An Approach to Dealing with Post-Traumatic Stress Disorders in Vietnam Veterans

Twenty-five to thirty years ago, during the Vietnam war, certain cultural roles and responsibilities were traditionally male: being the breadwinner--strong and enduring--and, of course, going to war. However, we Americans have witnessed the erosion of traditional male-dominant roles due largely to the women's movement. Lacking the physical strength of men, women have used the justice system, their intelligence, and their authentic attributes to gain deserved liberation from actual and presumed male domination. Women have successfully challenged men in most professions. Today, hardly any endeavor is a purely male one. But, during the Vietnam war, fighting was the domain of men, as it had been throughout the ages. As such, this manuscript pertains to men, specifically to Vietnam combat veterans and problems they face (Paulson, 1994).

Driven into a war they did not want, then prevented from fighting it with the military aggressiveness necessary to win, they lost confidence and respect. In many cases, upon their return from the war, Vietnam veterans were shunned by the civilian community and labeled "warmongers" and "baby killers." Many Vietnam veterans were forced to conceal their involvement in the war, so as not to be ridiculed but, in doing this, they lost any available cultural support so essential for adjustment for re-entry into civilian life. In moments of solitude and reflection, they could find no purpose for their involvement in the war. Many were in anguish because, without a purpose, how could they have killed fellow human beings just because they were labeled "the enemy?" They could not, so they became burdened with guilt.

As their fellow Americans protested the war and its cruelty, Vietnam veterans became more and more burdened with guilt. Often, this guilt grew into a feeling of utter worthlessness; they felt despicable as human beings.

I have researched the dilemma of the Vietnam veteran both as a human behavioral scientist and as a Vietnam combat veteran who has had a long, painful, first-hand experience of PTSD and the havoc it can bring to bear on one's life. I have witnessed the benefits of various pharmacologicals bring in relieving psychological pain, I have seen the value of systematic desensitization offered by behavior and cognitive-behavior therapies, I respect the importance of personal responsibility and choice offered by existential psychology, and I recognize the value of humanistic approaches. Yet one approach, I believe unnoticed, is to teach veterans to view their Vietnam experience in terms of an incomplete male "rite of passage" or an initiation rite. This approach can provide much needed meaning from participation in the war (Paulson, 1992, 1994).

The manner in which I use the term initiation rite" is not like a ritualistic rite as seen in the Old Roman Empire movies. Rather, it serves as a transition vehicle, helping one leave the present way or stage in life and enter into a new way or stage. These rites serves as bridges between the new and the old.

In ancient times, formal initiation rituals were used quite successfully as entry vehicles to new life stages. The initiatory rites were usually interwoven with a symbolic "mythological story." The story clearly explained to the initiate where he was (identity), where he was going (direction), and how he would get here in life (purpose). In short, it provided meaning.

In western contemporary society, we are lacking in processes that aid one in finding meaning in various life transitions provided by mythical, initiatory rites. While puberty, high school and/or college graduation, marriage and retirement are certainly rites of passage carrying some implicit psychological meaning, they are, for the most part, superficial social conventions. Moreover, social perceptions of men and women as unisexual beings may have actually weakened male development by suppressing aggressive assertion," as well as negative dominator aggression. To truly come into their own, men must be able to move beyond solely negative perceptions of aggression. Hence, males need to re-own their masculinity, their fierceness. Males need to know that their feelings of aggression are instinctive and natural. There is nothing wrong with them. Problems of aggression arise from acting them out inappropriately. War often brings the need to protect through aggression to the fore. In Vietnam, I think this was the case. Unfortunately, the Vietnam veteran was not able to fight with his full potential. He had to fight with his hands politically tied. Then when he came back to America, he was degraded as a baby-killer, a warmonger and a savage. I liken the Vietnam veteran's psychological plight to that of a man who watched his children killed and his wife raped, but was unable to protect them. He would be tormented not only by the injustice done, but by his own inability to act on his family's behalf.

With all the technological advancements in warfare, it is still the common infantryman or "grunt" who fights the built of the war. It is the infantryman who must experience the physical, emotional and mental anguish of war; being sick, being wounded, facing the tension and anxiety of impending death, and dealing with the deaths of others on a daily basis. For the Vietnam infantryman, like his predecessors, life was never again the same after he experienced combat. No longer could he dismiss death as an event far into the future. Even if he survived the war, he was aware that death is but an instant away. No matter where he was or is, no matter what job or position he may hold, no matter who he marries, no matter how financially secure he is, he will always know, deep in his heart, that life on this earth holds no permanence for him.

For the most part, his world view is contrary to the world view of his peers who did not experience combat. For the noncombatant, death is deniable; for the combat veteran, it is an overshadowing truth. While the noncombatant's world view is generally very predictable--graduation from high school, entering college, marrying, raising a family, working, and ultimately enjoying life in retirement --the combatant's world view tends to be one of living in an unpredictable world which is undergoing constant, threatening change. He has seen so much death, so much suffering, and has been forced to live so closely with insecurity that he can no longer feel secure The veteran's life, mirroring his Vietnam experience, has no meaning, no purpose, and no direction.

In many cases, meaning and purpose can be extracted from the Vietnam experience when viewed as an initiation rite process (Paulson, 1992). Rites of initiation are three stage processes where the initiate/warrior is 1) called to enter the adventure, 2) initiated via a number of adventures, and 3) upon completing these adventures, returned to his normal life, integrating his new initiatory experiences into his life where he can employ them to help himself and others. However, the problem with the modern Vietnam combat hero is that the "knowledge" he gained from the war was not recognized or respected by either his culture or himself.

When positive meaning is absent, an intense feeling of despair is a recurring situation experienced by many Vietnam veterans with whom I have worked. They are convinced there was and is nothing useful to be derived from their war experiences, and like most Americans, they feel that the United States did not obtain any type of victory but, rather, killed, maimed and psychologically defeated many of its young men. Moreover, the lack of psychological support from their country while serving in Vietnam was painful and traumatic, but being attacked, put down and protested against by their peers for involvement in Vietnam was excruciating (Lifton, 1973; Paulson, 1994; Shay, 1994).

One army veteran, Joe, clearly illustrates this situation. Joe had grown up on a farm in Kentucky and was a peaceful, laid-back farm boy. After high school graduation, he worked on his father's farm and was preparing to marry his high school sweetheart. But Joe was also a poor boy, unable to get a draft deferment. Thus, shortly after graduation, he was served a draft notice. Joe had absolutely no desire to go to Vietnam but, because he felt a moral responsibility to defend his nation from attack, he joined the U.S. Army. He was sent to Vietnam just in time for Christmas to fight the war. He saw comrade after comrade killed. One moment, they would be laughing and joking with him with a twinkle in their eyes about what they would do when they got out of Vietnam. The next moment, they would be dead, lying in the grass or mud with a poncho loosely covering them until they were picked up by a helicopter and taken to "Graves Registration." His friends were now cold and grey, their vacant eyes staring at nothing.

Joe ultimately survived Vietnam and was exuberant about returning home to marry his sweetheart whom he had left behind. Upon his return, however, things were not the same. The sweet smell of the summer's clover no longer made him glad to be alive. His sweetheart no longer brought him joy and happiness. He was now burdened with unfinished business. Nearly every night, the images of his dead buddies visited him in his dreams. He saw their gray, cold faces with empty, staring eyes. Life for Joe was now pain. His sweetheart turned away from him, marrying someone she had been seeing while he was in Vietnam. His parents kicked him off the farm because of his drinking problem. He tried college in Louisville, but was stereotyped by many as a warmonger and a baby-killer. Within four months of beginning college, he dropped out, and began a clouded, ten-year ordeal of drifting from town to town, bar to bar, and woman to woman, running from himself.

This story, while unique to Joe, is hauntingly similar to the life patterns of many other Vietnam veterans. But, while their past cannot be altered, they can make sense out of their Vietnam experience. They can turn their lives around (Shay, 1994). The approach will be to re-frame their perceptions of meaninglessness and purposelessness of the war and their lives and find positive meaning for the war experience, as well as their lives in the here and now.

Meaning operates not only in our conscious awareness, but outside as well. The meaning carried outside our personal awareness has a powerful effect on how we feel, think and act. The way in which we act or live may be thought of as our "personal mythology." In this sense, myths are not just stories but constellations of beliefs, feelings, and behaviors, organized around a central core or theme; these constellations can help or hinder us in comprehending our lives in meaningful ways and in feeling connected with the universe (Feinstein & Krippner, 1988).

Many mythological motifs portray the warrior hero as having to proceed through the initiation experience alone (Campbell, 1988). This was also so for the Vietnam combat veteran who had to deal with his experience alone. He left his community alone. He endured combat training alone. He contended with pre-combat anxiety alone. Alone, he dealt with his thoughts of being killed in battle. Re proved his worth to his combat unit alone. No one cheered him upon his return; he was again alone. Being alone, then, is something with which a combat veteran can identify. Since our society will probably never welcome him home or provide meaning for his involvement in the war, he must strive to gain a personal meaning from the war, a meaning unique to each warrior (Paulson, 1992, 1994).

Let us look at rites of passage in greater detail (Figure 1). Notice that it consists of three, invariant stages: 1) call to adventure, 2) initiation, and 3) return.

Call to Adventure

The call signifies that "destiny" has summoned the individual to move from his/her present position in life to one which will enhance his sphere of being (Metzner, 1988). During this phase, the initiate accepts the call and, therefore, the rite of passage which will take him, if successfully traversed, into a larger life arena (Campbell, 1949). Campbell (1949) subdivided the "call to adventure" into two categories: "acceptance" and "past the threshold."

Acceptance

During the course of life, one often comes to a crossroad where he must consciously choose the next step in his life (Metzner, 1988). It may concern a new career, a new lover, a new way of being, an opportunity to grow, or dealing with personal tragedy. Often, choice is precipitated by a life occurrence which makes the person dissatisfied with himself, with an interpersonal relationship, or with his life1s work (Walsh, 1990). This pain often serves as a catalyst which causes one to search for healing or comfort -- to move past one’s current sphere of life (Feinstein & Krippner, 1988).

Past the Threshold

Once the call has been accepted, one cannot return to one's former way of being. One must now continue the rite of passage (Campbell, 1949). This portion, "past the threshold," has been described as a period of anxiety and apprehension because of the many unknowns in the future (Campbell, 1972). However, it also has been associated with excitement and a sense of adventure concerning what lies ahead (Campbell, 1949; Paulson, 1992; Walsh, 1990). Closely associated with this period are the recurrent symbols of the doorway, threshold, gate, entrance, or passageway (Campbell, 1949; Metzner, 1988; Walsh, 1990). Campbell (1949) described this substage as a narrow and dangerous passage through which there is no return. This substage is not always distinct and clear-cut (Metzner, 1988). A number of myths describe it as stepping into a bank of fog, or a cloudy, indistinct region where the hero is confused and disoriented. Bridges (1980) describes this substage as a "neutral zone." One phase of the hero's life has ended (he has accepted the call), but the next phase is unclear (he has not yet been initiated).

Initiation

Once the hero has accepted the call to adventure, and has crossed the threshold, the initiation proper begins. Cross-culturally, this stage is a time when the hero is faced with tests, obstacles, challenges, and battles which must be endured to prove his worthiness. If the obstacles are successfully overcome, the hero attains the sought-after treasure or reward for the adventure. The initiation stage can also be subdivided into two substages (Campbell, 1949; Goodrich, 1962; Metzner, 1988; Walsh, 1990): the "descent into the depths" and the "journey."

Descent into the Depth

In mythological motifs, the beginning of the initiation, the descent into the depths, is often depicted as the "night-sea voyage," "the journey through hell," or the "dark night of the soul" (Campbell, 1949, 1988). In certain shamanistic and Hellenistic myths, the hero is depicted as undertaking a lower world, or underworld, journey (Walsh, 1990). This subphase is characterized as constricting, arduous, painful and often portrayed as a hell or a land of the dead (Campbell, 1949; Metzner, 1988). Religious heroes, including Jesus and Muhammad, are clearly depicted as traversing a hell in their initiatory rites (Campbell, 1949). This is also witnessed in the prototypical Christian initiation of the descent into and pilgrimage through hell portrayed in Dante's Divine Comedy.

Other mythical motifs represent this subphase as descending into the depths of the ocean (Campbell, 1949). Gilgamesh, for example, had to descend to the bottom of the sea to find the herb of immortality. Theseus descended into the sea to collect a crown of gold, which he used to illuminate his travels through a labyrinth (Goodrich, 1962).

A most poignant expression of this initiation phase is the journey through the wilderness (Metzner, 1988). Often, the hero is depicted as having lost his way, being disheartened, and roaming aimlessly. While these stories are frightening, they hold the potential for successfully completing the initiation (Metzner, 1988). Once the "descent into the depths" has been successfully met, as depicted by the hero finding a magical item--an amulet, a sword, a potion (i.e., the experience)--which enables him to complete the initiation.

The Journey

The rest of the initiation process is presented as a journey: a voyage up a holy mountain, a quest through a forest, through a wilderness, through a castle, or through a labyrinth (Campbell, 1949; Metzner, 1988). The journey helps him gain a new sense of life direction. No longer is he in transition, but is transformed into a new level of being (Campbell, 1949; Metzner, 1988).

The Return

Once the hero has completed the initiation, the return portion of the passage begins (Campbell, 1949). The return phase is one of understanding, integration and contribution. That is, the hero brings back his or her newly-acquired initiatory wisdom to those who did not experience it (Campbell, 1949). The hero has collected the treasure and can now assimilate it and share it with others. Rites of passage depict a cyclical movement of "going out" and "returning" (Metzner, 1988). This movement almost certainly can be identified as a universal human experience. It is common for' people to experience "going out," or extending themselves, learning from this extension, and returning to their routine life patterns with new knowledge integrated into their psyches.

The return phase did not occur for most Vietnam veterans. Instead, they were shunned by the very society which sent them to Vietnam, making it even more difficult for their integration and return.

Mythic Model for Reframing Combat as a Rite of Passage

By employing the initiatory model just presented, framed in a combat perspective, this structure can help those who have experienced combat to integrate that experience in their psyches in a positive manner. For those who have not experienced combat, it can provide them a "lighted way" to explain what they will experience and how they will feel.

The Call to Adventure

Every combat veteran had his own reasons for leaving the security of civilian life and going into the military. He was "called" to the combat adventure. It may be an internal calling to "prove himself a man," to put his life on the line for something he believes in, or the chance to have an exciting life adventure, instead of working at an unfulfilling job or educational experience. For me, I was deeply infatuated with a girl who really did not care about me. I was bored with high school and could see no reason for going on to college. I was unskilled in any kind of trade, such as carpentry or auto mechanics. I felt a sense of "power" telling people I was thinking of joining the Marine Corps. After I saw the John Wayne movie, The Green Berets, I was intrigued by the adventure. I saw a way to escape my boredom and, at the same time, defy my elders. I could finally show my parents and my teachers that I was tough and did not need them.

One of my Marine Corps acquaintances, Art, had a different story. He had been repeatedly in and out of trouble with the local police and, finally, with the federal government. He and a friend had spray-painted a federal hydroelectric dam with 25 obscene words. Since Art had repeatedly been in trouble with the law, the judge gave him a choice: join the military or go to jail. He chose the military.

Initiation

This period begins as soon as he experiences combat. Many of his comrades are killed during this period. But, for those who survive, a new psychological position occurs, that of total despair. He now feels that, no matter what he does, his efforts will not alter the low statistical probability of his survival. It is during this period that he is severely tested through combat, witnessing friend after friend brutally killed, as well as killing enemy soldiers himself

In my first two weeks of combat, our radio man was shot through the head just in front of me, while we were on patrol. He had moved into the path of a sniper's bullet destined for me. He was talking to another unit and, then, it was over. He was gone in an instant. He was then "tagged and bagged;" that is, he was identified by his unit and put into a body bag to be sent home.

I saw 17 of my companions who were coming in on a helicopter for a ground assault killed by a direct hit of a 121 mm rocket--all killed. They were gone in an instant. At the end of those two weeks, I watched six seasoned veterans destroyed by an incoming mortar round as they ate their C-rations. They, too, were gone in an instant. From my perspective, combat was far too ruthless, random and absolute for me to do anything to prevent my death.

But like the hero in mythology, after suffering, enduring, and surrendering to apparent utter failure, the combat initiate is often assisted by "supernatural forces." This assistance sometimes comes in the form of intuition. After a time, he actually begins to feel that he is being warned about dangerous situations before they occur.

For example, during the 1969 TET offensive, I was at the An Hoa Marine outpost with my unit, awaiting helicopter transportation to a very hot, bloody battle taking place in an area known as Elephant Valley. Elephant Valley was a treacherous place; we dreaded going there. I was very preoccupied with what kind of shit (combat) was going on there but, due to the heavy monsoon rains, we could not leave that night. A few hours later, I had a very strong feeling of impending danger while lying in my tent. I could not sleep, my heart raced, my anxiety escalated, and a voice inside me said, "Leave the tent now!" I gathered my flack jacket, helmet, ammunition and a poncho and walked to the perimeter trenches where I tried to sleep. About an hour later, the outpost was attacked and overrun by North Vietnamese Army (NVA) regulars. During the attack, the outpost was pounded with hundreds of high explosive rockets and mortar rounds. The ground shook from the impact explosions of these rounds and, when the ammunition dump was hit, it erupted in a series of huge, violent fire explosions. We thought we would never survive the night as we repelled wave after wave of NVA attackers. But, finally, by morning, they retreated.

Being tired and sore from the battle, I limped back to my tent to get some sleep. When I got there, I was shocked to find a huge hole in the tent, directly in line with where my head usually rested on my cot. A boulder, approximately three feet across lay on top of what was left of my cot. The boulder would have killed me had I stayed in the tent.

In mythological motifs, the hero often experiences an encounter with a father figure. The father image is important, for it is the father who guides the hero as he experiences the trying times of the initiation. The father image and guidance are also present for combat initiates. After having proven himself worthy (he is still alive after a number of battles), he is "mentored" by a more experienced combat veteran "father." This person acts as his guide, and takes an active role in mentoring him in the ways of combat.

A leathery old Marine took an interest in me and taught me how to survive. He taught me the ways of combat. I learned to distinguish sound differences between incoming and outgoing mortars and rockets, and I mastered the art of ~ the point" without being killed or getting the entire squad killed.

Finally, in many mythological motifs, the hero meets the goddess. This meeting is usually presented in mythological motifs only after the hero has endured many trials and proven himself worthy. An example of the goddess' function was to show the hero the ways of bliss and comfort, in spite of the hardships encountered during this initiation. For me, once I came to terms with my combat situation and accepted it, I was free to just "be." Gone were most of the fears of being killed, for now I accepted that if it was to be, it would be. I no longer felt responsible for me survival. If I were killed, that was simply the way things were intended to be. My number would simply be up.

Pseudo-Return

After the mythological hero successfully completes his initiation, he returns to the ordinary world to share his boon with the "common" people. Unlike the mythological hero, however, the contemporary initiate's return is often not his actual physical return from combat. When he returns, he has one more obstacle to contend with in the initiation process; his physical return from combat presents him with yet another trial. The actual return for the combat veteran comes later, if it ever comes.

This is a critical point. Many people, combat veterans included, think that the physical return is equivalent to the hero’s "return" in mythology. Many veterans think that, once they return from combat, their problems will be over but, unfortunately, they often find this is not so. Although they do not realize it, their initiation is not yet complete. They have another trial to face. It is to understand and integrate the "adventure" in which they have participated into their lives. Many veterans remain in that netherland, failing to accomplish the return.

Actual Return

There comes a time when the combat veteran can no longer escape from. the existential dilemma of the pseudo-return, the need for the actual completion of the initiation and return arises. For many, the actual return never occurs. However, for a minority, it usually takes place by confrontation of the combat adventure in psychotherapy.

The return is, in many ways, more traumatic and painful than actual combat. The veteran has to meet, experience and accept his shadow, or the dark side of his life, which means suffering and acknowledging his humanness. As he integrates his fragmented psyche and faces his existential position, he grows.. As he deals with this issue, he begins to realize that he is an integral part of a larger process, unfolding in a universe which has meaning beyond his physical life. He sees this meaning in his inner life, in his culture and in his external life.

That realization is his boon, the wisdom that he brings back from war. He realizes that "he is not alone in a meaningless universe but is an integral part of it."

The Stuck Veteran

Many Vietnam veterans remain in an uncompleted initiation state; they are "stuck." There are a number of issues which keep them stuck:

1) difficulties in readjusting to civilian life;

2) differences between Vietnam veterans and veterans of other wars;

3) relationship of the Vietnam veteran 5 pre-combat dispositional factors to his adjustment problems after the war;

4) the combat ordeal producing post-war adjustment problems;

5) current psychological strategies for treating disturbed Vietnam veterans; and

6) the social and political alienation of Vietnam veterans.

A majority of Vietnam combat veterans have faced problems adjusting to civilian life, the first category mentioned. Upon their return to the United States, many veterans felt as though they were aliens on a strange planet. They were misfits, no longer in the military, but no longer able to "fit in" with their friends or to function smoothly in society. Even today, they are no more integrated into civilian life than they were twenty-five years ago. Many have had a string of unsuccessful marital relationships; many cannot get or hold meaningful jobs, while others drift from city to city, year after year trying to "get their heads on straight." Quite a few have tried to numb their pain by excessive use of alcohol and/or drugs. In the final analysis, they are stuck in a hellish limbo. They are filled with emotional pain and suffering accompanied by feelings of anguish, total despair, rejection, self-hate, and an almost unbearable guilt for their involvement in Vietnam.

The second category of stress the Vietnam veteran experiences is based in the fundamental difference between him and veterans of other wars. The Vietnam veteran did not win the war and has been reminded of this repeatedly by both World War II and Korean veterans, as well as Desert Storm veterans. The shame Vietnam veterans experience over this loss has caused them to repress many aspects of the war; this has prevented them from being able to work through it psychologically.

For Pete, a former Army infantry officer, his life sums this up well. Pete's father was a highly decorated B-17 bomber pilot during World War II. Two of his brothers were killed in action, one in Iwo Jima and the other in France. Pete had to follow in those footsteps in Vietnam. When he came back, however, he just could not face his father. Pete felt as though he had let both his father and his country down by losing the war. When Pete and his father went to the local VFW post for a couple of drinks, not a word was spoken about Vietnam. Yet Pete could see the frustration in his father’s eyes. Pete thought all his efforts had been for naught. As Pete put it, "How could I face anyone? I participated in a war we lost."

How could the United States have won the Vietnam war? The military's hands were tied. Many United States politicians expected Hanoi's submission. In reality, we had to fight a tough, determined, and resistant opponent--the North Vietnamese soldier. We as a country just could not make a commitment to fight a war with little apparent purpose. We had a very powerful military, but we had no solid political and social support to back it. For political reasons, we could not just leave Vietnam. So infantrymen were essentially offered as a sacrifice, to buy a just retreat. This situation was not satisfactory to previous veterans. They could not understand how Vietnam was different from World War II.

The third category concerns psychological factors common to "stuck" veterans which significantly contributes to stress and adjustment. While not all Vietnam veterans were psychologically predisposed to adjustment difficulties, a number of those who are "stuck," who failed to make the return, are. Many volunteers were "running from themselves" by joining the military. They felt that going to Vietnam would somehow "straighten" them out. A very common perception among Marine Corps volunteers was that the Marine Corps could take you, an inadequate "boy," and mal(e you a "man." In fact, the recruitment slogan used was "The Marine Corps builds men." Since these men already felt inadequate and lacked self-confidence and self-direction, they were predisposed to psychological adjustment disorders. The burdens of the war were hard for them to bear; the social approval they had striven for turned out to be social rejection.

Roger, an Army helicopter gunner, stated that he joined the Army because it would make him a man. People would respect him then. He worked hard in boot camp, doing well in marksmanship, physical endurance, and combat sl4lls. In Vietnam, he worked hard at his mission: killing Vietnamese. Yet, upon his return to the United States, he found that instead of more respect from his peers, he now had less. Deeply troubled, he ultimately went into psychotherapy, only to discover that his problems were not solely Vietnam-caused. He found that he felt inadequate as a person many years before going into the military. For Roger, the military service was a way for him to compensate for feeling "weak" - an objective like that of Teddy Roosevelt, who joined the "Rough Riders" to compensate for his poor health and poor eyesight.

I think most who volunteered for the military share Roger's situation. We, too, felt a sense of inadequacy in ourselves. We needed a boost to our egos that we felt the military would provide. However, the military did not compensate for our feelings of inadequacy. When one needs to prove to himself that he is brave, strong and adequate, he will often put himself through a series of self-imposed tests and trials. No matter what the outcome, adequacy is never proven. Proof comes only through learning to accept oneself for what one is.

The fourth category of adjustment problems is rooted in the actual, traumatic combat experiences of the veterans. These experiences caused post-war adjustment problems, to some degree, in every combat veteran who served in Vietnam. True, many of the World War II veterans had this social readjustment problem when they returned home from the war, but not nearly to the degree we find it in the Vietnam veteran. The World War II veteran1s mission was clear; he also had tremendous support from his country. The Vietnam veteran had neither of these. More likely, he was belittled and made to feel like a criminal. He was alienated from a society that sent him to fight in a war it supported only halfheartedly. In my view, the noncommitted position of the United States has hurt more Vietnam veterans than all the physical and emotional wounds received in combat, at least tenfold. As the veteran perceived it, it was ultimate betrayal by his country.

Tom was an Army officer with the 101st Airborne Division in Vietnam. After being involved in college ROTC for four years and graduating in 1969, he was commissioned and sent to Vietnam. He felt pride in the military and strove to perform the best that he could in combat. Tom was wounded by a mortar round which severed his spinal cord, and he was paralyzed from the waist down. After he was discharged from the service, he found that he could not get a job in his field, finance, mainly due to his disability. He was told confidentially that customers coming into a bank for a loan did not want to deal with disabled people, especially one who was a Vietnam veteran. Tom was devastated. He had gone to Vietnam with the perception of protecting his society. Now he was permanently disabled - a consequence of his fighting for a society that now turned its back on him because his disability might remind them of the war. Tom gave up twenty years ago, lives solely on a government disability pension, and passes his days drinking.

The fifth category, that of the treatment strategies used for Vietnam veterans, has been a tremendous problem. The major reasons for this problem are: a) the wrong method of psychotherapeutic treatment and b) inadequate training of the counselor or therapist for the needs of the combat veteran.

By learning to see reality from the veteran's perspective, the healthcare professional can truly begin to help the veteran. It is critical to remember that each combat veteran is a unique individual with unique life experiences, and he must be treated as a unique person with unique problems. Otherwise, it is doubtful that the therapist will form a "therapeutic bridge" to work with the veteran. Once an authentic connection with the combat veteran’s unique, existential problems has begun, specific treatment modalities can be used as they are appropriate. While each healthcare professional has his/her own approach, he must consciously extend that approach to ameliorate the patient's existential situation. Each patient requires a unique, psychotherapeutic strategy--based on his needs, not the therapist's.

The sixth category of adjustment disorder stems from the general, political alienation of the veteran. By alienation, I mean to say that the veteran feels rejected and unsupported by the society he sought to support, denounced by both social and political systems in the United States. While this atmosphere was not meant to alienate Vietnam veterans, it did. Veterans went to Vietnam with at least the pseudo-support of their society, but they returned to ridicule and condemnation.

These six categories are the basis for the "limbo" state in which many Vietnam veterans find themselves. I seriously doubt if one can categorize a veteran's dilemma into just one of the specific categories. Rather, most post-war problems are combinations and permutations of all six categories, varying with the individual. and his life situation.

Conclusion

In conclusion, the Vietnam war and its effects on combat survivors has been devastating. However, this is their "thrown condition." It is important, then, not to focus on the "whys" of Vietnam but on the "hows" of growing and the process of assimilating the experience into the veteran's psyche. While the veteran has looked for the answer to his plight in healthcare professions, religions, work, philosophies, cultural practices and even in society, it will not be found there. Instead, it will be found in himself, as he moves toward being a whole person, feeling good about himself through self-acceptance, finding self-direction, and being responsible for his life and then toward expressing it in the wide community of his cultural life, while striving to contribute to his society.