Leveraging Ambiguity in the Clinic: Mild TBI and Veterans’ Forgetting

ABSTRACT

US military veterans who have histories of mild traumatic brain injury (mild TBI) are evaluated and treated in specialized clinics in the Veterans Health Administration (VA). In this ethnography of one such clinic, I explore the problem of veterans’ forgetting. I focus on doctors’ strategy of actively drawing attention to the ambiguous causes of forgetting to reposition past head injuries as among many possible explanations, including posttraumatic stress, pain, and everyday distractions. This leveraging of ambiguity as therapy highlights both the utility of and tensions inherent in the expansive clinical gaze of therapeutic medicine.

KEYWORDS:

• United States
• attention
• clinical medicine
• mild traumatic brain injury
• military veterans
• therapy

Acknowledgments

To the veterans and clinicians who participated in this research: thank you for your interest and engagement. I am grateful to three anonymous reviewers for their generous readings and insightful questions, and to Lenore Manderson and Victoria Team for wonderful editorial support. Special thanks to Patrick McKearney, Georgia Hartman, and Elizabeth Youngling for feedback on early drafts of this manuscript. The study was reviewed and approved by the Institutional Review Boards at the VA Medical Center where it was conducted and the University of Washington (protocol #45520), where I was a doctoral student at the time.

Notes

1. The United States Department of Veterans Affairs (VA) is a federal, cabinet-level organization, under which sits the Veterans Health Administration (VHA), which provides health care and other social services for veterans and their families. This article is about a VHA clinic, but I use the term “VA” because this is used colloquially by both veterans and staff, and is more recognizable to the nonspecialist reader. The medical center, staff, and veterans are anonymous to protect participants’ privacy.

Additional information

Funding

The fieldwork, data analysis, and writing of this work was supported by the National Science Foundation Division of Behavioral and Cognitive Sciences [1322659], the Wenner-Gren Foundation for Anthropological Research [8802], and the Mellon/American Council of Learned Societies Dissertation Completion Fellowship. Writing was supported by an Advanced Fellowship from the United States Department of Veterans Affairs, Office of Academic Affiliations and the Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System. None of these funders were involved in the study design, data collection, analysis, interpretation of data, writing of the report, or the decision to submit the article for publication. The views expressed in this article are those of the author and do not necessarily represent the position or policy of the Department of Veterans Affairs or the U.S. government.

Notes on contributors

Anna Zogas

Anna Zogas is a Postdoctoral Fellow at the Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA.