma-war.aspx

DSM-V (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing.

Duran, Eduardo; Duran, Bonnie. (1995). Native American Postcolonial Psychology. NY: State University of New York Press.

Edkins, Jenny (ed.), (2003). Trauma and the Memory of Politics. Cambridge, UK: Cambridge University Press.

Ehrenreich, John H. (2003). "Understanding PTSD: Forgetting “Trauma”." Analyses of Social Issues and Public Policy 3.1: 15-28.

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New Jersey: Prentice Hall.

Hobbes, Thomas. (1651/1958). Leviathan: parts One and Two. With an introduction by Herbert W. Schneider. Indianapolis/NY: The Bobbs-Merrill Company, Inc. 1651 title, Leviathan or The Matter, Form,a nd Power of a Commonwelath Ecclesiastical and Civil.

Hoge, C. W.; Auchterlonie, J. L.; Milliken, C. S. (2006). Mental health problems, use of mental health services, and attrition form military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association. Vol. 295 (9): 1023-1032. 

Hoge CW, Terhakopian A, Castro CA, et al. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry, Vol. 164:150–3.

Hoge, C.W., Castro, C.A., Messer, S.C.,  McGurk, D., Thomas, J.L., Cotting, D.I. and Koffman, R.L. (2004) Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. New England Journal of Medicine. 351(1): 13-22.

Kerig, Patricia. K. (2011). "Trauma and PTSD among youth involved with the juvenille justice system." Traumatic StressPoints 25 (2011): 5-6.

Kerig, Patricia K., et al. (2012). "Deconstructing PTSD: Traumatic experiences, posttraumatic symptom clusters, and mental health problems among delinquent youth." Journal of Child & Adolescent Trauma 5.2 (2012): 129-144.

Kuta, Sarah. (2014). CU-Boulder works to confront rising nationwide veteran suicide rate. Colorado University News. More, click here.

Lembcke, Jerry. (2013). PTSD: Diagnosis and Identity in Post-empire America. Lexington Books.

Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363-385.

Nugent S, Westermeyer J, Canive J.(2000) Assessing Barriers to Mental Health Care Seeking among American Indian and Hispanic American Veterans in Minnesota and New Mexico. Abstr Acad Health Serv Res Health Policy Meet.

Robb, David L. (2004). Operation Hollywood: How the Pentagon shapes and censors the movies. Prometheus Books.

Rosen, Gerald M.; Frueh, Christopher B. (2010). Clinician’s Guide to Posttraumatic Stress Disorder. NY: Wiley.

Siddiqui, Habib. (2009). "Is Free Market Capitalism Failing?." Available at SSRN 1507345.

Spitzer, Robert L., Michael B. First, and Jerome C. Wakefield. (2007). "Saving PTSD from itself in DSM-V." Journal of Anxiety Disorders 21.2: 233-241.

Stotzer, Rebecca L.; Whealin, Julia M.; Darden, Dawna. (2012). Social Work with Veterans in Rural Communities: Perceptions of Stigma as a Barrier to Accessing Mental Health Care. Advances in Social Work Vol. 13 No. 1 (Spring), 1-16. PDF click here

Wahl, O. F. (1999). Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25, 467-478.

Wakefield, Jerome C.; Horwitz, Allan V. (2007). The loss of Sadmess: How Psychiatry transfomred normal sorrow into depressive disorder. UK/NY: Oxford University Press.