The Influence of Service Era: Comparing Personality Assessment Inventory (PAI) Scale Scores Within a Posttraumatic Stress Disorder Treatment Clinic (PCT)

Research is mixed on the role of service era in symptom endorsement among Veterans, with differences emerging depending on the instrument evaluated. This study compares Personality Assessment Inventory (PAI) scale scores of VA test-takers who served during the Vietnam, Desert Storm, or Post-9/11 service eras. The sample was collected at a VA Posttraumatic Stress Disorder Clinical Team. Associations between gender and combat exposure were also examined as covariates. Results suggest that Veterans’ self-report on the PAI is influenced by service era, even after accounting for gender and combat exposure during deployment. The largest differences were between Vietnam or Post-9/11 Veterans and those from the Gulf War era. Symptom differences typically varied across scales commonly associated with symptoms of trauma exposure/posttraumatic stress disorder. Implications for the clinical use of, and research with, the PAI and other broadband personality assessments within the VA healthcare system and trauma treatment settings are discussed.

     

Using Internal Family Systems Theory in the Treatment of Combat Veterans with Post-Traumatic Stress Disorder and Their Families

As many as one-third of all combat veterans experience symptoms of post-traumatic stress disorder following their service to the military (United States Department of Veterans Affairs 2016). Despite government efforts to provide care for those suffering from PTSD symptoms, veterans still struggle to receive appropriate and effective treatments. Inadequate care often has devastating effects on the veteran and his or her family. Currently, veterans typically receive individual treatments such as cognitive behavioral therapy, exposure therapy, or eye movement desensitization and reprocessing. While the United States Department of Veterans Affairs provides individually focused evidenced based treatments, they do not currently endorse any particular model of family systems therapy for the treatment of PTSD in veterans or their families. The present article aims to demonstrate that Internal Family Systems (IFS), a systemic form of therapy, provides an effective treatment for combat veterans who suffer from PTSD. We propose that IFS’s collaborative approach, less-pathologizing stance, and simple language will resonate with military populations. We also argue that IFS provides a seamless transition between individual and family therapy allowing the therapist to address both the individual and relational effects of PTSD.     

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 reparation of the self: Clinical and theoretical dimensions in the treatment of Vietnam combat veterans

This paper discusses a broad range of theoretical and clinical issues pertaining to a proposed approach to individual psychotherapy with Vietnam combat veterans. Called theself-reparative process, this approach features four phases, ranging in the first from anactive behavioral-cognitive approach to the fourth phase that utilizes a less active, psychoanalytic approach. This range of approaches is essential in order to adapt to the ongoing progressivespectrum-of-needs of the veterans, with the objective of increasing psychological control to resolving narcissistic rage and building a cohesive self.The views contained in this paper represent those of the author, who is solely responsible for its contents. As such, the views herein are not necessarily those of the Veterans Administration. Paper presented at a Queens Hospital Center (affiliation of Long Island Jewish-Hillside Medical Center) Department of Psychiatry, Grand Rounds in Jamaica, New York on April 10, 1981. The author acknowledges the gracious assistance of Doctors Scott Mykel and Robert Mednick of Queens Hospital Center during the first draft of this paper.     

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.     

Respectful Lying

I argue that there are instances in which lying to an innocent and generally competent person respects her autonomy, contrary to arguments by Christine Korsgaard and Onora O’Neill. These authors say that respect for a person’s autonomy requires treating her in a way consistent with the possibility of consent, but I contend that the possibility of consent condition is unworkable. I maintain that lying can respect individual autonomy when being truthful to a person undermines her choices and lying gets her what she would reasonably see herself as having most reason to choose in the circumstances. I make my case by reflecting on lying invitations to a surprise party and on negotiation phenomena.     

The Vietnam veteran on wal: The relation of post-traumatic stress disorder to criminal behavior

The purpose of this paper is to conceptualize the relationship of Post-Traumatic Stress Disorder (PTSD) in Vietnam veterans to criminal behavior. A conceptual framework is discussed which proposes that the disposition to criminal behavior is determined by whether or not the veteran enters into the survivor mode of functioning as a behavioral defense mechanism against the disorder. It is hypothesized that there exists a relationship between the severity of PTSD and the tendency to commit illegal acts. The Vietnam Era Stress Inventory (Wilson and Krauss, 1980) was used to assess PTSD among a volunteer national sample of Vietnam combat veterans (N = 114) participating in the Veterans Administration's counseling program known as Operation Outreach. The results strongly supported the hypothesis and indicated that combat role variables, exposure to stressors in Vietnam and the severity of PTSD were significantly correlated with criminal acts.     

Stoic Warriors and Stoic Torturers: The Moral Psychology of Military Torture

Abstract

Nancy Sherman’s book Stoic Warriors provides an interesting reflection on how a modified version of the ancient teachings of stoicism may be applicable to the concerns and needs of the modern military. In the course of her book, she explains different aspects of the Stoic teachings, such as the importance of outward comportment and control of the emotions, and discusses how they might be relevant to the modern military. In this paper I will focus on her discussion of Abu Ghraib and other atrocities such as the My Lai massacre in the Vietnam War. I argue that her analysis of the contributing factors that lead to those abuses demonstrates a lack of understanding of how systematic atrocities come to occur and how military torturers are trained. In this paper I show that systematic torture arises not only out of unrestrained rage and hatred, but through a training process that builds on many of the features of basic military training and, ironically, incorporates many of the techniques of self-control and detachment that are characteristic of stoicism.     

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.     

The Comorbidity of Post-traumatic Stress Disorder and Suicidality in Vietnam Veterans

Vietnam veterans (N = 232) recruited from three sources were assessed for suicidal thinking and behaviors, and symptoms of posttraumatic stress disorder (PTSD) and depression. Findings support the notion that suicidal thoughts are prevalent in this group, with veterans in psychotherapy reporting a greater likelihood of such symptoms (82.6%) than veterans in the community (35.7%) or those seeking assistance through a veteran's outreach center (66.7%). Thoughts of ending one's life and a previous suicide attempt were significantly correlated with a diagnosis of PTSD (r = .53, p < .001; and r = .33, p < .001, respectively). Veterans with a diagnosis of PTSD and depression or dysthymia were also more likely to report suicidal thinking and behaviors than veterans with only one of the diagnoses.     

CHARACTER,PSYCHOANALYTIC IDENTIFICATION,AND NUMERICAL IDENTITY

Identification figures prominently in moral psychological explanations. I argue that in identification the subject has an ‘identity‐thought’, which is a thought about her numerical identity with the figure she identifies with. In Freud's psychoanalytic psychology character is founded on unconscious identification with parental figures. Moral philosophers have drawn on psychoanalysis to explain how undesirable or disadvantageous character dispositions are resistant to insight through being unconscious. According to Richard Wollheim's analysis of Freud's theory, identification is the subject's disposition to imagine, unconsciously, her bodily merging with the figure she identifies with. I argue that this explanation of identification is not adequate. Human character is held to be capable of change when self‐reflection brings unconscious identifications to conscious self‐knowledge. I argue that for self‐knowledge these identifications must be an intelligible part of the subject's self‐conception, and that Wollheim's ‘merging phantasy’ is not intelligible to the subject in this way. By contrast, the subject's thought that she is numerically identical to the figure she identifies with does provide an intelligible starting‐point for reflecting on this identification. This psychoanalytic account provides a clear conception of identification with which to investigate puzzle cases in the moral psychology of character.     

Self-reported problems: a comparison between PTSD-diagnosed veterans,their spouses,and clinicians

This study investigated self-reported problems in a sample of help-seeking Vietnam veterans, comparing the veteran's own view with clinician and spouse perspectives, with the aim of examining convergence in reports across different informants. Veterans with PTSD (N = 459) were asked to list and rate their five most serious problems. Spouses and treating clinicians completed the same questionnaire in relation to the veteran. Rates of endorsement for each problem area, and levels of agreement between raters, were calculated. Veterans, spouses, and clinicians were all likely to rate anger as a high priority, with veterans also likely to nominate anxiety and depression. Spouses were likely to nominate more observable behavioural problems such as interpersonal difficulties and avoidance, while clinicians were likely to nominate indications of psychopathology, such as anxiety, depression, and intrusive thoughts. Agreement across raters was generally high, although interpretation of agreement levels was complex.     

An Innovative Approach to Treating Combat Veterans with PTSD at Risk for Suicide

Suicide rates among military personnel had a significant drop in 2013, but there is no evidence of a drop among veterans. The problem of suicide among combat veterans with posttraumatic stress disorder (PTSD) remains a source of concern. The Department of Defense and the Department of Veterans Affairs are now calling for innovative treatment approaches to the problem. A short‐term psychodynamic therapy presented here may be able to fill that need by dissipating the guilt from veterans' combat‐related actions that leads to suicidal behavior. The treatment showed promise of success with veterans of the war in Vietnam. Preliminary work with combat veterans of the wars in Iraq and Afghanistan indicates that it may be equally successful in treating them. Basic aspects of the psychodynamic approach could be incorporated into current therapies and should improve their ability to treat veterans with PTSD at risk for suicide.     

The role of religious beliefs and thoughts of holy defence veterans in accepting the difficulties of imposed war

This study has surveyed the physical, emotional, psychological, educational, vocational, family, social and economic problems of 100 veterans of Iraq's imposed war on Iran. It has examined veterans’ reasons for the acceptance or non acceptance of the difficulties of being a veteran. It has also sought their opinions as to the necessity and usefulness of an active counseling center for facilitating veterans’ problems. One of the most important findings is that 82% of the veterans have easily accepted the problems associated with being a veteran. The most significant factor helping them to accept their various problems has been their religious beliefs. Fifty percent of them did not even know whether the Veterans’ Foundation had a counseling center or not. Sixty four percent of them have considered an active counseling center as necessary and useful, provided that the center (clinic) is independent and not related to the Veterans’ Foundation.     

Hannah Gadsby’s Nanette: Connection Through Comedy

Hannah Gadsby: Nanette (2018) is a brilliant and masterful work of comedy in which Gadsby announces she is quitting comedy. In this article, I draw on classical and contemporary humor theory to explore the comedic content of Nanette and critique Gadsby’s reasons for quitting. Although I largely agree with Gadsby’s concerns about comedy, I argue that the very show in which she presents them, Nanette, stands as evidence against their universal truth. Gadsby argues that comedy is no longer conducive to her health for at least three related reasons. First, the self-deprecatory comedy out of which she has built her career is a symptom of her humiliation which she is no longer willing or able to showcase for the pleasure of others. I argue that while self-deprecatory humor can, of course, be a sign of humiliation, it needn’t be. Comedians, including those on the margins, can and do effectively employ self-deprecation without humiliation or denigration of self, and one way comedians do this is as a ruse to expose the ignorance of the audience or of comic targets not present. Second, Gadsby analyzes jokes and argues their two-part structure, set-up and punch line, is inadequate for telling the whole story of the trauma she has endured as a lesbian who, as she puts it, presents as “gender not-normal.” However, I maintain that, although jokes may not be, stand-up sets are often complete wholes with beginnings, middles, and ends. In fact, Nannette is a prime example of such complex comedy. Finally, she argues that the comedian’s job is to create and dispel tension, but she is no longer willing to take responsibility for or do anything to dispel the tension created when she speaks of her past trauma. But I discuss how Gadsby, as a true master of her craft, is able to create a highly successful and very funny comedy show in which she completely controls the tension while explicitly choosing to leave significant portions of it with the audience. In fact, super stand-up comedy can introduce tension it neglects to remove without sacrificing the humor. Indeed, Hannah Gadsby’s Nanette is a prime example of comedy that powerfully does precisely this.     

Post-traumatic accelerated cohesion: Its recognition and management in group treatment of Vietnam veterans

Post-traumatic accelerated cohesion (p-TAC) is the name given to a frequently observed group phenomenon in the treatment of Vietnam veterans who suffer traumatic war neuroses. It is critical that this group dynamic be discussed, especially since group is widely regarded as the modality of choice in treating these veterans. Post-traumatic accelerated cohesion is the rapid, premature development of cohesion in a group of virtual strangers, and is here presented in terms of its harmful impact on the group and the impasses it creates. Suggestions are given to resolve p-TAC and move the group toward fulfilling its goals. Placed within the self psychology and object relations theoretical frameworks, the discussion addresses issues pertaining to developmental arrests and post-traumatic self disorders and their relationship to p-TAC dynamics.The views in this paper are the author's sole responsibility and do not necessarily reflect those of the Veterans Administration.     

A body with chronic fatigue syndrome as a battleground for the fight to separate from the mother

I describe the therapy of a 20-year-old woman who believed that her difficulties in concentrating and remembering were caused by her 'ME' (Myalgic encephalomyelitis, Chronic fatigue syndrome, or CFS). She had been fathered by a man who never left his own wife. Work with her dreams revealed a within-body drama in which she was locked in an unspeakable fight to the death with her mother. Her symptoms improved after parallels between a dream and an accident showed her own self-destructive hand in her story. Another dream, reflecting her first 'incestuous' affair, showed her search for her original father-self as someone separate from mother, and a later affair provided a between-body drama, helping her to own the arrogant and abject traits she had before seen only as her mother's. I show how we worked in the area of Winnicott's first 'primitive agony' as experienced by a somatizing patient, stuck in a too-close destructive relationship with her mother-body. I discuss how analytical work can be done with the primitive affects and conflicts against which the ME symptoms may be defending.