American politicians on both sides of the aisle have used post-traumatic stress disorder as a “strategic tool” through which to level sweeping criticism on the direction of U.S. foreign policy after staying mum on the subject for decades, a new study found.

The sudden shift in discourse about the disorder, also known as PTSD, is reflective of the “unique political dynamics” in the U.S.’ global war on terror, which resulted in a highly disproportionate number of American troops coming home with lingering mental trauma, according to the paper, published in late December in Perspectives on Politics.

Scholars have extensively studied the “politicized history and spread” of PTSD in the U.S., but “far less” research has focused on its ability to reshape the ways in which voters and officials alike talk about foreign policy issues like overseas military interventions, explained Adam Lerner, the author of the paper and an assistant professor of international relations at Royal Holloway, University of London.

“Political rhetoric about PTSD became an important way of extending foreign wars’ psychic consequences to the home front — demonstrating that, even though the wars in Iraq and Afghanistan seemed far away, their consequences lingered in soldiers returning home and became an urgent issue for American politics,” Lerner told The Academic Times.

Lerner, whose work focuses on trauma in international theory and national identity, found that PTSD did not enter the mainstream American political lexicon until at least 2005 — 25 years after the American Psychiatric Association entered it into the Diagnostic and Statistical Manual of Mental Disorders.

Yet the use of this diagnosis to describe the pains suffered by U.S. troops sent abroad did not truly take off until the 2008 presidential election, years after the U.S. invasions of Iraq and Afghanistan, despite a growing number of veterans suffering from mental trauma from both conflicts.

“The history of trauma-related disorders has always been a tense one,” Lerner said. “Some people undoubtedly experience trauma-related symptoms after confronting extreme violence or stress, but there’s always been a lot of social stigma around recognizing these symptoms and treating them with appropriate medical and sociocultural care.”

In addition to social stigma, U.S. military leaders had “dismissed traumatized soldiers as malingerers” for many years, before acknowledging a growing body of research showing that potentially hundreds of thousands of veterans may be afflicted, Lerner wrote.

An early study on this subject found that the Pentagon received research to this effect as early as 1988 that showed that as many as 30.9% of Vietnam War veterans had developed PTSD since the war and another 22.5% experienced partial symptoms. More recent figures suggest that as many as 600,000 war on terror veterans may be affected.

“The PTSD diagnosis’ scientific rigor and the endorsement of the APA went a long way toward normalizing psychic trauma,” Lerner said. “This process took a long time, but has led to mainstream acceptance of psychic trauma as a real and important condition.”

Through a quantitative and qualitative analysis of presidential documents and speeches, as well as the Congressional Record, an almanac of congressional debates, Lerner found that while PTSD was not mentioned in any presidential debates in 2004, President George W. Bush began to use the term the following year, invoking it three times late in his term.

The delay is “somewhat surprising,” Lerner said, given that between 1980 and 2005, mentions or discussions of PTSD in newspapers and books increased “immensely,” while the number of veterans getting benefits for PTSD grew to about 650,000 in 2013 from just 35,000 in 1990.

Lerner found that during the same period, presidents Ronald Reagan and Bill Clinton only made four mentions of trauma generally, without invoking PTSD, out of over 25,000 total documents.

In 2008, then-Sen. Barack Obama and his fellow Democrats cited PTSD eight times during the primary and general elections — in 20.5% of all debates — while Republican candidates did not make any mention of it.

This in turn helped shape Obama’s stance on broadly increasing military spending to improve veterans’ care, while supporting the Democratic challenge against the “endless wars” without appearing dovish before the public.

It wasn’t until 2012 that PTSD was introduced to the Republican presidential debate stage, though the Trump administration made multiple invocations of it to distance itself from Bush’s decision to intervene in the Middle East. Still, Obama made the most mentions of the disorder out of any U.S. president to date.

Because PTSD affects soldiers home from war, discussion of the disorder “allowed Obama to conflate largely separate budget allocations for defense and veterans’ health benefits to support his expansionist proposal,” while lambasting Bush’s failure to address the issue, according to Lerner.

“While PTSD appeared in many Democratic candidates’ discussion of veterans’ health care and criticism of the Iraq War, rarely did they specify the exact policy measures they would employ to improve veterans’ mental health and contain their suffering,” Lerner wrote.

“Instead, Democrats’ invocation of PTSD served primarily to amplify the negative consequences of the Bush administration’s foreign policy, extending them temporally into the future and spatially into the domestic political arena,” he added.

Lerner further argues that this trend should be examined not just as a political tool, but as a force that blurs the ethical boundaries of war by absolving American soldiers of civilian casualties and other wrongdoing, while neglecting to empathize with the sufferings of foreign civilians due to a U.S.-led war.

“Recognition of soldiers’ PTSD focused attention on returning veterans struggling to reintegrate to American society, oftentimes at the expense of foreign victims — primarily Iraqi and Afghan civilians — whose pain did not receive sophisticated medical attention,” he said.

Lerner also suggested that further research is needed on how political forces are influenced by and shape diagnostic categories, and whether other public health issues such as mass shootings and domestic violence may be affected in similar ways.

“I think it’s important that political science scholars not simply passively accept medical insight, but rather interrogate the way political forces shape medical advances,” he said. “This doesn’t mean that political scientists should question laboratory findings outside their expertise, but it does mean that issues like public funding for research, media coverage of public health, etc. are all subjects in need of critical interrogation.”

The paper, “Blurring the Boundaries of War: PTSD in American Foreign Policy Discourse,” was published Dec. 22, 2020 in Perspectives on Politics. It was written by Adam Lerner, a lecturer of international relations at Royal Holloway, University of London. He also serves as deputy director of Royal Holloway’s Centre for International Security. The paper also appears in an upcoming book by Lerner, “From the Ashes of History: Collective Trauma and the Making of International Politics.”