In May of 2014, CBS San Francisco claimed that Harvard School of Public Health researchers have determined that a form of Post Traumatic Stress Disorder (PTSD) is particular to the experiences of inner city school children. In contrast to what now might be called “combat PTSD,” this version of PTSD, which CBS offensively labeled “Hood Disease,” is supposedly triggered and sustained by the violence of daily life in city neighborhoods. The CBS segment opens with gunfire and images of overseas combat before shifting to footage of Oakland city streets, explaining that with this form of PTSD the children “never leave the combat zone.”
Watch Oakland CBS Station story: Hood Disease
The connection to combat is explicit, the spatial and temporal distinctions the point. It is the framing of this segment through the imagery and language of combat that is the departure point for this feminist hack. What does the introduction of a form of PTSD specific to city life do to discourses on PTSD and wellness? Inherently militaristic, U.S. culture mostly associates PTSD with combat, as the CBS news segment makes clear. Yet the need to disaggregate forms of PTSD demonstrates the distinct ways U.S. culture continues to pathologize bodies and spaces.
With attention to disparities in PTSD discourse, particularly its triggers, this feminist hack argues that PTSD delineates the ways notions of wellness are spatially and racially constructed. It unpacks “hood disease” and “moral injury,” focusing on how these concepts work to reify the black/white binary along lines of able-bodied privilege and citizenship. It also deploys media clips alongside and in between text in part to demonstrate the many interfaces of PTSD discourse, and the ways PTSD is depicted along racial lines.
Urban PTSD as a distinct health condition in “concentrated areas of deep poverty” is a curious addition to the discourse. As the CBS segment reports, children attending inner city schools live life in a state of perpetual fear; they suffer numerous traumas which produce a permanent state of anxiety akin to symptoms associated with PTSD. Yet this description of perpetual, constitutive angst differs from other recent discussions of PTSD and the people it affects. A key example is Veterans Affairs psychiatrist Dr. Jonathan Shay’s explanation of PTSD’s primary trigger. In 2010, Shay claimed that clinical definitions failed to note what he terms the fundamental and “moral” injury that initiates the behaviors associated with PSTD. This injury is comprised of three components: the “betrayal of one’s sense of right and wrong,” by someone who holds “legitimate authority,” in a situation of political “high stakes.” Now used regularly by the VA and Department of Defense, the term “moral injury” describes moral disruption and subsequent “despair” when service members think they have “become irredeemable,” and deserve no empathy or support.
Shay’s work on PTSD is considered definitive expertise, and Jeff Severns Guntzel of the Public Insight Network (PIN), an organization dedicated to seeking public sources for more thorough and inclusive journalism, wanted to make the work more accessible to diverse audiences. Collaborating with Andy Warner of Symbolia, Guntzel produced an “illustrated story” about PTSD titled “Invisible Injury: Beyond PTSD.”
Using an image of a tent housing a service member’s friends, family, fellow service members, U.S. citizens, and the people of Afghanistan and Iraq, or the people to whom he feels “responsible,” the story portrays moral injury resulting in the depletion of the service member’s moral horizon. The moment of injury is one that “betrays” the injured’s sense of purpose and understanding of right and wrong. The service member first externalizes blame, but soon feels increasingly responsible for what he sees as unjust sociality. People gradually vacate his tent and leave him accountable to his emotions.
In introducing the high-stakes situations that can engender moral injury, the story portrays a Vietnam veteran’s testimony that describes a moment of panic, uncertainty, and violence resulting in civilian casualties. Yet when representing moral injury occurring in contemporary warfare, the story’s example describes a service member ultimately scaring, not killing, a neighborhood dog, focusing on the narrator’s shame and discomfort in relation to the fearful dog and how the moment prompted him to question his purpose in Iraq. The spatio-temporal shift from immoral warfare in Vietnam to conscientious combat in Iraq is striking. The moral injury of current combat renders the combatants’ position and labor palatable. It not only portrays the soldier as cognizant of his ethical relationship to non-humans — that the animal is a dog adds to its emotional appeal — but sidesteps entirely the human to human militarized antagonism that defines combat spaces. In its single contemporary anecdote, meant to bring the space and experience of moral injury into intimate focus, the illustrated story presents the moment as one of critical and ethical reflection and responsibility with no lethal violence perpetrated against any human or non-human being.
This choice is suspect in that moral injury is about witnessing and perpetrating what would be considered “illegitimate” violence from the position of legitimate authority. The anecdote demonstrates that any combat experience can trigger moral injury, but also packages U.S. culture’s desensitized perception of devastation in Vietnam with its over-sensitized perception of combatant culpability in Iraq and Afghanistan. With urban PTSD in mind, what is key is that the illustrated story changed the veteran’s appearance and name to protect his identity, and this change was to a blond, fit, heteronormative, white, young man. If the story’s purpose is to compel readers to see the morally injured as a military everyman deserving empathy and support, this everyman is one of white, masculine, middle-class sociality.
It seems that Guntzel, Warner, and the creative team anticipated that readers would fail to be receptive to service members’ anguish if they had to witness the injured — who looks like them — killing other human beings. The narrator goes so far as to justify the order to kill dogs by explaining that the dogs were not vaccinated and posed a threat. In this sense, regardless of the disruption service members might feel, the moment of injury seems less destructive than innocuous and even necessary. Readers are called to recognize that service members are vulnerable to moral injury and can suffer tremendously, but must do so without facing the reality that U.S. service members, who are often white and even middle-class, can make immoral or inhumane decisions.
The illustrated story draws a clear connection between moral injury and whiteness, particularly white masculinity. This link is reaffirmed through Shay’s assertion that authority coupled with high political stakes is what makes the injury moral and its results toxic. According to Shay, to suffer moral injury is to be in a position of relative political authority and experience the disruption of an ethics produced through sovereign power over violence and death; the condition of possibility for PTSD’s moral injury is political authority through domination.
These PTSD triggers and effects involve distinctions of economic and political power as well as race, as the terms “moral injury” and “hood disease” make clear. “Hood disease” is seen not as a rupture of lived ethics and normality, but as a normality that includes living with PTSD. In this case, Black and Brown communities are described as embodying a pathological reaction to external violence, and this embodiment mirrors the ontological pathology attributed to blackness and brownness. Black and Brown communal life is seen as always already disturbed, whereas the language of disruption rests on the assumption that the bodies engaging overseas combat are otherwise well and functional. CBS Bay Area’s Wendy Tokuda touches on this distinction when, at end of her segment, she raises her palms and shrugs “it’s biological… you know… it’s in the biology.” The notion of biology suggests constitutive pathology whereas the notion of disruption suggests moral respectability and responsibility prior to injury. And as the story indicates, this position of righteousness is often associated with white, male bodies.
These pathological distinctions are also spatial. Combat PTSD is triggered by a singular experience that takes place in a space outside U.S. borders and disrupts a normative, Western moral compass, while urban PTSD is triggered through continuous experience that takes place within U.S. borders and constitutes the norm of city sociality. The space of overseas combat provides the conditions of possibility for white-masculine moral disruption, while the space of domestic, urban life cannot be morally disrupted because it is constituted through black and brown pathology. Discussing the historical connections between notions of morality and race, Roderick Ferguson suggests that spatial and moral distinctions along race lines constitute our U.S. civil institutions and imaginaries. He describes how the U.S. state infrastructure itself was constituted “within a genealogy of morality” which describes the power and privilege that accompanies “political and civil enfranchisement.” For Ferguson, morality was and is the “promise” of freedom with a check in the form of regulation. He terms this dynamic a “dialectic of freedom and unfreedom,” and claims that it stems from a “racialized genealogy” which “links emancipation and subjection” and mandates “commitment” to citizen ideals. This link between U.S. citizenship, normality, and morality indicates that a deviation from such normative choices and spaces not just forfeits a state-sanctioned moral compass as well as claim to citizenship and its protections, but serves to reify state structures of dominance.
At stake in the language of disruption is a sense of loss in relation to a normality that maintains socio-economic and racial hierarchies. In this way, notions of psychological wellness voiced through discourses on PTSD work to define and police the boundaries of U.S. citizenship and morality. With urban PTSD, the sufferers are the targets of illegitimate violence; in combat, they are the perpetrators. Thus, to suffer urban PTSD is to be psychosocially aligned with the non-western other of combat, and this alignment is strengthened through historical connections between race, morality, and citizenship. The space of urban PTSD is one that challenges citizenship. That the inner city life can produce continuous anguish places it, and the black and brown bodies it contains, both within and outside the realm of U.S. state belonging and protection.
PTSD’s relation to political space manifests in other areas of PTSD discourse as well. As this promotional image from Battling Bare, a digital activist campaign dedicated to raising awareness about veterans suffering from PTSD, indicates, the imagined community of psychological wellness is often one of white masculinity and global dominance.
Featuring the Canadian, British, and U.S. flags coddled within the heart-shaped frame of hands, this image names nations of colonialism, military dominance, and whiteness as vulnerable to PTSD’s moral wounding, solidifying the triad of (disrupted) morality, state authority, and white masculinity in PTSD discourse. Battling Bare’s pledged belief in a loving military community is an emotional investment in reifying and maintaining white masculinity as a space of political power.
Shay claims that the treatment for moral injury “happens not in the clinic, but in the community.” These discourses frame communal support as also national identification and pride. As Lisa Duggan puts it, this supportive community describes “domination and call[s] it freedom.” Domination becomes wellness and dictates which bodies are salvageable and which prone to pathology, which suffer disruption and which prescribed violence.
PTSD is and is not about bodies. Its narratives produce political and social spaces through raced notions of wellness. As moral disruption, combat PTSD reifies white masculinity as it is constituted through military action beyond U.S. borders and upholds the (un)civil pathology ascribed to bodies of color and U.S. urban spaces. And yet PTSD’s relation to space, morality, and authority is the discourse’s potentially disruptive power, a power deployed when to be well or unwell serves as embodied critique.
Duggan, Lisa and José Muñoz. “Hope and Hopelessness: A Dialogue.” Women & Performance: A Journal of Feminist Theory 19.2 (2010): 275-83. Taylor and Francis Online. Routledge: Taylor and Francis Group. Web. 8 May 2014. <http://www.tandfonline.com/doi/full/10.1080/07407700903064946#.VEHsU9R4qz0>.
Ferguson, Roderick. “Race.” Keywords for American Cultural Studies. Ed. Bruce Burgett and
Glenn Hendler. New York, NY: New York University Press, 2007. Kindle Edition.
Guntzel, Jeff Stevens and Andy Warner (Illustrator). “Invisible Injury: Beyond PTSD.” Public
Insight Network. American Public Media., 21 June, 2013. Web. 18 May 2014. <http://www.publicinsightnetwork.org/2013/06/21/invisible-injury-beyond-ptsd-illustrated-story/>
Tokuda, Wendy. “Inner-City Oakland Youth Suffering From Post-Traumatic Stress Disorder.”
CBS San Francisco Bay Area. CBS Local Media/CBS Radio Inc., 16 May 2014. Web. 18
Wise, Ashley. “Battling Bare.” Facebook.com. 22 April, 2012. Web. 15 Mat, 2012. https://www.facebook.com/BattlingBare/timeline.
Faini, M. (2015) The Bodies and Spaces of Post Traumatic Stress Disorder. Ada: A Journal of Gender, New Media, and Technology, No.6. doi:10.7264/N3VH5M3K
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
- Tokuda, Wendy. “Inner-City Oakland Youth Suffering From Post-Traumatic Stress Disorder.” CBS San Francisco Bay Area. CBS Local Media, CBS Radio Inc., 16 May 2014. Web. 18 May 2014. <http://sanfrancisco.cbslocal.com/2014/05/16/hood-disease-inner-city-oakland-youth-suffering-from-post-traumatic-stress-disorder-ptsd-crime-violence-shooting-homicide-murder/>.
- Harvard’s report claims that inner city youth experience symptoms similar to those of combat veterans, but at much higher rates. A youth worker states: “It’s depression, it’s stress, it’s withdrawal, it’s denial,” and any innocuous act can “set them off.”
- Tokuda. “Inner-City Oakland Youth Suffering From Post-Traumatic Stress Disorder”
- For Shay, if shrapnel is analogous to PTSD’s initial trauma, then the wound’s deadly complication–the infection and hemorrhaging–is combat PTSD’s moral injury.
- Dr. Shay claims that “In combat, soldiers become each other’s mothers. The rage, need for revenge, and self-sacrificial commitment toward protecting each other when comrades are killed [are] akin to when a mother’s offspring are put in danger or killed.” Also, irredeemability is an ethical prescription.
- a magazine of illustrated journalism
- This is the PIN’s terminology. The relationship between words and images inherent to the comic form, and the significance of using such relationships to explain the phenomenon of PTSD, is a discussion for a much longer piece.
- the locus of betrayal could be the commanding officer, for example
- This choice raises questions concerning humans and animal relations, the implications of which are beyond the scope of this project.
- Ferguson, Roderick. “Race.” Keywords for American Cultural Studies. Ed. Bruce Burgett and Glenn Hendler. New York, NY: New York University Press, 2007. Kindle Edition.
- For Ferguson, these ideas include “the nuclear family, conjugal marriage, and heterosexual monogamy” and “aris[e] out of an equally racialized genealogy of modern morality” (4638-4717). Kindle Edition
- “Peers are the key to recovery — I can’t emphasize that enough,” he said. “Credentialed mental health professionals like me have no place in center stage. It’s the veterans themselves, healing each other, that belong at center stage. We are stagehands — get the lights on, sweep out the gum wrappers, count the chairs, make sure it’s a safe and warm enough place…”
- (276) Lisa, Duggan, and José Muñoz. “Hope and Hopelessness: A Dialogue.” Women & Performance: A Journal of Feminist Theory 19.2 (2010): 275-83. Taylor and Francis Online. Routledge: Taylor and Francis Group. Web. 8 May 2014. <http://www.tandfonline.com/doi/full/10.1080/07407700903064946#.VRlvKJPF90x>.