May/june 1990 | Volume 41, Issue 4
In the hands of DSM-III ’s authors, the shock of combat was only one of several possible causes of PTSD. Posttraumatic stress disorder was now defined as a behavioral disorder that set in after “a person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.” Significantly, the new definition avoided suggesting that PTSD victims had personalities that made them especially susceptible. DSM-III merely referred to “several studies” that assigned a more important role to “preexisting psychopathological conditions,” but it carefully emphasized that if the stress was sufficiently extreme, anyone could succumb to the disorder. Natural disasters, catastrophic accidents, victimization by criminal or state action, the death of a loved one, and, of course, combat—any of these experiences were regarded as capable of invoking PTSD in even the best-adjusted people.
Three symptomatic complexes composed the disorder: a tendency to relive the traumatic event through recollections, dreams, hallucinations, or symbols; a general feeling of disaffection in which the victim avoided any situation that threatened to recall the original events of the shock; and finally, what was called increased arousal, or a combination of sleep disturbances, irritability or anger, inability to concentrate, hyperalertness, and what laymen would call jumpiness.
Even now the number of war veterans suffering from PTSD is difficult to gauge. Posttraumatic stress disorder or a milder variant less intractable to treatment, posttraumatic stress syndrome, is estimated by veterans’ groups to have affected as many as 500,000, perhaps as many as 800,000, ex-combatants. A recent study by the Research Triangle Institute’s William Schlenger found that PTSD sufferers now make up about one-third of the 38 percent of Vietnam veterans exposed to combat action. Translated into raw numbers, Schlenger’s figures amount to about 470,000 PTSD casualties. And there are suggestions that the numbers are increasing as time goes by.
Moreover, PTSD casualties are in one sense new casualties of the war. Certain aspects of the war, such as the episodic tempo of fire base-oriented fighting, the one-year tour of duty, and the soldiers’ access to alcohol and drugs—self-medication, in essence—meant that the fighting soldier could tough it out. Of course, a serious wound enabled a soldier to escape the fighting sooner, but physical wounds and stress disorders routinely coexist, and early evacuation clearly does not protect soldiers from the threat of PTSD. Most victims of the disorder fought their war without resorting to medical treatment for any but physical wounds, went home, and were discharged, only to find that while they had left the war, the war had not left them. Official figures show that during the war, “combat stress reactions,” the term of choice at the time, amounted to only 1.2 percent of American casualties, far lower than comparable figures for World War II (23 percent) and the Korean War (12 percent). One wartime psychiatrist reported that only 5 percent of psychiatric admissions were legitimate combat fatigue, whereas 40 percent of all recorded cases were simply psychiatric disorders common to civil life. Earlier wars appear to have contained their psychiatric casualties, and anyway, the declaration of peace seemed a proper prescription for any discontent. But the most prominent feature of the Vietnam War’s psychological history seems to have been its postponement.
The more common explanations of Vietnam’s lingering psychological effect were born in our judgments on the war as it was being fought. Vietnam was conceived as somehow unique, an aberration of America’s military experience, somehow un-Amercan. Convenient as such a judgment might be, it cannot withstand scrutiny. Except insofar as any historical event is unique, our military experience in Vietnam was hardly unusual. The same is true of PTSD.
If a Civil War soldier was morose and unable to function, he became a candidate for the diagnosis of “nostalgia.” A good dose of battle was considered the best “curative.”
For most Americans the standard upon which Vietnam has been judged—and found wanting—has been the Second World War, a conflict that makes a much more compelling claim to uniqueness than Vietnam ever could. We have fought revolutionary wars, guerrilla wars, punitive wars, imperial wars, limited wars for the finer points of policy, wars marked by low and grudging social support, wars that consumed disproportionately younger men, wars whose supposed nobility was spoiled by atrocity, wars in which the rhythms of life at home were hardly interrupted, and wars in which the soldiers had only the most meager idea of why they were fighting. Indeed, the Vietnam War has been described in all these ways. By contrast, World War II’s image is so gratifying that few of these descriptions have ever been applied to that conflict. Indeed, World War II’s image is so appealing to the national memory that it has overshadowed the intervening war in Korea, a conflict that in some respects was at least as unsatisfying as Vietnam. If we are forced to remember any war fondly, World War II is always the conflict of choice.