August 18, 2006

Vietnam Vets and post-traumatic stress syndrome.

It's been vastly overstated all these years, according to a new study:
The report, published in the journal Science and viewed by experts as authoritative, found that 18.7 percent of Vietnam veterans developed a diagnosable stress disorder that could be linked to a war event at some point in their lives, well under the previous benchmark number of 30.9 percent. And while the earlier analysis found that for 15.2 percent of the veterans the symptoms continued to be disabling at the time they were examined, the new study put that figure at 9.1 percent....

The researchers pored over data from the original 1988 study, and checked it against extensive military records and records of exposure to combat. They found that many servicemen in noncombat roles were exposed to considerable horrors, from shelling and ambushes to caring for the wounded, and that very few exaggerated their experiences.

But a number of veterans whose difficulties were diagnosed as post-traumatic disorder developed it before serving in the war. Others developed symptoms that could not be linked to any specific traumatic event — a crucial element in the diagnosis. And there were some veterans who exhibited symptoms, like nightmares, that were not severe enough to be disabling.
It's interesting to learn this now, when there have been so many articles -- in the NYT, in particular -- about the way the Iraq war is debilitiating the minds of those who doing the fighting.

I wonder how much of the stress the Vietnam vets suffered came from the way Americans treated them after the war. Not only did a lot of people regard them as war criminals, but a lot of us uncritically slid into accepting a Hollywood-influenced image of the Vietnam vet as a woeful shell of a man, if not a raging nut.


HaloJonesFan said...

I've read a lot of stuff by an author who served in Vietnam. His assertion was that you didn't need to have a specific traumatic event to wind up with stress disorders. Just being in that type of environment for a long period was enough.

RogerA said...

I am a VN vet but having said that, the VN experience was highly variable. Depended on where you were and what you did.

The Army in Viet Nam was not today's army; draftees and volunteers, and there were even a group known as McNamara's 100,000---an experiment which consisted of drafting marginal inductees for service and putting them in positions like ammo handlers and stevedores--these men were marginally functional and would not have been permitted to join in normal times. My point: those soldiers were much less likely to have been screened than are today's volunteers; moreover, today's policies make it easy to get rid of soldiers who manifest problems (no system is fool proof, of course). Given the fact that 2 and a half million men or so served during VN, the relevant statistic is how the numbers of men exhibiting psychological conditions vary from the population as a whole. To regard those who served in Viet Nam as whack jobs is painting with a very very broad brush and highly misleading.

Goesh said...

-sounds like a nice way to say the VA didn't need the money they weren't going to get in the first place - I worked with two different WW2 Vets who still had nightmares, irritability and relationship problems 40 years after the war ended. Neither had ever gotten any help anywhere or been involved with the VA. The peak force in Nam was roughly 500,000. I can't help but believe many thousands have stumbled through life with all kinds of psychological problems and never received any kind of help or registerd with the VA. That's life but it is also the statistic not addressed. I would question the validity of projecting the numbers presented onto the entire veteran population when we all know so many people who have gone to pieces and pretty much stayed that way after serious life events that did not involve combat duty. On top of cultural shock, sleep deprivation, bad food, separation from loved ones, weight loss, dehydration, malaria-like symptoms and dysentary and being dirty all the time, combat veterans also got to see people's guts and limbs lying all over and mutilated dead children. Hey! Who could forget that first arm hanging up in a tree, eh? And how about that kid's head lying on the side of the road?

My friend Harold is a professional, well eucated,happily married, successful, in pretty good health - he has a fair piece of the American dream. He was also a medic in Nam. About 4 years ago he came across a real bad traffic accident, freaked out, rushed home and locked himself in his room for 2 days and wouldn't come out. He did come out, was withdrawn for about a week and got back to normal. He was never involved with the VA or got any help because of Nam. I was in Nam too and got help for PTSD and I can't sleep at night unless there is a loaded gun in the bedroom. Go figure....PTSD is a tricky beast and we haven't heard the last word on it.

MadisonMan said...

My opinion as a non-veteran of Vietnam (too young) is that the Govt should err on the side of generous to its veterans. I have no doubt, however, that the present administration, which I perceive to be very hostile to veterans under the flag of cost-cutting, will use this study as a hammer to smash the VA budget.

Even with the new estimates, the story notes that there are 250000 Vietnam veterans suffering from PTSD. $3Bn doesn't seem like much to treat them and their counterparts from Iraq. The way veterans get the shaft from the Govt is a disgrace.

The Drill SGT said...

I'm a VN combat vet. The PTSD stuff is overblown. Yes, some folks had problems. real serious problems, but much of the PTSD inflation is done by;
1. folks wanting VA benefits
2. VA budget building
3. Anti-war left

Most VN vets were REMFs on the order of 10 support troops to every 11B (Grunt).

I've had a couple of nightmares over the last 30 years, and for a while when I returned, loud bangs spooked me, but I don't have a problem with blood or violence and went back into the Army after college.

Having said that, 24/7 stress even at low levels impacts some guys.

DaveG said...

the present administration, which I perceive to be very hostile to veterans under the flag of cost-cutting, will use this study as a hammer to smash the VA budget.

What am I missing? 1996, the budget for VA was $38.1 billion. The VA’s budget for this year [2006] is $73 billion, and for 2007, President Bush has proposed a record budget for veterans of over $80 billion.

Tibore said...

Drill Sgt.

BG Burkett of Stolen Valor says much the same thing. I think he goes a bit further with it - in his book, I remember him basically doubting nearly every case he's ever heard of - but he essentially challenges the conventional wisdom about PTSD, saying the same thing you did: Most Vietman vets weren't anywhere near combat.

Also having been too young to even remember Vietname, much less have been a participant, I don't know how to evaluate what he says. But it's interesting that you two hold the same opinion.

Elizabeth said...

Goesh, your description of WWII vets is my dad, spot on. After 20 years in the Air Force, he did another 20+ in the Red Cross, where he often represented veterans trying to get their benefits from the VA. He never went to the VA for help or healthcare because he didn't trust them; in his view, the VA represents the government's interests, which were counter to those of the vets. My brother didn't rely on the VA, either, after returning from VN. For a few months, both of them were up all night with nightmares and anxiety. My brother continued to deal with PTSD for about a decade. I don't like the association of PTSD and "whack job"; it's a stress disorder, it doesn't mean VN vets are going to go off like timebombs or have lost their minds. You don't have to be an anti-war leftie to see the results of war, justified or not.

Jeff said...

I've always found it interesting how returning vets with "combat fatigue" were depicted in post WWII movies. Movies such as The Blue Dahlia nad Till the End of Time depicted emotionally disturbed vets as men who were wounded in the service of their country, deserving of compassion and honor. A far cry from the Vietnam-vet-as-victim (and political pawn) of the 70's-90's.

MadisonMan said...

DaveG, I freely admit my view might be biased -- I'm happy to see the budget requests, for example, are increasing (my impression was that from 2000 - 2004, requests consistently dropped, but that might be politics -- it was an election year claim).

'Though then I read elizabeth's anecdotal remarks and go "Hmmm...". I do wonder what's really going on. Do increases in funding requests mean increases to veterans, or to VA bureaucrats and buildings?

RogerA said...

Elizabeth--sorry to have used the term "whack job." You are absolutely right; I was expressing some frustration about how the Viet Nam era soldiers tend to be commonly depicted (or perhaps thought of). For those actually suffering combat induced stress it is a genuinely serious condition.

Nasty, Brutish & Short said...

After law school, I has post-socratic stress disorder and it took me years to recover.

quietnorth said...

Two questions I have before I read the study: What does "whose difficulties were diagnosed as post-traumatic disorder developed it before serving in the war"? Does that mean that if I suffered from, say, anxiety before the war, was it assumed I couldn't have had PTSD? That would be a logical error. Secondly, is it true that our service personnel were generally treated as war criminals? I was too young to be in the military in those years, but I don't remember vets in my home town being treated badly. I am sure others have seen or experienced different things. What about the readers here?

Stephen B. said...
This comment has been removed by a blog administrator.
Stephen B. said...

I can't help but wonder about the correlation between PTSD and draftees. Today's fighting force is all-volunteer. These guys know what they signed up for before they signed up..they've been able to get their minds around it before hitting boots in the sand. VN draftees didn't have it so good. Joining the military wasn't a choice they made on their own. Maybe they weren't as mentally prepared (or able to be as mentally prepared) for combat as today's all-volunteer force.

MadisonMan said...

Stephen, I'd think a good statistic would also be PTSD percentages in Iraq for regular Army types vs. those for National Guard types. Compare that to %ages for Vietnam and Iraq forces.

Sloanasaurus said...

Only 25% of Vietnam vets were draftees. Contrast this with 75% of WW II vets. Hmmm.... maybe PTSD is all a myth... Another myth was that many of the deaths were 18 year old black youth draftees. Out of 50,000 killed less than 10 soldiers were actually 18 year old black draftees. How is that for dispelling a myth.

During Vietnam, some 10,000 fled to Canada to avoid the draft. During WWII over 40,000 fled to Canada.

Tons of lies about Vietnam were perpetrated by the media (i.e. Dan Rather). This was in an era before there was a blogosphere to point out the lies.

Go read BG Burkett's Stolen Valor. It is an incredible account of all the media myths about Vietnam.

One of may favorites was the myth about Ron Kovic, the soldier depicted in Oliver Stone's born on the Fourth of July. From the movie you get the impression that Kovic was convinced by Government propaganda to become a marine. Kovic does, goes over and gets paralyzed and then protests the war. Except the media and Stone left out a small detail. Kovic got injured on his SECOND TOUR in Vietnam. Yes, Kovic served an entire first tour in combat and then volunteered to go back for a second tour, where he was ultimately injured. Why does the media leave out this nugget?? Because the part about Kovic being brainwashed by the marine recruiter are less convincing.

If you think that fact is a shocker, read Burkett's book. There are many more.

stephenb said...

MadisonMan: I'd like to see such a statistic. That'd be interesting. I'm in the National Guard myself, and I sometimes wonder how my guys compare to the Regular Army guys.

On another note: I just finished reading Howard Bahr's new book "The Judas Field." At one point a character in the book is talking about how men group together in clubs, lodges, &c. She goes on to posit that "maybe war is the greatest Lodge Meeting of all. Death was the Grand Master, no women allowed, and the men, under their costumes and banners, were all the same, all playing at brotherhood, wallowing in tradition, ritual, pageantry, allegory...and secrets..." This particular passage from the book resonated with me, because I've experienced a bit of this phenomenon. Several members of my NG unit volunteered for combat missions with other units and lied to their wives and families telling them that they were ordered to go.

"Come on," they'd say, trying to get me to sign on, too. "We're gonna have a blast." And I just couldn't help but wonder why they didn't see war as war but instead as some sort of club meeting...just the guys hangin' out.

Anyway, Bahr's book is good; all his stuff is good. You should check it out.

Troy said...

A good source is a book called "On Killing" by Lt. Col. (Ret.) Dave Grossman which talks about the training differences between WW2 era soldiers and Vietnam-era soldiers and the advancements in psychological conditioning, etc. A lot of the PTSD was, according to Grossman(and he's also a psychologist in addition to an Army Ranger) was treatment on returning home and commentsd of politicians. If that's true, it makes Murtha's comments especially egregious since he, of all folks, should know better.

Grossman's conclusion though is that people are not hard-wired to kill people, most have to be trained to do so (absent disinhibition factors such as rage, alcohol, etc.) and if they are in a justifiable situation, expected situation, etc. and get some critical incident debriefing and/or follow-up (platoon reunions up to more structured environments) PTSD can be and usually is overcome.

The VA -- it's a government entity -- why anyone would expect humane treatment, customer service, and efficiency is beyond me. These are the folks that invented the DMV (at the state level), the IRS, Amtrak and the Social Security Admin (has anyone tried to get disability bennies?!? Ay Caramba!)

The Drill SGT said...

I agree with Troy and others

1. Pre-deployment factors
a. volunteer
b. draftee
c. draft motivated volunteer (like me. though only 25% were tru draftees, 50% I bet were in this category)

2. pre-deplotment training. Better now

3. UNIT Cohesion. Huge factor. VN was done with individual replacements rather than rotating units. HUGE mistake. not done anymore. much more stress when u are among strangers

4. support from Family, friends, mdeia, and public, while there

5. reception after return. same support issues

bearbee said...

FY 2007 Budget Submission
Summary Volume
provides various breakouts

2006 budget also at site.

DNR Mom said...

At first, while my husband served as port operations officer in Cam Ranh Bay, VN, '68-'69, I worked for Eugene McCarthy for president. That didn't quite work out.

After my husband returned from VN, it only took 30 years to get our 1960s egalitarian marriage back. Then he died.

Ann Althouse said...

DNR Mom: I'm sorry your husband died.

My mother was a WAC in WWII, and she worked with men who suffered from battle fatigue. She never said much about it. Maybe only once. She just expressed a lot of sympathy for those poor men. But I never heard the details. And, of course, that was never a reason to criticize the war. I also remember her talking abou thow awful it was to listen to the radio, in those days before she joined the Army, and to have no idea if we could win. She never really told me why she joined the Army, but I think she wanted to be involved and not just helplessly waiting at home, listening to the radio.

Today, people listen to the news and, feeling that helplessness, they condemn the war and call for it to end.

David said...

The way the VietNam vets were treated as we straggled back to the states in dribs and drabs exascerbated the experience of war. Without a supportive and caring society to say thanks for your sacrifice and the sacrifice of your loved ones the nightmares and memories stayed on the surface.

I still remember my feelings when I saw the picture of Hanoi Jane Fonda on the anti-aircraft gun in Hanoi. That ended any pretense I, and my brothers-in-arms, had that we would ever be honored for what we did.

Most of us don't march in parades on patriotic holidays out of force of habit. We do stand up when the colors pass, recite the pledge of allegiance, and cover our hearts or salute. I confess to having ambivalent feelings to those who talk on cell phones or continue sitting when our flag passes by.

The pageantry, etc., is what seperates the patriot from the whiner and teaches the discipline that trained warriors depend on to keep things in perspective and survive.

You had to be there to understand!

mikeyes said...

I guess I will have to disagree with Troy and The Drill SGT about the lack of PTSD in returning vets. The most recent studies show a 17% rate of PTSD in returning soldiers from Iraq and this is with a lot of the measures recommended by LTC Grossman in place.

As a treating psychiatrist, I have come across a number of vets from several different wars who suffered silently and were unable or unwilling to seek help. The VA usually has very little allocated for this most common of war injuries and the paperwork is daunting (including having to pass the ever changing requirements - at least WW II vets all had free care) but there are VA hospitals and clinics who are compassionate and helpful. The problem is that PTSD, if left untreated, is very hard to manage and even with the interventions mentioned in Troy's missive still hard to treat.

I am a combat vet as was my father and my grandfather (and his grandfather) and the things that were seen in combat should never be visited on anyone. Individuals vary as to their response, but combat and combat environs effect people. Unit cohesion, preparation, good follow-up will all modify the response in otherwise healthy people, but it still follows you around no matter what.

I was in Desert Storm as a member of a Combat Stress Unit. We saw a huge number of psychiatric cases (including some resurgent PTSD in VN vets) prior to combat. At the time we were being targeted by SCUD missiles but were relatively safe. Our biggest fear was the use of chemical weapons. Although most of this did not come to be, the fear changed us, even the REMFs who made up most of the cases we saw. Our job was to try and reconstitute those who were suffering if at all possible and we managed to keep most in the theater. During the combat phase we followed the fighting troops (the 24th ID in my case) providing mental health services along the way. In such a short war, combat stress casualties were not as evident, but my friends tell me that in the present war they are many.

PTSD is not a myth. It exists in large numbers no matter what precautions are taken because of the nature of war. It is not a simple matter of redefinition or boot-straps and it is a disservice to say otherwise.

Buffalowoman said...

I worked in A Marine bar in Tustin California when a lot of our guys were coming home from Viet Nam. I never had the feelings that I read about in the newspapers. I deeply respected the men who had served their country to the best of their ability. At 60 years of age, I gave up a job and the comforts of children and grandchildren to go to California from Colorado to live with a man who was twice in Viet Nam and helped to hold Hill 327. I am not all that familiar with the various battles. This man courted me from California for over two years. When he would come to Colorado to visit, he was fairly pleasant to be around, was generous with his time, attention and money. When I moved in to his home in didn't take long for everything to change and fall apart. He could be downright cruel. I felt as though I were a prisoner of his private war. There was sleep deprivation, days without him speaking to me,isolation (he would go to bingo several nights a week, come home close to midnight and sit in the dark and watch old war movies, or movies from the 50's and 60's until almost 3 in the morning. He was a sergeant, so he was very bossy, extemely rude and without apology. It was as if he did not like women. I learned that he was extremely hard on the mother of his children and the woman just before me, he treated her very bad as well. I only lasted 3 months as my self-worth and self esteem would not allow me to stay in such a heavily negative environment. So I need to know if this is a common "syndrome" among Viet Nam vets? This is a 66 year old man, and he drank heavily after the war but quit cold turkey ten years ago. I say he has not healed from his experiences in Nam, nor has he gone to any 12 step programs to help him deal with whatever caused him to drink in the first place. I see no growth in him, emotionally, spiritually, or mentally. I do care deeply about him but I don't know how to reach out to him because he is very good about pushing away any one who gets too close to him. Suggestions? Comments? Thank you for any feedback you can offer. Regards. Christinia