Yesterday, Today & Tomorrow

Blog site to accompany KUAR Public Radio program, the only program on radio today where the generations get together the first and third Tuesdays each month to compare and contrast their perspectives on a wide variety of topics.

Tuesday, July 05, 2005

Our program on War Injuries was one of the most moving that I have done. All four of my guests have endured suffering that I can not even begin to feel. These four represent only an immeasurable fraction of the sacrifices so many have given for our freedom. I hope anyone who heard the half hour program will download the full version. We air just half of all that we tape and editing is very difficult when so much is meaningful.

The email response is from Joann Szabo of Kingswood College in Texas and I really appreciate her taking the time to respond.

War Injuries—Middle Generation

1. Vietnam is the war your generation remembers most and would like to forget. What was the most common injury and what was the most feared?
The most common war injury for US soldiers in my own unscientific perception as a young college woman at the time was extreme loss of faith and trust, followed closely by substance addiction.
I do not know what the most common injury was of our Vietnamese allies, nor of our foes. The media played images of the scariest and most horrible devastation in that country that one could imagine. There were unforgettable images of naked children with their skin burned off, and of our guys shooting women, children and old men. There were terrifying pictures of huge patches of forest burning in an instant with incendiary Napalm, engulfing whole villages in enormous flames. There were stories about how “Charlie” appeared as innocent women and small children carrying bombs to kill GI’s in suicide attacks.
The worst injury legacies that I can think of now in Vietnam are the land mines that still blow up unsuspecting people these many years after the war, and the chemical residues that have poisoned the land, not to mention the social and economic response to the death of a million people in a small country. Clear Path International states that about once a week someone in the former DMZ still gets blown up with unexploded ordinance (UXO). Quang Tri Province alone reports 500 children dead and over 4000 injured since 1975. UXO look like toys, so children herding buffalo pick up pieces of UXO not expecting them to explode.
The government has played numbers games in the political turmoil surrounding the war, so it is hard to have faith in published numbers. The Vets Memorial web site has these data about the very height of the protracted war: “December 31, 1968, the breakdown of allied forces were as follows: 536,100 U.S. military personnel, with 30,610 U.S. military having been killed to date; 65,000 Free World Forces personnel; 820,000 South Vietnam Armed Forces (SVNAF) with 88,343 having been killed to date. At the war's end there were approximately 2,200 U.S. missing in action (MIA) or prisoner of war (POW).” Maybe three quarters of a million heavy combat ‘Nam Vets are still alive today. Out of that a quarter million are suffering from symptoms of post traumatic stress, according to Jonathan Shay, who wrote the book “Achilles in Vietnam—Combat Trauma and the Undoing of Character.” In any case there are a lot of guys still around suffering. Soldiers afflicted with PTSD and/or substance abuse have a significant ripple effect on their families, and on their families’ families, who also suffer enormously. That bumps the numbers of those suffering from combat injury up quite a bit on all sides.
The most feared injury for US soldiers from the point of view of those back home at the time was MIA, followed by death. The most feared injury from the point of view of US soldiers at the time seemed to be physical disability.
I had the privilege of doing an internship as a social worker at a Vet’s hospital, working both on a medical floor and on a psychiatric floor. The psych floor treated mainly soldiers with Post Traumatic Stress symptoms. There was also a substantial group of HIV positive Vietnam era soldiers, some with full-blown AIDS. Those men were getting help with both mental and physical problems, and it was prior to the time when there were effective cocktails of drugs to knock down the virus. All of the hospital work was very compelling. The number of homeless Vietnam Vets using, or attempting to use hospital services was outrageous. Homelessness is one common outcome for those with PTSD and/or substance abuse.
The loss of innocence was the worst injury for most of the Vets that I have known, physically injured or not. Our country and our army had moral force. Our young men who fought were motivated enough by that to face death repeatedly. When there is a victory, death, no matter how terrible, is anchored to meaning. The US in Vietnam won the battles, but lost the war, and lost in on moral grounds. Death had no meaning, and the “unanchored” dead visited the survivors to tell them about it. The returning survivors were not honored. The US dead were not honored until later either.
The warlords perpetrating the war were thousands of miles away, out of danger during the fighting. The on-site bureaucracy was so cumbersome that life and death decisions made by leaders consistently made no sense to the soldiers. Leaders in the battlefield were rotated in and out every six months, so they learned their job at soldiers’ expense, literally.
Modern soldiers have extreme dependency on their army. When systems fail due to an enemy, soldiers have legendary stoicism. When systems fail due to incompetence of superiors, it is a different story from the soldier’s point of view.
The picture of disenchantment gets clearer when the system failure kills treasured comrades needlessly and repeatedly. The loss of comrades gets more intense with survivor guilt—it should have been me; I should have done more to save him! I’ll never forget a ‘Nam Vet describing to me how under fire he held the headless corpse of his buddy until the blood stopped spurting and then let the warm body sink out of sight into the rice paddy. The Vet was reliving the experience and took me with him.
Soldiers can recover from horror, but recovery from loss of doing what is right for the right reasons is a harder pill to swallow. Combat under these conditions destroys the capacity for social trust. Prolonged contact with enemies, especially not knowing exactly who the enemies are as in a guerilla war like Vietnam was, demolishes a soldier’s faith in his or her own mental functioning.
Here’s the mix then: Detachment from moral and social restraint via betrayal + survivor guilt + the sense of being already dead and deserving to be dead = a soldier who started out normal and who is now a potential monster. He goes berserk and feels powerful, like God!
Bring that guy home after he has had a chance to go berserk and tell him that he is a monster and a loser. Imagine how that guy functions post war as a father, a husband, a son, a neighbor, a friend, an employee. Now you have a start at understanding the depth of a common war injury suffered by many Vietnam vets. Compound the nature of the injury with the fact that minorities and persons from poverty backgrounds were recruited and served in higher proportion than people of the dominant culture.
Jonathan Shay states, “More than 40 percent of Vietnam combat veterans sampled in the late 1980’s by the congressionally mandated National Vietnam Veterans Readjustment Study reported engaging in violent acts three times of more in the previous year. We’re talking about 300,000 men here. The percentage of combat veterans who reported averaging more than one violent act a month was almost five times higher than among the sample of civilian counterparts.”
2. Had medical attention in battle zones changed for your generation?
Vietnam had MASH units and speedy evacuation available by helicopter, which were major advances in helping wounded persons return to the battle. Persons with terrible injuries that would have died in other wars often did not die. Even still, the Washington Post cites that 24% of wounded soldiers did not survive in the Vietnam War.
One of the biggest long term impacts of the MASH system on civilian life was the ascendancy of the Physician’s Assistant as a viable post war profession born from systematic re-education of MASH medical personnel.
3. Fought in and around civilians, were civilian injuries a major part of your war experiences?
As a young American woman I did not fight in the war, however my father was one of the many US men who took advantage of civilian opportunities to work for corporations that contracted for the military to build air bases and other infrastructure. He left home and was gone for two years. He sent a few very descriptive letters back, leaving out much of the horror he had to have seen. His efforts helped our family financially, but not without emotional cost. I am sure that much money was made on the war by the civilian industrial complex. It would have been interesting to know more about the influence of the private business sector involved in the war on the political decision to remain in the war for as long as we did.
4. Much has been written and said about the lasting affects of the Vietnam soldier’s lives. How have those war injuries healed…both physical and emotional?
I can only hope that we as a society have learned not to treat our returning soldiers poorly in response to political disagreements about the justification of the war in which they served. I think that the distrust of government engendered during the political upheaval during the war has contributed to lack of participation in political processes on the part of many every day Americans. I fear that those who would use governmental power to further their social agendas have rushed into the participation vacuum and are changing the balance of those freedoms and privileges that we as a society have taken for granted, and for which our soldiers have fought. I fear that the violence, abuse and distrust that has cascaded down from the Vietnam War experiences of our soldiers has spread wide and far in our society, and has made us a meaner and less generous society than we were when we felt that our war efforts at least had a noble, defendable cause. I worry that our failure to win the Vietnam War has contributed to making us as a society value winning over other strategies for happiness in life. Certainly the substance abuse habits brought back by legions of Vietnam Veterans has had a cascade effect on society at large, and has contributed to the size of the “drug war” prohibition effort that is so hopeless and expensive for us.
5. Now that you are the parents of the Gulf and Iraq war soldiers, how do you respond to those who are injured? Have medical advances made any difference?
I am not a parent of a soldier. It chills me as a citizen to hear of our young soldiers in a war where they have to raid scrap heaps to armor their vehicles while others wear state of the art body armor. It chills me to hear about tours of duty extended, knowing what I know about what happens to one’s character with extensive contact with enemies. I fear for the mental health of our soldiers when I hear that we have found no Weapons of Mass Destruction to justify the deaths of so many soldiers and civilians on both sides in a guerilla war where Iraqi’s themselves want us out. One advance that may help is the fact that PTSD is now recognized by the American Psychological Association as a true diagnosis, and the armed forces also recognize it as a true, disabling disorder caused by reactions to abnormal circumstances. I can’t imagine the pain of soldiers in many previous wars who bore the stigma of the disorder and its cascade of personal consequences without any legitimization or efficacious treatments.
On the physical side, the Washington Post cites figures that only 10% of Iraq war soldiers injured die of their injuries, as opposed to nearly a quarter of those injured dying in the Gulf War and in Vietnam. The Post also states that 10,300 US soldiers have been injured with 1000 dead so far. In Vietnam it took about 45 days for a wounded soldier to get to a US hospital, whereas at the beginning of the Iraq war it was 8 days. Now it is 4. Blinding incidents are up, due to soldiers’ refusal to wear protective gear, and severe head and extremity lesions predominate in the physical side of injury. I haven’t seen numbers on PTSD for Iraq yet. The Abu Grebe violations seem to me to be the tip of an ice burg, showing us, if we will only see that decent human beings can turn into monsters in war. No amount of medical advance will stop that, the gravest of injury.