Marital intimacy,family support,and secondary traumatization: A study of wives of veterans with combat stress reaction

Abstract

The main aim of the study was to assess the role of family variables in the process of secondary traumatization among wives of post-traumatic veterans. We compared a sample of 49 wives of Israeli veterans with combat stress reaction (CSR) from the 1982 Lebanon War with a sample of 31 wives of Israeli veterans who fought in the war without developing CSR. We assessed their psychological reactions to the war, their health status six years later, and their reported levels of marital intimacy and family support after the war. When compared with controls, wives of veterans with CSR reported more negative emotions and lower perceived intimacy after the war, and greater severity of psychiatric and somatic symptoms six years later. Results also indicate that the greater the perceived marital intimacy, the less the negative emotions wives of veterans with CSR felt after the war and the better their health status six years later. In addition, wives of veterans with CSR who reported having received more support from their families after the war reported more anxiety and hostility than wives who received less support. The roles of marital intimacy and family support in the process of secondary traumatization were discussed.     

An Exploration of Implicit Racial Bias as a Source of Diagnostic Error

Recent events led this author to realize that an error made during the Vietnam War by him and others had been due to focusing too narrowly on predisposing factors for PTSD while failing to consciously acknowledge acute systemic stressors. In not accepting that along with the stress of combat, Black troops daily experienced acute pervasive systemic racism, he failed to understand correctly their disproportionately higher levels of PTSD when compared to white troops. Motivating factors to examine this error included a recent movie by Spike Lee. Oral histories of Black veterans were then used to research the experience of Blacks in the military in two world wars and the Vietnam War. Little change in the treatment of Black service members was evident across the time frame which included WWI, WWII and the Vietnam War. An understanding of Shay’s concept of moral injury was found very valuable in understanding the consequences of PTSD.

     

The Long-Term Effects of Military Service on Quality of Life: The Vietnam Experience1

In this study, we examined the effects of military service during the Vietnam War on the quality of life in middle adulthood for a cohort of men characterized by a privileged socioeconomic status. The final sample included 374 men who, upon graduating from an Ivy League college in 1966, performed military service in Vietnam, engaged in military service during this time in regions other than Vietnam, or did not serve in the military. As indices of quality of life in the middle years, we used a set of health-related behaviors, a series of life transitions experienced after the age of 40, and satisfaction with various components of life, as well as life as a whole. Multivariate analyses of variance and chi-square analyses revealed significant differences among the sample subgroups on several quality-of-life indices. The subgroup of Vietnam veterans reported more frequent alcohol use than the nonveterans. In terms of midlife transitions, the Vietnam veterans were most likely to have changed careers and to have moved residence, and the least likely to feel lonely in middle adulthood. Compared to the Vietnam veterans and the Vietnam-era veterans, the nonveteran group was least likely to have questioned their values, experienced depression, or to have moved to a new home. Finally, the Vietnam veterans were significantly less satisfied with their careers, finances, and with life in general, compared to their nonveteran counterparts; however, they reported more satisfaction with their male friendships than did Vietnam-era veterans. These findings suggest that the Vietnam War experience is associated with lower quality of life during middle adulthood in certain domains, even among a select group of individuals, of high socioeconomic status, whose privileged background could have presumably protected them from the adversities of the Vietnam War.     

Physiological arousal and attention in veterans with posttraumatic stress disorder

Psychophysiological reactivity has been well documented in WWII, Korean Conflict, and Vietnam veterans with posttraumatic stress disorder (PTSD). In addition, these individuals have demonstrated cognitive impairments within the domains of attention, concentration, new learning, and memory. However, there has been no research examining the impact of physiological arousal on attention in individuals with PTSD. This study documents the level of physiological arousal and associated disruption of attentional abilities in 28 Persian Gulf War veterans (18 without PTSD or other psychopathology and 10 with PTSD). This population represents a group of combat trauma victims who experienced a relatively acute onset of PTSD, thus providing a unique opportunity to compare prior psychophysiological and cognitive results with a group of veterans who manifested a recent onset of PTSD. Results indicated relatively comparable psychophysiological reactivity and arousal between Persian Gulf War veterans with PTSD and Persian Gulf War veterans without PTSD. Furthermore, attentional processes of veterans with PTSD were not more disrupted than in comparison soldiers. Results suggest that the intensity and chronicity of the disorder may impact physiological arousal and disruption of cognitive functioning. Following Persian Gulf War veterans with PTSD over time may reveal that psychophysiological arousal becomes more pronounced with chronicity, perhaps as memory networks become strengthened and/or neuroendocrine systems become increasingly disrupted.     

The Analytic Encounter,a Scene of Clashing Cultures

Three wars (WWII, the Vietnam War and the Iraq War) as well as the experience of immigration impacted on the analytic situation as described in this paper. A first generation immigrant patient, who was also a Vietnam veteran, and the immigrant analyst came together in harmony and in discord, around the issues of their common experiences of war and being an immigrant. The onset of the Iraq war brought these issues into a sharp focus in the mid-phase of an on-going analysis. The paper explores how countertransferential experiences of war and immigration were used to further analytic work. It is often assumed that analogous external experiences can give rise to greater empathic understanding on the part of the analyst. In this paper,I hope to demonstrate that there are both advantages and serious pitfalls in experiential overlaps between the cultural experiences of the analyst and patient.     

The Aging Of Grief: Parents' Grieving Of Israeli Soldiers

Abstract

This chapter examines long-term parental grief of soldiers within the context of the Israeli society. Parental grief is discussed along the life span, commencing at the immediate phase following the loss through the bereavement process in middle to late adulthood and its manifestations in aging. Interviews with a group of elderly bereaved parents whose sons were killed during military service give further support to previous findings regarding the notion that the passage of time has no diminishing effect on their grief nor does it relinquish their attachment to the deceased. With aging, there appears to be an increase in internalized involvement with the long-lost child, fears of fading memories, and the need to eternalize the deceased. In reviewing the past, parents reevaluate their coping with the loss and their relationship with the surviving children. The parents' preoccupation is twofold: On one hand, the strong attachment seems to continue in inner representations of the lost child, and, on the other, this preoccupation is enhanced externally owing to Israeli society's attitude toward dead soldiers. An intersection is therefore established between society and bereaved families. Grief is apparently a central theme in aging parents who are preoccupied with the “aging” of their grief rather than their own aging.     

Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support

Background and Objectives: Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. Design: The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Methods: Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. Results: While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. Conclusions: These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.     

Military Service and Stability in the Family Course

This study explores the popular thesis that the Vietnam War had severe disruptive influences on the marriages of veterans. Analysis of life-history data from 2,303 White men who graduated from Washington State high schools in 1966 and 1967 -just before the height of the Vietnam War - shows that the Vietnam combat veterans (n = 627) were more likely to marry than were noncombat veterans who served during the Vietnam era (n = 586) or nonveterans. We found no long-term evidence of a destructive impact of Vietnam combat service on life-course sequencing or veterans' first marriages. When marital duration and other covariates were taken into account, military service reduced the probability of marital dissolution for White men. This study corroborates Card's (1983) findings for veterans who served prior to the intense combat period.     

Political Attitudes and the Vietnam War: A Study of College-Educated Men of the Vietnam Generation1

Groups of Vietnam veterans (n= 52), Vietnam era veterans (n= 77), and nonveterans (n= 249), all of whom had graduated from an Ivy League university in 1966, were compared in terms of their retrospectively reported general political orientation in 1966 and their current orientation and specific political attitudes in 1990–1991. The Vietnam veterans rated themselves as being more conservative than the nonveterans on political orientation and on specific political issues in 1990–1991. The Vietnam-era veterans tended to take an intermediate position politically between the other two groups. Controlling for retrospective political orientation in 1966, intensity of military experience predicted more ideological conservatism and more support for the war against Iraq, as well as a more conservative position on a number of specific political issues of current interest. Results are consistent with the idea that critical experiences in young adulthood, namely military service in Vietnam, may affect political attitudes over many years.     

Return to Ithaca: A perspective on marriage and love in post traumatic stress disorder

This paper discusses the interactive effects of character development, love in marriage, and the stress pathology in the Vietnam War combatant. Over years of treating Vietnam veterans and their spouses, the authors have observed common patterns of interstructural or intercharacterological meshing between the Vietnam warrior and his wife. Implications for treatment are discussed along with useful intervention strategies.     

Treatment of grief and mourning through EMDR: Conceptual considerations and clinical guidelines

IntroductionEye Movement Desensitization and Reprocessing (EMDR) is an empirically-supported psychotherapeutic approach for treating trauma, which is also applicable to a wide range of other experientially-based clinical complaints. It is particularly useful in treating grief and mourning.Literature findingsEMDR is guided by the Adaptive Information Processing Model (AIP), which conceptualizes the effects of traumatic experiences in terms of dysfunctional memory networks in a physiologically-based information processing system. Numerous empirical studies have demonstrated EMDR's efficacy.DiscussionThe death of a loved one can be very distressing, with memories and experiences associated with the loss becoming dysfunctionally stored and preventing access to adaptive information, including positive memories of the deceased. EMDR can be utilized to integrate these distressing experiences and facilitate the assimilation and accommodation of the loss and movement through the mourning processes.ConclusionApplying the eight phases of EMDR to grief and mourning can yield potent clinical results in the aftermath of loss.     

Virtual Reality Exposure for Veterans with Posttraumatic Stress Disorder

Abstract

Two open trials of Virtual Reality based exposure therapy (VRE) to desensitize Vietnam veterans with Posttraumatic Stress Disorder (PTSD) to some of their traumatic memories are described. A total of 21 patients were exposed to one of two virtual Vietnam computer-generated environments in which their individual traumatic experiences were simulated in response to their recounting these events. Although two patients experienced significant increases in symptoms during VRE, all patients' PTSD symptoms were below baseline by the 3-month post-treatment assessment. When the data from the two open trials was combined, clinically meaningful and statistically significant reductions in PTSD symptoms were found. These changes were long lasting as evidenced by the 6-month follow-up assessments. Two case examples are provided and future applications of this treatment are discussed.     

Normative mid-life concerns among Vietnam veterans with post-traumatic stress disorders: Some preliminary empirical findings

Most Vietnam veterans are now in the mid-life years. Veterans suffering from post-traumatic stress disorder (PTSD) may find that mid-life concerns both precipitate and exacerbate their PTSD symptomatology. Preliminary research with four groups of adult males supports this notion. A cross-sectional study with nonveteans, Vietnam era noncombatants, Vietnam combat veterans not in treatment, and Vietnam veterans in treatment for PTSD suggests that the mid-life issues of affiliation, identity, demonic guilt, and work may be the most problematic. Implications for treatment are discussed.     

The Adjustment Process of Ex-Buddhist Monks to Life After the Monastery

This study explores the adjustment process of five Western ex-Buddhist monks to life after the monastery, using an in depth case study approach and thematic analysis. Participants discussed their initial experience of leaving, the process of creating a new life and their relationship with the past. The findings indicated that while each case was unique, significant common themes emerged as features of the adjustment process. The adjustment had been multi-dimensional, challenging, difficult, confusing, complex and profound for the participants. They had to contend with issues of grief, delayed development, missing out on life experiences, difficulties with intimacy, money, identity, depression, anxiety and confusion. This was combined with the hope and promise of many newly found freedoms involved in establishing a new life and identity. Parallels are drawn to the experience of Catholic priests and nuns who have departed their Orders, Vietnam veterans, ex-cult members and individuals who have left total institutions where their identity and daily lives were highly prescribed. The adjustment experience of ex-Buddhist monks extends the literature on Buddhist monks and provides an example of a life transition of interest to the helping professions because of its potential relevance to a range of major transitions for which clients may seek assistance. Tim Mapel is a lecturer in the Bachelor of Applied Social Sciences degree at the Eastern Institute of Technology in New Zealand. He has a Master’s degree in counseling and works with individuals, couples and groups. He has a passion for the practice of mindfulness and for facilitating a sense of aliveness in people’s lives. He is an advanced Psychodrama trainee and spent 12 years living as an ordained Buddhist monk. Originally from Boston, USA he has lived in the UK, Switzerland, and now considers New Zealand home.     

Prolonged exposure therapy for combat-related posttraumatic stress disorder: comparing outcomes for veterans of different wars

There is significant support for exposure therapy as an effective treatment for posttraumatic stress disorder (PTSD) across a variety of populations, including veterans; however, there is little empirical information regarding how veterans of different war theaters respond to exposure therapy. Accordingly, questions remain regarding therapy effectiveness for treatment of PTSD for veterans of different eras. Such questions have important implications for the dissemination of evidence based treatments, treatment development, and policy. The current study compared treatment outcomes across 112 veterans of the Vietnam War, the first Persian Gulf War, and the wars in Afghanistan and Iraq. All subjects were diagnosed with PTSD and enrolled in prolonged exposure (PE) treatment. Veterans from all three groups showed significant improvement in PTSD symptoms, with veterans from Vietnam and Afghanistan/Iraq responding similarly to treatment. Persian Gulf veterans did not respond to treatment at the same rate or to the same degree as veterans from the other two eras. Questions and issues regarding the effectiveness of evidence based treatment for veterans from different eras are discussed.     

Therapeutic and lifestyle reduction of aggressiveness in Vietnam veterans

Sixty-six Vietnam in-country veterans were surveyed to determine how three variables (rap group participation, self-management effectiveness, and support unit help) were related to aggressiveness measures on the Interpersonal Behavior Survey (IBS). The subjects were divided into three groups: veterans who were currently attending rap groups at local Vietnam Era Veterans Outreach Centers; veterans who had attended rap groups during the preceding year; and veterans who had never attended rap groups. Prerap group and postrap group levels of aggressiveness and self-management were assessed. The study produced three major findings: 1) Expression of Anger scores on the IBS were significantly lower for veterans who had participated in rap groups than for those who had not; 2) as aggressiveness decreased across subjects, self-management effectiveness increased; 3) level of support for the returning Vietnam veteran and self-reported aggressiveness were negatively correlated.     

The Political Consequences of Combat: Post‐Traumatic Stress and Political Alienation Among Vietnam Veterans

On average, veterans are more civically and politically engaged than civilians. Previous research on the effects of military service, however, did not account for differences in veterans’ combat experiences. Using survey data from a representative sample of Vietnam veterans, this study presents evidence that veterans who were exposed to severe combat trauma and veterans who exhibited attitudes and fears associated with post‐traumatic stress had significantly lower levels of political efficacy and trust. The negative consequences of combat exposure and post‐traumatic stress are not mitigated when veterans have quality social support or when they seek professional counseling. These findings inform political psychology and hold implications for claims regarding the empowering influence of service in the U.S. military, increased political engagement, in particular. Among Vietnam veterans, exposure to severe combat trauma and post‐traumatic stress were both associated with reduced political efficacy and trust.     

Mental ghosts and the process of grief

Abstract

Grieving the death of a loved one is an experience that many people will face at least once in their lifetime, but the lack of widely accepted guidelines as to what constitutes “normal” grieving results in mourning being a common experience with little universality. Memories may keep the deceased alive in the minds of the survivor and may even interfere with the formation of new relationships. This article considers the process of grieving the loss of a spouse and some of the individual factors, such as age, sex, and personal beliefs, that may account for variability in grief experiences. While several modeh detailing the grief process are discussed, the inappropriateness of establishing expectations for the nature and duration of grief is argued for.     

The Relationships Among Grief Experience,Problem-Solving Appraisal,and Depression: An Exploratory Study

Abstract

Research has consistently shown a relationship between problem-solving appraisal and depressive symptoms. This study expands that research by including grief symptomatology as a variable. A college student sample completed the Problem-Solving inventory, the Beck Depression Inventory, and the Revised Grief Experience Inventory. Consistent with hypotheses, those individuals who had experienced the death of a close loved one within the previous 5 years reported significantly higher levels of grief and depression than those who had not experienced such a loss. However, the group that had experienced the death of a close loved one did not report significantly worse problem-solving scores than the group that did not. This study also examined the relationships among problem-solving appraisal, depressive symptoms, and grief symptoms within the subsample that had experienced the loss of a close loved one within the previous 5 years. Consistent with predictions, grief symptoms were associated with depressive symptoms and self-appraised ineffective problem solving. The results of this study extend the research on grief and mourning. Also, the results expand our understanding of the grief process by providing preliminary evidence for the role of problem solving in this process