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.     

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.     

Post-traumatic stress disorder in Vietnam veterans: Assessment in a forensic setting

The recognition and proper evaluation of Vietnam veterans' demonstrating Post-Traumatic Stress Disorder syndromes is reviewed. The special problems of accurate diagnosis and assessment of former Vietnam combatants is emphasized. The forensic evaluation of Vietnam veterans' raising the Post Traumatic Stress Disorder syndrome in either civil or criminal proceedings is comprehensively discussed. The question “What are the clinical techniques necessary to accomplish a competent forensic evaluation of the Vietnam veterans?” is specifically addressed with special emphasis on legal dispositions and treatment implications. The relationship between the criminal acts of combat veterans and their exposure to the psychological trauma of war is explored.     

"Detoxification" of Vietnam War Trauma: A Combined Family-Individual Approach

Treatment with families of veterans suffering from the aftereffects of combat trauma in the Vietnam War often requires a preliminary phase of disjoint treatment, in which family members are seen separately, before conjoint treatment can proceed. In this disjoint phase of treatment, wives and children are introduced to the brutal realities of Vietnam combat experience and to an understanding of its sequelae. This disjoint phase of family therapy detoxifies combat experience so that it can be approached in subsequent conjoint sessions along with more traditional family therapy issues.     

Differential Reactions of Patients Receiving Group Psychotherapy with Concomitant Somatic and Drug Therapies

The embeddedness of combat aggression, violence, survival, and antiauthority dynamics in the psychic organization of Vietnam veterans in groups shape the treatment enterprise. Inherent in treatment interactions and dynamic processes of the Vietnam therapy group are the reactivations of Vietnam-historical reenactments. These involve strong affective reactions toward superiors and toward fellow combatants (“grunts”), with an attendant sense of group danger, unconsciously reminiscent of Vietnam's guerrilla war terrain. This paper notes that because of the tendency of the group to repeat actual events (as opposed to fantasied events), these groups require divergent conceptualizations and technical management. An innovative model comprising a series of developmental phases is presented. This model, called “the curvilinear regressive-progressive model” of treatment with Vietnam veterans, focuses on both peer- and leader-centered dynamics in working through guilt-driven defenses in members. The leader plays a pivotal function in monitoring levels of affect tolerance in the group, and is expected to manage countertransference reactions, and to have sensitivity to the effects of combat stress on self structure. As the Vietnam therapy group members relive the history of the Vietnam conflict in the group, the leader utilizes a flexible, phase-sensitive system of interventions to reactivate arrested development by creating a healing climate where developmental tasks can be mastered and integrated by group members.     

Cognitive Impairment and Personality Adjustment in Vietnam Veterans

This study investigated the intellectual functioning and personality characteristics of 81 Australian ex-servicemen, 42 of whom had served in Vietnam. A Cognitive Impairment Model (SCIM) developed by Savage (1978, 1981, 1984) enabled intellectual functioning levels, intellectual deterioration and learning ability in the verbal and performance modalities to be asses. The Clinical Analysis Questionnaire (CAQ) of Krug (1980) based 00 Cattell's theory and personality measurement techniques provided an assessment of normal personality characteristics and clinical factors. The data suggested that the two groups, Australian ex-servicemen and Australian Vietnam veterans, were relatively homogeneous with regard to cognitive functioning and gave no indication of impairment in their intellectual levels or of their learning ability. Significant personality differences were, however, found between the two groups of ex-servicemen. The Vietnam veterans showed significantly more tension, depression, guilt, resentment, alienation and hypochondriasis than their colleagues who had remained in Australia. They were more withdrawn from others and from reality and had more abnormal thought than the ex-servicemen who had not been to Vietnam. The cognitive data do not support the view that Vietnam veterans suffered from any serious cognitive impairment. The personality data, however, suggest a significant “Psycbological Stress Syndrome” in these Vietnam veterans which required professional psychological treatment.     

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.     

Interpersonal styles of Vietnam Era veterans.

The study aims were to identify the interpersonal style characteristics of Vietnam Era veterans by comparison with World War II veterans. The sample included 3,075 veterans in treatment in 47 VA health care facilities. Patients were categorized as medical-surgical, psychiatric, and drug addicted, and divided by age into the 24 or less, and the 45 to 55 age groups. The measuring device was the Interpersonal Style Inventory. Group differences on the 17 scores were tested by discriminant function analyses. The Vietnam Era veterans were found to be more rebellious, mistrustful, adventure-seeking and expedient than the older veterans.     

A Test of the Factor Structure Equivalence of the 50-Item IPIP Five-Factor Model Measure Across Gender and Ethnic Groups

The study aims were to identify the interpersonal style characteristics of Vietnam Era veterans by comparison with World War II veterans. The sample included 3,075 veterans in treatment in 47 VA health care facilities. Patients were categorized as medical-surgical, psychiatric, and drug addicted, and divided by age into the 24 or less, and the 45 to 55 age groups. The measuring device was the Interpersonal Style Inventory. Group differences on the 17 scores were tested by discriminant function analyses. The Vietnam Era veterans were found to be more rebellious, mistrustful, adventure-seeking and expedient than the older veterans.     

The Political Universe of Lyndon B. Johnson and His Advisors: Diagnostic and Strategic Propensities in Their Operational Codes

This study uses the Verbs in Context System (VICS) to analyze and compare the operational codes of President Lyndon Johnson and his advisors during the Vietnam conflict. The initial focus is on changes in Johnson's general operational code as revealed in public statements during the period leading to the decisions to bomb North Vietnam and to intervene with ground forces in South Vietnam. Johnson's public operational codes for the domestic, foreign, and Vietnam domains are then compared, and his public operational code for the Vietnam conflict is contrasted with the private operational code of his Vietnam advisors (as expressed in private memoranda). Period effects, domain effects, and other differences are revealed between the views of Johnson and those of his advisors.     

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.

     

Aftermath of Violence: Posttraumatic Stress Disorder Among Vietnam Veterans

Posttraumatic stress disorder (PTSD) frequently occurs in the aftermath of violence. A comprehensive four-phase treatment approach for Vietnam veterans with PTSD is presented. Phases in the recovery process are assessment, stabilization of symptoms, working through the trauma, and reintegration into the family and society.     

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.     

Vietnam Veterans: Overreporting Versus Acceptable Reporting of Symptoms

Overreporting of symptoms among Vietnam combat veterans is a problem area with little research. Five hundred thirty Vietnam-era veterans were given the MMPI. They were divided according to two criteria, combat status and reporting status. For combat status, subjects were either in Vietnam (in-country) or in the military but not in Vietnam (Vietnam-era) between 1964 and 1975. For reporting status, the MMPI overreporting criteria of the subtle-obvious (S-O) items given by Green (1986) were used. Overreporters had an S-O total of > 160, and acceptable subjects were at or below this figure. Also, all subjects who responded randomly were excluded (MMPI Test-Retest scales > 4). Results indicated that a high number of subjects randomly responded to the MMPI, and that in-country veterans met the overreporting criteria in greater numbers than the Vietnam-era group. Also, multivariate analyses of variance (MANOVAs) showed significant differences among groups in four distinct areas—MMPI basic scales, Harris-Lingoes, Wiggins, and special subscales—for both reporting status and combat status, but not for the interaction. Post hoc analyses of variance (ANOVAs) showed that reporting status was especially robust. Two Vietnam in-country PTSD types, overreporters and "acceptable" patients, are discussed. Overreporters are more pathological and a distinct challenge in treatment relative to the other in-country veterans.     

Back from Moriah: Moral trauma and the Vietnam veteran

Psychological termination with Vietnam war experience continues as a subclinical agenda for an estimated two million veterans. This essay proposes facilitating a shift in the veteran's inner sense from victim to survivor of moral trauma. Explored are psychodynamic parallels between Vietnam veterans and adult survivors of untreated childhood incest. Suggested is the importance of veterans' initiative in terminating the Vietnam Soldier Role.     

Child Maltreatment in Vietnam: Prevalence and Cross-Cultural Comparison

This Vietnam prevalence study on child maltreatment (VPM-2014) was designed to examine the prevalence of child maltreatment in Vietnam and to compare it with the child maltreatment prevalence in the Netherlands using the same measures and procedure. Questionnaires were filled out by 1,851 students aged 12 to 17 years (47.3% were boys). Results indicated that half of the students (49.9%) reported at least 1 event of child maltreatment in the past year. Emotional abuse was most frequently reported (31.8%), followed by physical abuse, neglect, and witnessing parental conflict. Sexual abuse was the least prevalent (2.6%). Compared with the Netherlands, the prevalence rates of most types of child maltreatment were higher in Vietnam: The largest difference was with emotional abuse, followed by neglect, physical abuse, and witnessing parental conflict. Only the past-year sexual abuse prevalence in Vietnam was lower. These findings highlight the alarming problem of child maltreatment in Vietnam.     

Adapted character styles of Vietnam veterans with Posttraumatic Stress Disorder

A total of 189 male Vietnam veterans who were admitted to a specialized inpatient treatment program were evaluated using the Millon Clinical Multiphasic Personality Inventory to assess character styles. The veterans were assessed for Posttraumatic Stress Disorder by using a subscale of the Minnesota Multiphasic Personality Inventory (MMPI) and 72% of the patients were classified as having Posttraumatic Stress Disorder. The character styles of passive-aggressive, schizoid, avoidant, and borderline were significantly associated with these patients. The most common 2-point profile was passive-aggressive and avoidant (8-2 or 2-8) and was significantly related to the diagnosis. While drug and alcohol abuse were common problem areas for the entire sample, the profile of patients with Posttraumatic Stress was different from those of substance abusers. These results indicate that treating Vietnam veterans with this disorder requires adopting strategies which include a character style focus as well as a symptom focus.     

Group therapy with Vietnam veterans: A brief review

This paper reviews the benefits and general considerations regarding group therapy with Vietnam veterans. A review of veteran rap groups and traditional therapy groups highlights the similarities and differences between types of groups used to treat this population. The importance of countertransference reactions and the need to consider a variety of treatment approaches is emphasized.