War-Borne PTSD Enters the DSM

How Veterans Forced Mental Health to Confront the New Trauma

Mary Sykes Wylie

In retrospect, it seems bizarre that hundreds of thousands of veterans, all suffering from similar, dramatic trauma symptoms, could be largely ignored by the Veterans Administration (VA) and psychotherapy in general. But before the 1970s, almost no mental health authorities---military or civilian---imagined, much less expected and prepared for, traumatic reactions to war to emerge years after the conflict ended. There was yet no official traumatic stress diagnosis, and the VA assumed that any psychiatric problem occurring more than one year after discharge couldn't be related to military service.

But after they returned stateside full of relief and happy to be alive, many of them---up to 50 percent according to the National Vietnam Veterans Readjustment Survey of 1988---began breaking down, months or even years later. Why? In spite of its time-limited nature for any individual vet, this war was in many ways even more stressful than others in the nation's history. First, troops were deployed individually, not in cohesive units, which undermined a sense of social support and increased their feelings of personal isolation and alienation. Second, troops were younger and less mature; Vietnam was often referred to as a "teenage war." Third, all wars are nasty, but this one had the special kind of nastiness that goes with a brutal guerilla war. There was an air of murderous futility about what soldiers were expected to do, and little experience of victory or accomplishment. A unit would take a hill one day, suffering massive casualties, only to have to take it again the next day.

And the Vietnamese didn't appreciate being "saved" and "liberated"; it was often impossible to tell friend from foe. As one vet said, "We are the unwilling, working for the unqualified, to do the unnecessary, for the ungrateful."

And the coup de grace: when they got home---deposited in the States maybe 36 hours after seeing a buddy's head shot off---they were unloved, unwanted, unappreciated, and often regarded as a kind of embarrassment. The United States had just lost its first war, and by the time it was over, a huge number of people thought the whole thing had just been a terrible mistake and wanted to forget about it. They also wanted to forget about the vets---the ones most visibly associated with the debacle, who kept reminding America that the war wasn't really over. Even veterans organizations were prejudiced against Vietnam vets, sometimes closing their doors to them.

Also, many PTSD symptoms didn't show up as the pitiful twitches and tremblings and motor paralysis that had afflicted the shell-shocked or combat-fatigued soldiers of earlier wars. The symptoms Vietnam vets experienced often appeared far more aggressive and less sympathetic. As public support for the war declined, so did the public perception of veterans, who were often undeservedly portrayed as drunk, drug-addled, brawling, wife-beating, unemployable, whacked-out guys. So it was easy for people to think, as one Vietnam vet wrote, "The Vietnam War was a disgusting and useless mess to which we had sent some of our most disgusting and useless people."

Beginning in the mid-'70s, vets all over the country became very active, forming hundreds of rap groups to talk about their war experiences and coalescing into large, politically powerful, organizations to struggle for financial, social, and medical recognition of their problems. Many of the psychiatrists and psychologists who treated these vets and led rap groups were Vietnam veterans themselves, and they became forceful allies in the drive to get better care from the VA. Finally, in 1979, Congress officially mandated the VA to provide a network of counseling centers for Vietnam vets, to treat their "readjustment problems," including the as-yet-named PTSD. Even so, VA hospitals didn't begin to provide treatment aimed at trauma until the early '80s, after PTSD was included in the DSM-III (the third edition of the Diagnostic and Statistical Manual of Mental Disorders ).

By the late 1970s, it had become obvious to many therapists that the old diagnostic system had fatal flaws. DSM-II seemed to have been written for a world in which serious trauma virtually never occurred. If somebody did perchance experience what DSM-II called "overwhelming environmental stress" (details never specified), it was assumed that, once the stress had been eliminated, recovery would occur in short order without any special help. If recovery didn't speedily happen, "another mental disorder is indicated"---suggesting that the failure to get better lay in the patient's own inherent psychological weakness or vulnerability, and had nothing to do with the trauma.

While the veterans were struggling for recognition on one front, another campaign was being waged---which included some of the same people---on another, to get traumatic stress back into the DSM. For the first time, they hoped, an official DSM diagnosis would assume a psychological disorder was caused not by inner dynamics or neurotic predisposition, but by outer events that happened to the person. And for the first time, political advocacy and social consciousness would overtly contribute to the creation of an official diagnostic category for a psychiatric illness, taking into specific account the recent man-made horrors of world history---war, torture, and genocide.

This blog is excerpted from “The Politics of PTSD.” Read the full article here. >>

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Topic: Trauma

Tags: add | consciousness | counseling | counseling center | Diagnostic and Statistical Manual | diagnostic system | DSM | dsm-iii | HEAL | mental disorders | mental health | prejudice | psychiatrist | psychologist | psychologists | PTSD | ptsd symptoms | SPECT | TED | therapist | therapists | traumatic | traumatic stress | veterans | Vietnam | Vietnam War

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