Post-Traumatic Stress Disorder

A Stowaway of the Mind:
Post-Traumatic Stress Disorder in Vietnam Veterans
April 1999

After finishing their tours in Vietnam, thousands of soldiers and personnel returned to the United States and began the work of returning to the lives they had left behind. Many brought home medals and amusing stories, and many others bullet wounds and stumps where their arms used to be. Virtually all returned home changed in some way. Some, like the narrator of “Ambush” and “The Man I Killed” in Tim O’Brien’s The Things They Carried, carried home lingering but endurable feelings of guilt and regret over their roles in the war, which often included killing enemy soldiers. For others, however, such as Norman Bowker from O’Brien’s “Speaking of Courage,” the horrors of the war proved more than they could handle on their own. They lived in a strange fusion of the present and the past. At night they dreamed of death, landmines, blood, and screaming. During the day, the world around them constantly reminded them of the war. After the wedding of one veteran, the backfire of a passing car made him dive into the bushes in terror (Caldwell 98). For many years, these veterans suffered from a poorly-understood condition which some called “shell shock” or “battle fatigue” (Butler 105). Finally, in 1980, the American Psychiatric Association officially categorized it as “post- traumatic stress disorder,” or PTSD, and sparked an increase in the study of the disorder (Foa/Meadows 449). Due to its elusive nature and devastating effects upon veterans and their families, PTSD is one of the most tragic products of the Vietnam War, but new research and treatments are providing relief for many who suffer from it.

Vietnam veterans, like rape victims and survivors of serious automobile accidents, often experienced sustained and/or extreme periods of terror and anxiety. Whether searching for the Viet Cong in the jungle or carrying supplies upriver, the soldiers constantly faced the deaths of other men and the threat of their own. Many were plagued by feelings of guilt or the shock of their own bloodlust after killing other men. Death surrounded them, and they knew that any breath they took could be their last. Because of this constant fear, horror, and anxiety, about one-third of all Vietnam veterans returned home with some degree of PTSD (Wartik 250). Certain stimuli, such as hearing fireworks, seeing a Vietnamese person on the street, or smelling smoke, can trigger intense flashbacks or panic attacks. “I go into deep flashbacks,” one vet said. “It’s like I’m right there again–the sounds, the smells, the screaming. It’s almost like a blackout; the present doesn’t exist. It can be snowing and I sweat like I’m in the jungle” (Caldwell 96). Many suffer from other symptoms such as difficulty in sleeping, nightmares, irritability, anger, isolation, withdrawal, depression, or bipolar disorder (Harris).

The clinical definition developed by the American Psychiatric Association centered upon four main points: a universally distressing event “outside the range of usual human experience,” persistent reexperience of that event through dreams or flashbacks, persistent avoidance behavior regarding thoughts or activities connected to the event, and “persistent symptoms of increased arousal,” e.g. sleeping disorders, concentration difficulty, and angry outbursts (Sinclair 35-37). The key is not that the victim’s thoughts repeatedly return to the event, but that the victim feels as if he/she is reliving the experience “in all aspects of all senses” (37). It involves a lack of conscious control of one’s connection with the present; past emotions and sensations are felt as if occurring in the present.

Recent neuroscientific research has shown that periods of overwhelming or prolonged terror can alter the functioning and chemistry of the brain. This alteration can blur the distinction between the present and the past and is the probable cause of PTSD (Butler 105).

These changes center around the way in which the brain processes sensory input and the emotions which it evokes. Sensory nerves from the eyes, ears, and other sense organs carry information into the brain, which then interprets it, analyzes it, and uses it to determine a response. Researchers disagree on the exact mechanisms in the brain which cause PTSD. Some believe that it results from the work of the amygdala, an almond-like structure which is a main processor of fear in the brain (Caldwell 97). They argue that the brain associates sensory input–an enemy soldier, the smell of death, the cold of the steel barrel of an M-16–with extreme fear or panic. If the stress is intense enough or long in duration, the sensory information forms and reinforces new pathways in the brain. Some of these pathways can bypass the cortex, the center for rational processing, and go directly to the amygdala. When this occurs, illogical but terrifying associations occur in the veteran’s brain and can remain after he leaves the war. A similar but nonthreatening stimuli, such as seeing a Vietnamese man on the street, may bypass the logical part of the brain which would tell him that the man is not a threat and travel straight to the amygdala (101). This evokes a sense of terror and reaction similar to those he experienced in the war when he saw a Vietnamese soldier. The process resembles the conditioning response exhibited by Pavlov’s dogs, which he trained to salivate at the sound of a bell in anticipation of food (98).

Other researchers argue for a more chemical explanation for PTSD, although the two explanations may not be mutually exclusive. In times of great danger, “our nervous systems kick into survival mode, releasing a cascade of adrenaline and other neurochemicals that ready us for fight, flight, or prolonged struggle….If the threat is prolonged, the body releases other hormones, including cortisol and brain opioids, to suppress inflammation and numb what would otherwise be excruciating pain” (Butler 105). Although these hormones save lives and ease suffering, excessive amounts such as those produced in battle can cause changes in brain function. Excessive adrenaline, for example, may cause confusion or amnesia as well as hinder learning and memory, as well as produce a more long-term condition of “biochemical alert.” One researcher, John Krystal of Yale University Medical School, suspects that “trauma may somehow damage tiny brain receptors that normal slow and calibrate the body’s release of adrenaline.” This would explain the “biochemical alert” and jumpiness which are some of the main symptoms of PTSD patients. Some new evidence suggests that traumatic experiences such as war may also injure the hippocampus, “a seahorse- shaped structure deep in the brain that is crucial for learning and memory” (106). Regardless of the exact mechanisms of the changes, it is becoming clear that PTSD is related to changes in the functioning of the brain (104).

The effects of PTSD on veterans are debilitating and often reduce the veterans’ ability to return to the life which they led before the war. Some recover within months, while others suffer for years or even decades. The nightmares and anxiety prevent them from sleeping well at night. In order to avoid triggers for flashbacks, they may avoid certain situations such as crowds or noisy places. Their depression, isolation, and irritability may keep others, including loved ones, at bay. Many during the war turned to alcohol and/or drugs as an escape from the ubiquitous death of their surroundings, and many retained this practice back home as an escape from their PTSD symptoms (Harris). Serious cases generally prevent the veterans from holding jobs and hinder their ability to have normal interpersonal relationships. Many become alcoholics or drug addicts, and many others become physically or emotionally abusive with others, particularly loved ones. “During a war,” one research team explained, “many veterans learn that having and expressing feelings other than hostility and aggression is a weakness that can cost lives….[and] when faced with postwar feelings of helplessness or weakness, they may cope by becoming angry” (Nelson/Wright 58).

One veteran named Oswald Harris, years ago the first black member of the U.S. Navy’s elite Honor Guard and a pallbearer at the funeral of President John F. Kennedy, developed PTSD after his time in Vietnam. His symptoms included bipolar disorder, alcoholism, flashbacks, nightmares, and irritability. Periodically he felt the need to be alone, so he drove his van out to a park with some bottles of gin and lived there for a few days at a time before returning to his family. When he was at home he couldn’t work at a normal job, although he could perform some community service and work with children in theater, as well as play with his grandchildren. In an interview his wife, Linda Harris, said that when she needed to wake him up in the morning, “I had to call him ‘Baby.’ I couldn’t call him ‘Oswald’ or ‘Harris,’” because waking up to those names sent him mentally back to the war, and he woke up terrified.

In addition to all the effects of PTSD upon the victims themselves, the disorder also affects their loved ones and changes many aspects of the relationships among them. Although they do not fit the APA definition of PTSD, having not personally experienced the trauma, wives and girlfriends of PTSD veterans sometimes exhibit some of the symptoms of the disorder themselves (Nelson/ Wright 55). They experience the trauma of worrying about them during their military service, of hearing about their traumatic experiences in the war, and knowing about the terrible secrets which their partners can never tell them. This is called “secondary traumatization” (61). Upon the veterans’ return, many women take on more of a caretaking/ mothering role in the relationship. They know the men are suffering, but do not know how to alleviate their pain. The men often become withdrawn, irritable, moody, or depressed. Many try to escape through alcohol and drugs. In this way the men separate themselves from the women in their lives and push them away, leaving the women feeling isolated, frustrated, hurt, and helpless (Harris; Nelson/Wright 57). Many women experience physical, emotional, or verbal abuse as well. Often physical violence is a result of flashbacks, and the veteran is unaware of his actions in the present. Other times it is intentional, a result of the violent mindset of the war. According to one study, 25% of all wives of Vietnam veterans were physically abused in some way (58). Even if not abused physically, the veterans’ anger, anxiety, and frustration can result in “verbal ‘beatings’” of their family members (59). In addition to the effects on female partners, if the veteran has children who live with him, his disorder can cause many similar problems for them as well, including anxiety, abuse, and isolation. All these factors combine to create a frequently stressful family environment and an additional set of challenges for all relationships with these veterans.

To escape from their personal hell, as well as ease the stress which PTSD places upon their families, many veterans with PTSD seek treatment. The Department of Veterans Affairs provides treatment programs for victims which involve a combination of group therapy, one-on-one counseling, and drug and alcohol rehabilitation. These programs generally last for at least three months and will not admit veterans unless they are currently free of any alcohol or drug abuse (Harris). In Oswald Harris’ case, the treatment program helped him a great deal, but once he finished the program he returned to his old habits of alcohol abuse and periods of extreme anxiety.

One specific form of one-on-one therapy is called cognitive-behavioral therapy. Although very difficult for some victims, it is now used frequently for PTSD. The goal is to desensitize the victims to the trauma by having them repeatedly remember their trauma and process it directly instead of avoiding it. One psychologist described this form of therapy as “sort of like eating a bad meal and staying sick until you digest it” (Wartik 250). Other treatment programs take a different approach to the disorder. Anxiety management treatments (AMTs) place much of the blame for PTSD on the inability of the sufferers to manage anxiety. Although this explanation does not account for the neuroscientific elements of the disorder, it does hold some validity in the sense that PTSD is based largely upon anxiety. AMTs, accordingly, focus on several anxiety management techniques such as relaxation, positive self-talk, biofeedback, and distraction techniques. Thus, cognitive-behavioral therapy treats the “underlying pathological anxiety,” while AMTs try to “provide ways to manage anxiety when it occurs” (Foa/Meadows 473). Both involve changing the way in which the brain processes stimuli, memory, and emotion. Recently, in response to PTSD cases caused by the United Nations’ 1994 peacekeeping efforts in Rwanda, the Canadian military has begun work on an “unprecedented” video aimed at preparing its soldiers for the horrors of war. In the video, veterans from the Rwanda mission describe their experiences: the countless bloody corpses that they saw, the feelings of helplessness, uselessness, and shock, and the ethical and tactical questions. Military officials hope that with a clearer idea of the trauma which they could face, the soldiers will enter their war experience better prepared to accept it. Across the Atlantic, at a September 1998 NATO meeting in Berlin, representatives discussed ways to educate soldiers on the psychological and physical effects of battle and made plans to prepare a report on the subject (Fisher 24).

As PTSD receives more attention and recognition, further research into causes, treatments, and prevention should further ease the trauma of war upon veterans. As they realize that their bizarre and debilitating symptoms have neuroscientific causes and are a natural result of their military experiences, veterans should feel more willing to seek treatment as their disorder continues to gain legitimacy. Although the functioning of the brain may never be completely understood, researchers now know more than ever about the causes of PTSD and effective ways to treat and prevent it. War itself is tragic; PTSD only adds to the tragedy. America owes its veterans, as well as its current and future military personnel, to continue to study this disorder and loosen its grip on the veterans who serve her.