Fighting for Life: War Trauma, Healing, and Ritual Communities in the American Pacific Northwest

This dissertation traces the complex connections between violence, trauma, healing, and medicalization in North America. The project connects to conversations in medical anthropology and American studies, and intersects with science studies, postcolonial studies, the anthropology of militarism, and Native American studies. The central innovation in this dissertation is its focus on veterans who suffer from both the violence of war and the limits of trauma's conventional treatments. I track their experiences through a therapeutic system designed by and for Native people, and argue that questions about suffering and healing from war are inextricable from discourses and practices of gender, race, and territory.Since the Posttraumatic Stress Disorder (PTSD) diagnosis was codified in the Diagnostic and Statistical Manual of Mental Disorders in 1980, the object of combat trauma has grown to occupy significant space in popular culture. In the contemporary world, PTSD serves as the primary lens for translating military experience to both the public and veterans themselves. However, the diagnosis and all of its clinical appurtenances fall short of contextualizing the full range of traumas associated with military service and its treatments often fail to relieve sufferers of their symptoms. An early example of this was observed in American Indian veterans of the Vietnam War, who demonstrated marked “treatment resistance” to novel PTSD therapies that were developed in the 1980s. In response to this, a Veterans Affairs (VA) hospital in southern Puget Sound responded to requests by local tribal leaders to make indigenous healing and purification rituals available for American Indian veterans. Noting the efficacy of these rituals, a ritual community of indigenous veterans became established there who continue to practice their ceremonies today on a piece of sacred land adjacent to the VA hospital. The clinical PTSD diagnosis has evolved in accordance with medicalizing trends in the four decades since its recognition in the DSM. However, the social construct of combat trauma that is often known discursively as “PTSD” has grown and become increasingly entangled with various sociopolitical projects associated with war, gender, and racial/ethnic identity. In the 21st century, veterans increasingly prefer the signifier “warrior” over the civil term “veteran.” The warrior signifier conjures a more mythical notion of timeless, transcultural castes located in martial societies. At the same time, this warrior identity is being embraced by many outside of the military, including police and civilian defense contractors. Warriors are seen as a distinct kind of person who experiences war, suffering, and healing differently than civilians. Within this context, the combat trauma construct that is often generalized as “PTSD” becomes the fundamental marker of legitimate warrior experience. When the VA approved of making space for indigenous ceremony in the 1980s, it was because indigenous veterans were seen as denizens of “warrior cultures,” and understood to be ontologically distinct from non-indigenous veterans who were expected to heal best in a clinical environment. Until relatively recently, the ritual healing community was almost exclusive to the indigenous veterans it was created for. However, the ceremonies increasingly appeal to non-indigenous veterans and are now being seen as a therapeutic option for treatment-resistant veterans of all ethnicities. This situation creates the conditions for the complex intersection of several socioepistemological projects, including medicalization, race, indigeneity, militarism, and “warrior” identity among many other things. As a combat veteran with a PTSD diagnosis, my fieldwork centered on extended participation in the ceremonial life of this ritual community. Over a period of 36 months I made several trips to the site, including seven months of continuous fieldwork in 2019. I became close with the Elder Council, the team of experienced Native chaplains who officiate ceremonies in the ritual community. Drawing from several tribal traditions, particularly from Lakota/Plains traditions, these elders conduct sweat lodges, “talking circles,” and other ceremonies. These rituals serve a dedicated cohort of regular attendees, a segment of patients from the hospital’s inpatient PTSD program, and periodic visitors who are seeking healing after the failure of clinical therapy. My findings detail two developments: First, the ritual community exposes the limits of the 20th century process of medicalizing trauma associated with war/military service. For instance, ritual participants draw on the Lakota concept of iwáyazaŋ azúyeya, "the sickness one acquires from fighting others and the self" as the therapeutic object at stake, in contrast to "PTSD". Ceremonies directly address this sickness by highlighting Native experiences of colonization, the unique ways that trauma was experienced by Native veterans (particularly from the Vietnam War era), and the connections between violence and masculinity. Second, the site shifts the ways “warriordom” connects concepts of violence to concepts of culture. The notion that warriors are a unique kind of person who both suffer and heal differently from civilians may account for the increasing appeal of ritual therapy among non-Native veterans. However, the ceremonies compel veterans to confront warrior identity as a feature of white settler violence, and effectively turn healing into a process of social critique.