
CONTINUING READJUSTMENT PROBLEMS AMONG VIETNAM VETERANS
-------------------------------------------------------

              by Jim Goodwin, Psy.D.

The Etiology of Combat-Related Post-Traumatic Stress Disorders

        Published by DISABLED AMERICAN VETERANS
National Headquarters  P O Box 14301 Cincinnati, OH 45214

INTRODUCTION
------------

  Most Vietnam veterans have adjusted well to life back in the 
United States, following their wartime experiences.  That's a 
tribute to these veterans who faced a difficult homecoming to say 
the least.

  However, a very large number of veterans haven't made it all 
the way home from the war in Southeast Asia.  By conservative 
estimates, at least half a million Vietnam veterans still lead 
lives plagued by serious, war-related readjustment problems.  Such
problems crop up in a number of ways, varying from veteran to 
veteran.  Flashbacks to combat... feelings of alienation or 
anger... depression, loneliness and an inability to get close to 
others... sometimes drug or alcohol problems... perhaps even 
suicidal feelings.  The litany goes on.

  In its efforts to help these veterans, the 700,000-member 
Disabled American Veterans (DAV) funded the FORGOTTEN WARRIOR
PROJECT research on Vietnam veterans by John P. Wilson, Ph.D. at 
Cleveland State University.  That research resulted in formation 
of the DAV Vietnam Veterans Outreach Program to provide counseling
to these veterans in 1978.  With 70 outreach offices across the 
United States, this DAV program served as a model for the Veterans
Administration (VA) Operation Outreach program for Vietnam era 
veterans, which was established approximately a year later.

  Clinically, the readjustment problems these veterans suffer 
were designated as Post Traumatic Stress Disorders in the 
American Psychiatric Association's DIAGNOSTIC & STATISTICAL 
MANUAL III (DSM III).  Counseling psychologists working with 
Vietnam veterans in the DAV and VA outreach programs emphasize 
that these disorders are not mental illnesses.  Rather, they are 
delayed reactions to the stress these veterans--particularly 
combat veterans--underwent during the war in Southeast Asia.

  The nature of post-traumatic stress disorders among Vietnam 
veterans is described in this paper by Jim Goodwin, Psy.D.  
Himself a Marine Corps veteran of Vietnam combat, Dr. Goodwin 
worked as a volunteer counselor in the DAV Vietnam Veterans 
Outreach Program while doing graduate work at the University of 
Denver's School of Professional Psychology.  Following these 
studies, Dr. Goodwin rejoined the Armed Forces and is now a 
captain on active duty with the U.S. Army.

  The material presented here is a condensation of Dr. Goodwin's
chapter in POST-TRAUMATIC STRESS DISORDERS OF THE VIETNAM 
VETERAN:  OBSERVATIONS AND RECOMMENDATIONS FOR THE PSYCHOLOGICAL
TREATMENT OF THE VETERAN AND HIS FAMILY.

  Edited by Tom Williams, Psy.D., this book was published by the
nonprofit Disabled American Veterans as a guide to counseling 
professionals who are working with or interested in the problems
of Vietnam veterans.  Due to limited quantities, the complete 
book has been made available chiefly to psychiatrists, 
psychologists and other mental health counseling professionals.
It is hoped that Dr. Goodwin's paper will provide all of the 
information on post-traumatic stress disorders needed by 
veterans, their families, and the general public.

  A final note:  Gerald R. Ford, when he was President of our 
country, asked the American public to put Vietnam behind them and 
forget it.  I can think of no Presidential injunction that has 
been more effective.  As a Vietnam War veteran, myself, I believe 
it's both healthful and necessary to put the bitterness and 
dissension of the war years behind us.  But to forget the Vietnam 
War, its troubled veterans, and their families would be 
unforgivable.
                            Sherman E. Roodzant
                            National Commander
                            Disabled American Veterans

RECOLLECTIONS
-------------

  What price must the heart pay to live and love?  Say you long 
hot days ahead without a kind word--days when fear will tear your 
insides apart - but one must go for duty calls... so very far 
away.

  My heart is numb, my brain reels--yet no tears.  Another friend 
is laid to rest.  God rest his soul this brave man.  Keep him 
safe for we'll meet again--at another time, in another place.  
Hot sun, endless hours grant me some respite from loneliness.
Sharp rattle, orange streaks across the black sky--a sensation of 
torn steel, woven with hot flesh and blood beside me.  God!  God 
whatever God you be, speed my soul on its way but not in endless 
eternity.  Thoughts of home come to me--don't let me go;  please 
no--I'm afraid!

  A cold refreshing wind penetrates my bones--what a strange 
place this be.  I hear familiar voices that have long passed from 
existence--I see faces--faces of friends long since dead.  I 
realize now what has happened and where I am, yet I am happy with 
those whose names are carved in stone amidst the grass of a place 
called Arlington.

  Please don't weep for me for I no longer worry about what 
tomorrow brings... for me it brings a much needed rest... a rest 
forever.
                     by:  George L. Skypeck
                          Captain, U.S.A.
                                   12/71



THE ETIOLOGY OF COMBAT-RELATED POST-TRAUMATIC STRESS-DISORDERS
    BY:  Jim Goodwin, Psy.D.

  "My marriage is falling apart.  We just don't talk any more.  
Hell, I guess we've never really talked about anything, ever.  I 
spend most of my time at home alone in the basement.  She's 
upstairs and I'm downstairs.  Sure we'll talk about the groceries 
and who will get gas for the car, but that's about it.  She's 
tried to tell me she cares for me, but I get real uncomfortable 
talking about things like that, and I get up and leave.  
Sometimes I get real angry over the smallest thing.  I used to 
hit her when this would happen, but lately I just punch out a 
hole in the wall, or leave and go for a long drive.  Sometimes I 
spend more time on the road just driving aimlessly than I do at 
home.

  "I really don't have any friends and I'm pretty particular 
about who I want as a friend.  The world is pretty much dog eat 
dog, and no one seems to care much for anyone else.  As far as 
I'm concerned, I'm really not a part of this messed up society.  
What I'd really like to do is have a home in the mountains, 
somewhere far away from everyone.  Sometimes I get so angry with 
the way things are being run.  I think about placing a few blocks 
of C-4 (military explosive) under some of the sons-of-bitches.  A 
couple of times a year, I get into fights at bars.  I usually 
pick the biggest guy.  I don't know why.  I usually get creamed.  
There are times when I drive real crazily, screaming and yelling 
at other drivers.

  "I usually feel depressed.  I've felt this way for years.  
There have been times I've been so depressed that I won't even 
leave the basement.  I'll usually start drinking pretty heavily 
around these times.  I've also thought about committing suicide 
when I've been depressed.  I've got an old .38 that I snuck back 
from Nam.  A couple of times I've sat with it loaded, once I even 
had the barrel in my mouth and the hammer pulled back.  I 
couldn't do it.  I see Smitty back in Nam with his brains smeared 
all over the bunker.  Hell, I fought too hard then to make it 
back to the World (U.S.):  I can't waste it now.  How come I 
survived and he didn't?  There has to be some reason.

  "Sometimes, my head starts to replay some of my experiences in 
Nam.  Regardless of what I'd like to think about, it comes 
creeping in.  It's so hard to push back out again.  It's old 
friends, their faces, the ambush, the screams, their faces 
(tears)... You know, every time I hear a chopper (helicopter) or 
see a clear unobstructed green treeline, a chill goes down my 
back;  I remember.  When I go hiking now, I avoid green areas.  I 
usually stay above timber line.  When I walk down the street, I 
get real uncomfortable with people behind me that I can't see.  
When I sit, I always try to find a chair with something big and 
solid directly behind me.  I feel most comfortable in the corner 
of a room, with walls on both sides of me.  Loud noises irritate 
me and sudden movement or noise will make me jump.

  "Night is hardest for me.  I go to sleep long after my wife has 
gone to bed.  It seems like hours before I finally drop off.  I 
think of so many of my Nam experiences at night.  Sometimes my 
wife awakens me with a wild look in her eye.  I'm all sweaty and 
tense.  Sometimes I grab for her neck before I realize where I 
am.  Sometimes I remember the dream; sometimes it's Nam, other 
times it's just people after me, and I can't run anymore.

  "I don't know, this has been going on for so long;  it seems to 
be getting gradually worse.  My wife is talking about leaving.  I 
guess it's no big deal.  But I'm lonely.  I really don't have 
anyone else.  Why am I the only one like this?  What the hell is 
wrong with me?"

  The above description of one Vietnam veteran's problematic 
lifestyle, more than ten years after the war in Southeast Asia, 
is unfortunately not an unusual phenomenon.


THE EVOLUTION OF POST-TRAUMATIC STRESS DISORDER
-----------------------------------------------
  It was not until World War I that specific clinical syndromes 
came to be associated with combat duty.  In prior wars, it was 
assumed that such casualties were merely manifestations of poor 
discipline and cowardice.  However, with the protracted artillery 
barrages commonplace during "The Great War," the concept evolved 
that the high air pressure of the exploding shells caused actual 
physiological damage, precipitating the numerous symptoms that 
were subsequently labeled "shell shock."  By the end of the war, 
further evolution accounted for the syndrome being labeled a "war 
neurosis" (Glass, 1969).

  During the early years of World War II, psychiatric casualties 
had increased some 300 percent when compared with World War I, 
even though the preinduction psychiatric rejection rate was three 
to four times higher than World War I (Figley, 1978a).  At one 
point in the war, the number of men being discharged from the 
service for psychiatric reasons exceeded the total number of men 
being newly drafted (Tiffany and Allerton, 1967).

  During the Korean War, the approach to combat stress became 
even more pragmatic.  Due to the work of Albert Glass (1945), 
individual breakdowns in combat effectiveness were dealt with in 
a very situational manner.  Clinicians provided immediate onsite 
treatment to affected individuals, always with the expectation 
that the combatant would return to duty as soon as possible.  The 
results were gratifying.  During World War II, 23 percent of the 
evacuations were for psychiatric reasons.  But in Korea, 
psychiatric evacuations dropped to only six percent (Bourne, 
1970).  It finally became clear that the situational stresses of 
the combatant were the primary factors leading to psychological 
casualty.

  Surprisingly, with American involvement in the Vietnam War, 
psychological battlefield casualties evolved in a new direction.  
What was expected from past war experiences -- and what was
prepared for -- did not materialize.  Battlefield psychological
breakdown was at an all-time low, 12 per one thousand (Bourne, 
1970).  It was decided that use of preventative measured learned 
in Korea and some added situational manipulation which will be 
discussed later had solved the age-old problem of psychological 
breakdown in combat.

  As the war continued for a number of years, some interesting 
additional trends were noted.  Although the behavior of some 
combatants in Vietnam undermined fighting efficiency, the 
symptoms presented rare but very well documented phenomenon of 
World War II began to be reobserved.  After the end of World War 
II, some men suffering from acute combat reaction, as well as 
some of their peers with no such symptoms at war's end, began to 
complain of common symptoms.  These included intense anxiety, 
battle dreams, depression, explosive aggressive behavior and 
problems with interpersonal relationships, to name a few.  These 
were found in a five-year follow-up (Futterman and Pumpian-
Mindlin, 1951) and in a 20-year follow-up (Archibald and 
Tuddenham, 1965).

  A similar trend was once more observed in Vietnam veterans as 
the war wore on.  Both those who experienced acute combat 
reaction and many who did not began to complain of the above
symptoms long after their combatant role had ceased.  What was so 
unusual was the large numbers of veterans being affected after 
Vietnam.  The pattern of neuropsychiatric disorder for combatants 
of World War II and Korea was quite different than for Vietnam.  
For both World War II and the Korean War, the incidence of 
neuropsychiatric disorder among combatants increased as the 
intensity of the wars increased.  As these wars wore down, there 
was a corresponding decrease in these disorders until the 
incidence closely resembled the particular prewar periods.  The 
prolonged or delayed symptoms noticed during the postwar periods 
were noted to be somewhat obscure and few in numbers;  therefore, 
no great significance was attached to them.  However, the Vietnam 
experience proved different.  As the war in Vietnam progressed in 
intensity, there was no corresponding increase in 
neuropsychiatric casualties among combatants.  It was not until 
the early 1970s, when the war was winding down, that 
neuropsychiatric disorders began to increase.  With the end of 
direct American troop involvement in Vietnam in 1973, the number 
of veterans presenting neuropsychiatric disorders began to 
increase tremendously (President's Commission on Mental Health
1978).

  During the same period in the 1970s, many other people were 
experiencing varying traumatic episodes other than combat.  There 
were large numbers of plane crashes, natural disasters, fires, 
acts of terrorism on civilian populations and other catastrophic 
events.  The picture presented to many mental health professionals 
working with victims of these events, helping them adjust after 
traumatic experiences, was quite similar to the phenomenon of the 
troubled Vietnam veteran.  The symptoms were almost identical.  
Finally, after much research (Figley, 1978a) by various veterans'
task forces and recommendations by those involved in treatment of
civilian post-trauma clients, the DSM III (1980) was published 
with a new category: post-traumatic stress disorder, acute, 
chronic and/or delayed.

HOW THE VIETNAM EXPERIENCE DIFFERED FROM PREVIOUS WARS AND 
SUBSEQUENTLY PREDISPOSED THE COMBATANT TO THE POST-TRAUMATIC 
STRESS DISORDER:  DELAYED AND/OR CHRONIC TYPE

  When direct American troop involvement in Vietnam became a 
reality, military planners looked to previous war experiences to 
help alleviate the problem of psychological disorder in combat.  
By then it was an understood fact that those combatants with the 
most combat exposure suffered the highest incidence of breakdown.  
In Korea this knowledge resulted in use, to some extent, of a 
"point system."  After accumulating so many points, an individual 
was rotated home, regardless of the progress of the war.  This 
was further refined in Vietnam, the outcome being the DEROS (date 
of expected return from overseas) system.  Every individual 
serving in Vietnam, except general officers, knew before leaving 
the United States when he or she was scheduled to return.  The 
tour lasted 12 months for everyone except the Marines who, known 
for their one-upmanship, did a 13-month tour.  DEROS promised the 
combatant a way out of the war other than as a physical or 
psychological casualty (Kormos, 1978).

  The advantages were clear:  there would not be an endless period 
of protracted combat with the prospect of becoming a psychological
casualty as the only hope for return to the United States without
wounds.  Rather, if a combatant could just hold together for the 
12 or 13 months, he would be rotated to the United States; and,
once home, he would leave the war far behind.

  The disadvantages to DEROS were not as clear, and some time 
elapsed before they were noticed.  DEROS was a very personal 
thing; each individual was rotated on his own with his own 
specific date.  This meant that tours in Vietnam were solitary, 
individual episodes.  It was rare, after the first few years of 
the war, that whole units were sent to the war zone simultaneously.
Bourne said it best: "The war becomes a highly individualized and
encapsulated event for each man.  His war begins the day he arrives
in the country, and ends the day he leaves" (p. 12, 1970).  Bourne 
further states, "He feels no continuity with those who precede or
follow him: He even feels apart from those who are with him but 
rotating on a different schedule" (p. 42, 1970).

  Because of this very individual aspect of the war, unit morale, 
unit cohesion and unit identification suffered tremendously 
(Kormos, 1978).  Many studies from past wars (Grinker and 
Spiegel, 1945) point to the concept of how unit integrity acts as 
a buffer for the individual against the overwhelming stresses of 
combat.  Many of the veterans of World War II spent weeks or 
months with their units returning on ships from all over the 
world.  During the long trip home, these men had the closeness 
and emotional support of one another to rework the especially 
traumatic episodes they had experienced together.  The epitaph 
for the Vietnam veteran, however, was a solitary plane ride home 
with complete strangers and a head full of grief, conflict, 
confusion and joy.

  For every Vietnam combatant, the DEROS date became a fantasy 
that on a specific day all problems would cease as he flew 
swiftly back to the United States.  The combatants believed that 
neither they as individuals nor the United States as a society 
had changed in their absence.  Hundreds of thousands of men lived 
this fantasy from day to day.  The universal popularity of short-
timer calendars is evidence of this.  A short-timer was a GI who 
was finishing his tour overseas.  The calendars intricately 
marked off the days remaining of his overseas tour in all manner 
of designs with 365 spaces to fill in to complete the final 
design and mark that final day.  The GIs overtly displayed these 
calendars to one another.  Those with the shortest time left in 
the country were praised by others and would lead their peers on 
a fantasy excursion of how wonderful and carefree life would be 
as soon as they returned home.  For many, this became an almost 
daily ritual.  For those who may have been struggling with a 
psychological breakdown due to the stresses of combat, the DEROS 
fantasy served as a major prophylactic to actual overt symptoms 
of acute combat reaction.  For these veterans, it was a hard-
fought struggle to hold on until their time came due.

  The vast majority of veterans did hold on as evidenced by the 
low neuropsychiatric casualty rates during the war (The 
President's Commission on Mental Health, 1978).  Rates of acute 
combat reaction or acute post-traumatic stress disorder were 
significantly lowered relative to the two previous wars.  As a 
result, many combatants, who in previous wars might have become 
psychological statistics, held on somewhat tenuously until the 
end of their tours in Vietnam.

  The struggle for most was an uphill battle.  Those motivators 
that keep the combatant fighting -- unit ESPIRIT DE CORPS, small 
group solidarity and an ideological belief that this was the good 
fight (Moskos, 1975) -- were not present in Vietnam.  Unit 
ESPIRIT was effectively slashed by the DEROS system.  Complete 
strangers, often GIs who were strangers even to a specific unit's 
specialty, were transferred into units whenever individual 
rotations were completed.  Veterans who had finally reached a 
level of proficiency had also reached their DEROS date and were 
rotated.  Green troops or "fucking new guys" with almost no 
experience in combat were thrown into their places.  These FNGs 
were essentially avoided by the unit, at least until after a few 
months of experience;  "short timers" did not want to get 
themselves killed by relying on inexperienced replacements.  
Needles to say, the unit culture or ESPIRIT was often lost in the
lack of communication with the endless leavings and arrivals.

  There were other unique aspects of group dynamics in Vietnam.  
Seasoned troops would stick together, often forming very close 
small groups for short periods, a normal combat experience noted 
in previous wars (Grinker and Spiegel, 1945).  Some groups formed 
along racial lines due to lack of unit cohesion within combat 
outfits.  As a seasoned veteran got down to his last two months 
in Vietnam, he was struck by a strange malady known as the "short 
timer's syndrome."  He would be withdrawn from the field and, if 
logistically possible, would be settled into a comparatively safe 
setting for the rest of his tour.  His buddies would be left 
behind in the field without his skills, and he would be left with 
mixed feelings of joy and guilt.  Interestingly, it was rare that 
a veteran ever wrote to his buddies still in Vietnam once he 
returned home (Howard, 1975).  It has been an even rarer 
experience for two or more to get together following the war.  
This is a strong contrast to the endless reunions of World War II 
veterans.  Feelings of guilt about leaving one's buddies to 
whatever unknown fate in Vietnam apparently proved so strong that 
many veterans were often too frightened to attempt to find out 
what happened to those left behind.

  Another factor unique to the Vietnam War was that the 
ideological basis for the war was very difficult to grasp.  In 
World War II, the United States was very clearly threatened by a 
uniformed and easily recognizable foe.  In Vietnam, it was quite 
the opposite.  It appeared that the whole country was hostile to 
American forces.  The enemy was rarely uniformed, and American 
troops were often forced to kill women and children combatants.  
There were no real lines of demarcation, and just about any area 
was subject to attack.  Most American forces had been trained to 
fight in conventional warfare, in which other human beings are 
confronted and a block of land is either acquired or lost in the 
fray.  However, in Vietnam, surprise firing devices such as booby 
traps accounted for a large number of casualties with the human 
foe rarely sighted.  A block of land might be secured but not 
held.  A unit would pull out to another conflict in the vicinity;  
and, if it wished to return to the same block of land, it would 
once again have to fight to take that land.  It was an endless 
war with rarely seen foes and no ground gains, just a constant 
flow of troops in and out of the country.  The only observable 
outcome was an interminable production of maimed, crippled bodies 
and countless corpses.  Some were so disfigured it was hard to 
tell if they were Vietnamese or American, but they were all dead.  
The rage that such conditions generated was widespread among 
American troops.  It manifested itself in violence and mistrust 
toward the Vietnamese (DeFazio, 1978), toward the authorities, 
and toward the society that sent these men to Vietnam and then 
would not support them.  Rather than a war with a just 
ideological basis, Vietnam became a private war of survival for 
every American individual involved.

  What was especially problematic was that this was America's 
first teenage war (Williams, 1979).  The age of the average 
combatant was close to 20 (Wilson, 1979).  According to Wilson 
(1978), this period for most adolescents involves a psychosocial 
moratorium (Erickson, 1968), during which the individual takes 
some time to establish a more stable and enduring personality 
structure and sense of self.  Unfortunately for the adolescents 
who fought the war, the role of combatant versus survivor, as 
well as the many ambiguous and conflicting values associated with 
these roles, let to a clear disruption of this moratorium and to 
the many subsequent problems that followed for the young 
veterans.

  Many men, who had either used drugs to deal with the 
overwhelming stresses of combat or developed other behavioral 
symptoms of similar stress-related etiology, were not recognized 
as struggling with acute combat reaction or post-traumatic stress 
disorder, acute subtype.  Rather, their immediate behavior had 
proven to be problematic to the military, and they were offered 
an immediate resolution in the form of administrative discharges, 
often with diagnoses of character disorders (Kormos, 1978).

  The administrative discharge proved to be another method to 
temporarily repress any further overt symptoms.  It provided yet 
another means of ending the stress without becoming an actual 
physical or psychological casualty.  It, therefore, served to 
lower the actual incidence of psychological breakdown, as did the 
DEROS.  Eventually, this widely used practice came to be 
questioned, and it was recognized that it had been used as a 
convenient way to eliminate many individuals who had major 
psychological problems dating from their combat service (Kormos, 
1978).

  When the veteran finally returned home, his fantasy about his 
DEROS date was replaced by a rather harsh reality.  As previously 
stated, World War II vets took weeks, sometimes months, to return 
home with their buddies.  Vietnam vets returned home alone.  Many 
made the transition from rice paddy to Southern California in 
less than 36 hours.  The civilian population of the World War II 
era had been treated to movies about the struggles of 
readjustment for veterans (i.e. The Man In The Grey Flannel Suit, 
The Best Years of Our Lives, Pride of The Marines) to prepare 
them to help the veteran (DeFazio, 1978).  The civilian 
population of the Vietnam era was treated to the horrors of the 
war on the six o'clock news.  They were tired and numb to the 
whole experience.  Some were even fighting mad, and many veterans 
came home to witness this fact.  Some World War II veterans came 
home to victory parades.  Vietnam veterans returned in defeat and 
witnessed antiwar marches and protests.  For World War II 
veterans, resort hotels were taken over and made into 
redistribution stations to which veterans could bring their wives 
and devote two weeks to the initial homecoming (Boros, 1973).  
For Vietnam veterans, there were screaming antiwar crowds and 
locked military bases where they were processed back into 
civilian life in two or three days.

  Those veterans who were struggling to make it back home finally 
did.  However, they had drastically changed, and their world 
would never seem the same.  Their fantasies were just that: 
fantasy.  What they had experienced in Vietnam and on their 
return to their homes in the United States would leave an 
indelible mark that many may never erase.

THE CATALYSTS OF POST-TRAUMATIC STRESS DISORDERS FOR VIETNAM 
COMBAT VETERANS
  More than 8.5 million individuals served in the U.S. Armed 
Forces during the Vietnam era, 1964-1973.  Approximately 2.8 
million served in Southeast Asia.  Of the latter number, almost 
one million saw active combat or were exposed to hostile, life-
threatening situations (President's Commission on Mental Health, 
1978).  It is this writer's opinion that the vast majority of 
Vietnam era veterans have had a much more problematic 
readjustment to civilian life than did their World War II and 
Korean War counterparts.  This was due to the issues already 
discussed in this chapter, as well as to the state of the economy 
and the inadequacy of the GI Bill in the early 1970s.  In 
addition, the combat veterans of Vietnam, many of whom 
immediately tried to become assimilated back into the peacetime 
culture, discovered that their outlook and feelings about their 
relationships and future life experiences had changed immensely.  
According to the fantasy, all was to be well again when they 
returned from Vietnam.  The reality for many was quite different.

  A number of studies point out that those veterans subjected to 
more extensive combat show more problematic symptoms during the 
period of readjustment (Wilson, 1978; Strayer & Ellenhorn, 1975; 
Kormos, 1978; Shatan, 1978; Figley, 1978b).  The usual pattern 
has been that of a combat veteran in Vietnam who held on until 
his DEROS date.  He was largely asymptomatic at the point of his 
rotation back to the U.S. for the reasons previously discussed;  
on his return home, the joy of surviving continued to suppress 
any problematic symptoms.  However, after a year or more, the 
veteran would begin to notice some changes in his outlook 
(Shatan, 1978).  But, because there was a time limit of one year 
after which the Veterans Administration would not recognize 
neuropsychiatric problems as service-connected, the veteran was 
unable to get service-connected disability compensation.  
Treatment from the VA was very difficult to obtain.  The veteran 
began to feel depressed, mistrustful, cynical and restless.  He 
experienced problems with sleep and with his temper.  Strangely, 
he became somewhat obsessed with his combat experiences in 
Vietnam.  He would also begin to question why he survived when 
others did not.

  For approximately 500,000 veterans (Wilson, 1978) of the combat 
in Southeast Asia, this problematic outlook has become a chronic 
lifestyle affecting not only the veterans but countless millions 
of persons who are in contact with these veterans.  The symptoms 
described below are experienced by all Vietnam combat veterans to 
varying degrees.  However, for some with the most extensive 
combat histories and other variables which have yet to be 
enumerated, Vietnam-related problems have persisted in disrupting 
all areas of life experience.  According to Wilson (1978), the 
number of veterans experiencing these symptoms will climb until 
1985, based on his belief of Erickson's psychosocial 
developmental stages and how far along in these stages most 
combat veterans will be by 1985.  Furthermore, without any 
intervention, what was once a reaction to a traumatic episode may 
for many become an almost unchangeable personality characteristic.

** DEPRESSION **
----------------
  The vast majority of the Vietnam combat veterans I have 
interviewed are depressed.  Many have been continually depressed
since their experiences in Vietnam.  They have the classic 
symptoms (DSM III, 1980) of sleep disturbance, psychomotor 
retardation, feelings of worthlessness, difficulty in 
concentrating, etc.  Many of these veterans have weapons in their 
possession, and they are no strangers to death.  In treatment, it 
is especially important to find out if the veteran keeps a weapon 
in close proximity, because the possibility of suicide is always 
present.

  When recalling various combat episodes during an interview, the 
veteran with a post-traumatic stress disorder almost invariably 
cries.  He usually has had one or more episodes in which one of 
his buddies was killed.  When asked how he handled these death 
when in Vietnam, he will often answer, "in the shortest amount of 
time possible" (Howard, 1975).  Due to circumstances of war, 
extended grieving on the battlefield is very unproductive and 
could become a liability.  Hence, grief was handled as quickly as 
possible, allowing little or no time for the grieving process.  
Many men reported feeling numb when this happened.  When asked 
how they are now dealing with the deaths of their buddies in 
Vietnam, they invariable answer that they are not.  They feel 
depressed;  "How can I tell my wife, she'd never understand?" 
they ask.  "How can anyone who hasn't been there understand?" 
(Howard, 1975).

  Accompanying the depression is a very well developed sense of 
helplessness about one's condition.  Vietnam-style combat held no 
final resolution of conflict for anyone.  Regardless of how one 
might respond,t he overall outcome seemed to be just an endless 
production of casualties with no perceivable goals attained.  
Regardless of how well one worked, sweated, bled and even died, 
the outcome was the same.  Our GIs gained no ground; they were 
constantly rocketed or mortared.  They found little support from 
their "friends and neighbors" back home, the people in whose name 
so many were drafted into military service.  They felt helpless.  
They returned to the United States, trying to put together some 
positive resolution of this episode in their lives, but the 
atmosphere at home was hopeless.  They were still helpless.  Why 
even bother anymore?

  Many veterans report becoming extremely isolated when they are 
especially depressed.  Substance abuse is often exaggerated 
during depressive periods.  Self medication was an easily learned 
coping response in Vietnam;  alcohol appears to be the drug of 
choice.

** ISOLATION **
---------------
  Combat veterans have few friends.  Many veterans who witnessed 
traumatic experiences complain of feeling like old men in young 
men's bodies.  They feel isolated and distant from their peers.  
The veterans feel that most of their non-veteran peers would 
rather not hear what the combat experience was like;  therefore, 
they feel rejected.  Much of what many of these veterans had done 
during the war would seem like horrible crimes to their civilian 
peers.  But, in the reality faced by Vietnam combatants, such 
actions were frequently the only means of survival.

  Many veterans find it difficult to forget the lack of positive 
support they received from the American public during the war.  
This was especially brought home to them on the return from the 
combat zone to the United States.  Many were met by screaming 
crowds and the media calling them "depraved fiends" and 
"psychopathic killers" (DeFazio, 1978).  Many personally 
confronted hostility from friends and family, as well as 
strangers.  After their return home, some veterans found that the 
only defense was to search for a safe place.  These veterans 
found themselves crisscrossing the continent, always searching 
for that place where they might feel accepted.  Many veterans 
cling to the hope that they can move away from their problems.  
It is not unusual to interview a veteran who, either alone or 
with his family, has effectively isolated himself from others by 
repeatedly moving from one geographical location to another.  The 
stress on his family is immense.

  The fantasy of living the life of a hermit plays a central role 
in many veterans' daydreams.  Many admit to extended periods of 
isolation in the mountains, on the road, or just behind a closed 
door in the city.  Some veterans have actually taken a weapon and 
attempted to live off the land.

  It is not rare to find a combat veteran who has not had a 
social contact with a woman for years -- other than with a 
prostitute, which is an accepted military procedure in the combat 
setting.  If the veteran does marry, his wife will often complain 
about the isolation he imposes on the marital situation.  The 
veteran will often stay in the house and avoid any interactions 
with others.  He also resents any interactions that his spouse 
may initiate.  Many times, the wife is the source of financial 
stability.

** RAGE **
----------
  The veterans' rage is frightening to them and to others around 
them.  For no apparent reason, many will strike out at whomever 
is near.  Frequently, this includes their wives and children.  
Some of these veterans can be quite violent.  This behavior 
generally frightens the veterans, apparently leading many to 
question their sanity;  they are horrified at their behavior.  
However, regardless of their afterthoughts, the rage reactions 
occur with frightening frequency.

  Often veterans will recount episodes in which they became 
inebriated and had fantasies that they were surrounded or 
confronted by enemy Vietnamese.  This can prove to be an 
especially frightening situation when others confront the veteran 
forcibly.  For many combat veterans, it is once again a life-and-
death struggle, a fight for survival.

  Some veterans have been able to sublimate their rage, breaking 
inanimate objects or putting fists through walls.  Many of them 
display bruises and cuts on their hands.  Often, when these 
veterans feel the rage emerging, they will immediately leave the 
scene before somebody or something gets hurt;  subsequently, they 
drive about aimlessly.  Quite often, their behavior behind the 
wheel reflects their mood.  A number of veterans have described 
to me the verbal catharsis they've achieved in explosions of 
expletives directed at any other drivers who may wrong them.

  There are many reasons for the rage.  Military training equated 
rage with masculine identity in the performance of military duty 
(Eisenhart, 1975).  Whether one was in combat or not, the 
military experience stirred up more resentment and rage than most 
had ever felt (Egendorf, 1975).  Finally, when combat in Vietnam 
was experienced, the combatants were often left with wild, 
violent impulses and no one upon whom to level them.  The nature 
of guerrilla warfare -- with its use of such tactics as booby 
trap land mines and surprise ambushes with the enemy's quick 
retreat -- left the combatants feeling like time bombs;  the 
veterans wanted to fight back, but their antagonists had long 
since disappeared.  Often they unleashed their rage at 
indiscriminate targets for want of more suitable targets (Shatan, 
1978).

  On return from Vietnam, the rage that had been tapped in combat 
was displaced against those in authority.  It was directed 
against those the veterans felt were responsible for getting them 
involved in the war in the first place -- and against those who 
would not support the veterans while they were in Vietnam or when 
they returned home (Howard, 1975).  Fantasies of retaliation 
against political leaders, the military services, the Veterans 
Administration and antiwar protesters were present in the minds 
of many of these Vietnam combat veterans.  These fantasies are 
still alive and generalized to many in the present era.

  Along with the rage at authority figures from the Vietnam era, 
these veterans today often feel a generalized mistrust of anyone 
in authority and the "system" in the present era.  Many combat 
veterans with stress disorders have a long history of constantly 
changing their jobs.  It is not unusual to interview a veteran 
who has had 30 to 40 jobs during the past 10 years.  One veteran 
I interview had nearly 80 jobs in a 10-year span.  The rationale 
quite often given by the veterans is that they became bored or 
the work was beneath them.  However, after I made some extended 
searched into their work backgrounds, it became apparent that 
they felt deep mistrust for their employers and coworkers; they 
felt used and exploited; at times, such was the case. Many have 
had some uncomfortable confrontations with their employers and 
job peers, and many have been fired or have resigned on their 
own.

** AVOIDANCE OF FEELINGS: ALIENATION **
---------------------------------------
  The spouses of many of the veterans I have interviewed complain 
that the men are cold, uncaring individuals.  Indeed the veterans 
themselves will recount episodes in which they did not feel 
anything when they witnessed the death of a buddy in combat or 
the more recent death of a close family relative.  They are often 
somewhat troubled by these responses to tragedy; but, on the 
whole, they would rather deal with tragedy in their own detached 
way.  What becomes especially problematic for these veterans, 
however, is an inability to experience the joys of life. They 
often describe themselves as being emotionally dead (Shatan, 
1973).

  The evolution of this emotional deadness began for Vietnam 
veterans when they first entered military boot camp (Shatan, 
1973). There they learned that the Vietnamese were not to be 
labeled as people but as "gooks, dinks, slopes, zipperheads and 
slants."  When the veterans finally arrived in the battle zone, 
it was much easier to kill a "gook" or "dink" than another human 
being.  This dehumanization gradually generalized to the whole 
Vietnam experience.  The American combatants themselves became 
"grunts," the Viet Cong became "Victor Charlie," and both groups 
were either "KIA" (killed in action) or "WIA" (wounded in 
action).  Often, many "slopes" would get "zapped" (killed) by a 
"Cobra" (gunship), and the "grunts" would retreat by "Shithook" 
(evacuation by a Chinook helicopter); the jungle would be sown by 
"Puff the Magic Dragon" (a C-47 gunship with rapid-firing mini-
gattling guns).

  The pseudonyms served to blunt the anguish and the horror of 
the reality of combat (DeFazio, 1978).  In conjunction with this 
almost surreal aspect of the fighting, psychic numbing furthered 
the coping and survival ability of the combatants by effectively 
knocking the aspect of feelings out of their cognitive abilities 
(Lifton, 1976).  This defense mechanism of survivors of traumatic 
experiences dulls an individual's awareness of the death and 
destruction about him.  It is a dynamic survival mechanism, 
helping one to pass through a period of trauma without becoming 
caught up in its tendrils.  Psychic numbing only becomes 
nonproductive when the period of trauma is passed, and the 
individual is still numb to the affect around him.

  Many veterans find it extremely uncomfortable to feel love and 
compassion for others.  To do this, they would have to thaw their 
numb reactions to the death and horror that surrounded them in 
Vietnam.  Some veterans I've interview actually believe that if 
they once again allow themselves to feel, they may never stop 
crying or may completely lose control of themselves;  what they 
mean by this is unknown to them.  Therefore, many of these 
veterans go through life with an impaired capacity to love and 
care for others.  they have no feeling of direction or purpose in 
life.  They are not sure why they even exist.

** SURVIVAL GUILT **
--------------------
  When others have died and some have not, the survivors often 
ask, "How is it that I survived when others more worthy than I 
did not?" (Lifton, 1973).  Survival guilt is an especially guilt-
invoking symptom.  It is not based on anything hypothetical.  
Rather, it is based on the harshest of realities, the actual 
death of comrades and the struggle of the survivor to live.  
Often the survivor has had to compromise himself or the life of 
someone else in order to live.  The guilt that such an act 
invokes or guilt over simply surviving may eventually end in 
self-destructive behavior by the survivor.

  Many veterans, who have survived when comrades were lost in 
surprise ambushes, protracted battles or even normal battlefield 
attrition, exhibit self-destructive behavior.  It is common for 
them to recount the combat death of someone they held in esteem; 
and, invariably, the questions comes up, "Why wasn't it me?"  It 
is not unusual for these men to set themselves up for hopeless 
physical fights with insurmountable odds.  "I don't know why, but 
I always pick the biggest guy," said the veteran in the 
transcript at the beginning of this chapter.  Shatan (1973) notes 
that some of these men become involved in repeated single-car 
accidents.  This writer interviewed one surviving veteran, whose 
company suffered over 80% casualties in one ambush.  The veteran 
had had three single-car accidents during the previous week, two 
the day before he came in for the interview.  He was wondering if 
he were trying to kill himself.

  I have also found that those veterans who suffer the most 
painful survival guilt are primarily those who served as corpsmen 
or medics.  These unfortunate veterans were trained for a few 
months to render first aid on the actual field of battle.  The 
services they individually performed were heroic.  With a bare 
amount of medical knowledge and large amounts of courage and 
determination, they saved countless lives.  However, many of the 
men they tried to save died.  Many of these casualties were 
beyond all medical help, yet many corpsmen and medics suffer 
extremely painful memories to this day, blaming their 
"incompetence" for these deaths.  Listening to these veterans 
describe their anguish and torment... seeing the heroin tracks up 
and down their arms or the bones that have been broken in 
numerous barroom fights... is, in itself, a very painful 
experience.

  Another less destructive trend that I have noticed exists among 
a small number of Vietnam combat veterans who have become 
compulsive blood donors.  One very isolated and alienated 
individual I interviewed actually drives some 80 miles round-trip 
once every other month to make his donation.  His military 
history reveals that he was one of 13 men out of a 60-man platoon 
who survived the battle of Hue.  He was the only survivor who was 
not wounded.  this veteran and similar vets talk openly about 
their guilt, and they find some relief today in giving their 
blood that others may live.
 
** ANXIETY REACTIONS **
-----------------------
  Many Vietnam veterans describe themselves as very vigilant 
human beings;  their autonomic senses are tuned to anything out 
of the ordinary.  A loud discharge will cause many of them to 
start.  A few will actually take such evasive action as falling 
to their knees or to the ground.  Many veterans become very 
uncomfortable when people walk closely behind them.  One veteran 
described his discomfort when people drive directly behind him.  
He would pull off the road, letting others pass, when they got 
within a few car lengths of him.

  Some veterans are uncomfortable when standing out in the open.  
Many are uneasy when sitting with others behind them, often 
opting to sit up against something solid, such as a wall.  The 
bigger the object is, the better.  Many combat veterans are most 
comfortable when sitting in the corner in a room, where they can 
see everyone about them.  Needless to say, all of these behaviors 
are learned survival techniques.  If a veteran feels continuously 
threatened, it is difficult for him to give such behavior up.

  A large number of veterans possess weapons.  This also is a 
learned survival technique.  Many still sleep with weapons in 
easy reach.  The uneasy feeling of being caught asleep is 
apparently very difficult to master once having left the combat 
zone.
 
** SLEEP DISTURBANCE AND NIGHTMARES **
--------------------------------------
  Few veterans struggling with post-traumatic stress disorders 
find the hours immediately before sleep very comfortable.  In 
fact, many will stay awake as long as possible.  They will often 
have a drink or smoke some cannabis to dull any uncomfortable 
cognition that may enter during this vulnerable time period.  
Many report that they have nothing to occupy their minds at the 
end of the day's activities, and their thoughts wander.  For many 
of them, it is a trip back to the battle zone.  Very often they 
will watch TV late into the mornings.

  Finally, with sleep, many veterans report having dreams about 
being shot at or being pursued and left with an empty weapon,, 
unable to run anymore.  Recurrent dreams of specific traumatic 
episodes are frequently reported.  It is not unusual for a 
veteran to reexperience, night after night, the death of a close 
friend or a death that he caused as a combatant.  Dreams of 
everyday, common experiences in Vietnam are also frequently 
reported.  For many, just the fear that they might actually be 
back in Vietnam is very disquieting.

  Some veterans report being unable to remember their specific 
dreams, yet they feel dread about them.  Wives and partners 
report that the men sleep fitfully, and some call out in 
agitation.  A very few actually grab their partners and attempt 
to do them harm before they have fully awakened.  Finally, 
maintaining sleep has proven to be a problem for many of these 
veterans.  They report waking up often during the night for no 
apparent reason.  Many rise quite early in the morning, still 
feeling very tired.

** INTRUSIVE THOUGHTS **
------------------------
  Traumatic memories of the battlefield and other less affect-
laden combat experiences often play a role in the daytime 
cognitions of combat veterans.  Frequently, these veterans report 
replaying especially problematic combat experiences over and over 
again.  Many search for possible alternative outcomes to what 
actually happened in Vietnam.  Many castigate themselves for what 
they might have done to change the situation, suffering 
subsequent guilt feelings today because they were unable to do so 
in combat.  The vast majority report that these thoughts are very 
uncomfortable, yet they are unable to put them to rest.

  Many of the obsessive episodes are triggered by common, 
everyday experiences that remind the veteran of the war zone: 
helicopters flying overhead, the smell of urine (corpses have no 
muscle tone, and the bladder evacuates at the moment of death), 
the smell of diesel fuel (the commodes and latrines contained 
diesel fuel and were burned when filled with human excrement), 
green tree lines (these were searched for any irregularity which 
often meant the presence of enemy movement), the sound of popcorn 
popping (the sound is very close to that of small arms gunfire in 
the distance), any loud discharge, a rainy day (it rains for 
months during the monsoons in Vietnam) and finally the sight of 
Vietnamese refugees.

  A few combat veterans find the memories invoked by some of 
these and other stimuli so uncomfortable that they will actually 
go out of their way to avoid them.  When exposed to one of the 
above or similar stimuli, a very small number of combat veterans 
undergo a short period of time in a dissociative-like state in 
which they actually reexperience past events in Vietnam.  These 
flashbacks can last anywhere from a few seconds to a few hours.  
One veteran described an episode to me in which he had seen some 
armed men and felt he was back in Vietnam.  The armed men were 
police officers.  Not having a weapon to protect himself and 
others, he grabbed a passerby and forcefully sheltered this 
person in his home to protect him from what he felt were the 
"gooks."  He was medicated and hospitalized for a week.

  Such experiences among Vietnam veterans are rare, but not as 
uncommon as many may believe.  Many veterans report flashback 
episodes that last only a few seconds.  For many, the sound of a 
helicopter flying overhead is a cue to forget reality for a few 
seconds and remember Vietnam, reexperiencing feelings they had 
there.  It is especially troublesome for those veterans who are 
still "numb" and specifically attempting to avoid these feelings.  
For others, it is just a constant reminder of their time in 
Vietnam, something they will never forget.

** REFERRALS FOR HELP **
------------------------
  As already discussed, post-traumatic stress disorders result in 
widely varying degrees of impairment.  When a single veteran 
(whether bachelor or divorced) with the disorder requests help, I 
refer him to a group of other combat veterans.  The reasons are 
twofold.  First, the veteran is usually quite isolated and has 
lost many of his social skills.  He has few contacts with other 
human beings.  The group provides a microcosm in which he can 
again learn how to interact with other people.  It also helps 
remove the fear, prevalent among these veterans, that each 
individual veteran is the only individual with these symptoms.  
In addition, many of the veterans form close support groups of 
their own outside the therapy sessions;  they telephone each 
other and help each other through particularly problematic 
episodes.

  Second, the most basic rationale for group treatment of these 
veterans is that it finally provides the veteran with that "long 
boat ride home" with other veterans who have had similar 
experiences.  It provides a forum in which veterans troubled by 
their combat experiences can work their feelings through with 
other veterans who have had similar conflicts.  In addition, the 
present symptoms of the disorder are all quite similar, and there 
is more reinforcement in working through these symptoms with 
one's peers than in doing it alone.

  The group situation is appropriate for most degrees of the 
symptoms presented.  The especially isolated individuals will 
often be quite frightened of the initial group session.  When 
challenged by questioning the strength that brought them to the 
initial interview, however, they will usually respond by 
following through with the group.  Those with severely homicidal 
or suicidal symptoms are best handled in a more crisis-oriented, 
one-to-one setting until the crisis is resolved.  I refer these 
veterans to an appropriate emergency team, with the expectation 
directly shared with the veteran that he will join the group as 
soon as the crisis has abated.

  Veterans who are presently married or living with a partner 
present a somewhat different picture.  Their relationships with 
their partners are almost invariable problematic.  Frequently, a 
violent, explosive episode at home created the crisis that 
brought the veteran in for counseling in the first place.  When 
such is the case or there is a history of battering of the 
partner, it is extremely important to refer the veteran and his 
partner to a family disturbance counseling center.  The 
consequences of this continued behavior are obvious.  In 
addition, a referral for the veteran to a group with other combat 
veterans is appropriate.  The partner of the veteran may find 
some understanding of her plight and additional support from a 
woman's group created specifically for partners of Vietnam combat 
veterans.

  Other veterans who are married or living with a partner may not 
be experiencing so serious a problem.  However, the partners are 
often detached from one another;  they just seem to live under 
the same roof, period.  Referral of the veteran to a combat 
veterans group and referral of the partner to a partners of 
Vietnam veterans group is important.

  Some veterans and their partners will jointly attend the 
screening session.  Both are troubled by what has been happening 
and often want to enter marital therapy together immediately.  In 
my experience, the veteran finds it extremely difficult in the 
beginning of therapy to deal with interactional aspects with his 
partner when other past interactions with traumatic overtones 
overshadow the present.  When these traumatic experiences do 
surface, the partner is often unable to relate.  Therefore, it is 
much more beneficial, in my opinion, to allow the veteran time 
with other combat veterans in a group.  In the meantime, suggest 
a woman's support group for partners of Vietnam veterans for the 
spouse.  Here she would receive additional support as well as an 
understanding of post-traumatic stress disorders.  Sometime 
thereafter, marital therapy, couples group therapy or family 
therapy may be appropriate.

  Many veterans with post-traumatic stress disorders, in addition 
to the symptoms already described, also have significant problems 
due to multiple substance abuse.  In my experience, those 
veterans who have habitually medicated themselves have compounded 
the problem.  Not only do they experience many of the symptoms 
already described, but the additional symptoms of chronic 
multiple substance abuse and alcoholism may mask the underlying 
reasons for self-medication as well.  Therefore, these chronic 
syndromes, which perpetuate themselves through addictive 
behavior, must be dealt with first.  Then a more accurate picture 
of the underlying problem will result, and an appropriate 
referral can be made.

  Except for some help with an immediate crisis upon being first 
interviewed during the screening session, the combat veteran 
struggling with the symptoms of post-traumatic stress disorder, 
chronic and/or delayed, benefits most from group interaction with 
his combat peers.  Throughout this paper I have emphasized the 
individual, solitary aspect of the war for each veteran.  The 
aftermath of the war has followed in kind.  Now, with the help 
from the DAV Vietnam Veterans Outreach Program and the VA's 
Operation Outreach (Vet Center) program, models have been 
established for reintegrating troubled Vietnam veterans with 
themselves and their society.  Helping the community to recognize 
the problem and directing the veteran to the specialized services 
of the community have given the veteran struggling with this 
disorder a means of "coming home."


** REFERENCES **
----------------

Anderson, R.S. (Ed.). NEUROPSYCHIATRY IN WORLD WAR II, Volume I. 
  Washington, D.C. Office of the Surgeon General, 1966
Archibald, H.E. & Tuddenham, R.D. Persistent stress reaction 
  after combat:  A twenty-year follow-up.  ARCHIVES OF GENERAL 
  PSYCHIATRY, 1965, 12: 475-481
Boros, J.F. Reentry: III.  Facilitating healthy readjustment in 
  Vietnam veterans.  PSYCHIATRY, 1973, 36(4):428-439
Bourne, P.G. MEN, STRESS AND VIETNAM. Boston: Little, Brown, 1970
Dancey, T.E. Treatment in the absence of pensioning for 
  psychoneurotic veterans.  AMERICAN JOURNAL OF PSYCHIATRY, 1950, 
  107:347-349
DeFazio, V.J. Dynamic perspectives on the nature and effects of 
  combat stress.  In C.R. Figley (Ed.), STRESS DISORDERS AMONG 
  VIETNAM VETERANS: THEORY, RESEARCH AND TREATMENT>  New York: 
  Brunner/Mazel, 1978.
DIAGNOSTIC AND STATISTICAL MANUAL, Edition I. Washington D.C.: 
  American Psychiatric Association, 1952.
DIAGNOSTIC AND STATISTICAL MANUAL, Edition II. Washington D.C.: 
  American Psychiatric Association, 1968.
DIAGNOSTIC AND STATISTICAL MANUAL, Edition III. Washington D.C.: 
  American Psychiatric Association, 1980.
Dividend from Vietnam, TIME, Oct. 10, 1969, pp. 60-61
Egendorf, A. Vietnam veteran rap groups and themes of postwar 
  life.  In D.M. Mantell & Pilisuk (Eds.), JOURNAL OF SOCIAL 
  ISSUES: SOLDIERS IN AND AFTER VIETNAM, 1975,31(4): 111-124
Eisenhart, R.W. You can't hack it little girl: A discussion of 
  the covert psychological agenda of modern combat training.  In 
  D.M. Mantell & Pilisuk (Eds.), JOURNAL OF SOCIAL ISSUES: 
  SOLDIERS IN AND AFTER VIETNAM, 1975,31(4):13-23
Erikson, E. IDENTITY, YOUTH AND CRISIS. New York: W.W. Norton, 
  1968
Figley, C.R. Introduction.  In C.R. Figley (Ed.), STRESS 
  DISORDERS AMONG VIETNAM VETERANS: THEORY, RESEARCH AND 
  TREATMENT. New York: Brunner/Mazel, 1978(a).
Figley, C.R. Psychosocial adjustment among Vietnam veterans: An 
  overview of the research.  In C.R. Figley (Ed.), STRESS 
  DISORDERS AMONG VIETNAM VETERANS: THEORY, RESEARCH AND 
  TREATMENT. New York: Brunner/Mazel, 1978(b).
Futterman, S. & Pumpian-Mindlin, E. Traumatic war neuroses five 
  years later.  AMERICAN JOURNAL OF PSYCHIATRY, 1951, 108(6): 
  401-408.
Glass, A.J. Psychotherapy in the combat zone.  AMERICAN JOURNAL 
  OF PSYCHIATRY, 1954, 110:725-731
Glass, A.J. Introduction.  In P.G. Bourne (Ed.), THE PSYCHOLOGY 
  AND PHYSIOLOGY OF STRESS.  New York: Academic Press, 1969, xiv-
  xxx.
Grinker, R.R. & Spiegel, J.P. MEN UNDER STRESS.  Philadelphia: 
  Blakiston, 1945
Horowitz, M.J. & Solomon, G.F. A prediction of delayed stress 
  response syndromes in Vietnam Veterans.  In D.M. Mantell & 
  Pilisuk (Eds.), JOURNAL OF SOCIAL ISSUES: SOLDIERS IN AND AFTER 
  VIETNAM, 1975,31(4):67-80.
Howard, S. The Vietnam warrior: His experience and implications 
  for psychotherapy.  AMERICAN JOURNAL OF PSYCHOTHERAPY, 
  1976,30(1):121-135.
Jones, F.D. & Johnson, A.W. Medical psychiatric treatment policy 
  and practice in Vietnam.  In D.M. Mantell & M. Pilisuk (Eds.), 
  JOURNAL OF SOCIAL ISSUES: SOLDIERS IN AND AFTER VIETNAM, 1975, 
  31(4):49-65.
Kormos, H.R.  The nature of combat stress. In C.R. Figley (Ed.), 
  STRESS DISORDERS AMONG VIETNAM VETERANS: THEORY, TREATMENT AND 
  RESEARCH.  New York: Brunner/Mazel, 1978.
Lifton, R.J. HOME FROM THE WAR.  New York: Simon and Schuster, 
  1973.
Lifton, R.J. THE LIFE OF THE SELF. New York:Simon & Schuster, 
  1976.
Moskos, C.C. The American combat soldier in Vietnam.  In D.M. 
  Mantell & Pilisuk (Eds.), JOURNAL OF SOCIAL ISSUES: SOLDIERS IN 
  AND AFTER VIETNAM, 1975, 31(4): 25-37.
PRESIDENT'S COMMISSION ON MENTAL HEALTH.  Report of the special 
  working group: Mental health problems of Vietnam era veterans. 
  Washington: Feb. 15, 1978.
Seligman, M.E.P. & Maier, S.F. Failure to escape traumatic shock.  
  JOURNAL OF EXPERIMENTAL PSYCHOLOGY, 1967, 74: 1-9.
Shatan, C.F.  The grief of soldiers: Vietnam combat veterans' 
  self-help movement. AMERICAN JOURNAL OF ORTHOPSYCHIATRY, 1973, 
  43(4): 640-653.
Shatan, C.F. Stress disorders among Vietnam veterans: The 
  emotional content of combat continues.  In C.R. Figley (Ed.), 
  STRESS DISORDERS AMONG VIETNAM VETERANS: THEORY, RESEARCH AND 
  TREATMENT.  New York: Brunner/Mazel, 1978.
Strayer, R. & Ellenhorn, L. Vietnam veterans: A study exploring 
  adjustment patterns and attitudes.  In D.M. Mantell & M. 
  Pilisuk (Eds.), JOURNAL OF SOCIAL ISSUES: SOLDIERS IN AND AFTER 
  VIETNAM, 1975, 31(4):81-93.
Tiffany, W.J. & Allerton, W.S. Army psychiatry in the mid-60s. 
  AMERICAN JOURNAL OF PSYCHIATRY, 1967, 123: 810-821.
Williams, T. VIETNAM VETERANS.  Unpublished paper presented at 
  the University of Denver, School of Professional Psychology, 
  Denver, Colorado: April, 1979.
Wilson, J.P.  Identity, ideology and crisis: The Vietnam veteran 
  in transition.  Part I.  Identity, ideology and crisis: The 
  Vietnam veteran in transition.  Part II.  Psychosocial 
  attributes of the veteran beyond identity:  Patterns of 
  adjustment and future implications.  FORGOTTEN WARRIOR PROJECT, 
  Cleveland State University, 1978. (Reprinted by the Disabled 
  American Veterans, Cincinnati, Ohio, 1979.  Now out of print.  
  Dr. Wilson's findings are updated and summarized in C.R. 
  Figley's STRANGERS AT HOME.  See following reference.)
Wilson, J.P. Conflict, stress and growth:  the effects of the 
  Vietnam War on psychosocial development among Vietnam veterans.  
  In C.R. Figley & S. Leventman (Eds.), STRANGERS AT HOME: 
  VIETNAM VETERANS SINCE THE WAR, Praeger Press, 1980.