The journey from combat to hospitals to rehabilitation and release from military service appeared at the time to be the final leg of our journey in uniform. The journey had begun with military training followed by orders to troop units and combat in Vietnam. The journey was unique for each of us who followed the path from civilian life to duty in jungle fatigues.
Our jobs differed from infantry grunts to artillerymen and aviators, as well as cooks and bakers, who each made different contributions to the conflict. Along the way, we bonded with fellow soldiers. We took pride in our new units with long service in defense of freedom, some reaching back to the Revolutionary War.
Our abrupt arrival in the stifling heat and humidity of South Vietnam was a shock. Before we could adjust to the heat of our new surroundings, large transport aircraft, helicopters, and trucks transported novice warriors to new homes – tent cities in exotic settings from highlands to river deltas. Vietnam was a huge country divided into forty-four provinces—each unique and exotic.
The country stretched hundreds of miles from the North Vietnamese border to the mangrove swamps and rice paddies at the southern tip of the country known as Ca Mau. We had never experienced anything quite like it; and the beauty of the land amazed us as we gazed out upon the vast countryside.
Encounters with the enemy would come later. We gradually came to know our opponents – North Vietnamese Army units, as well as Viet Cong guerrillas.
The enemy strategy was to take control of the rural population and defeat the men dressed in the uniforms of the soldiers of the Saigon Government. Although we did not see it at the time, we were part of the larger Cold War struggle. Our war was a proxy war between America and the Soviet Union. It pitted Hanoi against South Vietnam. The Soviet Union and the Peoples’ Republic of China supported Hanoi. The Americans and their Asian allies – South Korea, Australia, and Thailand, backed Saigon.
Our fight was a test of the Cold War containment strategy that had halted Soviet expansion in Europe. In Northeast Asia, the containment strategy had been tested and had held in Korea; but in Southeast Asia, the situation remained fluid and its outcome uncertain.
We did not perceive that we were part of a protracted struggle that would continue far longer than we could imagine. Our participation in the struggle between the two Vietnams endured for over a decade. The long struggle saw the building of a large South Vietnamese defense establishment and the decimation of the indigenous guerrilla force we knew as the Viet Cong, who were virtually annihilated in the conflict. Their leadership, known as the National Liberation Front (NLF), did not learn they were puppets until the cannon were silent.
The NLF– the face of the communist enemy in the South and their few surviving Viet Cong soldiers– were excluded from the victory parade in Saigon celebrating Hanoi’s conquest of the South. Instead, the Viet Cong survivors joined North Vietnamese units. The NLF fared no better. The survivors found no jobs in the new administration of the South they thought they would govern, as their propaganda proclaimed.
Instead, the NLF cadre were offered menial jobs by Hanoi’s generals, who ruled South Vietnam. Some of the NLF survivors fled as boat people in leaking fishing boats to watery graves or new beginnings in distant lands.
The Americans departed following the signing of the Paris Peace Treaty in 1972, taking our prisoners of war with us as we departed. We had sent home 58,000 American dead for burials in cemeteries across America. The South Vietnamese lost a quarter of a million troops. The North Vietnamese lost 1.4 million soldiers in the extended combat. The collateral damage of the war was extensive. Civilian casualties were heavy on both sides. In addition, wounded soldiers filled hospitals from Hanoi to Saigon and from Hawaii to Washington, DC.
The most severely wounded remained hospitalized indefinitely. The majority of the wounded were treated and released to return to homes they had departed years before.
The final cost of the dramatic events of the long war included animosity on the Home Front. The mood of the country had changed. The war had changed everyone – the soldiers, their families, civilians on the Home Front and those, who elected to oppose the war. Riots, demonstrations, and angry mobs had seized universities, encouraged by a liberal press, Hollywood and folk singers, who became icons of the period. Frequently, the returning veterans discovered they were no longer welcome in their hometowns, which inflicted emotional scars upon battle scared veterans.
Years later soldiers, innocent of their internal scars from traumatic stress, turned to alcohol and drugs to medicate depression and anger that become constant companions, haunting the living with memories of the dead and dying.
Many veterans had the good fortune to reside near medical facilities of the Veterans Administration (VA). They learned help was available through the VA. VA psychiatrists provided care and counseling. Those suffering from depression and acute stress received medication. Participation in group therapy sessions was available on a voluntary basis.
Most veterans seeking treatment from the VA expected cures. We thought that after counseling and treatment we could return to normal lives in our communities. I recall asking my counselor how long it would take to cure my Post Traumatic Stress Disorder. The answer was honest, clear and unmistakable. She replied, “You will take it to your grave.” Granted my case was one of prolonged exposure to high stress levels, but I had no inkling of the consequences of my combat duties.
The VA could assist me with therapy, counseling and medication for depression and anger, but at the end of the day the treatment only contained the most severe symptoms of the disorder. There was no cure in sight. Normality was a thing of the distant past.
Veterans spent years together in therapy listening to fellow warriors telling of their long journey through jungle and highlands, rice paddies and mangrove swamps.
We shared homecomings that were frequently, incredibly bitter – wives had deserted their men, families rejected brothers and sons, complete strangers mocked veterans along with Hollywood and the media in daily vitriol that exiled us in our own land. The most common and difficult emotional burden of combat was survivor’s guilt, which was widespread. We confessed our survivor’s guilt because God spared us, while taking the lives of our closest companions – warriors we loved.
Together we had shared brutality beyond description and close combat that never ended. With the loss of our closest companions, we stuffed emotions so we could carry on. Those of us in leadership position had to be ready for combat only hours away; and our soldiers had to be prepared. No tears, no looking back, and no show of weakness were possible leading the young troopers, who needed us. We refused to look back.
We buried our grief so deep in the hidden recesses of our subconscious that it was beyond recall. The unconscious burial of dark memories took with it all memories and emotions of shared times, faces, names and entire operations disappeared into a fog of denial that shielded us from pain too intense to endure, sights too ugly to recall without jeopardizing our ability to function in combat without end. Duty demanded we move on and prepare for enemy contact in the night or certainly in the morning that was not far off. Over time, we became hardened and felt no pain, no remorse, and no emotions other than rage that drove warriors in combat. The subconscious colluded in our need for protection from trauma and memories too heavy to bear. The denial and stuffing of the ugly past protect us from burdens too heavy to endure for years – ten, twenty years – until the subconscious was exhausted by the constant weight of its enormous burden and began to leak visions of the distant past.
When the subconscious began to surrender its burden, warriors entered a new phase of the journey, when brief memories would surface for brief seconds that prompted anger, curses and then nothing. It was gone – the flashback — and we had no idea what had convulsed us in anger and left us trembling and covered in sweat. Sometimes flashbacks came during the day triggered by a smell that resembled the stench of the battlefield, or a word, or sounds. Other flashbacks returned in the night as dreams that tormented old warrior and their loved ones.
Patients with brief exposure to moderate to low stress levels had the best chance of making progress in the quest to rejoin society, although they also faced the difficulty of regression and public display of PTSD symptoms. Everyday situations often triggered suppressed combat memories – the backfiring of a truck, the slamming of a door in a high wind, an angry confrontation with a co-worker – resulting in angry outbursts, rage, and depression. Such workers were recognized as a problem in the workplace, which usually was followed by a pink slip in the envelope with his or her last paycheck.
Group therapy sessions offered veterans an opportunity to make sense of painful agonies visited upon the survivors of an ugly past. The sessions were difficult for many because it threw together men of dramatically different combat experiences, many of whom exhibited anger and at times violent responses to combat memories. The benefits of the sessions included the opportunity for soldiers to compare their experiences, as well as the dreams and flashbacks that haunted those exposed to prolonged combat. An unintended outcome of group therapy was that it allowed veterans to find men with similar backgrounds, who became friends in a world hostile to veterans in the aftermath of the long and unpopular conflict.
Regrettably, tensions existed among veterans in group therapy sessions that I attended. The therapy revealed many different categories of stress casualties. Men with multiple combat tours in units that saw heavy and prolonged combat were hardened veterans—angry men – without much concern for those exposed to very real, but less intense stress, while supporting combat operations in supply, transportation and support units on airfields or large logistical installations.
The combat support soldiers periodically experienced incoming rockets and artillery, as well as the stress associated with convoy duties that exposed them to sniper fire, mines and occasional ambushes in forward areas. Even cooks and bakers went to sleep with the sound of artillery fire – friendly and enemy—in the night. Medical personnel were exposed to trauma and stress unique to their calling, but every bit as bitter as that experienced by soldiers across the battlefield. Doctors and nurses witnessed the drama of wounded men and women arriving hourly by choppers with wounds of every description.
They tried valiantly to save the lives of the most seriously injured, but invariably many of those they struggled to keep alive died.
Those of us with extended combat duty during multiple tours of duty in Vietnam recognized intuitively that PTSD could not be understood as simply one category of casualties. It was not a matter of one size fits all. We were a diverse population with stress related symptoms that ranged from infrequent exposure to low stress levels to prolonged exposure to combat trauma – high stress levels –over many years. The most severe cases of traumatic stress were normally found among the veterans, who had served as infantrymen in several wars.
Moreover, soldiers had unique tolerances to stress that differed dramatically. Simply the act of putting on a uniform and undergoing military training from dawn to dusk was highly stressful for some. Military training posed no problem and produced little stress for volunteers from farms and rural communities, who hunted all their lives and were accustomed to hard physical labor from dawn until dusk.
Veterans with PTSD spent years in therapy and came to know fellow veterans, their journey into hell, their problems with flashback, their dreams, and the great sorrows they carried. Over time the sharing, counseling, and listening to the experiences of members of the therapy group brought us to an understanding of what had happened to us as the subconscious gradually revealed the hidden past. The friendships formed in the therapy groups led to close associations as we met for coffee and attended veteran’s organizations like The Combat Infantryman’s Association, The Military Order of the Purple Heart, Vietnam Veterans of America, Disabled American Veterans, The American Legion and The Veterans of Foreign Wars.
Friends sat together in the therapy sessions. The senior warriors with multiple combat tours sat with friends with similar experiences. Soldiers with less exposure to danger and stress sat apart. The severely, wounded, senior warriors were a dying breed. They had been wounded multiple times. Typical problems included exposure to Agent Orange, crippling stress that manifested itself in heart disease, diabetes, and cancer.
These medical conditions aggravated the disabilities veterans brought back from war – gunshot wounds, loss of limbs, lost hearing, impaired lungs, lost vision, and deeply personal wounds that we were only able to share after years of friendship and earned trust. Alcoholism haunted those of us who had resorted to drink to medicate stress in the years before we found VA treatment. Each year our numbers dwindled as trusted comrades lost their struggle for life.
It became obvious to all of us that PTSD was not a single malady with one method of treatment. Both Psychiatrists and patients alike recognized marked differences between PTSD patients who required different approaches to treatment. The most severely disturbed patients required hospitalization. Other PTSD victims required different dosages of medications that varied with the severity of the veteran’s symptoms. Patients exposed to violent trauma and combat stress for extensive periods required more medications and counseling than patients with shorter exposure times to lower stress levels.
Many of the older veterans with extensive service discussed the advantages of segregating patients into groups reflecting the severity of their PTSD symptoms. Such an approach would allow the most seriously injured and aggravated, combat, stress-impaired patients to relate to men and women with similar experiences, reducing the tensions between men and women exposed to dramatically different stress levels.
Discussion of the problem suggested the need for recognition of a hierarchy of PTSD cases in a manner similar to the classification of burn victims in multiple categories reflecting the different treatment required based on the severity of the wound. The following concept of PTSD types is suggested as the basis for further study of the disorder based upon the dramatically different PTSD patients found in VA therapy sessions.
Categorizations of Post Traumatic Stress Disorder
First Degree Post Traumatic Stress Disorder:
· Stress Exposure: Short to moderate duration.
· Trauma: Limited exposure to traumatic injuries.
· Victim: Mechanic, cook, accident victim, nurse (depending upon duties), battered wives.
· Characteristics: Nurturing personality or employed in a non-combat role.
· Symptoms: Anger, depression, anxiety, and reduced job site effectiveness.
Second Degree Post Traumatic Stress Disorder:
· Stress Exposure: Extended exposure to stress.
· Trauma: Typically exposed to extreme cases of trauma.
· Victims: Combat infantry, intensive care nurse, police and firefighters, rape or incest victim, EMT personnel, and battered wives exposed to abuse over long periods.
· Characteristics: Insensitive, history of frequent or multiple tours of duty in combat units, career firefighters and police officer serving in high-risk environment.
· Symptoms: Combative, angry, sleep disorders, suppressed memories, anti-social, experiences flashbacks.
Third Degree Post Traumatic Stress Disorder:
· Stress Exposure: Routine exposure over many years.
· Trauma: Routine exposure to severe trauma over many years.
· Victims: Combat leaders, Special Forces personnel, SWAT team members.
· Characteristics: Highly trained professional, impersonal and passionless, takes initiative, insensitive personality.
· Symptoms: Often none for many years, resorts to alcohol as self-medication to control stress and anxiety, considers psychological disorders a sign of weakness, and denies symptoms of PTSD.
Fourth Degree Post Traumatic Stress Disorder:
· Stress Exposure: Extensive exposure to intense stress.
· Trauma: Routine exposure to violent trauma.
· Victims: The avenger (Killer Angels – General Lee’s infantry in the Army of Northern Virginia), incest victims exposed to molestation over a period of years, prisoners of war exposed to prolonged torture and deprivation.
· Characteristics: Fights with rage, combat is personal, long history of suffering and personal loss.
· Symptoms: Anger, combative, use of alcohol to control stress or grief, and frequently denies symptoms of disorder.
Fifth Degree Post Traumatic Stress Disorder:
· Stress Exposure: Often life-long exposure to stress.
· Trauma: Extended exposure to multiple forum of trauma.
· Victims: Victims of multiple form of PTSD.
· Characteristics: Incest victim that becomes a combat infantryman in more than one war, or rape victim that works as an intensive care nurse.
· Symptoms: Symptoms may be suppressed for years; later symptoms emerge including uncontrollable anger, history of substance abuse, depression, flashbacks, and sleep disorders
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