The Helping Professions
And the Building of the Vietnam Veteran Stereotype
By Dr. Phoebe S. Spinrad
(Presented at the International Vietnam
© 1996, Phoebe S. Spinrad, Ph.D.
Dr. Phoebe S. Spinrad, Capt., USAF (Ret), is associate professor of English at Ohio State University.
Several years ago, as an English Department faculty member, I was the outside reader at a Ph.D. dissertation defense in another department. After the defense, I was engaging in the usual professional chatter with members of the dissertation committee, and as I talked about my Vietnam research, I mentioned casually, Im a Vietnam veteran myself. Oh, really, said one of the other professors excitedly; Do you have flashbacks?
I had a momentary impulse to reply, Yeah, and I have an M-16 stashed behind the door; in a minute Im going to pull it out and spray the room. But I simply smiled and said, No; very few of us do.
Remember, this was a professional occasion, and I was present as a tenured faculty member and representative of the Graduate School. I was dressed respectably in a business suit, and I hadnt exhibited any unusual behaviorunusual for an academic, that is. And yet, as soon these other professionals heard I was a Vietnam veteran, the person theyd been talking to disappeared and a new person took her place: the shattered Vietnam veteran who has flashbacks and routinely goes berserk; the crazed killer and/or zombie victim.
And yet, according to all the surveys and studies over the past fifteen years, most Vietnam veterans are more likely than their civilian counterparts to lead stable and even happy lives. Their education level is as high or higher, theyre more likely to own homes and participate in civic activities, and believe it or not, in every one of the surveys they report enjoying life and recreational activities more than their nonveteran counterparts. However, these same surveys show that theyand their civilian counterpartsbelieve otherwise.
The impression that Vietnam veterans are unstable, unhappy misfits is a prevalent one. It appears in novels, films, newspaper headlines screaming Vietnam Vet Goes On Shooting Spree, and even, apparently, Ph.D. dissertation defenses. Even well-meaning veterans advocacy groups and magazines seem to have absorbed the idea. And, of course, every conference about Vietnam (including this one) invariably has at least one session on the subject. Mention Vietnam veterans, and the subject immediately turns to . . . Trauma. Counseling. Healing. Even at the famous Wall in Washington, which should be a tribute to veterans, every year the call goes out to let the healing begin.
Healing? Is serving ones country a disease? Where did this idea begin? And how did it last so long? Well, it had professional help.
In 1973, a New York psychiatrist published a book about his research on Vietnam veterans, a book in which he stated outright in the first chapter that hed deliberately chosen a biased sample, hed decided before beginning his research what the results would be, and his purpose in doing this so-called research was primarily political, to build a cadre of activist veterans who would lend credence to his antiwar claims. Normally, no one would take such a biased study seriously; but not only did the book become a best-sellerreissued at least three times since thenbut it also became the basis of other books on veterans, as well as new definitions in the American Psychiatric Associations Diagnostic and Statistical Manual (DSM), a series of VA programs, and, of course, part of American folklore.
The psychiatrists name was Robert Jay Lifton. The book, Home from the War. The legacy, what is now known as post-traumatic stress disorder, or PTSD.
Lifton had drawn his sample of Vietnam veterans from members of the New York City chapter of Vietnam Veterans Against the Waran organization with which hed been working earlier, an organization of disaffected veterans. But even before he began working with the group, hed already begun announcing in public that the war itself was turning combatants into guilt-ridden, violent misfits, with the emphasis on guilt. His name had appeared on antiwar advertisements in newspapers as early as 1967, many of which, again, emphasized the guilt and the victimization of U.S. troops; and in 1969 he spoke on the subject before a meeting of SANE, whose policy statement that year included the purpose of mobiliz[ing] serious academic opinion in the social and behavioral sciences against the ABM and the growing influence of the military. And indeed, the social and behavioral sciences were being mobilizedwithout the minor impediment of properly researched evidence.
Lifton, of course, wasnt the only member of the helping professions to be mobilized, although he was the chief mobilizer. Others who helped him with his program were such figures as Charles Figley, Arthur Egendorf, and others whose names wont be immediately familiar to nonspecialists here today. But they became very familiar within the continuing mobilization. Many of them participated in the 1971 so-called Winter Soldier Investigation, a media event staged in Detroit at which over a hundred of Liftons antiwar veterans testified that American GIs were routinely committing atrocities in Vietnam and returning home shattered hulks because of it. Guenter Lewy, in his book America in Vietnam, later revealed that many of the supposed veterans had misstated their experiencesand in some cases even their identities; however, the participants, including the psychologists who had mobilized the event, later testified as well before Congress about these supposed atrocities and subsequent damage to the veterans psyches. And they continued transcribing the bogus stories into learned journals and those books edited by the people who had organized the antiwar events.
This same group of psychologists and psychiatrists, in addition to flooding the field with books and articles on the subject throughout the 1970s and 1980s, were the ones who codified their ideas in the third edition of the DSM, published in 1980, where PTSD appeared for the first time, defined by the same people who had done all the mobilizing. And they, with their antiwar veterans (or pseudo-veterans) were also the ones who lobbied for, helped to set up in 1979, and primarily staffed what are now known as Vet Centers within the VA. Significantly, the methods used in these Vet Centers mirrored the ones used by Lifton and his disciples in the original New York rap groups that led to Home from the War. And the methods used in those rap groups, in turn, sound startlingly like the brainwashing sessions described by Lifton in his first book in 1961, an account of brainwashing methods used in North Korean POW camps.
Its now been 23 years since Home from the War was published, and 16 years since the appearance of PTSD in the DSM-III. In those years, a lucrative PTSD industry has grown up, complete with the usual institutes, journals, government agencies, on-line databases, and heavily subsidized research pools. Ordinarily, such academically specialized concerns would hardly touch the general public, although they would certainly line the specialists pockets. But remember, the members of the helping professions who codified the idea of PTSD had as their primary goal the mobilization of popular opinion as well as that of their own colleagues. And they were not in the mobilization business alone, but had the support of various peace organizations, the popular press, film producers, and of courseas one might expectJane Fonda, who supplied much of the funding for the Winter Soldier Investigation.
Sadly enough, as heart-wrenching stories about PTSD began showing up in magazine articles, films, television programs, novels, war memorial dedications, and even (God save the mark) literary criticism of all those books, articles, and films, many veterans themselves were drawn into perpetuating the idea. As Charles Moskos of Northwestern University pointed out as early as 1980, the only acceptable war story for a Vietnam veteran to tell, both during the war and for years afterwardand certainly the only war story that would be given a public hearingwas the atrocity story and, later, the PTSD story. So the veterans began telling atrocity and PTSD storiesfictional stories, in most cases. Many came to believe their own stories; others, listening to the stories, began to feel the symptoms of what they so constantly heard about, just as medical students often feel the symptoms of the diseases theyre studying.
In the same year that I was asked whether I had flashbacks, I happened to run across someone Id been stationed with during the war, a pararescue NCO whod often been in heavy combat zones. Hes an easy-going man, happily married, with many hobbies and a good career position in a major national van line. As we talked over old times, he told me he occasionally had bad memories or bad dreams about the war, but he never seemed to have any of the reactions hed heard so much about: no flashbacks, no violent impulses, none of it. Tell me, he said, do you think theres something wrong with me?
Of course there was nothing wrong with him, any more than theres anything wrong with the vast majority of men and women who served during the Vietnam War, even in heavy combat zones. However, theres certainly been something wrong with the study of PTSD, right from the beginning. And it continues today.
The literature on PTSD, which, remember, was tainted from the beginning by inadequate research methods, is still tainteda mass of poorly gathered and analyzed statistics, unquestioned and unverified assumptions, a lack of control groups, and double standards. To give just a few examples of the problems Ive encountered in tracking this literature:
1. In 1992, I spoke to the author of a survey instrument being distributed by a researcher at the University of California at Irvine, yet another attempt to measure the readjustment of Vietnam veterans. (And isnt it strange that no other group of veterans is so constantly surveyed on their readjustment, the assumption obviously being that Vietnam veterans are the only group with a readjustment problem in the first place?) Surprised at having been contacted at all, I asked the researcher how she was gathering her subject pool. She said she was mostly trying to get at the underrepresented veterans, especially the homeless, the incarcerated, the minimally employedand college professors (obviously a subclass of the minimally employed). When I asked whether she had any representation among corporate managers and other nonacademic professionals, she said she hadnt thought of itwith the implication that she had no intention of thinking of it further. Obviously, the people shed be surveying were people with problems (especially the college professors?), so of course her survey wound up showing a high rate of problems. QED.
2. In 1994-95, I beta tested an automated patient intake system for the Pacific Institute for PTSD Studies. (I also do some database development and programming on the side.) When I mentioned to the programmer, who was also a clinician, that some of the questions wouldnt apply to womeneven women veteransor to victims of natural disasters, and that these people would answer some other questions in a way that would give a misleading impression, the programmer replied that the instrument had originally been written for male Vietnam veterans, and they were finding that they had to do a lot of adjustment in order to make it suitable for the general publicand for female veterans. In other words, the original premises on which a whole literature had been based simply werent holding up to the evidence of the facts.
3. A 1992 best-seller, Trauma and Recovery, by psychiatrist Judith Herman, shows the same tendency to adjust the facts in order to maintain the stereotype. Whenever Herman discusses Vietnam veterans, she proposes completely different assumptions, symptoms, and methods of treatment from those she gives for other sufferers of trauma. In particular, other sufferers must examine the facts of what has happened to them; veterans must simply accept the fact of their guilt and/or victimization in being caught up in a futile and evil war. Furthermore, other sufferers are expected to recover in a matter of a few years or even months; veterans can never recover but must learn to live with their condition.
4. The myth of permanence shows up in other literature as well, even in the popular memoir Home Before Morning, by Lynda Van Devanter, a book used in almost every Vietnam War Literature course in our colleges and universities. In this book, Van Devanter claims to have been helped by Shad Meshad, one of the primary figures in setting up Vet Centers in the late 1970s. According to Van Devanter, Meshads help included assuring her that she would never entirely recover from her PTSD, but she could learn to accommodate it into her life. And in fact, all the PTSD literature, including the PTSD Institutes flagship publication, the PTSD Quarterly, routinely makes this assumption that the Vietnam veteran can never recoverwhile at the same time it proposes six-month to two-year recovery times for victims of rape, child abuse, natural disaster, and kidnap or hostage situations.
5. And finally, a recent book supposedly written for a general literary audience, Jonathan Shays Achilles in Vietnam, on which a paper will be presented later in this symposium, not only uses an insufficient sampling his own patients at a VA facility in Bostonto make generalizations about all Vietnam veterans, but its since become evident that even those patients were lying to him about their experiences. Furthermore, Shay skews the statistics he cites from the 1990 National Vietnam Veterans Readjustment Study (NVVRS), using the highest figures he can cull from the tables to represent the PTSD rates of all veteransthat is, he uses the figures for veterans of high combat-level areas who have had any symptoms whatsoever at any time in their lives. Shay thus manages to posit an alarming 70% PTSD rate among veterans. But by the very terms of the DSM definition of PTSD, nonexistent or insufficient symptoms cannot be diagnosed as PTSD. And therein lies a problem with the NVVRS itself.
Before examining this study, we should note that it was mandated by Congress in 1983 as a condition for the continued funding of VA Vet Centers. The surveyers therefore had a vested interest in finding high rates of PTSD, in order to show a need for these Vet Centers. However, even with questionable surveying practices (which Ill discuss in a moment), they could come up with only 15.2% of theater veterans with diagnosable cases. They therefore created two new categorieslifetime and partial PTSDand further separated the veterans into those whod supposedly been in high, moderate, and low levels of combat within the war zone.
Lifetime PTSD, in the NVVRS, means a fully diagnosable case, with all five required symptoms present, at any time in the veterans lifepresumably even the day after combat. Partial PTSD means any one or more of the five required symptoms. Theres already something wrong here. According to the terms of the definition, all symptoms must be present for a diagnosis; and . . . well, they must be present. Furthermore, the only way to determine whether the symptoms were present in the past, the surveyers must rely on the veterans memory and a good deal of prompting, some of which begins, Many people report . . . , as though the syptom is a common occurrence and even an expected one. And herein lies another problem with the methods used in the survey.
Most of the interviewers for the survey were nonveterans who were ill equipped to evaluate the answers they received, and the question used to determine the level of combat in the area where the veteran served was simply a request that the veteran describe his or her experiences. Even putting aside the problem inherent in asking a veteran to tell war stories, which usually leads to a flood of exaggerations, obviously a person whos suffering seriously from memories of an experience will describe the experience in elaborate and perhaps exaggerated detail, while the person whos accommodated the experience well will describe it briefly and probably minimize it. So high warzone stress becomes simply a measure of how excited the subject has been in telling the story; in other words, the intensity of the situation is measured by the intensity of the reaction, rather than the other way around. And remember, by this time (1983-90), the subjects have been influenced by a flood of books and films about Vietnamand about PTSDand may be remembering other peoples experiences (or fabrications) along with their own. Furthermore, no unit records or even control groups were used to determine what actually happened or whether different people in the same unit described the intensity of combat the same way. The statistics, then, become a circular argument.
However, by accepting unsupported war stories and counting partial symptoms and symptoms that no longer exist, the NVVRS is finally able to come up with a 53.4% lifetime partial PTSD rate for high warzone veterans, which certainly sounds more impressive than the original 15.2%
As for Shays 70% figure, he states in a well-hidden footnote that he put this figure together from various tables in the NVVRS on separate symptoms. When I attempted to check these figures, I discovered something even more appalling about the study. (And by the way, Shays tabulation was inflated by the possibility that he was counting the same veterans multiple times because of the way the figures are presented.) Simply stated, the validation group used in the study seems actually to have invalidated it.
The validation group was composed of veterans who had been diagnosed with full cases of PTSD, and most of these veterans were patients of the authors of the survey instrument. But according to the figures given in Tables III-2 through III-4, a full 40% of them did not show all the required symptoms for a diagnosis of PTSD. Think about that: forty percent of diagnosed cases didnt meet the criteria for the diagnosis.
So . . . either these patients had been misdiagnosed (by the very experts who were doing the study, remember); or the instrument on which the study was built was faulty; or the definition of PTSD is faulty; or . . . all of the above. And on this study, cited everywhere as the last word on Vietnam veterans, the stereotype continues to flourish.
After almost 25 years, its hard to dispel an image thats permeated the whole fabric of a society. And yet, other stereotypes that have been in place much longer have come under attack and in many ways have been dispelledor at least made taboo to speak in public. Unfortunately, the same people whove worked so hard to dispel the other stereotypes are the very ones whove promulgated and perpetuated this one: the so-called helping professions, who have been of very little help to the image of Vietnam veterans.
Why, its almost enough to make a girl want to pull out her M-16 and spray the room.
 Guilt Feelings Seen for Returning GIs, Washington Post, 3 May 1969.
 Charles Moskos, Surviving the War in Vietnam, in Strangers at Home: Vietnam Veterans Since the War, ed. Charles R. Figley and Seymour Leventman (New York: Praeger, 1980), 84.
"They expected you to be a napalm-dropping, baby murdering, dope-smoking Vietnam veteran, so of course you had to do it. F*** them if they couldn't take a joke. --- Mike Byers, guoted in The Ravens, 1989