Signature Wounds Cover

Signature Wounds

The Untold Story of the Military’s Mental Health Crisis

David Kieran

New York University Press, New York, 2019, 404 pages

Book Review published on: March 19, 2021

In Signature Wounds: The Untold Story of the Military’s Mental Health Crisis, author David Kieran looks at the wounds from wars in Afghanistan and Iraq: posttraumatic stress disorder, traumatic brain injury, and suicide. Combining information from researchers, medical practitioners, soldiers, veterans, families, and politicians, he breaks down what has been done or not been done for the mental health issues arising from these wars. He also explains how the various groups above come from different perspectives and how varying agendas have impacted soldiers and veterans getting the services they need. He asserts there are certain dynamics that occur when medical knowledge and conditions collide with foreign policy and political questions.

Kieran lays out the mental health situation, including statistics, from those returning from Iraq and Afghanistan. He then describes Veterans Affairs (VA) policies put in place to try to help meet these mental health needs. Signature Wounds outlines the challenges of carrying out a recovery/rehabilitation plan, while continuing to incur the costs of war and the costs of healthcare for not only soldiers but also the many criticisms the VA received throughout this process.

Another significant obstacle was getting professional services to the people who needed it most. This required reducing the stigma of mental health issues. Interviews with people such as Jimmie Keenan, hospital commander at Fort Carson, Colorado, explains how the Army would have to be creative to get reluctant veterans involved in accepting services. This particularly applies to leadership because leaders are often trained or expected to continue to perform even when injured. Keenan points out that even though the program BATTLEMIND was created in 2005 to identify those at risk, and there was an increase in veterans using the mental health services, it often was not the veterans at greatest risk for suicide accepting the available help.

The advertising for programs provided by the VA even received criticism. The VA conducted an advertisement’s initiative in an effort to try to spread the word about mental health services. It was, however, criticized that the soldiers in these advertisements did not look like modern soldiers. They looked outdated and needed rebranding in order to attract the current population of veterans.

While some worried about outreach, others worried about trying to identify those at high risk and get them the evaluations they needed. Gerald Cross, the VA’s principal deputy undersecretary for health, mandated suicide prevention coordinators. Lists of high-risk patients were tracked and soldiers were kept on this list for a three-month period after discharge for monitoring. Evaluations were performed on these soldiers at least weekly in their first thirty days after discharge, and if they did not show up for evaluations, then rapid follow-up occurred.

Signature Wounds successfully utilizes information from documents, interviews, and personal stories combined to create this book. Kieran also looks at the information from several viewpoints including those of the military, medical practitioners, and politicians in order to lay out the big picture and all the moving parts involved. By reading this book, one becomes very aware of all the challenges the VA has had in setting up, maintaining, and providing outreach for this crisis.

Signature Wounds’ target audience is those who have served in the military, their families and friends, and more importantly, those who have served and suffer from any of the mental health issues. It helps explain why certain decisions may have been made and to help one have a better understanding of the mental health crisis portrayed by popular media.

Book Review written by: Rodney S. Morris, EdD, Fort Leavenworth, Kansas