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

Nov 14, 2025

David Kieran, a historian specializing in war and American culture, dives into the military's overlooked mental health response during the Iraq and Afghanistan wars. He reveals how the concept of PTSD and TBI emerged as the 'signature wounds' of these conflicts. Kieran discusses the complexities of military mental health care, the stigma surrounding it, and how varying interests shaped the response. He also highlights the alarming rise in veteran suicides and innovative VA outreach efforts to address these issues comprehensively.

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INSIGHT

Prewar Military Mental-Health Capacities

The Army entered Iraq and Afghanistan with strong capacity for treating acute combat stress and for rapid field research.
It lacked substantial investment in PTSD treatment because that had been seen as a VA responsibility.

INSIGHT

MHATs Turn Research Into Policy

The Walter Reed research teams adapted 1990s peacekeeping survey methods into MHATs to measure stress in real time.
Those MHAT findings directly shaped Army behavioral-health policy in theater.

INSIGHT

Mental Health As A Political Frame

Mental-health harms became a potent, pro-soldier frame for anti-war critics to argue against continued deployments.
This allowed opponents to claim they supported troops while opposing policy.

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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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