- Jim Goodwin Research
- Griffin's Lair
There is an excellent case study on the Internet about a Korean War veteran's struggle with
Post Traumatic Stress. It is entitled, "Korean War Flashbacks: Treating PTSD," published in Mental
Health Nursing, July 2003 by Alan Pringle and Dass Musruck. Referring to the veteran only as
"John," the editors of Mental Health Nursing state:
"Perhaps one of the most striking features of this case is that it concerns a very
ordinary man living in a very ordinary street in a very ordinary catchment area. This does beg the
question how many other veterans of armed conflict suffer in silence from PTSD symptoms."
How many "very ordinary men (and women) living on very ordinary streets" suffer in silence
from PTSD symptoms? Lots and lots of our veterans. Too many. In an article published in
PTSD Research Quarterly 7 (1) 1-8, researchers J. Wolfe and S.P. Proctor listed the main features of
PTSD as follows:
Upsetting memories such as images or thoughts about the trauma
Feelings that the trauma is happening again (flashbacks)
Bad dreams and nightmares
Getting upset when reminded of the trauma by something which is seen, heard, smelt, felt
Anxiety, fear or a feeling of danger
Aggressive feelings and feeling the need to defend oneself
Trouble controlling emotions because reminders lead to sudden anxiety, anger or upset
Trouble concentrating or thinking clearly
In the weeks and months ahead, the Korean War Educator will be expanding this page of the
KWE as a service to Korean War veterans and their families. This page of the KWE opened on March 28,
Jim Goodwin Research
[KWE Note: The following article is the online version of a published article written by Jim
Goodwin, Psy.D. that originally appeared on pages 1-18 of Post-Traumatic Stress Disorders: a handbook for
clinicians (Tom Williams, Ed.) in 1987. The Disabled American Veterans organization published the
following online version on its website, and graciously granted permission to the Korean War Educator to
post it on the KWE.
The article refers to veterans of the Vietnam War, but the content is equally apropos to veterans of the
Korean War who suffer from the devastating effects of post-traumatic stress disorder, thus its posting on
the KWE. All wars are different and unique in their own point in time and places of battle. But
all wars also have similarities. So, too, are the PTSD symptoms experienced by all combat veterans.
Note Dr. Goodwin's list of symptoms of PTSD in Vietnam War veterans: chronic and/or delayed depression,
isolation, rage, avoidance of feelings, alienation, survival guilt, anxiety reactions, sleep disturbance and
nightmares, intrusive thoughts. While the Korean War and the Vietnam War greatly differed in many
respects, the symptoms enumerated by Dr. Goodwin are the exact symptoms now being experienced by Korean War
veterans who suffer from PTSD.]
The Etiology of Combat-Related Post-Traumatic Stress Disorders
Most Vietnam veterans have adjusted well to life back in the United States, following their wartime
experiences. That's a tribute to these veterans who faced a difficult homecoming to say the least.
However, a very large number of veterans haven't made it all the way home from the war in Southeast Asia.
By conservative estimates, at least half a million Vietnam veterans still lead lives plagued by serious,
war-related readjustment problems. Such problems crop up in a number of ways, varying from veteran to
veteran. Flashbacks to combat... feelings of alienation or anger... depression, loneliness and an inability
to get close to others... sometimes drug or alcohol problems... perhaps even suicidal feelings. The litany
In its efforts to help these veterans, the 700,000-member Disabled American Veterans (DAV) funded the
Forgotten Warrior Project research on Vietnam veterans by John P. Wilson, Ph.D. at Cleveland State
University. That research resulted in formation of the DAV Vietnam Veterans Outreach Program to provide
counseling to these veterans in 1978. With 70 outreach offices across the United States, this DAV program
served as a model for the Veterans Administration (VA) Operation Outreach program for Vietnam era veterans,
which was established approximately a year later.
Clinically, the readjustment problems these veterans suffer were designated as Post Traumatic Stress
Disorders in the American Psychiatric Association's Diagnostic & Statistical Manual III (DSM III).
Counseling psychologists working with Vietnam veterans in the DAV and VA outreach programs emphasize that
these disorders are not mental illnesses. Rather, they are delayed reactions to the stress these
veterans--particularly combat veterans--underwent during the war in Southeast Asia.
The nature of post-traumatic stress disorders among Vietnam veterans is described in this paper by Jim
Goodwin, Psy.D. Himself a Marine Corps veteran of Vietnam combat, Dr. Goodwin worked as a volunteer
counselor in the DAV Vietnam Veterans Outreach Program while doing graduate work at the University of
Denver's School of Professional Psychology. Following these studies, Dr. Goodwin rejoined the Armed Forces
and is now a captain on active duty with the U.S. Army.
The material presented here is a condensation of Dr. Goodwin's chapter in Post-Traumatic Stress
Disorders: a handbook for clinicians. Edited by Tom Williams, Psy.D., this 1987 book was published
by the nonprofit Disabled American Veterans as a guide to counseling professionals who are working with or
interested in the problems of Vietnam veterans. Due to limited quantities, the complete book has been made
available chiefly to psychiatrists, psychologists and other mental health counseling professionals. It is
hoped that Dr. Goodwin's paper will provide all of the information on post-traumatic stress disorders needed
by veterans, their families, and the general public.
A final note: Gerald R. Ford, when he was President of our country, asked the American public to put
Vietnam behind them and forget it. I can think of no Presidential injunction that has been more effective.
As a Vietnam War veteran, myself, I believe it's both healthful and necessary to put the bitterness and
dissension of the war years behind us. But to forget the Vietnam War, its troubled veterans, and their
families would be unforgivable.
Sherman E. Roodzant
Disabled American Veterans
What price must the heart pay to live and love? Say you long hot days ahead without a kind
word--days when fear will tear your insides apart - but one must go for duty calls... so very far away. My
heart is numb, my brain reels--yet no tears. Another friend is laid to rest. God rest his soul this brave
man. Keep him safe for we'll meet again--at another time, in another place. Hot sun, endless hours grant
me some respite from loneliness. Sharp rattle, orange streaks across the black sky--a sensation of torn
steel, woven with hot flesh and blood beside me. God! God whatever God you be, speed my soul on its way
but not in endless eternity. Thoughts of home come to me--don't let me go; please no--I'm afraid!
A cold refreshing wind penetrates my bones--what a strange place this be. I hear familiar voices
that have long passed from existence--I see faces--faces of friends long since dead. I realize now what
has happened and where I am, yet I am happy with those whose names are carved in stone amidst the grass of
a place called Arlington.
Please don't weep for me for I no longer worry about what tomorrow brings... for me it brings a much
needed rest... a rest forever.
by George L. Skypeck
Captain, U.S.A. 12/71
The Etiology Of Combat-Related Post-Traumatic Stress-Disorders
Below is a description of one Vietnam veteran's life more than ten years after the end of the war in
"My marriage is falling apart. We just don't talk any more. Hell, I guess we've never really talked
about anything, ever. I spend most of my time at home alone in the basement. She's upstairs and I'm
downstairs. Sure we'll talk about the groceries and who will get gas for the car, but that's about it.
She's tried to tell me she cares for me, but I get real uncomfortable talking about things like that, and
I get up and leave. Sometimes I get real angry over the smallest thing. I used to hit her when this would
happen, but lately I just punch out a hole in the wall, or leave and go for a long drive. Sometimes I
spend more time on the road just driving aimlessly than I do at home.
"I really don't have any friends and I'm pretty particular about who I want as a friend. The world is
pretty much dog eat dog, and no one seems to care much for anyone else. As far as I'm concerned, I'm
really not a part of this messed up society. What I'd really like to do is have a home in the mountains,
somewhere far away from everyone. Sometimes I get so angry with the way things are being run. I think
about placing a few blocks of C-4 (military explosive) under some of the sons-of-bitches. A couple of
times a year, I get into fights at bars. I usually pick the biggest guy. I don't know why. I usually get
creamed. There are times when I drive real crazily, screaming and yelling at other drivers.
"I usually feel depressed. I've felt this way for years. There have been times I've been so depressed
that I won't even leave the basement. I'll usually start drinking pretty heavily around these times. I've
also thought about committing suicide when I've been depressed. I've got an old .38 that I snuck back from
Nam. A couple of times I've sat with it loaded, once I even had the barrel in my mouth and the hammer
pulled back. I couldn't do it. I see Smitty back in Nam with his brains smeared all over the bunker. Hell,
I fought too hard then to make it back to the World (U.S.): I can't waste it now. How come I survived and
he didn't? There has to be some reason.
"Sometimes, my head starts to replay some of my experiences in Nam. Regardless of what I'd like to
think about, it comes creeping in. It's so hard to push back out again. It's old friends, their faces, the
ambush, the screams, their faces (tears)... You know, every time I hear a chopper (helicopter) or see a
clear unobstructed green tree-line, a chill goes down my back; I remember. When I go hiking now, I avoid
green areas. I usually stay above timber line. When I walk down the street, I get real uncomfortable with
people behind me that I can't see. When I sit, I always try to find a chair with something big and solid
directly behind me. I feel most comfortable in the corner of a room, with walls on both sides of me. Loud
noises irritate me and sudden movement or noise will make me jump.
"Night is hardest for me. I go to sleep long after my wife has gone to bed. It seems like hours before
I finally drop off. I think of so many of my Nam experiences at night. Sometimes my wife awakens me with a
wild look in her eye. I'm all sweaty and tense. Sometimes I grab for her neck before I realize where I am.
Sometimes I remember the dream; sometimes it's Nam, other times it's just people after me, and I can't run
"I don't know, this has been going on for so long; it seems to be getting gradually worse. My wife is
talking about leaving. I guess it's no big deal. But I'm lonely. I really don't have anyone else. Why am I
the only one like this? What the hell is wrong with me?"
The above description of one Vietnam veteran's problematic lifestyle, more than ten years after the war
in Southeast Asia, is unfortunately not an unusual phenomenon.
The Evolution Of Post-Traumatic Stress Disorder (Ptsd)
It was not until World War I that specific clinical syndromes came to be associated with combat duty. In
prior wars, it was assumed that such casualties were merely manifestations of poor discipline and cowardice.
However, with the protracted artillery barrages commonplace during "The Great War," the concept evolved that
the high air pressure of the exploding shells caused actual physiological damage, precipitating the numerous
symptoms that were subsequently labeled "shell shock." By the end of the war, further evolution accounted
for the syndrome being labeled a "war neurosis" (Glass, 1969).
During the early years of World War II, psychiatric casualties had increased some 300 percent when
compared with World War I, even though the pre-induction psychiatric rejection rate was three to four times
higher than World War I (Figley, 1978a). At one point in the war, the number of men being discharged from
the service for psychiatric reasons exceeded the total number of men being newly drafted (Tiffany and
During the Korean War, the approach to combat stress became even more pragmatic. Due to the work of
Albert Glass (1945), individual breakdowns in combat effectiveness were dealt with in a very situational
manner. Clinicians provided immediate onsite treatment to affected individuals, always with the expectation
that the combatant would return to duty as soon as possible. The results were gratifying. During World War
II, 23 percent of the evacuations were for psychiatric reasons. But in Korea, psychiatric evacuations
dropped to only six percent (Bourne, 1970). It finally became clear that the situational stresses of the
combatant were the primary factors leading to psychological casualty.
Surprisingly, with American involvement in the Vietnam War, psychological battlefield casualties evolved
in a new direction. What was expected from past war experiences -- and what was prepared for -- did not
materialize. Battlefield psychological breakdown was at an all-time low, 12 per one thousand (Bourne, 1970).
It was decided that use of preventative measures learned in Korea and some added situational manipulation
which will be discussed later had solved the age-old problem of psychological breakdown in combat.
As the war continued for a number of years, some interesting additional trends were noted. Although the
behavior of some combatants in Vietnam undermined fighting efficiency, the symptoms presented rare but very
well documented phenomenon of World War II began to be re-observed. After the end of World War II, some men
suffering from acute combat reaction, as well as some of their peers with no such symptoms at war's end,
began to complain of common symptoms. These included intense anxiety, battle dreams, depression, explosive
aggressive behavior and problems with interpersonal relationships, to name a few. These were found in a
five-year follow-up (Futterman and Pumpian- Mindlin, 1951) and in a 20-year follow-up (Archibald and
A similar trend was once more observed in Vietnam veterans as the war wore on. Both those who experienced
acute combat reaction and many who did not began to complain of the above symptoms long after their
combatant role had ceased. What was so unusual was the large numbers of veterans being affected after
Vietnam. The pattern of neuropsychiatric disorder for combatants of World War II and Korea was quite
different than for Vietnam. For both World War II and the Korean War, the incidence of neuropsychiatric
disorder among combatants increased as the intensity of the wars increased. As these wars wore down, there
was a corresponding decrease in these disorders until the incidence closely resembled the particular prewar
periods. The prolonged or delayed symptoms noticed during the postwar periods were noted to be somewhat
obscure and few in numbers; therefore, no great significance was attached to them. However, the Vietnam
experience proved different. As the war in Vietnam progressed in intensity, there was no corresponding
increase in neuropsychiatric casualties among combatants. It was not until the early 1970s, when the war was
winding down, that neuropsychiatric disorders began to increase. With the end of direct American troop
involvement in Vietnam in 1973, the number of veterans presenting neuropsychiatric disorders began to
increase tremendously (President's Commission on Mental Health 1978).
During the same period in the 1970s, many other people were experiencing varying traumatic episodes other
than combat. There were large numbers of plane crashes, natural disasters, fires, acts of terrorism on
civilian populations and other catastrophic events. The picture presented to many mental health
professionals working with victims of these events, helping them adjust after traumatic experiences, was
quite similar to the phenomenon of the troubled Vietnam veteran. The symptoms were almost identical.
Finally, after much research (Figley, 1978a) by various veterans' task forces and recommendations by those
involved in treatment of civilian post-trauma clients, the DSM III (1980) was published with a new category:
post-traumatic stress disorder, acute, chronic and/or delayed.
Vietnam's Predisposing Effects For Ptsd
When direct American troop involvement in Vietnam became a reality, military planners looked to previous
war experiences to help alleviate the problem of psychological disorder in combat. By then it was an
understood fact that those combatants with the most combat exposure suffered the highest incidence of
breakdown. In Korea this knowledge resulted in use, to some extent, of a "point system." After accumulating
so many points, an individual was rotated home, regardless of the progress of the war. This was further
refined in Vietnam, the outcome being the DEROS (date of expected return from overseas) system. Every
individual serving in Vietnam, except general officers, knew before leaving the United States when he or she
was scheduled to return. The tour lasted 12 months for everyone except the Marines who, known for their
one-upmanship, did a 13-month tour. DEROS promised the combatant a way out of the war other than as a
physical or psychological casualty (Kormos, 1978).
The advantages were clear: there would not be an endless period of protracted combat with the prospect of
becoming a psychological casualty as the only hope for return to the United States without wounds. Rather,
if a combatant could just hold together for the 12 or 13 months, he would be rotated to the United States;
and, once home, he would leave the war far behind.
The disadvantages to DEROS were not as clear, and some time elapsed before they were noticed. DEROS was a
very personal thing; each individual was rotated on his own with his own specific date. This meant that
tours in Vietnam were solitary, individual episodes. It was rare, after the first few years of the war, that
whole units were sent to the war zone simultaneously. Bourne said it best: "The war becomes a highly
individualized and encapsulated event for each man. His war begins the day he arrives in the country, and
ends the day he leaves" (p. 12, 1970). Bourne further states, "He feels no continuity with those who precede
or follow him: He even feels apart from those who are with him but rotating on a different schedule" (p. 42,
Because of this very individual aspect of the war, unit morale, unit cohesion and unit identification
suffered tremendously (Kormos, 1978). Many studies from past wars (Grinker and Spiegel, 1945) point to the
concept of how unit integrity acts as a buffer for the individual against the overwhelming stresses of
combat. Many of the veterans of World War II spent weeks or months with their units returning on ships from
all over the world. During the long trip home, these men had the closeness and emotional support of one
another to rework the especially traumatic episodes they had experienced together. The epitaph for the
Vietnam veteran, however, was a solitary plane ride home with complete strangers and a head full of grief,
conflict, confusion and joy.
For every Vietnam combatant, the DEROS date became a fantasy that on a specific day all problems would
cease as he flew swiftly back to the United States. The combatants believed that neither they as individuals
nor the United States as a society had changed in their absence. Hundreds of thousands of men lived this
fantasy from day to day. The universal popularity of short- timer calendars is evidence of this. A
short-timer was a GI who was finishing his tour overseas. The calendars intricately marked off the days
remaining of his overseas tour in all manner of designs with 365 spaces to fill in to complete the final
design and mark that final day. The GIs overtly displayed these calendars to one another. Those with the
shortest time left in the country were praised by others and would lead their peers on a fantasy excursion
of how wonderful and carefree life would be as soon as they returned home. For many, this became an almost
daily ritual. For those who may have been struggling with a psychological breakdown due to the stresses of
combat, the DEROS fantasy served as a major prophylactic to actual overt symptoms of acute combat reaction.
For these veterans, it was a hard- fought struggle to hold on until their time came due.
The vast majority of veterans did hold on as evidenced by the low neuropsychiatric casualty rates during
the war (The President's Commission on Mental Health, 1978). Rates of acute combat reaction or acute
post-traumatic stress disorder were significantly lowered relative to the two previous wars. As a result,
many combatants, who in previous wars might have become psychological statistics, held on somewhat tenuously
until the end of their tours in Vietnam.
The struggle for most was an uphill battle. Those motivators that keep the combatant fighting -- unit
esprit de corps, small group solidarity and an ideological belief that this was the good fight (Moskos,
1975) -- were not present in Vietnam. Unit esprit was effectively slashed by the DEROS system.
Complete strangers, often GIs who were strangers even to a specific unit's specialty, were transferred into
units whenever individual rotations were completed. Veterans who had finally reached a level of proficiency
had also reached their DEROS date and were rotated. Green troops or "fucking new guys" with almost no
experience in combat were thrown into their places. These FNGs were essentially avoided by the unit, at
least until after a few months of experience; "short timers" did not want to get themselves killed by
relying on inexperienced replacements. Needles to say, the unit culture or esprit was often lost in
the lack of communication with the endless leavings and arrivals.
There were other unique aspects of group dynamics in Vietnam. Seasoned troops would stick together, often
forming very close small groups for short periods, a normal combat experience noted in previous wars (Grinker
and Spiegel, 1945). Some groups formed along racial lines due to lack of unit cohesion within combat
outfits. As a seasoned veteran got down to his last two months in Vietnam, he was struck by a strange malady
known as the "short timer's syndrome." He would be withdrawn from the field and, if logistically possible,
would be settled into a comparatively safe setting for the rest of his tour. His buddies would be left
behind in the field without his skills, and he would be left with mixed feelings of joy and guilt.
Interestingly, it was rare that a veteran ever wrote to his buddies still in Vietnam once he returned home
(Howard, 1975). It has been an even rarer experience for two or more to get together following the war. This
is a strong contrast to the endless reunions of World War II veterans. Feelings of guilt about leaving one's
buddies to whatever unknown fate in Vietnam apparently proved so strong that many veterans were often too
frightened to attempt to find out what happened to those left behind.
Another factor unique to the Vietnam War was that the ideological basis for the war was very difficult to
grasp. In World War II, the United States was very clearly threatened by a uniformed and easily recognizable
foe. In Vietnam, it was quite the opposite. It appeared that the whole country was hostile to American
forces. The enemy was rarely uniformed, and American troops were often forced to kill women and children
combatants. There were no real lines of demarcation, and just about any area was subject to attack. Most
American forces had been trained to fight in conventional warfare, in which other human beings are
confronted and a block of land is either acquired or lost in the fray. However, in Vietnam, surprise firing
devices such as booby traps accounted for a large number of casualties with the human foe rarely sighted. A
block of land might be secured but not held. A unit would pull out to another conflict in the vicinity; and,
if it wished to return to the same block of land, it would once again have to fight to take that land. It
was an endless war with rarely seen foes and no ground gains, just a constant flow of troops in and out of
the country. The only observable outcome was an interminable production of maimed, crippled bodies and
countless corpses. Some were so disfigured it was hard to tell if they were Vietnamese or American, but they
were all dead. The rage that such conditions generated was widespread among American troops. It manifested
itself in violence and mistrust toward the Vietnamese (DeFazio, 1978), toward the authorities, and toward
the society that sent these men to Vietnam and then would not support them. Rather than a war with a just
ideological basis, Vietnam became a private war of survival for every American individual involved.
What was especially problematic was that this was America's first teenage war (Williams, 1979). The age
of the average combatant was close to 20 (Wilson, 1979). According to Wilson (1978), this period for most
adolescents involves a psychosocial moratorium (Erickson, 1968), during which the individual takes some time
to establish a more stable and enduring personality structure and sense of self. Unfortunately for the
adolescents who fought the war, the role of combatant versus survivor, as well as the many ambiguous and
conflicting values associated with these roles, let to a clear disruption of this moratorium and to the many
subsequent problems that followed for the young veterans.
Many men, who had either used drugs to deal with the overwhelming stresses of combat or developed other
behavioral symptoms of similar stress-related etiology, were not recognized as struggling with acute combat
reaction or post-traumatic stress disorder, acute subtype. Rather, their immediate behavior had proven to be
problematic to the military, and they were offered an immediate resolution in the form of administrative
discharges, often with diagnoses of character disorders (Kormos, 1978).
The administrative discharge proved to be another method to temporarily repress any further overt
symptoms. It provided yet another means of ending the stress without becoming an actual physical or
psychological casualty. It, therefore, served to lower the actual incidence of psychological breakdown, as
did the DEROS. Eventually, this widely used practice came to be questioned, and it was recognized that it
had been used as a convenient way to eliminate many individuals who had major psychological problems dating
from their combat service (Kormos, 1978).
When the veteran finally returned home, his fantasy about his DEROS date was replaced by a rather harsh
reality. As previously stated, World War II vets took weeks, sometimes months, to return home with their
buddies. Vietnam vets returned home alone. Many made the transition from rice paddy to Southern California
in less than 36 hours. The civilian population of the World War II era had been treated to movies about the
struggles of readjustment for veterans (i.e. The Man In The Grey Flannel Suit, The Best Years of Our Lives,
Pride of The Marines) to prepare them to help the veteran (DeFazio, 1978). The civilian population of the
Vietnam era was treated to the horrors of the war on the six o'clock news. They were tired and numb to the
whole experience. Some were even fighting mad, and many veterans came home to witness this fact. Some World
War II veterans came home to victory parades. Vietnam veterans returned in defeat and witnessed antiwar
marches and protests. For World War II veterans, resort hotels were taken over and made into redistribution
stations to which veterans could bring their wives and devote two weeks to the initial homecoming (Boros,
1973). For Vietnam veterans, there were screaming antiwar crowds and locked military bases where they were
processed back into civilian life in two or three days.
Those veterans who were struggling to make it back home finally did. However, they had drastically
changed, and their world would never seem the same. Their fantasies were just that: fantasy. What they had
experienced in Vietnam and on their return to their homes in the United States would leave an indelible mark
that many may never erase.
The Catalysts Of Post-Traumatic Stress Disorders
For Vietnam Combat Veterans
More than 8.5 million individuals served in the U.S. Armed Forces during the Vietnam era, 1964-1973.
Approximately 2.8 million served in Southeast Asia. Of the latter number, almost one million saw active
combat or were exposed to hostile, life- threatening situations (President's Commission on Mental Health,
1978). It is this writer's opinion that the vast majority of Vietnam era veterans have had a much more
problematic readjustment to civilian life than did their World War II and Korean War counterparts. This was
due to the issues already discussed in this chapter, as well as to the state of the economy and the
inadequacy of the GI Bill in the early 1970s. In addition, the combat veterans of Vietnam, many of whom
immediately tried to become assimilated back into the peacetime culture, discovered that their outlook and
feelings about their relationships and future life experiences had changed immensely. According to the
fantasy, all was to be well again when they returned from Vietnam. The reality for many was quite different.
A number of studies point out that those veterans subjected to more extensive combat show more
problematic symptoms during the period of readjustment (Wilson, 1978; Strayer & Ellenhorn, 1975; Kormos,
1978; Shatan, 1978; Figley, 1978b). The usual pattern has been that of a combat veteran in Vietnam who held
on until his DEROS date. He was largely asymptomatic at the point of his rotation back to the U.S. for the
reasons previously discussed; on his return home, the joy of surviving continued to suppress any problematic
symptoms. However, after a year or more, the veteran would begin to notice some changes in his outlook (Shatan,
1978). But, because there was a time limit of one year after which the Veterans Administration would not
recognize neuropsychiatric problems as service-connected, the veteran was unable to get service-connected
disability compensation. Treatment from the VA was very difficult to obtain. The veteran began to feel
depressed, mistrustful, cynical and restless. He experienced problems with sleep and with his temper.
Strangely, he became somewhat obsessed with his combat experiences in Vietnam. He would also begin to
question why he survived when others did not.
For approximately 500,000 veterans (Wilson, 1978) of the combat in Southeast Asia, this problematic
outlook has become a chronic lifestyle affecting not only the veterans but countless millions of persons who
are in contact with these veterans. The symptoms described below are experienced by all Vietnam combat
veterans to varying degrees. However, for some with the most extensive combat histories and other variables
which have yet to be enumerated, Vietnam-related problems have persisted in disrupting all areas of life
experience. According to Wilson (1978), the number of veterans experiencing these symptoms will climb until
1985, based on his belief of Erickson's psychosocial developmental stages and how far along in these stages
most combat veterans will be by 1985. Furthermore, without any intervention, what was once a reaction to a
traumatic episode may for many become an almost unchangeable personality characteristic.
The Symptoms Of Ptsd:
Chronic and/or Delayed Depression
The vast majority of the Vietnam combat veterans I have interviewed are depressed. Many have been
continually depressed since their experiences in Vietnam. They have the classic symptoms (DSM III, 1980) of
sleep disturbance, psychomotor retardation, feelings of worthlessness, difficulty in concentrating, etc.
Many of these veterans have weapons in their possession, and they are no strangers to death. In treatment,
it is especially important to find out if the veteran keeps a weapon in close proximity, because the
possibility of suicide is always present.
When recalling various combat episodes during an interview, the veteran with a post-traumatic stress
disorder almost invariably cries. He usually has had one or more episodes in which one of his buddies was
killed. When asked how he handled these death when in Vietnam, he will often answer, "in the shortest amount
of time possible" (Howard, 1975). Due to circumstances of war, extended grieving on the battlefield is very
unproductive and could become a liability. Hence, grief was handled as quickly as possible, allowing little
or no time for the grieving process. Many men reported feeling numb when this happened. When asked how they
are now dealing with the deaths of their buddies in Vietnam, they invariable answer that they are not. They
feel depressed; "How can I tell my wife, she'd never understand?" they ask. "How can anyone who hasn't been
there understand?" (Howard, 1975).
Accompanying the depression is a very well developed sense of helplessness about one's condition.
Vietnam-style combat held no final resolution of conflict for anyone. Regardless of how one might respond,
the overall outcome seemed to be just an endless production of casualties with no perceivable goals
attained. Regardless of how well one worked, sweated, bled and even died, the outcome was the same. Our GIs
gained no ground; they were constantly rocketed or mortared. They found little support from their "friends
and neighbors" back home, the people in whose name so many were drafted into military service. They felt
helpless. They returned to the United States, trying to put together some positive resolution of this
episode in their lives, but the atmosphere at home was hopeless. They were still helpless. Why even bother
Many veterans report becoming extremely isolated when they are especially depressed. Substance abuse is
often exaggerated during depressive periods. Self medication was an easily learned coping response in
Vietnam; alcohol appears to be the drug of choice.
Combat veterans have few friends. Many veterans who witnessed traumatic experiences complain of feeling
like old men in young men's bodies. They feel isolated and distant from their peers. The veterans feel that
most of their non-veteran peers would rather not hear what the combat experience was like; therefore, they
feel rejected. Much of what many of these veterans had done during the war would seem like horrible crimes
to their civilian peers. But, in the reality faced by Vietnam combatants, such actions were frequently the
only means of survival.
Many veterans find it difficult to forget the lack of positive support they received from the American
public during the war. This was especially brought home to them on the return from the combat zone to the
United States. Many were met by screaming crowds and the media calling them "depraved fiends" and
"psychopathic killers" (DeFazio, 1978). Many personally confronted hostility from friends and family, as
well as strangers. After their return home, some veterans found that the only defense was to search for a
safe place. These veterans found themselves crisscrossing the continent, always searching for that place
where they might feel accepted. Many veterans cling to the hope that they can move away from their problems.
It is not unusual to interview a veteran who, either alone or with his family, has effectively isolated
himself from others by repeatedly moving from one geographical location to another. The stress on his family
The fantasy of living the life of a hermit plays a central role in many veterans' daydreams. Many admit
to extended periods of isolation in the mountains, on the road, or just behind a closed door in the city.
Some veterans have actually taken a weapon and attempted to live off the land.
It is not rare to find a combat veteran who has not had a social contact with a woman for years -- other
than with a prostitute, which is an accepted military procedure in the combat setting. If the veteran does
marry, his wife will often complain about the isolation he imposes on the marital situation. The veteran
will often stay in the house and avoid any interactions with others. He also resents any interactions that
his spouse may initiate. Many times, the wife is the source of financial stability.
The veterans' rage is frightening to them and to others around them. For no apparent reason, many will
strike out at whomever is near. Frequently, this includes their wives and children. Some of these veterans
can be quite violent. This behavior generally frightens the veterans, apparently leading many to question
their sanity; they are horrified at their behavior. However, regardless of their afterthoughts, the rage
reactions occur with frightening frequency.
Often veterans will recount episodes in which they became inebriated and had fantasies that they were
surrounded or confronted by enemy Vietnamese. This can prove to be an especially frightening situation when
others confront the veteran forcibly. For many combat veterans, it is once again a life-and- death struggle,
a fight for survival.
Some veterans have been able to sublimate their rage, breaking inanimate objects or putting fists through
walls. Many of them display bruises and cuts on their hands. Often, when these veterans feel the rage
emerging, they will immediately leave the scene before somebody or something gets hurt; subsequently, they
drive about aimlessly. Quite often, their behavior behind the wheel reflects their mood. A number of
veterans have described to me the verbal catharsis they've achieved in explosions of expletives directed at
any other drivers who may wrong them.
There are many reasons for the rage. Military training equated rage with masculine identity in the
performance of military duty (Eisenhart, 1975). Whether one was in combat or not, the military experience
stirred up more resentment and rage than most had ever felt (Egendorf, 1975). Finally, when combat in
Vietnam was experienced, the combatants were often left with wild, violent impulses and no one upon whom to
level them. The nature of guerrilla warfare -- with its use of such tactics as booby trap land mines and
surprise ambushes with the enemy's quick retreat -- left the combatants feeling like time bombs; the
veterans wanted to fight back, but their antagonists had long since disappeared. Often they unleashed their
rage at indiscriminate targets for want of more suitable targets (Shatan, 1978).
On return from Vietnam, the rage that had been tapped in combat was displaced against those in authority.
It was directed against those the veterans felt were responsible for getting them involved in the war in the
first place -- and against those who would not support the veterans while they were in Vietnam or when they
returned home (Howard, 1975). Fantasies of retaliation against political leaders, the military services, the
Veterans Administration and antiwar protesters were present in the minds of many of these Vietnam combat
veterans. These fantasies are still alive and generalized to many in the present era.
Along with the rage at authority figures from the Vietnam era, these veterans today often feel a
generalized mistrust of anyone in authority and the "system" in the present era. Many combat veterans with
stress disorders have a long history of constantly changing their jobs. It is not unusual to interview a
veteran who has had 30 to 40 jobs during the past 10 years. One veteran I interview had nearly 80 jobs in a
10-year span. The rationale quite often given by the veterans is that they became bored or the work was
beneath them. However, after I made some extended searched into their work backgrounds, it became apparent
that they felt deep mistrust for their employers and coworkers; they felt used and exploited; at times, such
was the case. Many have had some uncomfortable confrontations with their employers and job peers, and many
have been fired or have resigned on their own.
Avoidance of Feelings: Alienation
The spouses of many of the veterans I have interviewed complain that the men are cold, uncaring
individuals. Indeed the veterans themselves will recount episodes in which they did not feel anything when
they witnessed the death of a buddy in combat or the more recent death of a close family relative. They are
often somewhat troubled by these responses to tragedy; but, on the whole, they would rather deal with
tragedy in their own detached way. What becomes especially problematic for these veterans, however, is an
inability to experience the joys of life. They often describe themselves as being emotionally dead (Shatan,
The evolution of this emotional deadness began for Vietnam veterans when they first entered military boot
camp (Shatan, 1973). There they learned that the Vietnamese were not to be labeled as people but as "gooks,
dinks, slopes, zipperheads and slants." When the veterans finally arrived in the battle zone, it was much
easier to kill a "gook" or "dink" than another human being. This dehumanization gradually generalized to the
whole Vietnam experience. The American combatants themselves became "grunts," the Viet Cong became "Victor
Charlie," and both groups were either "KIA" (killed in action) or "WIA" (wounded in action). Often, many
"slopes" would get "zapped" (killed) by a "Cobra" (gunship), and the "grunts" would retreat by "Shithook"
(evacuation by a Chinook helicopter); the jungle would be sown by "Puff the Magic Dragon" (a C-47 gunship
with rapid-firing mini-gattling guns).
The pseudonyms served to blunt the anguish and the horror of the reality of combat (DeFazio, 1978). In
conjunction with this almost surreal aspect of the fighting, psychic numbing furthered the coping and
survival ability of the combatants by effectively knocking the aspect of feelings out of their cognitive
abilities (Lifton, 1976). This defense mechanism of survivors of traumatic experiences dulls an individual's
awareness of the death and destruction about him. It is a dynamic survival mechanism, helping one to pass
through a period of trauma without becoming caught up in its tendrils. Psychic numbing only becomes
nonproductive when the period of trauma is passed, and the individual is still numb to the affect around
Many veterans find it extremely uncomfortable to feel love and compassion for others. To do this, they
would have to thaw their numb reactions to the death and horror that surrounded them in Vietnam. Some
veterans I've interview actually believe that if they once again allow themselves to feel, they may never
stop crying or may completely lose control of themselves; what they mean by this is unknown to them.
Therefore, many of these veterans go through life with an impaired capacity to love and care for others.
they have no feeling of direction or purpose in life. They are not sure why they even exist.
When others have died and some have not, the survivors often ask, "How is it that I survived when others
more worthy than I did not?" (Lifton, 1973). Survival guilt is an especially guilt- invoking symptom. It is
not based on anything hypothetical. Rather, it is based on the harshest of realities, the actual death of
comrades and the struggle of the survivor to live. Often the survivor has had to compromise himself or the
life of someone else in order to live. The guilt that such an act invokes or guilt over simply surviving may
eventually end in self-destructive behavior by the survivor.
Many veterans, who have survived when comrades were lost in surprise ambushes, protracted battles or even
normal battlefield attrition, exhibit self-destructive behavior. It is common for them to recount the combat
death of someone they held in esteem; and, invariably, the questions comes up, "Why wasn't it me?" It is not
unusual for these men to set themselves up for hopeless physical fights with insurmountable odds. "I don't
know why, but I always pick the biggest guy," said the veteran in the transcript at the beginning of this
chapter. Shatan (1973) notes that some of these men become involved in repeated single-car accidents. This
writer interviewed one surviving veteran, whose company suffered over 80% casualties in one ambush. The
veteran had had three single-car accidents during the previous week, two the day before he came in for the
interview. He was wondering if he were trying to kill himself.
I have also found that those veterans who suffer the most painful survival guilt are primarily those who
served as corpsmen or medics. These unfortunate veterans were trained for a few months to render first aid
on the actual field of battle. The services they individually performed were heroic. With a bare amount of
medical knowledge and large amounts of courage and determination, they saved countless lives. However, many
of the men they tried to save died. Many of these casualties were beyond all medical help, yet many corpsmen
and medics suffer extremely painful memories to this day, blaming their "incompetence" for these deaths.
Listening to these veterans describe their anguish and torment... seeing the heroin tracks up and down their
arms or the bones that have been broken in numerous barroom fights... is, in itself, a very painful
Another less destructive trend that I have noticed exists among a small number of Vietnam combat veterans
who have become compulsive blood donors. One very isolated and alienated individual I interviewed actually
drives some 80 miles round-trip once every other month to make his donation. His military history reveals
that he was one of 13 men out of a 60-man platoon who survived the battle of Hue. He was the only survivor
who was not wounded. this veteran and similar vets talk openly about their guilt, and they find some relief
today in giving their blood that others may live.
Many Vietnam veterans describe themselves as very vigilant human beings; their autonomic senses are tuned
to anything out of the ordinary. A loud discharge will cause many of them to start. A few will actually take
such evasive action as falling to their knees or to the ground. Many veterans become very uncomfortable when
people walk closely behind them. One veteran described his discomfort when people drive directly behind him.
He would pull off the road, letting others pass, when they got within a few car lengths of him.
Some veterans are uncomfortable when standing out in the open. Many are uneasy when sitting with others
behind them, often opting to sit up against something solid, such as a wall. The bigger the object is, the
better. Many combat veterans are most comfortable when sitting in the corner in a room, where they can see
everyone about them. Needless to say, all of these behaviors are learned survival techniques. If a veteran
feels continuously threatened, it is difficult for him to give such behavior up.
A large number of veterans possess weapons. This also is a learned survival technique. Many still sleep
with weapons in easy reach. The uneasy feeling of being caught asleep is apparently very difficult to master
once having left the combat zone.
Sleep Disturbance and Nightmares
Few veterans struggling with post-traumatic stress disorders find the hours immediately before sleep very
comfortable. In fact, many will stay awake as long as possible. They will often have a drink or smoke some
cannabis to dull any uncomfortable cognition that may enter during this vulnerable time period. Many report
that they have nothing to occupy their minds at the end of the day's activities, and their thoughts wander.
For many of them, it is a trip back to the battle zone. Very often they will watch TV late into the
Finally, with sleep, many veterans report having dreams about being shot at or being pursued and left
with an empty weapon,, unable to run anymore. Recurrent dreams of specific traumatic episodes are frequently
reported. It is not unusual for a veteran to reexperience, night after night, the death of a close friend or
a death that he caused as a combatant. Dreams of everyday, common experiences in Vietnam are also frequently
reported. For many, just the fear that they might actually be back in Vietnam is very disquieting.
Some veterans report being unable to remember their specific dreams, yet they feel dread about them.
Wives and partners report that the men sleep fitfully, and some call out in agitation. A very few actually
grab their partners and attempt to do them harm before they have fully awakened. Finally, maintaining sleep
has proven to be a problem for many of these veterans. They report waking up often during the night for no
apparent reason. Many rise quite early in the morning, still feeling very tired.
Traumatic memories of the battlefield and other less affect- laden combat experiences often play a role
in the daytime cognitions of combat veterans. Frequently, these veterans report replaying especially
problematic combat experiences over and over again. Many search for possible alternative outcomes to what
actually happened in Vietnam. Many castigate themselves for what they might have done to change the
situation, suffering subsequent guilt feelings today because they were unable to do so in combat. The vast
majority report that these thoughts are very uncomfortable, yet they are unable to put them to rest.
Many of the obsessive episodes are triggered by common, everyday experiences that remind the veteran of
the war zone: helicopters flying overhead, the smell of urine (corpses have no muscle tone, and the bladder
evacuates at the moment of death), the smell of diesel fuel (the commodes and latrines contained diesel fuel
and were burned when filled with human excrement), green tree lines (these were searched for any
irregularity which often meant the presence of enemy movement), the sound of popcorn popping (the sound is
very close to that of small arms gunfire in the distance), any loud discharge, a rainy day (it rains for
months during the monsoons in Vietnam) and finally the sight of Vietnamese refugees.
A few combat veterans find the memories invoked by some of these and other stimuli so uncomfortable that
they will actually go out of their way to avoid them. When exposed to one of the above or similar stimuli, a
very small number of combat veterans undergo a short period of time in a dissociative-like state in which
they actually re-experience past events in Vietnam. These flashbacks can last anywhere from a few seconds to
a few hours. One veteran described an episode to me in which he had seen some armed men and felt he was back
in Vietnam. The armed men were police officers. Not having a weapon to protect himself and others, he
grabbed a passerby and forcefully sheltered this person in his home to protect him from what he felt were
the "gooks." He was medicated and hospitalized for a week.
Such experiences among Vietnam veterans are rare, but not as uncommon as many may believe. Many veterans
report flashback episodes that last only a few seconds. For many, the sound of a helicopter flying overhead
is a cue to forget reality for a few seconds and remember Vietnam, re-experiencing feelings they had there.
It is especially troublesome for those veterans who are still "numb" and specifically attempting to avoid
these feelings. For others, it is just a constant reminder of their time in Vietnam, something they will
Referrals For Help
As already discussed, post-traumatic stress disorders result in widely varying degrees of impairment.
When a single veteran (whether bachelor or divorced) with the disorder requests help, I refer him to a group
of other combat veterans. The reasons are twofold. First, the veteran is usually quite isolated and has lost
many of his social skills. He has few contacts with other human beings. The group provides a microcosm in
which he can again learn how to interact with other people. It also helps remove the fear, prevalent among
these veterans, that each individual veteran is the only individual with these symptoms. In addition, many
of the veterans form close support groups of their own outside the therapy sessions; they telephone each
other and help each other through particularly problematic episodes.
Second, the most basic rationale for group treatment of these veterans is that it finally provides the
veteran with that "long boat ride home" with other veterans who have had similar experiences. It provides a
forum in which veterans troubled by their combat experiences can work their feelings through with other
veterans who have had similar conflicts. In addition, the present symptoms of the disorder are all quite
similar, and there is more reinforcement in working through these symptoms with one's peers than in doing it
The group situation is appropriate for most degrees of the symptoms presented. The especially isolated
individuals will often be quite frightened of the initial group session. When challenged by questioning the
strength that brought them to the initial interview, however, they will usually respond by following through
with the group. Those with severely homicidal or suicidal symptoms are best handled in a more
crisis-oriented, one-to-one setting until the crisis is resolved. I refer these veterans to an appropriate
emergency team, with the expectation directly shared with the veteran that he will join the group as soon as
the crisis has abated.
Veterans who are presently married or living with a partner present a somewhat different picture. Their
relationships with their partners are almost invariable problematic. Frequently, a violent, explosive
episode at home created the crisis that brought the veteran in for counseling in the first place. When such
is the case or there is a history of battering of the partner, it is extremely important to refer the
veteran and his partner to a family disturbance counseling center. The consequences of this continued
behavior are obvious. In addition, a referral for the veteran to a group with other combat veterans is
appropriate. The partner of the veteran may find some understanding of her plight and additional support
from a woman's group created specifically for partners of Vietnam combat veterans.
Other veterans who are married or living with a partner may not be experiencing so serious a problem.
However, the partners are often detached from one another; they just seem to live under the same roof,
period. Referral of the veteran to a combat veterans group and referral of the partner to a partners of
Vietnam veterans group is important.
Some veterans and their partners will jointly attend the screening session. Both are troubled by what has
been happening and often want to enter marital therapy together immediately. In my experience, the veteran
finds it extremely difficult in the beginning of therapy to deal with interactional aspects with his partner
when other past interactions with traumatic overtones overshadow the present. When these traumatic
experiences do surface, the partner is often unable to relate. Therefore, it is much more beneficial, in my
opinion, to allow the veteran time with other combat veterans in a group. In the meantime, suggest a woman's
support group for partners of Vietnam veterans for the spouse. Here she would receive additional support as
well as an understanding of post-traumatic stress disorders. Sometime thereafter, marital therapy, couples
group therapy or family therapy may be appropriate.
Many veterans with post-traumatic stress disorders, in addition to the symptoms already described, also
have significant problems due to multiple substance abuse. In my experience, those veterans who have
habitually medicated themselves have compounded the problem. Not only do they experience many of the
symptoms already described, but the additional symptoms of chronic multiple substance abuse and alcoholism
may mask the underlying reasons for self-medication as well. Therefore, these chronic syndromes, which
perpetuate themselves through addictive behavior, must be dealt with first. Then a more accurate picture of
the underlying problem will result, and an appropriate referral can be made.
Except for some help with an immediate crisis upon being first interviewed during the screening session,
the combat veteran struggling with the symptoms of post-traumatic stress disorder, chronic and/or delayed,
benefits most from group interaction with his combat peers. Throughout this paper I have emphasized the
individual, solitary aspect of the war for each veteran. The aftermath of the war has followed in kind. Now,
with the help from the DAV Vietnam Veterans Outreach Program and the VA's Operation Outreach (Vet Center)
program, models have been established for reintegrating troubled Vietnam veterans with themselves and their
society. Helping the community to recognize the problem and directing the veteran to the specialized
services of the community have given the veteran struggling with this disorder a means of "coming home."
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Peter Griffin has a website that expands on the subject of Post Combat Stress Disorder. Peter's
website includes poems he has written to honor veterans, but it is also a highly informative website about
Post Combat Stress Disorder. To learn about the complexities of PCSD and to
gain some understanding about those who suffer from it, visit the "Griffin's Lair" website here: