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Signature Wounds: The Untold Story of the Military’s Mental Health Crisis

David Kieran’s Signature Wounds is a playbook of the numerous challenges inherent to providing behavioral health care for service members. It not only illustrates critical concepts that are not typically part of behavioral health training (I was aware of these aspects prior to reading the book because my medical and residency training were completed in military programs), but it also reviews the impact that leaders and the public can have on military behavioral health care. As such, this book is relevant to everyone involved in the behavioral health of service members. Signature Wounds artfully reveals the multiplicity of perspectives and priorities related to the mental health crises by meticulously (there are 82 pages of references) outlining the vantages from the often disparate groups involved in caring for Soldiers: Army behavioral health researchers (Ch 1 & 6), the public (Ch 2), National leadership (Ch 3), Army leadership (Ch 4 &7), the families of US Soldiers (Ch 5), and the VA (Ch 8). In each of these chapters Kiernan reveals the assumptions that each group made based on previous, short-duration wars and the impact changes in combat and culture can have on injury. Most damning, Keirnan repeatedly reveals the impact a society disconnected from the wars they wage can have on the Soldiers who fight them. Left with little understanding of military service, it appears most cannot help but serve their own agendas in their clamor over the mental health of their soldiers. In his final chapter (Ch 9), Keiran provides a final synthesis (p. 292). It is stunning that these four common sense observations require such a balanced and well referenced history. First, it is paramount to start from a position that we are in this together. All too often there is an assumption that others (leaders, providers, society) do not care enough for service members and that is the cause of our current state. Such assumptions result in in-fighting and barriers to care. We are all equally committed but separately limited in our understanding of the problem – we must work together. Second, behavioral health care delivery requires understanding behavioral health. Policy makers and leaders must understand what mental health is if they are to create meaningful programs to support it. Third, behavioral health is as much a cultural issue as it is a medical one. Embedding behavioral health providers as far forward as possible Book Review