Blog: On this Veterans Day: Understanding War-Generated Psychopathology

On this Veterans Day:
Understanding War-Generated Psychopathology
 
By Norman M. Camp, MD
 
We all know that the rapidly approaching Veterans Day holiday (November 11) presents Americans with an opportunity to renew their gratitude for the men and women who took up arms in the nation’s behalf. But the greater challenge is how to keep it from being tokenistic…how to avoid feeling that in so doing one has discharged this sacred obligation. In this regard I respectfully offer the following material pertaining to Vietnam veterans from my recent publication, US Army Psychiatry in the Vietnam War. I would argue that much of it can be extrapolated to our more recent wars. Please note that the exclusive use of the male pronoun is consistent with that Vietnam War era source.
 
“It is worth considering that in general a deployed soldier invariably worries about how he will be treated when he reenters stateside life, and this strongly influences his adjustment within the theater. Once back stateside it then becomes necessary for him to master and assimilate “his” war (his ordeal, reactions, and losses, and their meaning to him). If he succeeds, he is likely strengthened. If not, he may make costly psychological compromises and remain more or less permanently affected or even disabled. For all who served in the theater, but surely more so for the veterans of the combat itself, his cherished pre-military self-image may have become damaged if circumstances contributed to his concluding that he had faced his personal war ordeal as a coward, or as a savage. Recovering his mental equilibrium as a veteran in large part depends on positive relationships, that is, social supports. His effort to reconcile his own moral dilemma about killing (or even feeling that simply by serving he was an accessory to the killing) and the war’s destructiveness is a process that is especially affected by the manner in which he is treated by his family and the nation. Is there sustained evidence of affirmation, redemption, as if in a fashion he is a hero? Or is there disregard (or worse), as if he’s a pariah? Reconciling his experience becomes more difficult for the citizen-soldier who, following his enlistment, leaves the military and its generally supportive culture. It seems safe to say that when it is all over no one is the same as before it began.
 
With regard to Vietnam, the clash of values over the war not only encouraged widespread problems among veterans, but it can additionally be said that sooner or later every soldier who served there had to contend with the added psychological burden of knowing he participated in, and sacrificed for, a lost and socially repudiated cause. Public opposition to the war meant that adulation was instead directed to those who resisted the draft, opposed the military, or in other ways avoided Vietnam. Families were pleased to see their sons and husbands return, but there were few heroes’ welcomes. (And I would further add that there is no such thing as “lack of support” for the veteran, or “nonsupport,” suggesting a neutral or indifferent response. To the veteran any ambiguity or nonsupport is contextually experienced as blame and condemnation, provoking a deeply troubling sense of being a social outcast.)”
 
In conclusion, it is incumbent for all of us who understand how war-generated psychopathology takes root to do all we can to oppose these corrosive forces, both with individual patients and within our communities.
 
 
Norman M. Camp, MD, FACPsa
Colonel, Medical Corps, US Army (Ret)
Clinical Professor of Psychiatry
Medical College of Virginia
Virginia Commonwealth University