Nobody Gets Off the Bus:
|
Texts made available by the Sixties Project, are generally copyrighted by the Author or by Viet Nam Generation, Inc., all rights reserved. These texts may be used, printed, and archived in accordance with the Fair Use provisions of U.S. Copyright law. These texts may not be archived, printed, or redistributed in any form for a fee, without the consent of the copyright holder. This notice must accompany any redistribution of the text. A few of the texts we publish are in the public domain. For information on a specific text, contact Kalí Tal. The Sixties Project, sponsored by Viet Nam Generation Inc. and the Institute of Advanced Technology in the Humanities at the University of Virginia at Charlottesville, is dedicated to using electronic resources to provide routes of collaboration and make available primary and secondary sources for researchers, students, teachers, writers and librarians interested in the 1960s. |
Therapy for PTSD: Whose Search for Meaning? (Part I)
David S. Harrington, LCSW, Washington, DC
Therapists acquainted with the Vietnam veteran and his or her loved ones, know that, while difficult and challenging, clinical work with these veterans can be as enriching and rewarding as any available. That is because, as a group, we, Vietnam veterans, have been touched deeply on emotional, social, political and moral levels by the seminal issues of our times: Vietnam, trauma, stress, feminism, civil and human rights. Each of us has had to question ourselves in a profound way about these issues; and, while our conclusions differ, you will learn a great deal from each of us.
Let me share a personal experience. In 1988, my friend, Emanuel Heard, received his master's degree in Human Services. His wife, Blanche, two stepchildren, and their daughter were there as were my wife, Lucy, and myself. My four stepchildren, nearly grown, were unable to attend but sent Emanuel their best. While unremarkable, perhaps, the components of a healthy therapeutic outcome were present at that graduation. Emanuel is a black veteran who spent many years incarcerated for crimes committed while rageful against America after Vietnam; I am a white veteran who submerged his own feelings while doing social work with others. We met, while Emanuel was still incarcerated, back in 1981. We struggled to understand each other and how our separate searches for meaning had taken us through such varied and difficult paths. Emanuel's progress moved him quickly from client to friend and now colleague. To be sure, because we both struggled with relationships early on, we can acknowledge the important roles Lucy and Blanche and our blended families have played in our ongoing healing from the war.
Our group at the graduation ceremony at Lincoln University represented that therapy with veterans can draw on the truth of the trauma and renew in the Vietnam veteran strength to persevere through adversity, the hope for ourselves and our children and the commitment to make our corner of the world a little better from what we learned as a result of the Vietnam war. This process of healing is one which many Vietnam veterans have also begun or wish to undertake. Hopefully, as clinicians, you will find, reach out and relate to Vietnam veterans and their loved ones. You will grow from the experience.
Who Needs Our Care and Concern?
As a columnist for Vietnam Veterans of America's monthly publication, The Veteran, I have been in the privileged position of hearing directly from Vietnam veterans and their families. Let me share their letters with you.
Dear Dave:
It's about time someone helped police officers who are Vietnam veterans. Some of us are nothing short of walking time bombs.
I served in Tuy Hoa and Chu Lai in '68-'69, came back to the world and six months later I was on the local police department. I was on the force for almost nine years, many of them spent in bars. A lot of my "on-duty" hours were also spent in the back room of a liquor store, or a bar on my beat.
I was having marital problems and I turned to a few people for help. The first stop was at a clinic to see the police department psychiatrist. I told him I felt like I was losing my mind, and also told him about the problems I was having at home. He sent me to a marriage counselor, and things worked out okay, for a while.
Things flared up again in '79, and I turned to the counselor and psychiatrist again. No help. I went to see the Catholic Chaplain on the department, but he was on vacation. So I went to this church in my precinct, and the priest told me he was not equipped for the type of help I needed. He had to go to work at a local hospital and he was late. We talked later, but still no help.
On Saturday night I tried to kill my wife with my hands, but my senses came back to me. The police came but, because I was a police officer, and it was a domestic problem, they left. She and I talked and nothing was resolved.
The following Tuesday morning she was dead by means of a 12 gauge shotgun. I buried her in the woods, and shed no tears. Right now, I'm doing the last of my time in prison and will be out shortly.
Everybody I talked to, I told them about my wife's infidelity and her plans to leave, and take my son, and how she continued to push and pressure me. Some say her death wish was stronger than my own. You see, I know what it's like to put your service revolver in your mouth and cry because you can't pull the trigger. I've been there.
The main reason I'm writing, no matter how often you think about this, it's not the right answer. Killing is not the answer. Nor is eating your service revolver. Too many officers have done that. Keep crying for help. Keep looking. Find the answers somewhere.
--Steve S., incarcerated veteran, ex-police officer
"Phoenix" Veterans Rising from the Ashes
Dear Dave:
Your essay on "Hearts and Minds" on the Phoenix program sent me back a notch. I have been in abyss for over a week. I am now slowly coming out of it. God, it still hurts!
I, too, am married with four children, two boys and two girls. If you call successful ($50,000 plus in income and live in a nice home), then I am. I, too, suffer in silence. It still hurts.
I volunteered for the draft and was assigned to an intelligence unit in Okinawa. In December, 1962, I volunteered for classified duty in Vietnam because another guy got sick. (Technically, I'm not a Vietnam veteran.) The first day in `Nam, I toured the torture facility on a island near Saigon. I saw men, women, and children being tortured. I wanted to kill every ARVN I could get my hands on.
During a firefight, I panicked. The mortar barrage left me shaking in a bunker where a Green Beret found me and slapped me around. I got up and replaced one of our guys who had been hit. I was scared to death. After the firefight, we shot and killed six ARVN who had fought badly. Altogether, sixteen were eliminated. While we were waiting to be medevaced a child with a grenade approached the perimeter. He had to be taken out. I was the closest.
Things fell apart when I got back to Okinawa. I answered back to everyone who gave me an order. After I was punished, I kept my mouth shut. I wasn't surprised when, a few months later, President Diem was assassinated. I expected it. However, I didn't know the timing. My service records indicate none of this.
I am a college graduate. I don't know how I did it. Seventy percent of the time, I never opened the books. I just made it.
A number of years ago, I flipped out at work. I was labeled "crazy" by my boss. But the stress is better now. Because of nightmares, I gritted my teeth at night. As a result, I must have my jaw broken and reset. But before I do, my lower teeth must "grow" a little. To do this, I must wear a bite plate. I am now on my fifth. My dentist has never heard of this before.
My marriage feels empty in one respect. Whenever my wife or kids relive an event, I listen but can't feel their emotions. When my kids get hurt, I don't get upset. I take them to the doctor but I don't feel their hurt. My emotions are completely buried.
I don't have close friends. I don't want to get hurt. One day I discussed what happened in `Nam with my best friend of ten years. I haven't heard from him since.
I still suffer in silence. One of the fathers on my son's soccer team was a SEAL. One day, he talked to me about taking children suffering from Agent Orange, to the doctor. He didn't want to talk about Vietnam. He knew I understood. I went back to my car and cried. I didn't cry when my parents or my third daughter died.
What does help are my VVA chapter and the Vet Center. I've been in two groups and in one-to-one for two years. I am now on maintenance. Unfortunately, I cannot eliminate the flashbacks and the nightmares nor the emotional effect.
--GI Joe, New Jersey
Dear Dave:
I too was involved in Phoenix. My basic job was that of builder on a five man "Civic Action Team": throughout most of I Corps. I was educated in a personal response course to understand the Vietnamese people, their customs, religions and the country, in general. My job, as I understood it, was to win the Vietnamese people over to our side by building various projects in and around villages and hamlets.
What my real position was (without my knowledge) to be the eyes and ears of the CIA/Marines. I was debriefed every night at the NCO Club by Marines who posed as friends. The nights I didn't go to the Club, they came to my hooch. In other words, I was taught to understand the people and offer them friendship. At the same time, many were being assassinated because I had mentioned them to the Marines who was sleeping or not working hard on the job. I was used by my government to betray people I respected and have since lost respect for myself.
I returned to the States to be put through the Berlitz language school and for SEAL training then went back for another thirteen month tour. I didn't know what Air America was. Some readers may be more familiar with Task Force 157 that went side by side with Operation Phoenix.
My present isolation is partially due to my guilt, that has gradually increased as I've learned more about what I actually did. I was proudly decorated by the Army, Navy and the Marine Corps. But I'm finding it increasingly hard to live with the facts as they unveil themselves to me.
--Lonnie, Indiana
Wives write often:
Dear Dave:
My husband is a Vietnam veteran. However, let me hasten to add that he is successful in his career and can often be sensitive and caring in our relationship.
However, my husband goes through cycles in our marriage that confuse me. He is very committed and intense about his work, and he can be that way at home. However, at other times, the strains at work turn him into a snappish, irritable, low-energy "couch potato" at home. Nothing I can do is right. And then, when he gets into bed, he expects a four-star performance from me. Well, he doesn't get it.
For the next few days, I get the cold shoulder. What is this?
Dear Dave:
My husband is a Vietnam veteran. I need some advice. His self-destruction is unbearable, especially when I'm included. He drinks very heavily. Sometimes, I have to defend myself from his verbal and physical abuse.
We have only been married a year and one-half, and already I question my willingness to endure. Since we were both married before and are in our late 30s, I felt we would understand our union and work harder on it. I am incapable of giving when he doesn't even try. I love him but cannot take much more.
Can you advise me on how to make him realize the torment I am going through?
Girlfriends write:
Dear Dave:
The feelings and concerns expressed by the Marine from Boston are the same ones my boyfriend has been expressing for over a year. He served two tours in Vietnam--one of them with the Phoenix program. He has been in the VA hospital for the past year but says nothing changed for him.
He has lived with his anger and rage since Vietnam. He finished college and worked successfully in sales. However, he never let anyone get close and never talked about `Nam. Then, one day last year, the rage went away and so did his will to live. He has tried to take his life four times in the past year. He doesn't feel anything but a tremendous, overwhelming sadness. He can't feel love and nothing matters.
He is to be discharged from the hospital. But he says, "nothing's changed." He feels it is a matter of time before he tries to take his life again. I know he wants something to change his mind, but--how, what? Where do we go from here after his discharge?
--God Bless You For That Article, Connecticut
For mental health professionals, the needs and concerns of Vietnam veterans are challenging and varied. A short list of issues from these few letters includes:
- morality in war
- isolation
- murder
- psychic numbing
- rage
- spouse abuse
- substance abuse
- PTSD
- suicide
It is not surprising that many therapists avoid treating Vietnam veterans: none of these issues alone is easy; the composite can be overwhelming. For those therapists willing to rise to the therapeutic challenge, let us reflect on a few assumptions about ourselves as therapists we, too often, bring to our clinical interventions with Vietnam veterans.
Therapists' Assumptions About Vietnam Veterans and Their Loved Ones
Assumption Number One: Trauma is an intellectual concept understood generally by therapists
Have we defined the trauma that was Vietnam? I don't think so. A recent article on the literature of the Holocaust in the New Republic closes with this paragraph:
"It is foolish," writes Primo Levi, "to think that human justice can eradicate the crimes of Auschwitz. Or that the human imagination can encompass and transfigure them. Some losses cannot be made up, neither in time nor eternity. They can only be mourned." In a poem entitled, "Written in Pencil in a Sealed Freight-Car," the Israeli poet Don Pagis writes:
- "Here in this transport
- I Eve
- and Abel my son
- Cain son of man
- tell him that I."
Cry to heaven or cry to earth: that sentence will never be completed..
We are mistaken if we think that the trauma that was the Vietnam war has been explained or understood. Moral culpability for the war has not yet been assigned according to role or responsibility. Tell me of the horrors of two-and-one-half million Vietnamese dead, of the bombs, of Agent Orange and of the ten million refugees we created before 1974. Please let me know why more Americans are informed about the evils of communism and the boat people since 1975 than are informed about the evils of French colonialism and American involvement from 1856-1974?
As therapists we need to understand the trauma in order to treat it. We must ask ourselves, what was the Vietnam war? If we accept responsibility for seeking an answer, then we begin to understand the burden of the Vietnam veteran. At the same time, the inquiry into the Vietnam war as trauma must no be so difficult that it stifles us into silence. Let us recognize that current efforts to popularize the war in Time-Life books or popular videotapes are insufficient to any veteran's search for meaning. Let us proceed with all due haste, tempered by a deep humility, toward an understanding of the Vietnam war as trauma?
Assumption Number Two: Societal context does not matter.
Can the victim of trauma find meaning in a society that denies suffering and death? What is the goal of therapy with Vietnam veterans? We must address the ambivalence of our patients to life in a society that exaggerates the joys of material consumption and ignores the cost of our excesses here and abroad. Too many Vietnam veterans have already offered themselves as undeniable evidence of life's harsher realities through suicide, homelessness, drug and alcohol abuse.
Many more Vietnam veterans will continue to struggle with survival unless and until they see a way to live in America. As therapists, we must ask ourselves whether America today is responsive to those who are suffering? And if not, what is our role in stripping society of its blinders? One friend describes that responsibility as speaking truth to power.
Assumption Number Three: PTSD is sound clinical terminology.
Is PTSD viable terminology? Post-traumatic stress disorder, as a term, serves the mental health community far better than our clients. Why? Because we do not name the incident. The trauma becomes `generic,' is less significant. Our role in it becomes value neutral. We do not have to account for our own feelings about trauma. Nor do we have to accept any responsibility for its aftermath.
Let me elaborate. Was it therapists who called attention to rape as a trauma or was it the woman's movement? For torture, was it therapists or Amnesty International? For Vietnam, who will take responsibility? So far, we therapists have yet to come forward. Yet, if we are to treat veterans of Vietnam, how is it that we acknowledge their trauma? If we were not in Vietnam, where were we? How do we feel about Vietnam and its veterans? And, what are we doing about our feelings?
Assumption Number Four: The therapeutic community has established a clinical direction for the treatment of PTSD.
Is there an established direction for inquiry into the PTSD in Vietnam veterans? Right now, our search for understanding of PTSD in Vietnam veterans is a muddle. Therapists offer multiple definitions and a veritable menu of therapies. Let's be clear--this definitional confusion has its price. It seems to me that there is an arrogance born of power in all of the probing into veteran's psyches. Many therapists seek catharsis when it may not be part of the solution. The sacred secrets of a Vietnam veterans soul are violated in the prideful name of "therapeutic technique." If this sounds harsh, we must explain the rising interest in "fictitious PTSD!"
As mental health professionals, we must abrogate prerogative and have the humility to acknowledge the limitations of our clinical understanding and our influence on the morality of this society. If we have that humility, I dare say we will reestablish the truth: With PTSD in Vietnam veterans, the constraints on healing are many and the solutions few.
Assumption Number Five: The course of treatment for PTSD is without paradox.
How can we overlook the dilemma: What's harder? Being disenfranchised in America or a soldier in Vietnam?
Hispanic veterans are good examples. I am reminded of the story of the young psychology intern at the Brentwood VA Hospital in Los Angeles who, when interviewing a Mexican-American Vietnam veteran, inquired whether he had flashbacks. "Oh yes," replied the veteran, "I had my first after only two weeks in Vietnam." Noticing the incredulous look on the intern's face, the veteran went on. "We were on patrol in the A Shau Valley when all of a sudden, the setting, the whole place, brought back the time when, as an eleven-year-old, I was working fourteen hour days in the fields of the Central Valley!" You can substitute the Puerto Rican Marine who fought in Hue City and had flashbacks of the South Bronx. In either case, the point is that, for Hispanic Vietnam veterans, survival was not only a childhood experience but an adult fact of life.
There are at least two other paradoxes in the way of any understanding of the Vietnam veteran: Vietnam and coming home. In Vietnam, many veterans had more in common than in conflict with the Vietnamese people. At the same time, many veterans had volunteered for overseas duty for patriotic reasons; and most were well-grounded in the moral principles of Christianity. What questions, unique to their working-class experience, arose in Vietnam for these veterans?
What was it like returning home? These veterans had a clearer sense of all the differences in America and with the Third World. Did they still have hope for their future? Their families and communities were most often very proud of their military service. Were the veterans themselves proud? And when it came time to move on in their lives, how did their families and communities respond to any reluctance to move ahead?
The Cost of Therapists' Denial
First, what is the basis for the change of the Vietnam veteran from pariah to patient? As a social outcast, the Vietnam veteran served America as the "whipping boy" of societal blame for the havoc of Vietnam. Now, as patient, he serves America as a repository for guilt and an object of denial for the larger crimes against the Vietnamese people. In neither case has the therapeutic community altered the course of societal interpretation, i.e., in the pariah days, we were into crisis intervention with sirens and radios; and in today's patient era, we poke and probe with jargon and white coats.
In the particular case of Vietnam veterans, the second question is, "What's new?" For so many years, therapists have been complicit in the denial of America's mistreatment of Vietnam veterans. Whether in hospitals, community clinics or local social service agencies, we have for too long put a big band-aid on a terrible social injustice.
And the third question for us therapists is when do we acknowledge our social responsibility? Let me return to Hispanic veterans and their loved ones. Isn't it difficult to treat Hispanics and ignore the Reagan administration's policy of genocide in South and Central America and right here in the USA? In America, Hispanics are not merely the fastest growing ethnic group but also the fastest growing poor. Joblessness is nearly double that of Anglos and no solutions exist or are sought. As Hispanic families grow in urban areas, how will they resist the pressures of divorce, drug and alcohol abuse and worse without the advantages of jobs and income? How dishonest can our immigration laws be when they exploit Mexican labor on both sides of the border? And how can we deny sanctuary to victims of political upheaval in Central America?
Central and South America represent important frontiers we must cross if we are to treat the Hispanic veteran. In my view, a President who proclaimed he would teach a lesson to the dictator "in green fatigues" and designer glasses is totally insensitive to the Hispanic experience and naive to ex-President Ortega's strength of character. At age sixteen, Daniel Ortega organized Nicaraguan youth to oppose the takeover of small plots of land--including his father's--by large landowners. For this organizing work, he was jailed and tortured by the Somoza National Guard for five years. After his release, he spent ten years in the hills before final victory in 1979. Ronald Reagan was making war movies while millions of Americans were fighting Hitler; Ortega accepted the responsibility for doing something about the horror of the Somoza regime.
When President Reagan threatened the Nicaraguans with the seventh U.S. invasion in this century, did we realize that large numbers of any U.S. force will be Hispanic? That our Hispanic youth would have been used to kill the Hispanic youth of Nicaragua? And did we face the fact that the situation in Central America was not about East-West relations, but about North-South dynamics? Did we admit that the hand of death in Central America--60,000 in El Salvador, 40,000 Indians in Guatemala, and 15,000 Nicaraguans in the contra war--is the American hand? Can we as therapists acknowledge the connections of all these factors to the treatment of Hispanic Vietnam veterans?