The Legacy of Psychological Trauma from the Vietnam War for American Indian
Military Personnel
A National Center for PTSD Fact Sheet
The Matsunaga Vietnam Veterans Project
Military personnel of many ethnic backgrounds served with distinction in the
Vietnam War. The 1988 National Vietnam Veterans Readjustment Study (NVVRS)
demonstrated that Black and Hispanic veterans who served in Vietnam experienced
significantly greater readjustment problems and higher levels of Posttraumatic Stress
Disorder (PTSD) than White veterans.
To extend the study to other minority veterans, the late Senator from
Hawaii, Spark Matsunaga, initiated a major project to assess the readjustment
experiences of American Indian, Japanese American, and Native Hawaiian veterans
of the Vietnam War. This resulted in Public Law 101-507, which directed the
VA's National Center for PTSD to conduct what became known as the Matsunaga
Vietnam Veterans Project.
The Matsunaga Project involved two parallel studies. The American Indian
Vietnam Veterans Project surveyed a sample of Vietnam in-country veterans
residing on or near two large tribal reservations, one in the Southwest and the
other in the Northern Plains. These
populations had sufficient numbers of Vietnam military veterans to draw
scientifically and culturally sound conclusions about the war and readjustment
experiences.
The Hawaii Vietnam Veterans Project surveyed two samples, one of Native Hawaiians
(the indigenous peoples of the Hawaiian Islands, who constitute about 22% of
the permanent population in Hawaii) and another of Americans of Japanese
Ancestry (the descendants of Japanese immigrants who comprise about 24% of the
permanent population in Hawaii).
Matsunaga study participants were interviewed face-to-face for several hours
with culturally sensitive questions about their prewar and war experiences;
their Posttraumatic Stress Disorder (PTSD) and other health problems; their
personal, family, work, and education readjustment experiences; and their use
of Veterans Affairs health care services. Only men participated because,
despite their key contributions to the military, there are few women Vietnam
veterans in these survey populations. Although many American Indian veterans
from other tribes and areas of the United States served in Vietnam, in a single
study it is not possible to characterize every possible American Indian tribe
or veteran. The many American Indian experiences and cultures all require
recognition and respect. The similarities and differences revealed by surveying
hundreds of Vietnam veterans from each of two large and different tribes bring
to life the richness and diversity of the American Indian experience before,
during, and after the Vietnam War.
The Matsunaga Study's key finding is that exposure to war zone stress and
other military danger places veterans at risk for PTSD several decades after
military service. Native Hawaiian and American Indian Vietnam in-country veterans
had relatively high levels of exposure to war zone stress and high levels of
PTSD. Caucasian and Japanese American veterans tended to have somewhat lower
levels of exposure to war zone stress and later PTSD.
The unique cultural traditions, society, and family experiences of each
different ethnic group played an important role in the veteran's homecoming and
readjustment after Vietnam, but they do not appear to either cause or prevent
PTSD.
American Indian Veterans' Experiences before and during the War
"I was a happy, healthy boy, and I felt in harmony with my family, my
people, and the earth because of the teachings my grandfather shared in
traditional ceremonies and that my father shared when we'd go fishing. I grew
up in a hurry when I enlisted in the Marines after high school, and I hated
being looked down on as an Indian. I had to swallow the anger and shame when
they jokingly called me Chief. Nothing prepared me for the physical and
spiritual violation of war. I stayed for three tours because I lived so much
with death that I couldn't come home."
Before Military Service
American Indian veterans described growing up in a supportive tribal
community, on or off reservation, in which they felt securely included in their
extended families and close to their parents. They rarely recalled physical
abuse, less so than any other ethnic group except Japanese Americans. They and
their families were very involved in traditional activities such as tribal
gatherings and ceremonies, and they learned to trust and honor traditional
values. These men often attended and completed school and were actively
involved with their peer group and in organized activities such as athletics.
Disciplinary or legal problems were rare. However, many experienced the
stressor of adult members of their families who suffered from substance abuse
or PTSD.
Entering Military Service
American Indian veterans often joined the military as a way to obtain
opportunities for education, jobs, and travel not otherwise available to them.
In addition to wanting to serve their country, many wanted to become
warriors to protect their families, to uphold the honor of their tribes, and to
prove themselves as men. Military training was a shocking new experience with
good and bad aspects. For the good, many found the discipline, skills, and team
spirit an invaluable preparation both for war and later adulthood.
On the other hand, many felt torn between traditional spiritual and
community values and the military emphasis on aggression and killing. Many
faced racial prejudice and discrimination, often for the first time up close,
and felt disillusioned when they or other Indians encountered racial hostility
or disrespect.
More than one in two American Indian veterans experienced war-related trauma
in Vietnam. The war traumas included being on frequent or prolonged combat
missions in enemy territory; encountering ambushes and firefights; being
attacked by sappers, snipers, artillery, or rockets; and witnessing death and
terrible harm to their own or others' bodies.
Traumas also included being under fire on helicopters, cargo and
reconnaissance aircraft, patrol boats, and cargo trucks and being on very
hazardous duty such as walking point or being a radio operator, medic, scout,
tunnel rat, perimeter sentry, long range patrol, or door gunner.
American Indians faced war trauma so often for many reasons, including
because they were more likely than any other ethnic group to serve in the
Marines (the branch of service with most combat duty) and in the northernmost
sector of Vietnam (I-corps, the area under greatest enemy attack).
American Indians and Native Hawaiians received combat service medals more
often than individuals in other ethnic groups.
American Indian Veterans' Homecoming and Readjustment Experiences
"I was spit on and called a baby-killer in the mainstream culture when
I first came home, and no way any college would accept me or any good job would
be open to me. I felt too ashamed and enraged to accept the love and gratitude
my family and community showed me. I thought I was going crazy, waking up in a
sweat trying to choke my wife, seeing signs of Charley around every corner when
the weather was hot and steamy. I'd always kept my feelings to myself, but now
I didn't seem to have any feelings except anger. I couldn't get through a day
without getting into a fight, and when I tried to numb the pain with alcohol I
just got more angry and out of control. I left my wife and kids because I was
ashamed and afraid of what I was doing to them, but I miss them still. I've had
more jobs than I can count, and I walked out on every one because I'd start to
feel trapped. I really never left Vietnam until just a couple of years ago
after I got sober in a program, and then I felt I had to either go back to my
tribe and go through the healing ceremonies or I was going to kill myself. I'm
finally beginning to come home, with the help of a Vet Center counselor and the
Blessing Way in my community."
The Long Journey Home
Many veterans are unable to leave behind the trauma of Vietnam and
psychologically return home. They struggle with a variety of extremely severe
problems that they and their families, friends, and communities do not
understand or know how to cope with:
- Fears (such as of closed
spaces, crowds, unfamiliar places, or sudden attack)
- Anxiety (such as
restlessness, obsessive worries, compulsive rituals)
- Panic (such as a terror of
losing control, suffocating, or going crazy)
- Depression (such as
hopelessness, loss of all interests, suicidal impulses)
- Rage in the form of either
intense violent emotions or violent actions
- Irritability (such as
feeling constantly annoyed, on edge, and critical)
- Shame (such as feeling
embarrassed, exposed, violated, or like a misfit)
- Guilt (such as feeling
others should have lived and he should have died, or feeling that he
failed or made mistakes that had terrible consequences)
- Isolation (such as being
physically present but emotionally absent, going off alone for long periods
of time, or refusing to talk about family matters)
- Emotional emptiness (such as
staring off into space blankly or refusing to show any feelings when
everyone else is very emotional)
- Alienation (such as feeling
that no one understands or that everyone makes too much fuss about
unimportant things and too little about big problems)
- Being over-controlling (such
as being extremely demanding or needing to make all decisions even if they
are really someone else's responsibility)
- Inability to relax (such as
always being on the go, never able to have fun, or turning everything into
serious work or a crisis)
- Addiction (such as
compulsive overuse of alcohol, drugs, or gambling)
The Hidden Enemy: Posttraumatic Stress Disorder (PTSD)
What neither these veterans nor their families (nor even many VA counselors
and doctors) knew was that many of these veterans were and are suffering from
PTSD. The symptoms of PTSD include:
- Unwanted distressing memories
or a feeling of reliving traumatic Vietnam experiences (flashbacks)
- Nightmares and difficulty
falling or staying asleep restfully
- Bodily stress and tension,
especially when reminded of traumatic Vietnam experiences
- Loss of interest in
activities and difficulty concentrating on activities or projects
- Detachment or withdrawal from
emotional involvement in relationships
- Difficulty feeling or
expressing emotions other than irritability or frustration
- Feeling like there is no
future or their lives will be cut short by an untimely death
- Feeling jumpy, on edge, and
easily startled
- Feeling constantly unsafe and
unable to let down their guard (hyper-vigilant)
About one in three American Indian Vietnam veterans who served in-country
suffered from full or partial PTSD at the time of the study, a quarter century
or more after the war. More than two in three American Indian Vietnam veterans
suffered from full or partial PTSD sometime since Vietnam. PTSD prevalence for
American Indians is very high, more than twice as high as for White or Japanese
American Vietnam veterans.
PTSD's Effect on Family and Friendships
American Indian Vietnam veterans reported the most severe problems of any
ethnic group in the NVVRS or Matsunaga Project. They tended to be extremely
isolated from relationships and community, primarily as a result of PTSD. The
Northern Plains veterans were by far the most likely of any study group,
including Southwest tribal veterans, to have been verbally hostile in the
recent past, to have been homeless or vagrant, to have been divorced once or
several times, and to have had problems as a parent. PTSD explains much of
these interpersonal problems. In addition, the Northern Plains veterans had
great difficulty in rejoining the very tightly knit extended families and
communities of their tribes after the war. For example, only one in seven of
these veterans had participated in a traditional healing ceremony, compared to
one in two Southwest Indian veterans.
Other people, such as spouses, children, family members, friends, or
coworkers, often are more aware of the veteran's emotional distress than he is
himself. Decades of haunting memories and overwhelming feelings leave the
veteran suffering from PTSD feeling demoralized and alone. He may believe that
as a man he must bear the burden of pain, fear, anger, shame, and guilt
silently. He may believe that he has failed his most precious loved ones and
lost the respect of his community. He may feel helpless to conquer the habitual
urge to drink alcohol. As a result, it becomes almost impossible for him to
enjoy life or relationships, and the harder he tries to fight the symptoms the
more stressed he becomes! Yet, when family or friends see signs of the
veteran's inner turmoil, they don't know why it's happening and often blame
themselves: "I always thought it was something I was doing wrong, but I
never knew what!" Nor do they know how to help: "I gave up trying to
break through his emotional walls."
The family's view of PTSD may include:
- "Little things get him
very depressed or enraged, like he's always at the end of his rope."
- "He tries to enjoy
being with us, but his heart's not in it and his mind's always somewhere
else."
- "For him, every
problem's a disaster, and we're slow, stupid, and never careful or tough
enough."
- "He's always got to be on
the go, can never sit still, and can't even hold the same job for
long."
- "I never understood why
he kept going back to alcohol, even though he always ends up in a fight,
in jail, or out in the mountains for weeks after he's been drinking. He
won't stop even though it's killing him."
PTSD's Effect on Work and Education
Getting and keeping a good job, or returning to complete school or for
advanced education, require exactly the abilities that are most impaired by
PTSD: mental concentration, managing anger, solving problems without turning
them into crises, communicating clearly, balancing work with relaxation, and
feeling a sense of hopefulness and purpose. Despite courageous efforts,
veterans with PTSD often become trapped in the vicious cycle of settling for
bad jobs and avoiding or walking out on good jobs. Now well into their 40s and
50s, Vietnam veterans with PTSD face great difficulty in getting a good
education or having a rewarding career. Of all survey groups, the Northern
Plains veterans have had the most difficulty keeping jobs, mainly because they
also were the most likely to suffer from PTSD.
PTSD's Effect on Addiction
Over 70% of the American Indian Vietnam veterans have current serious
problems with alcohol overuse or dependence, more than twice as many as any
other group in the NVVRS or Matsunaga Project. Addiction to any drug other than
alcohol, however, was not a greater problem for American Indian veterans than
for other veterans. PTSD plays a substantial role in these veterans' alcohol
problems, but the discrimination, isolation, and demoralization experienced by
Native American civilians and veterans is also a factor. Alcohol is a tempting
(false) solution to PTSD symptoms such as nightmares ("drink yourself into
a dreamless stupor"), unwanted memories and fears ("drink until your
mind is blank"), anger and tension ("drink to take away the
edge"), hopelessness and emotional numbness ("drink until you feel no
pain"), and hyper-vigilance ("drink until you don't care
anymore"). Unfortunately, excessive habitual use of alcohol causes a
person to feel edgy, irritable, unable to concentrate, and more demoralized
than ever.
PTSD's Effect on Physical Health
American Indian Vietnam veterans reported the poorest physical health and
the highest level of medical care use of any NVVRS or Matsunaga Project group.
This may be partly due to chronic alcohol overuse, which often is associated
with smoking and poor health habits. However, PTSD also plays a role in poor
physical health. PTSD symptoms such as restlessness, tension, irritability,
anxiety, and poor sleep are exhausting and hard on the body. Culturally, it
also may be more acceptable to disclose somatic problems and pains to family or
medical providers than to admit emotional distress. Physical illness more often
results in sympathy and concern, while emotional distress may be mistakenly
viewed (by the veteran, his family and community, or the medical provider) as a
sign of weakness or lack of character. In fact, the emotional distress and poor
physical health associated with PTSD are both signs of a legitimate need for
traditional healing and mainstream medical and mental-health care.
Steps toward Recovery for the Veteran and Family
Recovery from PTSD involves several steps by which a veteran and family can
begin to recover from the emotional wounds.
Recovery also involves taking steps toward regaining a healthy, happy,
and satisfying life:
- Talk frankly and privately
to a trusted healer or counselor who is sensitive to the understandable
feelings of guilt or embarrassment.
- Learn about psychological
stress and trauma, for example by reading or by taking a class.
- Books often recommended by
veterans and families include:
- I Can't Get Over It: A Handbook for Trauma Survivors by Aphrodite
Matsakis, New Harbinger Publications, 1992
- Recovering from War by Patience Mason. Viking Penguin, 1990
- Two video programs
describing the Vietnam and post-Vietnam experience of American Indian
veterans are also available. These materials have been distributed throughout
the VA and may be obtained through the VA Library system:
- Wounded Spirits Ailing Hearts:
PTSD and the Legacy of War among American Indian & Alaska Native
Veterans. See below for more information. This video is also available online: Wounded Spirits
Ailing Hearts.
- The Shadow of the Warrior, St. Louis Regional Learning Resources
Service, Department of Veterans Affairs, 1986
- Begin experimenting with small changes in your activities and lifestyle
that give you a feeling of greater satisfaction, enjoyment, relaxation, and
accomplishment. Every small step toward feeling more in control of your own
destiny brings emotional renewal and genuine intimacy in relationships.
- Become involved with traditional teachers and healing ceremonies in your
community. Rediscover traditions that have helped countless warriors return
home, heal the wounds of war, and become vital members of their families and
communities.
- Seek medical or mental-health help from your nearest Department of Veterans
Affairs Vet Center, Medical Center, Outpatient Clinic, or Veteran Benefits
Office.
Wounded Spirits Ailing Hearts:
PTSD and the Legacy of War among American Indian & Alaska Native
Veterans. This project was jointly sponsored by the National
Center for PTSD, the American Indian and Alaska Native Mental Health
Research Department of Psychiatry, University of Colorado, Denver
Colorado, and VA Employee Education System, 2000. This video is available online: Wounded Spirits
Ailing Hearts
A set of four videotapes with an accompanying
booklet have been developed and distributed in separate binders to facilitate
broad use by multiple audiences. All videotapes contain instructional content
related to Posttraumatic Stress Disorder and interviews with native veterans
and family members. They provide powerful personal examples of military
experience and readjustment to civilian life including experiences with VA and
Indian Health Resources. Only the materials contained in video 3 and 4 and
print materials include independent study material for primary care and mental
health staff. Specific instructions for registration and completion of the
study are contained in the accompanying booklets.
Videotape 1 and booklet:
For general audiences
Videotape 2 and booklet:
For
Native veterans, family members, and the community
Videotape 3 and booklet:
Independent
Study for Primary Care Providers
Videotape 4 and booklet:
Independent
Study for Mental-Health Providers
Guidelines for productive and helpful discussion of stress and trauma:
Each person has a different point of view that should be stated honestly and
respected, not criticized or rejected. Stress and trauma affect everyone in a
family or close relationship, so everyone in the situation needs to help and be
helped. Listen carefully to learn, provide moral support, and find solutions
rather than blaming or finding fault. Tell what is most important to you, not
what you think you are supposed to say to be polite or to attract sympathy.
Take each person's feedback seriously, as we all see our own stress
reactions less clearly than other people see them. If talking seems to make
things worse, or just doesn't help, find a helper such as a counselor, elder,
or a spiritual advisor.
Help is available for American Indian Vietnam veterans suffering from
PTSD
Because of the publication of the Matsunaga Study's findings in June1997,
medical and mental-health clinicians at all Department of Veterans Affairs Vet
Centers, Medical Centers, and Outpatient Clinics are more aware than ever that
American Indian veterans who experienced trauma in Vietnam may need help with PTSD.
Vet Center counselors often provide outreach services right in the community
(as well as to prisons and schools) to help veterans who are reluctant or
unable to come to a VA hospital. VA clinicians and counselors know how to
privately and sensitively help veterans to recover from health or family
problems that are the hidden result of PTSD.
If you have never sought or received care from a DVA hospital or clinic,
here are practical steps any veteran can take today to enroll in DVA medical
care.
1. Call the VA Benefits Office near you
and ask for an initial appointment to discuss how to file an application for
healthcare eligibility or financial benefits from VA. This toll-free number can
also help you locate the other services listed below: 1-800-827-1000
2. Call the Vet Center
nearest you and ask for an intake appointment to discuss with a counselor any
health, stress, or mental-health concerns that you suspect are due to Vietnam
military service or to service in the military in any other war zone before or
since Vietnam. Consult your local telephone directory under United States
Government, Veterans Affairs, or call 1-202-273-8967.
3. Call a VA medical center or outpatient
clinic near you and ask for an intake appointment for a thorough health check.
4. If you would like more information on programs and services for veterans,
consult the Department of Veterans Affairs
education home page on the Internet. Visit your local library if you do not
have access to the Internet at home. The Veterans Affairs Internet address is: http://www.va.gov.
5. For assistance in establishing eligibility for VA medical care or help in
receiving VA financial benefits, make an appointment to speak with a Service
Officer from a Veterans Service Organization such as:
Every VA hospital and clinic has a PTSD specialist who is familiar with
readjustment problems that can be caused by war trauma. The specialist can provide you with a
thorough evaluation and recommendations for treatment. PTSD treatment may
involve:
- Educational classes for
veterans and for families about trauma, PTSD, and recovery
- Educational and support
groups for dealing with anger, depression, anxiety, and stress
- Special supportive therapy
and socialization groups for American Indian veterans
- Special therapy groups for
veterans with PTSD from war or other military trauma
- One-to-one therapy and
supportive guidance
- Evaluation to determine if medication
would be beneficial and acceptable to the veteran
- Counseling and education to
assist in coping with the stress of chronic medical problems
- Evaluation and treatment for
alcohol abuse or dependence
"Oh
Grandfather, there is one war left that is raging, worse than all the wars I
have survived." "Oh Grandfather, I need guidance, patience,
understanding as this final war rages within me." "Oh Grandfather,
help me overcome this turmoil within my heart and mind, bring peace to my mind,
end these feelings of hatred, of hurt, of death, of revenge, and replace them
with love, compassion, and caring for my people. So I can live the rest of my
life in peace."
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