David Kieran, "Signature Wounds: The Untold Story of the Military's Mental Health Crisis" (NYU Press, 2019)

Nov 14, 2025

David Kieran, a historian and expert on military mental health, dives into the complex narratives surrounding PTSD and traumatic brain injuries from the Iraq War. He uncovers the Army's slow adaptation to mental health challenges and dispels myths about its responsiveness. Kieran emphasizes the importance of understanding soldiers’ experiences and advocates for reducing stigma surrounding mental health care. His insights reveal the diverse agendas of various stakeholders and the significant strides needed to support veterans and active-duty personnel.

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INSIGHT

Prewar Behavioral Doctrine Carried Forward

The Army entered 21st-century wars with strong acute-combat stress practices and deployed real-time behavioral research teams.
They needed to adapt those practices for longer, repeated deployments and new threats like IEDs.

INSIGHT

Rapid Field Research Shaped Policy

MHAT teams from Walter Reed adapted 1990s survey methods to assess stress in Iraq quickly.
Their findings directly informed Army policies and clinical efforts during early deployments.

INSIGHT

Mental Health Fueled Political Framing

Mental health became a vehicle for antiwar advocates to argue they supported troops while opposing the war.
This reframed criticism as concern for soldiers' wellbeing rather than being anti-military.

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The surprising story of the Army's efforts to combat PTSD and traumatic brain injury

The wars in Iraq and Afghanistan have taken a tremendous toll on the mental health of our troops. In 2005, then-Senator Barack Obama took to the Senate floor to tell his colleagues that "many of our injured soldiers are returning from Iraq with traumatic brain injury," which doctors were calling the "signature wound" of the Iraq War. Alarming stories of veterans taking their own lives raised a host of vital questions: Why hadn't the military been better prepared to treat post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI)? Why were troops being denied care and sent back to Iraq? Why weren't the Army and the VA doing more to address these issues?

Drawing on previously unreleased documents and oral histories, David Kieran tells the broad and nuanced story of the Army's efforts to understand and address these issues, challenging the popular media view that the Iraq War was mismanaged by a callous military unwilling to address the human toll of the wars. The story of mental health during this war is the story of how different groups--soldiers, veterans and their families, anti-war politicians, researchers and clinicians, and military leaders--approached these issues from different perspectives and with different agendas. It is the story of how the advancement of medical knowledge moves at a different pace than the needs of an Army at war, and it is the story of how medical conditions intersect with larger political questions about militarism and foreign policy.

Signature Wounds: The Untold Story of the Military's Mental Health Crisis (NYU Press, 2019) shows how PTSD, TBI, and suicide became the signature wounds of the wars in Iraq and Afghanistan, how they prompted change within the Army itself, and how mental health became a factor in the debates about the impact of these conflicts on US culture.

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