PTSD and Vietnam Veterans

Over the course of the twentieth century, empirical data in the field of psychology has elucidated a wide range of ailments and disorders. Because of research carried out in this field, professionals have been better able to identify and classify disorders among various populations. Interestingly, however, even when psychologists are able to make broad generalizations about disorders among certain populations, there are notable variations that occur in these populations. To illustrate this point, one only needs to consider ethnic and gender differences among veterans from the Vietnam War experiencing post-traumatic stress disorder or PTSD. Although psychologists first identified the basic elements of PTSD in the context of experiences of Vietnam veterans, subsequent research on this topic demonstrates that gender and ethnicity clearly plays a role in the etiology of PTSD for Vietnam veterans.

With the realization that there are extrinsic personal variables that can impact the progression of PTSD in the larger population of Vietnam veterans, there is a clear impetus to examine what has been written about the experiences of different groups classified as Vietnam veterans. To this end, this investigation considers current research that has been undertaken in an effort to examine differences in the PTSD experiences among different groups that served in the Vietnam War. Though a careful consideration of what has been written on this issue, it will be possible to demonstrate that while post-traumatic stress disorder is a pervasive problem for the larger group of Vietnam veterans, the manner in which it impacts the individual can be further examined when parameters of race or gender are applied.

PTSD and Vietnam Veterans

In order to begin this investigation, it is helpful to first consider an overview of the Vietnam veteran and the experiences of PTSD that have been recorded in the literature. Scott (1993) in his review of the diagnosis of post-traumatic stress disorder notes that this diagnosis first appeared in the American Psychological Association's (APA) DSM-III in 1980. Based on work that had been completed with Vietnam veterans, psychologists had developed an all-encompassing diagnosis for the psychological problems that had befallen veterans since their return from combat. Describing some of the most salient features of the diagnosis, Scott reports that PTSD is classified by "development of characteristic symptoms following a psychologically traumatic event.... The characteristic symptoms involve re-experiencing the traumatic event; numbing of responsiveness to, or reduced involvement with, the external world; and a variety of autonomic, dysphoric, or cognitive symptoms" (p. 27). Scott goes on to note that the traumatic event is seen as one that stands outside of the realm of normal events that could happen to the individual. "After experiencing the stressor, many develop symptoms of excessive autonomic arousal, such as hyperalertness, exaggerated startle response, and difficulty falling asleep" (p. 28).

As a direct response to the onset of PTSD, the afflicted individual could engage in a number of negative behaviors to reduce the feelings associated with PTSD. Alcohol and drug use became a common feature among Vietnam veterans. In addition, PTSD often appears comorbidly with a host of other psychological disorders, which include depression and anxiety disorders. As such, the individual diagnosed with PTSD often faced a number of notable challenges when it came to improving mental health. In addition to dealing with the trauma that promulgated the onset of the condition, the individual could also face a host of problems ranging from depression to drug or alcohol addiction. Therefore the identification and diagnosis of post-traumatic stress disorder was critical for the mental health of individuals that had served in the Vietnam War. Through this diagnosis, psychologists were able to identify the root cause of dysfunction and provide a salient treatment plan to improve outcomes for the patient.

Women in Vietnam

Although the criteria for PTSD outlined by the APA are clearly defined, researchers examining the development of this disorder in subgroups of Vietnam veterans have noted differences in etiology overall. Critically reviewing what has been written about the experiences of women in Vietnam, it becomes quite evident that while women were not allowed on the frontlines of battle during the war, many female military personnel fulfilled their service obligations in military hospitals set up to treat the wounded. Norman (1990) reports that female military personnel were highly visible in positions outside of the frontline in Vietnam. Thus, while these female soldiers were not exposed to the harsh realities of war, they were exposed to the horrific medical trauma that was produced as a result of battle on the frontlines.

Examining these female veterans in the context of post-traumatic stress disorder, Norman goes on to note that once PTSD had been identified and established in the literature, professional psychologists estimated that as many as 50 percent of all men that had been involved in the war would eventually suffer with this disorder. However, in making these predictions, researchers made no mention of how the condition would impact female veterans of the war. Therefore, when significant numbers of cases involving female veterans suffering with PTSD began to proliferate in the literature in 1982, researchers became more aware of how the condition impacted women who served in the Vietnam War. Once this connection had been made, researchers were then able to explore how this disorder impacted women.

Norman, in his assessment of PTSD in the female military personnel that had served in the Vietnam War, makes the observation that the development of PTSD in these women had two distinct characteristics: "On the one hand, the women with PTSD re-experienced the war in painful recollections, and recurrent dreams and nightmares. On the other, they also felt numb and experienced a loss of emotional reaction to the world around them" (p. 143). While these features were similar to those experienced by men, two specific differences in the development of this disorder when compared with men were reported. First many women experienced the symptoms in a cyclical manner. Re-experience was followed by loss of emotional reaction. Many men reported experiencing these issues at the same time. Further, Norman notes that women often experienced PTSD within four months after returning home. The average onset for most male veterans was one year to 18 months.

American Indian Vietnam Veterans

Other researchers examining the development of PTSD in Vietnam veterans have examined the specific experiences of American Indian veterans. Beals, Manson and Shore (2002) in their examination of the development of PTSD among American Indian Vietnam veterans note that while the lifetime prevalence of this condition is approximately 30 percent for all male veterans, this same percentage is much higher for male American Indian veterans. Lifetime diagnosis rates for American Indians were identified to be as high as 57 percent in some cases-depending on the specific origin of the group-i.e. Southwest versus Plains Indians. What this data suggests is that American Indian Vietnam veterans experienced considerably more problems as a result of their experiences in Vietnam.

Seeking to discern why American Indian Vietnam veterans have experienced such notably higher rates of PTSD, Beals, Manson and Shore go on to note that while ethnicity clearly plays a mitigating factor, it has been hypothesized that American Indian Vietnam veterans experienced a higher exposure to combat violence than their white counterparts. Unfortunately, this hypothesis proves difficult to substantiate as there have been no uniform methods for describing the combat conditions that evolved in the context of the Vietnam War. Thus, ethnicity is clearly seen as a mitigating factor in the development and onset of post-traumatic stress disorder.

Asian American Vietnam Veterans

Researchers have also examined the development of PTSD in Asian American Vietnam Veterans. Loo, Fairbank and Scurfield (2001) in their examination of the development of PTSD in Asian American Vietnam Veterans also found higher prevalence rates among this population when compared to white male veterans. Much like the results obtained in the context of American Indian veterans, lifetime rates of PTSD for Asian American veterans were notably higher overall-i.e. 56 percent for this population. As such, this population has also suffered with higher lifetime rates of PTSD when compared with their white male counterparts.

While the authors speculate that race is indeed a mitigating factor, with respect to Asian American veterans, Loo and coworkers speculate that there is some element of race-related exposure during combat that had a greater impact on Asian American veterans. Specifically, these authors note: "There is suggestive evidence that the postmilitary adjustment of minority combat veterans was affected by exposure to race-related experiences. [...] The missing link in understanding the factors underlying racial differences in the postwar adaptation of Vietnam veterans may be the impact that minority status and exposure to race prejudice played among minorities who served in that theater" (p. 518). What this effectively suggests is that Asian Americans had a significantly different experience in combat than white male veterans. These experiences must be taken into account when providing care for the Asian American Vietnam veteran.

Australian Vietnam Veterans

Finally, researchers have also examined the development of PTSD in Australian Vietnam Veterans. Grayson, Dobson and Marshall (1998) note that in this group the lifetime prevalence rate of PTSD is 11.8 percent, significantly lower than the while male American veteran lifetime rate for PTSD. In an effort to understand why PTSD rates are so low in this population, these researchers reviewed critical data on age at combat, enlisting IQ and personality or psychological problems before going to Vietnam. The research suggests that those with personality and/or psychological problems before leaving were most susceptible to the development of PTSD upon returning home. Given the significant rates of PTSD that have been noted in various ethnic minority Vietnam veterans, application of this mitigating variable to research may provide a more integral insight in why this condition has developed in these specific veteran populations.

Conclusion

The experiences of Vietnam veterans upon return home from combat were so shocking to psychologist that these professionals were able to develop specific diagnostic criteria for understanding and treating these individuals. The umbrella of post-traumatic stress disorder has provided psychologists and patients with the tools needed to improve outcomes after diagnosis. However, when one looks at the current research on Vietnam veterans and PTSD, it becomes evident that not all subgroups of Vietnam veterans have developed the disorder at the same rate or in the same manner. Female Vietnam veterans experienced similar symptoms with some notable variations. American Indians, Asian Americans and Australian Vietnam veterans experienced differing rates of the condition. Explications have been offered in an effort to understand these differences. In each case, however, the theory offered clearly reflects a unique experience of the individual predicated upon the variable of race. Thus, while PTSD is a reliable means for diagnosis, it is evident that its application is not uniform among all subgroups of Vietnam veterans.

References

Beals, J., Manson, S.M., Shore, J.H. (2002). The prevalence of posttraumatic stress disorder among American Indian veterans: Disparities and context. Journal of Traumatic Stress, 15(2), 89-97.

Grayson, D., Dobson, M., & Marshall, R. (1998). Current combat-related disorder in the absence of PTSD among Australian Vietnam veterans. Social Psychiatry, 33(4), 186-192.

Loo, C.M., Fairbank, J.A., & Scurfield, R.M. (2001). Measuring exposure to racism and validation of a race-related stressor scale (RRSS) for Asian American Vietnam veterans. Psychological Assessment, 13(4), 503-520.

Norman, E.M. (1990). Women at War: The Story of Fifty Military Nurses Who Served in Vietnam. Philadelphia, PA: University of Pennsylvania Press.

Scott, W.J. (1993). The Politics of Readjustment: Vietnam Veterans since the War. New York: Aldine de Gruyter.