After the Sept. 11, 2001, attacks, New York City dispatched thousands of mental health workers to care for its residents, a mobilization that signaled a fundamental shift in the American understanding of trauma.

For decades, the public had debated whether post-traumatic stress disorder should be taken seriously. Sometimes the disagreements concerned people coming home from the Vietnam War, other times, those tormented by sexual assault or incest.

Despite a growing recognition of trauma — and a concurrent interest in how government, business and civil society could tend to such invisible wounds — many remained suspicious. These skeptical voices have never fully disappeared, but throughout the post-9/11 era they have taken a back seat to a new consensus that insists on the need to heal the psychological suffering of U.S. citizens. Such citizens have included everyone from New Yorkers devastated by the fallen twin towers to the family members of the dead. In time, though, attention has centered on the mental health struggles of America’s most celebrated archetype — the military veteran.

In “Combat Trauma: Imaginaries of War and Citizenship in Post-9/11 America,” the scholar Nadia Abu El-Haj narrates this history while lodging an unrelenting critique of its ideological implications. She begins a half-century ago with the Vietnam Veterans Against the War and affiliated antiwar psychiatrists who attempted to make sense of what they called “post-Vietnam Syndrome.” Like so many today, these physicians sought to heal the innermost scars of uniformed service members and veterans.

But this endeavor was always embedded in a wider appraisal of U.S. militarism and empire. For them, in fact, it was impossible to heal warfighters without challenging the imperial domination responsible for the wreckage — not just the spiritual wreckage of Americans, but also the far greater wreckage America itself had unleashed abroad.

Glossing the thinking of Robert Jay Lifton, one of the most prominent psychiatrists of the time, El-Haj writes, “The banality of American military violence — its very ordinariness — was precisely what made it so dangerous. Only a radical transformation of American power across the globe could make it stop.”

To present ears (at least in the United States) this might sound like the ravings of a flier-hawking radical. But in the 1960s and ’70s, Lifton was no outlier. While assessments like his didn’t go uncontested, they nevertheless received mainstream hearings, especially within the field of psychology. It wasn’t until the rise of Reagan and the New Right that such views became marginalized, and even that marginalization, when it came, sprang from complicated reasons. On the one hand, feminists and the crime victims’ movement united in reconceiving subjects of trauma as endowed with an unimpeachable innocence. This marked a departure from previous, more complex readings of trauma, where women demanded a right to “be bad” — without being assumed responsible for their own assaults — and antiwar veterans wrestled with their complicity in war crimes or crimes against humanity as “self-traumatized perpetrators.” On the other hand, Cold War conservatives and liberals slowly gathered around an expedient conviction that the central wrong of the Vietnam War wasn’t the war itself but rather the hostile treatment of veterans on the home front.

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That last conceit — the idea that veterans were dragged down not by what they’d seen and done abroad but by being spat on at home — is more myth than reality, and El-Haj cites the scholarship of Jerry Lembcke and others to expose that fact. But she’s most interested in mapping the unfortunate convergence of anti-sexual-assault activism, tough-on-crime politics, and a renewed, bipartisan militarism. This convergence, El-Haj argues, came to elevate the U.S. warfighter — and therefore the United States — as the real victim of Vietnam. In due course this same logic would be applied to America’s subsequent wars, too, and “Combat Trauma” catalogs the ways psychologists and psychiatrists aided and abetted this militaristic grievance politics. Namely, such medical experts elided the differences between the psychic harms of rape or incest victims and the harms inflicted on those tasked with prosecuting wars of aggression. They continually revised the entries for combat trauma in the Diagnostic and Statistical Manual of Mental Disorders away from initial themes of self-incriminating agency and guilt toward depoliticized notions of self-exculpating helplessness and shame. And this shift — from taking responsibility for American violence to pathologizing the regrettable trauma of the troops — was in keeping with a rising mood of national self-pity.

Mental health professionals also spurned social or political explanation for what they called “evidence-based” research. When it came to war-related PTSD, this meant ignoring the role that U.S.-led oppression plays in shaping the inner lives of its enforcers while positing veterans as a mere sum of their symptoms. This move helped practitioners and researchers alike believe they could treat traumatized veterans without engaging in the politics of their service. Some of this reversal in thinking was coerced. Veteran Outreach Centers, originally designed to offer a space for vets to wrestle with the political dimensions of their deployments, were strong-armed into a more apolitical, “professional model” lest they risk losing government funding. Insurance companies stopped covering therapeutic treatments that they deemed too vague, which often translated into any therapies interested in questions of morality and power. But plenty of medical professionals themselves were happy with a new paradigm that entertained delusions, on the part of military-industrial proponents, that the homecoming costs of empire can be medicated to oblivion. If antidepressants alone wouldn’t work to ensure the efficient return of soldiers to the battlefield — or their optimal integration into a civilian workforce — other biomedical fixes like prolonged exposure or cognitive processing therapy just might. In the words of El-Haj, the proponents of such approaches became addicted to a “technoscientific fantasy: that one might find a way to conduct war while averting, in advance, its damaging psychological consequences.”

Can Americans change their minds?

As America’s post-9/11 wars have dragged on, and the mental health crises of military and veteran communities (never mind the broader public) have worsened, there has been an increased focus on how the choices service members make at war sometimes conflict with their own sense of right and wrong, thus leading to “moral injury.” El-Haj concedes that the more recent turn to ethics — particularly among government-sanctioned religious institutions — is a welcome improvement from the value-free therapeutics that preceded it. But she is quick to note that even these conversations tend to presume that the relevant trauma does not originate with the immorality of the wars themselves, but with the contradiction between the military’s purported moral standards and the unavoidable realities of modern warfare. To the extent the veteran is guilty of anything, their guilt still emerges as noble or necessary. And if the veteran must make amends at all, it is by giving back to their own community, which rarely means demanding reparations for Afghans, Iraqis, Pakistanis, Yemenis, Syrians, Libyans, Somalis and the ever-expanding list of peoples ravaged by America’s 21st-century wars. Nor does it mean opposing the U.S.-led global order that turns a blind eye to such ravages. To the contrary, encouraging such opposition is still considered unprofessional among those now charged not only with treating veterans but, in El-Haj’s formulation, “caring for militarism.”

El-Haj is an academic, and her book amounts to a brave act of scholarship. But at its best moments, “Combat Trauma” also musters a rhetorical force reminiscent of past public intellectuals like Hannah Arendt. Indeed, on multiple occasions El-Haj cites Arendt, who likewise pushed readers to think critically about war and empire. There is much in El-Haj’s argument that can be questioned, beginning with whether her anti-imperialist approach to healing could be put to work within the halls of power, an idea bound to trip over its own paradoxical preconditions. Likewise, it’s not entirely clear how her approach applies to veterans who don’t share her politics or her commitment to transformative activism. But as a prod for a citizenry whose unspoken politics is one of imperial amnesia or self-congratulation, El-Haj’s contribution couldn’t be more welcome. And for a nation that persists in seeing itself as the victim to justify its status as avenging victimizer, this book may be a necessary one.

Imaginaries of War and Citizenship in Post-9/11 America

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