title: "Heroes' invisible wounds of war:" constructions of posttraumatic stress disorder in the text of US federal legislation.
abstract: Public policies contribute to the social construction of mental health problems. In this study, I use social constructivist theories of policy design and the methodology of ethnographic content analysis to qualitatively explore how posttraumatic stress disorder (PTSD) has been constructed as a problem in US federal legislation. I analyzed the text of 166 bills introduced between 1989 and 2009 and found that PTSD has been constructed as a problem unique to combat exposures and military populations. These constructions were produced through combat-related language and imagery (e.g., wounds, war, heroism), narratives describing PTSD as a military-specific phenomenon, and reinforced by the absence of PTSD in trauma-focused legislation targeting civilians. These constructions do not reflect the epidemiology of PTSD-the vast majority of people who develop the disorder have not experienced combat and many non-combat traumas (e.g., sexual assault) carry higher PTSD risk-and might constrain public and political discourse about the disorder and reify sociocultural barriers to the access of mental health services.
authors.affiliation: Department of Health Management & Policy, Dornife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA 19104, USA. Electronic address: JPP46@Drexel.edu.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Purtle
mesh_terms: D003130:Combat Disorders / Q000453:epidemiology*; D035082:Federal Government; D006297:Health Services Accessibility; D006801:Humans; D008605:Mental Health Services; D008889:Military Personnel / Q000523:psychology*; D011640:Public Policy; D036301:Qualitative Research; D066269:Social Theory; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Policy design theory; Posttraumatic stress disorder; Public policy; Qualitative document analysis; United States