Medicine and the Armed Forces with Jocelyn Chua
August 11, 2020 |
Associate Professor of Anthropology Jocelyn Chua discusses her current research on the use of psycho-pharmaceuticals by active-duty soldiers in the US Army post 9/11.
Transcript
Philip Hollingsworth:
Welcome to the Institute, a podcast on the lives and work of Fellows and friends of the Institute for the Arts and Humanities at the University of North Carolina at Chapel Hill. I’m Philip Hollingsworth. In this episode, I speak with Associate Professor of Anthropology Jocelyn Chua. In our conversation, Professor Chua discusses her current research on the use of psychopharmaceuticals by active-duty soldiers in the US Army post 911.
PH:
First of all, thank you for joining me today.
Jocelyn Chua:
Yeah, thanks for the invite to be here.
PH:
Yeah. And so to start off, can you give an overall, I guess, snapshot of what you do at UNC?
JC:
Yeah, so I am a medical anthropologist, which means I’m broadly interested in the ways in which health and wellbeing and healthcare systems are shaped by broader macro-scale forces, including historical forces, political, economic and socio-cultural forces. And so I teach medical anthropology to our undergraduates, as well as to our graduate students. In addition to teaching, I’m also engaged in research.
PH:
Great. And can you talk a little bit about your current research project, what you’re working on right now?
JC:
Sure. So I am currently engaged in a three-year ethnographic — so qualitative research — project funded by the National Science Foundation and the Wenner-Gren Foundation, looking essentially at a phenomenon that I would argue, has had and will continue to have a significant impact on the way that war is waged. And on how the American public understands the nature of military suffering. Which is to say that, since the post 911 conflicts in Iraq and Afghanistan, we have seen a historically unprecedented and market turned to the shift in the use of psychopharmaceuticals in war zones, including active combat by US military personnel. So up until around the late 1990s, US military psychiatry was pretty conservative with the use of psychopharmaceuticals, particularly FDA-approved psychiatric medications. But with the post 911 conflicts, that has changed significantly.
PH:
So when you say psychopharmaceuticals, what are some of the drugs that are being given to the- is it active soldiers and veterans or both or?
JC:
So yes. So we know that there is increase in use of psychopharmaceuticals within the VA system. But this project is looking specifically at the use of these medications, quote, unquote, downrange, that’s sort of a term that’s used by the Department of Defense to refer to overseas deployed environments.
PH:
Okay.
JC:
So part of this research project is to intervene into the literature. We know something about how these medications are used by military personnel in garrison. So within the context of the United States, on military installations, for example, we know something about how they’re used and dispensed by the VA system among veteran populations, but very, very little — and certainly very little qualitative information — about how these medications are dispensed and used, both in authorized and unauthorized ways in war zones, including active combat.
PH:
So who were you talking to? You know, you mentioned, it’s ethnographic.
JC:
There’s multiple populations that I’ve been talking to over the last two and a half years. So we have been talking to enlisted soldiers. So largely junior enlisted across all kinds of occupational specialties within the Army. So I should mention that this is an army-based study, looking at the experiences of active duty National Guard and Reserve components of the US Army. And so we’ve been speaking to junior enlisted folks, senior enlisted folks, we’ve been talking to officers as well. And then I’ve also been talking to military medical care providers. So physician assistants, physicians, nurses, social workers- folks who are providing mental and behavioral health in downrange environments. We have aspirations to talk to folks in the pharmaceutical industry as well to get that side perspective of how the process of getting and gaining contracts with the Department of Defense works. And then I’ve also been engaged in archival research as well as FOIA requests to provide contextual information.
PH:
So are there any findings so far they’ve been particularly surprising or interesting to you?
JC:
An assortment of things. Well, I should say one of the motivations for this project is that the use of psychopharmaceuticals has been In a topic that has received quite a bit of attention within the media, and oftentimes through sensationalized stories. And there have been instances of the media representing psychopharmaceutical use in often highly moralized ways.
So pharmaceutical use is talked about as sort of a sign of the exploitation of military personnel, or more broadly, a sign of the failures of the conflicts post 911. What we’re finding as we talk to military personnel who have had the experience of either being on these medications while deployed or observing the use of these medications by others, is in many ways, a much more complex situation. One, what we’re finding is that pharmaceuticals — psychopharmaceuticals — enter into war zones in an assortment of ways. So you can have, for example, someone who has deployed four times to a combat zone, was diagnosed with PTSD and is put on an antidepressant so that they can deploy again, we also have folks who were prescribed by civilian providers even before they enlisted into the military. And so they resume use of those medications once they enter military service. And then you can also have instances of people taking medications for the first time while they are deployed for the management of relatively short-term symptoms.
And so medications, like antidepressants and anti-anxiety medications come to matter differently to the military, right? There’s no sort of single line of causality that can be drawn in the use of medications by the military and by military personnel. Another thing we’re finding is that there’s been a lot of internal critique within the military as well as within the VA health system and research infrastructure more generally, around the concern about stigma and mental health in the military, right. So there’s concern about how stigma within the highly sort of masculinist institutions of the military often impedes people’s ability and desire to seek help, right? Particularly around mental health, which is arguably stigmatized in ways that other potential conditions are not. And what’s really interesting is that we’re finding that in part because of the corporate environment, and just the ways in which people live in very close physical proximity to each other in deployment, people learn about the medication use of others. And people will often talk about their own medication use in ways that suggest there’s something else going on that stigma doesn’t quite capture, right?
And so because oftentimes, people will work very closely with other soldiers on their teams and they rely on one another as part of an operational unit. I have heard many stories of people saying, well, my buddy needed to know that I was put on this medication to ensure my own safety, but also the safety of the team. Right? And so what we understand to be a very individualized experience of medication taken in a quote-unquote, civilian environment becomes quite a different thing in an operational setting where people are relying on one another, people are living in close proximity to one another, in ways that stigma is maybe not fully capturing.
PH:
I have a kind of a logistical question. So in these interviews, have you had to travel? Is it a mix of traveling or like electronic correspondence in these interviews? And then as a follow-up, how is the current you know, we’re- whenever you’re listening to this, we’re in the middle of the COVID 19 pandemic, how has that impacted your ability to get this ethnographic information?
JC:
Great question. And since March, all of the fieldwork has been remote. And so I’ve been able to continue what had been face-to-face interviews by Zoom. And so those components of the fieldwork continue. I was lucky in the sense that the vast majority of this fieldwork was done before the Coronavirus-related shutdowns. But as far as the fieldwork itself, a lot of it has taken place in North Carolina. And so driving up to Fayetteville once a week was sort of my schedule during the last few academic semesters. I’ve also been conducting fieldwork and participant observation at clinical trainings for VA clinicians and military clinicians, as well as doing observation at military health conferences. In addition to speaking to folks all around North Carolina.
PH:
What drew you to the field of anthropology in the first place?
JC:
Yeah, I guess I should say I was drawn less to the field of anthropology than to the field of medical anthropology, specifically, medical anthropology is a discipline within anthropology. But as an undergraduate, I was a premed major and a neuroscience major with aspirations of pursuing a career in medicine, following in the footsteps of my parents. And then my senior year, I took an anthropology class and became deeply interested and invested in questions related to global health, actually. But less from the perspective of maybe public health, or from the perspective of clinical questions and more from the perspective of what are the kinds of historical processes and structures that shape the ways in which global health programs are devised and implemented? And so that actually led me to the field of anthropology and specifically to medical anthropology. And that’s how I got interested in questions related to health in global contexts.
PH:
Yeah, it’s funny I did, I did graduate school in Romance Studies here at UNC. I studied literature. And so I was looking at narratives and poetry that use opium and morphine as a literary device. And so in doing that, I did a little bit of like, medical history and like reading about stuff, and I found these old books written by doctors about addiction and things like that. And so I’ve always been kind of fascinated by the — I don’t know why — but there’s something about especially like older like turn of the 20th century, they’re kind of wrapping their heads around medicine and the technology advancing so fast. I’ve always found it really fascinating. It seems kind of related to, is tangential to the work you’re doing. But there’s one story it was like during the Civil War, and they were just pumping soldiers full of morphine. And there’s this one story of this one doctor that was riding around on a horse and he’d run out of like syringes and was just like, pouring it into his hands. And people were like drinking out of his hands. And he would just keep enough at the end of the day for himself because he would have such a like, traumatic day.
JC:
I mean, I think that’s fascinating because it gets to the point that medical historians have made, which is that the history of medicine is very much the history of war and vice versa. Right? So my interest as a medical anthropologist, particularly in teaching about Biomedicine to undergraduates, is thinking about how you can’t think about the history of the development of medicine without thinking about war and without thinking about the military. You know, it’s an old adage that war breeds medical innovation, right? or war breeds scientific innovation, right? So we’ve often thought about the relationship between war and medicine in terms of this kind of perverse synergy, right? But the more the body is damaged by war technologies, the more there’s an opportunity to, to expand medicine, right? And as medicine expands, we can then submit bodies to further damage in conditions of war. And what’s interesting is with psychopharmaceuticals, that relationship doesn’t really hold in the same way. In part because mental health and the effects of psychopharmaceuticals are in some ways more ambiguous, right? And so it offers a way to kind of disrupt that relationship.
PH:
I have one more question if that’s okay? This is a question we ask most of our guests. What’s a book that changed your life?
JC:
Wow [laughs]. What is a book that changed my life? There’s a bunch that have in different ways, but the one that comes to mind is one that I read when I was an undergraduate, is Roland Barthes’ Camera Lucida. In part, because I find it beautifully written and it kind of — as a young person — it kind of attuned me to the power of sort of scholarly and poetic writing, which just was fascinating to me and exciting. But I think I kind of go back to it now because it has so much to do with technology and shifting representations of the human and shifting ideas of subjectivity. Which, even though Barts is, in many ways, far afield of the field of medical anthropology, a lot of those questions still feature in the kinds of questions that I asked about medicine in relationship to war.
PH:
Great. Well, Jocelyn, it’s been a pleasure and thanks so much for talking with me today.
JC:
Yeah, thanks for inviting me too.
PH:
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