Staff Perspective: Old Wounds, New Insight - Helping our Vietnam Veterans Heal Now
This year marks the 50th anniversary of the beginning of the Vietnam War. Although more than 40 years has passed since the end of that war, it has become evident that long-term psychological repercussions still linger, impacting both those who served and the nation that sent them. Collectively, the experiences of those who fought have touched our country and been well documented in postwar art, literature and film, yet questions still remain about the specific impact of that war on the individual warrior today.
So what about the Vietnam Vet?
Recent research as delineated by Marmar et al.’s Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War (as published in JAMA, July 2015) presents findings from the National Vietnam Veteran’s Longitudinal Study (NVVLS) with Veterans who were previously assessed as a part of an earlier study known as the Vietnam Veterans Readjustment Study (NVVRS).
Results of this study indicated that approximately 271,000 war-zone exposed Vietnam Veterans still currently have full-blown, symptomatic PTSD. Within this group, the prevalence of war-zone related current PTSD was approximately 4.5% for male and 6.1% for female Veterans (with the lifetime PTSD prevalence rate being 17.0% for males and 15.2% for females, respectively). Furthermore, in addition to experiencing current “residual” PTSD, just over one-third (36.7%) of these Veterans also suffers from a co-morbid major depressive disorder. These numbers, though surprising, do not even take into account the prevalence of PTSD from what was categorized as non-war zone military stress, including exposure to civilian casualties and threats occurring in-country but outside of the combat theater. Altogether it is estimated that - more than 40 years later - the prevalence of those with current PTSD due to any cause related to service in Vietnam stands at 12.2% for male and 8.5% for female Veterans. Of this group, many reportedly continue to get worse versus getting better, calling into question whether time does, in fact, heal all wounds.
I bring up this study, not to quell hope, but to highlight the fact that the Vietnam War, not unlike other wars, has resulted in longstanding psychological aftereffects and difficulties with readjustment in later life for the Veteran population. However, this particular group experienced and continues to experience record problems including physical issues related to war exposure, substance use problems, and homelessness. Due to wide-spread awareness of this issue, vets from more recent conflicts are receiving quicker assessment and treatment for war-related psychological concerns. In looking forward, it is as if we have partially learned our lesson, so to speak. Only now the question from an old war still remains…
What about healing for the Vietnam Vet now?
The question of helping Vietnam Veterans and their families in the present holds both personal and professional meaning for me. You see, I was born in an Army field hospital in Vietnam during the height of what was looking like a lost war. My mother’s village was attacked during the Tet Offensive and my father was a well-meaning teen who volunteered to serve his country, with two tours in Vietnam. When we evacuated, my one-year-old sister was inadvertently left behind only to be reunited with us years later following a refugee camp stay subsequent to a misfortune-laden boat escape after the fall of Saigon. By coincidence or providence, depending on what one believes, years later, I would find myself counseling Vietnam Veterans in a VA hospital setting.
So when Dr. Camp arrived to talk about the findings outlined in his research and recent book, I was excited to learn more about what he had to say about his experience working in Vietnam with this special group of Service members. Dr. Camp is a retired Army psychiatrist who was served as the CO of the 98th Neuropsychiatric Detachment in Vietnam from 1970-1971. His military medical training included stints at Letterman Army Medical Center and Walter Reed Army Medical Center. He is currently a professor of Clinical Psychiatry at Virginia Commonwealth University and is the author of U.S. Army Psychiatry in the Vietnam War: New Challenges in Extended Counterinsurgency Warfare.
Following just over two hours of vibrant conversation with copious notes and relevant detours, I realized that I was mistakenly seeking simple answers about a richly complex war era and group of Service members who were wrapped up in that era/war. It became evident that a simple presentation of Q & A would not do the topic justice. Instead, I have chosen to highlight a few of the takeaways Dr. Camp and I spoke about (many points are explained in more detail in his book about working as a psychiatrist in Vietnam), looking back at Vietnam to learn while leaning forward toward a greater understanding of what might facilitate healing for our Vietnam Veterans today. Here are a few of those takeaways, as discussed with and taking into account Dr. Camp’s expertise:
Our Vietnam Vets were impacted as much by the culture of the times in the U.S., in addition to being affected by the war itself – especially upon their returns from Vietnam.
During our discussion, it was evident that America was going through a tumultuous culture shift in the 60’s and 70’s. This, in turn, affected American sentiment about the war in Vietnam – and the service men and women who were fighting it. These feelings were, at best, ambivalent but more often were unsupportive or negative, often attacking those who were simply fulfilling their military duty, either by choice or by draft. Dr. Camp writes of talking with a colleague describing his work with Veterans:
“ [S]ince 1973 I have treated, evaluated, supervised the treatment of, or discussed the cases of approximately 1,400 Veterans of Vietnam with PTSD and have yet to hear a single case where
the Veteran’s symptoms were not accompanied by either: (1) significant doubts or conflicts about the worthiness of the war, or (2) considerable anger about perceived lack of support for the war by the government or the nation. Furthermore, although researchers have been barred from exploring the relationship between the occurrence of PTSD and the overwhelmingly conflicted nature of the war [emphasis added], it is the observation of almost all clinicians who have treated substantial numbers of Vietnam Veterans with PTSD that the clinical condition is almost always accompanied by a deeply flawed sense of purpose concerning what happened in Vietnam.” (Camp, n.d.)
Burned draft cards and war protests became demonstrations against the war, but sometimes bled into a vilification of those fighting that war. Many, angry about the war, misdirected that anger toward those involved in it. As a result, Service members were stripped of the honor they deserved, in the ultimate act of stolen valor. Talk to Vietnam Veterans today and this hurt still resonates with many of them.
As a cohort, Vietnam Vets have specific risk and resilience factors as determined by a different, somewhat controversial kind of war.
Dr. Camp explained the factors contributing to a sense of “inverted morale” during the Vietnam War. It seems the controversial, protracted nature of the war combined with a continued struggle between “Is it right for us to be there or is it wrong?” contributed to a sense of meaningless and helplessness for some. In spite of this, resilience was seen in many in the earlier stages of war.
However, risk factors for this cohort included no clear front lines, an ever-present general sense of danger (even when out of theater/combat zone), the increase of “fragging” (the deliberate killing of fellow soldiers, oftentimes unpopular officers), increased alcohol and drug use both during and after the war, lack of use of Reserve forces in favor of draftees, young warriors being so far from home in rough jungle terrain and year-long tours which impacted any continuity of force. This, along with the loss of over 58,000 American lives, continues to haunt some of those who served even today.
As we discussed “Lessons Learned”, Dr. Camp highlighted some key points that may help in facilitating healing in therapy for our Vietnam Vets today.
Dr. Camp emphasized the opportunity to honor and recognize our Vietnam Veterans at the semi-centennial anniversary of the war. He discussed healing on a community and an individual level for our vets. For those who felt he or she returned alone from the battle, now could be the time for him or her to be united with others who either served or are honoring those who served in Vietnam. This time represents an opportunity for national reconciliation and collective, reparative healing for both the nation and the vet. It is a time to welcome them home, so to speak, with genuine acts recognizing and thanking them for their sacrifice on behalf of a grateful country. In addition to efforts such as the Department of Defense’s Vietnam War Commemoration project, other efforts can be made to continue to honor and remember those who served in and in support of the effort in Vietnam.
When discussing therapeutic “lessons learned” Dr. Camp highlights the importance of recognizing our mistakes with the Vietnam War and learning not to repeat these same mistakes. Specific to his experience, he notes that adjustments should have been made to the distribution of mental health resources as the situation in Vietnam worsened and changed. Much of this effort can be seen in the allocation of additional mental health resources in theater and the quick assessment and treatment of troops returning from more recent conflicts. He also emphasized the need for skilled care of military Service members by those trained in the military medicine model or, specifically, in military culture.
As we spoke it became clear that healing should go beyond looking at just the PTSD: it should validate the experience and not deign to diminish some of the humanistic factors contributing to the Veteran’s suffering. Time should be given to addressing issues of past trauma triggered by the Vietnam experience, holistic care of the individual Service member, identifying and addressing spiritual or moral injuries, and rebuilding families and relationships negatively impacted by war. In doing so, we can finally help to bring honor and healing to those who bravely served in Vietnam.
In closing, I wish to express a heartfelt thank you to Dr. Camp for his service, research and willingness to share in the effort to further healing for those who served in Vietnam. Thank you for the opportunity to learn more about your work as a psychiatrist in Vietnam and for your care of our Service members. Also, my deepest gratitude and respect to the Vietnam Veterans: Without you I would not be here enjoying the freedom you so dearly fought for. Thank you for your bravery, your families and your service. I am forever indebted to you all!
Kimberly A. Copeland, Psy.D. is a Deployment Behavioral Health Psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
References:
Dr. Norman “Mike” Camp, personal communication, November 2015.
Camp, N. (n.d.). US army psychiatry in the Vietnam war: New challenges in extended counterinsurgency warfare.
Available online: http://www.cs.amedd.army.mil/Portlet.aspx?ID=68f93226-ac0d-4e79-a92f-9033426de0ad
Marmar, C., Schlenger, W., Henn-Haase, C., Qian, M., Purchia, E., Li, M., . . . Kulka, R. (2015). Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War. JAMA Psychiatry,875-881. doi: 10.1001/jamapsychiatry.2015.0803.
This year marks the 50th anniversary of the beginning of the Vietnam War. Although more than 40 years has passed since the end of that war, it has become evident that long-term psychological repercussions still linger, impacting both those who served and the nation that sent them. Collectively, the experiences of those who fought have touched our country and been well documented in postwar art, literature and film, yet questions still remain about the specific impact of that war on the individual warrior today.
So what about the Vietnam Vet?
Recent research as delineated by Marmar et al.’s Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War (as published in JAMA, July 2015) presents findings from the National Vietnam Veteran’s Longitudinal Study (NVVLS) with Veterans who were previously assessed as a part of an earlier study known as the Vietnam Veterans Readjustment Study (NVVRS).
Results of this study indicated that approximately 271,000 war-zone exposed Vietnam Veterans still currently have full-blown, symptomatic PTSD. Within this group, the prevalence of war-zone related current PTSD was approximately 4.5% for male and 6.1% for female Veterans (with the lifetime PTSD prevalence rate being 17.0% for males and 15.2% for females, respectively). Furthermore, in addition to experiencing current “residual” PTSD, just over one-third (36.7%) of these Veterans also suffers from a co-morbid major depressive disorder. These numbers, though surprising, do not even take into account the prevalence of PTSD from what was categorized as non-war zone military stress, including exposure to civilian casualties and threats occurring in-country but outside of the combat theater. Altogether it is estimated that - more than 40 years later - the prevalence of those with current PTSD due to any cause related to service in Vietnam stands at 12.2% for male and 8.5% for female Veterans. Of this group, many reportedly continue to get worse versus getting better, calling into question whether time does, in fact, heal all wounds.
I bring up this study, not to quell hope, but to highlight the fact that the Vietnam War, not unlike other wars, has resulted in longstanding psychological aftereffects and difficulties with readjustment in later life for the Veteran population. However, this particular group experienced and continues to experience record problems including physical issues related to war exposure, substance use problems, and homelessness. Due to wide-spread awareness of this issue, vets from more recent conflicts are receiving quicker assessment and treatment for war-related psychological concerns. In looking forward, it is as if we have partially learned our lesson, so to speak. Only now the question from an old war still remains…
What about healing for the Vietnam Vet now?
The question of helping Vietnam Veterans and their families in the present holds both personal and professional meaning for me. You see, I was born in an Army field hospital in Vietnam during the height of what was looking like a lost war. My mother’s village was attacked during the Tet Offensive and my father was a well-meaning teen who volunteered to serve his country, with two tours in Vietnam. When we evacuated, my one-year-old sister was inadvertently left behind only to be reunited with us years later following a refugee camp stay subsequent to a misfortune-laden boat escape after the fall of Saigon. By coincidence or providence, depending on what one believes, years later, I would find myself counseling Vietnam Veterans in a VA hospital setting.
So when Dr. Camp arrived to talk about the findings outlined in his research and recent book, I was excited to learn more about what he had to say about his experience working in Vietnam with this special group of Service members. Dr. Camp is a retired Army psychiatrist who was served as the CO of the 98th Neuropsychiatric Detachment in Vietnam from 1970-1971. His military medical training included stints at Letterman Army Medical Center and Walter Reed Army Medical Center. He is currently a professor of Clinical Psychiatry at Virginia Commonwealth University and is the author of U.S. Army Psychiatry in the Vietnam War: New Challenges in Extended Counterinsurgency Warfare.
Following just over two hours of vibrant conversation with copious notes and relevant detours, I realized that I was mistakenly seeking simple answers about a richly complex war era and group of Service members who were wrapped up in that era/war. It became evident that a simple presentation of Q & A would not do the topic justice. Instead, I have chosen to highlight a few of the takeaways Dr. Camp and I spoke about (many points are explained in more detail in his book about working as a psychiatrist in Vietnam), looking back at Vietnam to learn while leaning forward toward a greater understanding of what might facilitate healing for our Vietnam Veterans today. Here are a few of those takeaways, as discussed with and taking into account Dr. Camp’s expertise:
Our Vietnam Vets were impacted as much by the culture of the times in the U.S., in addition to being affected by the war itself – especially upon their returns from Vietnam.
During our discussion, it was evident that America was going through a tumultuous culture shift in the 60’s and 70’s. This, in turn, affected American sentiment about the war in Vietnam – and the service men and women who were fighting it. These feelings were, at best, ambivalent but more often were unsupportive or negative, often attacking those who were simply fulfilling their military duty, either by choice or by draft. Dr. Camp writes of talking with a colleague describing his work with Veterans:
“ [S]ince 1973 I have treated, evaluated, supervised the treatment of, or discussed the cases of approximately 1,400 Veterans of Vietnam with PTSD and have yet to hear a single case where
the Veteran’s symptoms were not accompanied by either: (1) significant doubts or conflicts about the worthiness of the war, or (2) considerable anger about perceived lack of support for the war by the government or the nation. Furthermore, although researchers have been barred from exploring the relationship between the occurrence of PTSD and the overwhelmingly conflicted nature of the war [emphasis added], it is the observation of almost all clinicians who have treated substantial numbers of Vietnam Veterans with PTSD that the clinical condition is almost always accompanied by a deeply flawed sense of purpose concerning what happened in Vietnam.” (Camp, n.d.)
Burned draft cards and war protests became demonstrations against the war, but sometimes bled into a vilification of those fighting that war. Many, angry about the war, misdirected that anger toward those involved in it. As a result, Service members were stripped of the honor they deserved, in the ultimate act of stolen valor. Talk to Vietnam Veterans today and this hurt still resonates with many of them.
As a cohort, Vietnam Vets have specific risk and resilience factors as determined by a different, somewhat controversial kind of war.
Dr. Camp explained the factors contributing to a sense of “inverted morale” during the Vietnam War. It seems the controversial, protracted nature of the war combined with a continued struggle between “Is it right for us to be there or is it wrong?” contributed to a sense of meaningless and helplessness for some. In spite of this, resilience was seen in many in the earlier stages of war.
However, risk factors for this cohort included no clear front lines, an ever-present general sense of danger (even when out of theater/combat zone), the increase of “fragging” (the deliberate killing of fellow soldiers, oftentimes unpopular officers), increased alcohol and drug use both during and after the war, lack of use of Reserve forces in favor of draftees, young warriors being so far from home in rough jungle terrain and year-long tours which impacted any continuity of force. This, along with the loss of over 58,000 American lives, continues to haunt some of those who served even today.
As we discussed “Lessons Learned”, Dr. Camp highlighted some key points that may help in facilitating healing in therapy for our Vietnam Vets today.
Dr. Camp emphasized the opportunity to honor and recognize our Vietnam Veterans at the semi-centennial anniversary of the war. He discussed healing on a community and an individual level for our vets. For those who felt he or she returned alone from the battle, now could be the time for him or her to be united with others who either served or are honoring those who served in Vietnam. This time represents an opportunity for national reconciliation and collective, reparative healing for both the nation and the vet. It is a time to welcome them home, so to speak, with genuine acts recognizing and thanking them for their sacrifice on behalf of a grateful country. In addition to efforts such as the Department of Defense’s Vietnam War Commemoration project, other efforts can be made to continue to honor and remember those who served in and in support of the effort in Vietnam.
When discussing therapeutic “lessons learned” Dr. Camp highlights the importance of recognizing our mistakes with the Vietnam War and learning not to repeat these same mistakes. Specific to his experience, he notes that adjustments should have been made to the distribution of mental health resources as the situation in Vietnam worsened and changed. Much of this effort can be seen in the allocation of additional mental health resources in theater and the quick assessment and treatment of troops returning from more recent conflicts. He also emphasized the need for skilled care of military Service members by those trained in the military medicine model or, specifically, in military culture.
As we spoke it became clear that healing should go beyond looking at just the PTSD: it should validate the experience and not deign to diminish some of the humanistic factors contributing to the Veteran’s suffering. Time should be given to addressing issues of past trauma triggered by the Vietnam experience, holistic care of the individual Service member, identifying and addressing spiritual or moral injuries, and rebuilding families and relationships negatively impacted by war. In doing so, we can finally help to bring honor and healing to those who bravely served in Vietnam.
In closing, I wish to express a heartfelt thank you to Dr. Camp for his service, research and willingness to share in the effort to further healing for those who served in Vietnam. Thank you for the opportunity to learn more about your work as a psychiatrist in Vietnam and for your care of our Service members. Also, my deepest gratitude and respect to the Vietnam Veterans: Without you I would not be here enjoying the freedom you so dearly fought for. Thank you for your bravery, your families and your service. I am forever indebted to you all!
Kimberly A. Copeland, Psy.D. is a Deployment Behavioral Health Psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
References:
Dr. Norman “Mike” Camp, personal communication, November 2015.
Camp, N. (n.d.). US army psychiatry in the Vietnam war: New challenges in extended counterinsurgency warfare.
Available online: http://www.cs.amedd.army.mil/Portlet.aspx?ID=68f93226-ac0d-4e79-a92f-9033426de0ad
Marmar, C., Schlenger, W., Henn-Haase, C., Qian, M., Purchia, E., Li, M., . . . Kulka, R. (2015). Course of Posttraumatic Stress Disorder 40 Years After the Vietnam War. JAMA Psychiatry,875-881. doi: 10.1001/jamapsychiatry.2015.0803.