Vietnam and the Elusion of Combat Trauma

On this day in 1973, President Richard Nixon announced the successful completion of the Paris Peace Accords, a treaty with North Vietnam that would end  U.S. military involvement in the Vietnam War.
[1] Over 2,700,000 American military personnel served in the war, almost 10% of their generation.[2] Over 58,000 of them were killed. [3] A 1983 study by the U.S. Congress found approximately 30% percent of men and 27% of women who served in Vietnam had experienced combat-related PTSD at some point in their lives since returning.[4]


It's well known that war tends to generate a wide variety of technological and medical innovations. Certainly, conceptions and treatments of PTSD have evolved dramatically throughout the 20th century, as wars raged, and physicians and psychiatrists have struggled to understand and treat the symptoms of  combat PTSD.
In the article "From shell-shock to PTSD, a century of invisible war traumas," three philosophy professors discuss how combat-related PTSD has been conceptualized from WWI and until today.
In 1967, Vietnam vets marched together to advocate for their own mental health. From the First World War until Vietnam, typical psychological symptoms of combat PTSD were considered a sign of character weakness, and a "disease of manhood." But activist vets of Vietnam era sought to re-frame traumatic symptoms as "a normal response to the experience of atrocity." In 1980, Post-Traumatic Stress Disorder was included in the third edition of the Diagnostic and Statistical Manual (DSM III) of the American Psychological Asssociation.
Today, sufferers of combat PTSD have access to an array of "evidence-based" treatments. "..[W]hile WWI was about soldiers and punishing them for their weakness, in the contemporary era, the ideal veteran PTSD patient is a health care consumer who has an obligation to plan an active role in figuring out and optimizing his own therapy." [5]
The V.A.'s National Center for PTSD even has an online "decision aid" to assist veterans with determining the right treatment to meet their personal needs. The authors go on to describe this consumeristic approach to treating PTSD as a kind of work-around used to side-step remaining questions and complexities associated the disorder.
"This buffet of treatment options lets us set aside our lack of understanding of why people experience trauma and respond to interventions so differently. It also relieves the pressure for psychomedicine to develop a complete model of PTSD. We reframe the problem as a consumer issue instead of a scientific one."[6]
The authors conclude with a discussion researchers have yet to understand about the nature of combat trauma.
"What is still missing is an explanation of why people have different responses to trauma, and why different responses occur in different historical periods. For instance, the paraylsis and amnesia that epitomized WWI shell-shock cases are now so rare that they don’t even appear as symptoms in the DSM entry for PTSD. We still don’t know enough about how soldiers’ own experiences and understandings of PTSD are shaped by the broader social and cultural views of trauma, war and gender. Though we have made incredible strides in the century since World War I, PTSD remains a chameleon, and demands our continued study."[7]
For me, their discussion calls to mind the work of psychiatrist Jonathan Shay, whose research partly led him away from treatments based on medical and psychiatric precepts. His recommendations treating PTSD, outlined in his book Achilles in Vietnam: Combat Trauma and the Undoing of Character, are based on his observation that the most effective treatments for combat PTSD are fundamentally social.
"The essential injuries in combat PTSD are moral and social, and so the central treatment must be moral and social. The best treatment restores control to the survivor and actively encourages communalization of the trauma. Healing is done by survivors, not to survivors." [8]
Shay also goes so far as to lay some of the responsibility for survivor's healing on the people to whom they tell their stories.  
"To achieve trust, listeners must respect the narrator. The advice that veterans consistently give to trauma therapists is to 'Listen! Just listen.' Respect, embodied in this kind of listening, is readiness to be changed by the narrator. The change may be small or large. It may be simply learning something not previously known, feeling something, seeing something from a new perspective, or it may be as profound as redirection of the listener's way of being in the word." [9]
In essence, veterans' stories must belong to all of us, they must be an integral part of the stories what he tell ourselves of about humanity as a whole


Further Reading


Notes
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