Department of Family and Community Medicine, Center for Healthy Communities and Research, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America.
PLoS One. 2022 Aug 31;17(8):e0267424. doi: 10.1371/journal.pone.0267424. eCollection 2022.
Posttraumatic Stress Disorder continues to be a highly stigmatized disease for the veteran population and stigma, experienced as a mark of discredit or shame, continues to be identified as the main deterrent in treatment seeking. Little attention has been paid to how the process of obtaining service-connected disability status can amplify veterans' perceptions of being stigmatized. The following ethnographic study identified how combat veterans experienced stigma in processing through Veterans Affairs care and the effects of linking a Posttraumatic Stress Disorder diagnosis with disability compensation. Stigma was identified in two inter-related areas: 1) the structural level in the Veterans Affairs disability claims process and 2) the individual level in interactions with Veterans Affairs service providers. Findings based on veterans' narratives suggest that the disability claims process, requiring multiple repetitions of personal trauma, coupled with perceptions of institutional stigmas of malingering, created bureaugenic effects: a worsening of symptoms caused by bureaucratic protocols intended to help veterans. This process influenced first time treatment users of the Veterans Affairs by deterring treatment-seeking behavior but was not found to affect veterans who had already initiated treatment. Despite the experience of stigma and commodification of their suffering through disability and diagnostic screening, veterans still sought disability compensation. Veterans viewed this compensation as acknowledgment of their loss and validation of their sacrifice.
创伤后应激障碍仍然是退伍军人中高度污名化的疾病，而耻辱感这种被视为名誉受损或羞耻的经历，仍然被认为是寻求治疗的主要障碍。很少有人关注获得与服务相关的残疾身份的过程如何放大退伍军人被污名化的感觉。以下人种学研究确定了战斗退伍军人在通过退伍军人事务护理处理过程中经历污名化的方式，以及将创伤后应激障碍诊断与残疾赔偿联系起来的影响。污名化存在于两个相互关联的领域：1）退伍军人事务残疾索赔过程中的结构性层面，2）与退伍军人事务服务提供者互动中的个人层面。基于退伍军人叙述的发现表明，残疾索赔过程需要多次重复个人创伤，再加上对装病的机构污名的看法，造成了官僚主义效应：旨在帮助退伍军人的官僚主义协议导致症状恶化。这个过程通过阻止寻求治疗的行为影响了退伍军人事务的首次治疗使用者，但没有发现它会影响已经开始治疗的退伍军人。尽管残疾和诊断筛查使他们的痛苦变得污名化和商品化，但退伍军人仍寻求残疾赔偿。退伍军人认为这种赔偿是对他们的损失的承认，也是对他们牺牲的肯定。
