I was only dimly aware of the depth of unrest of the Vietnam veterans and thus mentally compared it to the unrest of any wartime military men upon their return home. Unrest existed after World War II and after the Korean episode. But recently it has become apparent that this situation is different and there is substance to the complaints of the present group of veterans. While the earlier groups had been praised and feted upon their return, these men were ignored. In fact, many thoughtless younger compatriots made no effort to hide their displeasure at the whole misconceived Vietnam venture and acted as if they considered the returnees responsible for the nation's poor judgment.
Bad dreams and guilt feelings have been reported by some World War II returnees. Marine sergeants and others felt guilty because their buddies were killed and they were not. However, the guilt is deeper in Vietnam veterans. In the Vietnam War there were more reports of women and children being killed by soldiers. Many women even carried explosives and small children were often booby trapped. One can understand the difficulty involved in forgetting such episodes and can only conclude that the whole wretched affair was a ghastly mistake.
The articles in this issue of Psychiatric Annals discuss some of the problems encountered following the return of the most recent combat veterans.
The guest editor, Dr. Harry Wilmer, is an innovative and resourceful clinician and researcher who has gathered together a series of papers by men of wide experience. Wilmer had broad experience with the returnees from World War II and Korea. According to Wilmer the presentation here is a spin-off of his experiences with schizophrenic Vietnam veterans in a therapeutic community of the Audie Murphy Veteran Hospital.
There has been no way for the veterans to work through the memories of the killing in the Vietnam War. Thus, stress disorders have appeared years later. Wilmer regarded his work with these veterans as a kind of archeology of that silence. How best to get through these depths in a healing way? In some the war is being relived as if it were still being fought.
Wilmer noted a kind of schizophrenic who, though recovering from his hallucinations and delusions, is still at the mercy of unconscious forces typified by nightmares. Wilmer began a dream seminar focusing exclusively on the manifest content of one or two dreams, believing that if dream awareness were facilitated "patients would be on better terms with their unconscious and less at its mercy."
The first article, written by Dr. Lawrence KoIb stems from a refinement of Kolb's interest in World War II patients. Even 35 years ago, KoIb was recognized as an authority on phantom limbs and comparable phenomena.
In Kolb's study, combat veterans with Post-Traumatic Stress Disorders were exposed to a 30-second sound tape of combat noises and they responded: I) with immediate dissociation when in an altered state of consciousness and 2) an increase in pulse rate, systolic blood pressure and muscle tension when fully conscious. Other men of the same age who were non-combatants reacted differently. The authors go on to suggest the existence of a chronic conditioned emotional response to meaningful stimuli.
Dr. Robert J. Lifton has an international reputation for his earlier writings along the lines of this symposium. He begins his article by stating that intense psychological trauma, perhaps trauma in general, has been a stepchild of psychiatry. One can readily say amen to that while silently notingthat even if he were inclined to do more, the opportunities offered to him in the present general style of practice are few. Perhaps the present increasing interest in emergency medicine will improve the opportunity for his understanding of this admittedly very important subject. One has to read the presentation carefully to get a better idea of an aspect of our practice which has been neglected.
Shatan's "The Tattered Ego of Survivors" is interesting, for it describes many of the veterans in question. The appeal is to recognize and define combat survivors in order that proper intervention can be made for them. Shatan believes that we dare not turn away from them and their unique knowledge lest tomorrow we walk in their footsteps.
Colonel Corcoran, USAF, MC, writes of some of his observations as Chief of Psychiatry at Brooks Air Force Base, Texas, and gives his personal view of the Concentration Camp Syndrome and USAF Vietnam Prisoners of War.
Dr. C. Jess Groesbeck of Sacramento describes the "Dreams of a Vietnam Veteran - A Jungian Analytic Perspective." This furnishes a nice general discussion in keeping with the Jungian tone that Dr, Wilmer lends to the symposium.
One doesn't get away easily after reading these presentations - they report some scientific facts but they also make one wonder about men under stress. I assume that the psychological outlook of occupation army personnel can become volatile at times and all of this points to the necessity that psychiatrists remain aware of the underlying current of feelings of veterans in their care.
I recommend this symposium to you for it appears at a time ofturmoilintheNear East and of military buildupin many troubled spots around the world.