The Legacy of Psychological Trauma of the Vietnam War for
Native Hawaiian and American of Japanese Ancestry Military
Personnel
The Department of Veterans Affairs 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 findings
to other minority veterans, the late Senator from Hawaii, Spark
Matsunaga, initiated a major project to assess the readjustment
experience 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.
Native Hawaiian Veterans' Experiences Before, During, and After
the Vietnam War
"I grew up close to my family and the land, protected from the
outside world. I enlisted in the Army Reserves when I was working
and going to college part time, and the military discipline was
good for me. Everything fell apart in Vietnam; I felt cut off from
my home and family, in a bloody nightmare. I re-upped for a second
tour because I wanted to die in Vietnam. I came home, went back to
work, got married-but never escaped the memories and dreams of
death. I still feel dead inside much of the time, although I'm
beginning to feel a part of my family as I tell my story in
counseling and to my kupunas."
Before Military Service
Native Hawaiian veterans generally described a positive
relationship with their parents while growing up and valued the
support of their extended families and communities. Some Native
Hawaiians, however, did encounter physical abuse and family
substance abuse while growing up. They learned to trust and honor
traditional values but to distrust the government and mainstream
culture. These men were likely to attend and complete school, have
friends, and be involved in organized activities such as
athletics.
Entering Military Service
More than half of the Native Hawaiian veterans volunteered for
duty in Vietnam to obtain opportunities for education, jobs, and
travel, and they were proud to protect their home and country. Many
re-enlisted and served more than one tour, and many attained the
rank of noncommissioned officer. They tended to value the training
and discipline of military service but often felt isolated from
their fellow soldiers. Many faced close and personal racial
prejudice and discrimination for the first time and felt
disillusioned and angry when they encountered racial hostility or
disrespect.
The Trauma of Military Service in War
More than one out of every two Native Hawaiian veterans
experienced war-related trauma in Vietnam. The war traumas included
being under fire on helicopters, cargo and reconnaissance aircraft,
patrol boats, navy ships, or cargo and transport trucks; being on
frequent or prolonged combat missions in enemy territory (including
Cambodia and Laos); and encountering ambushes and firefights.
Traumas also included being attacked by sappers, snipers,
artillery, or rockets; witnessing death and terrible harm to their
own or others' bodies; and performing very hazardous duties as
walking point, radio operators, medics, scouts, tunnel rats,
perimeter sentries, long range patrollers, or door gunners. Native
Hawaiians and American Indians were more likely than any other
survey group to receive combat service medals in recognition of
their hazardous combat duty.
The Long Journey Home
Upon returning home after one or more tours in Vietnam, many
Native Hawaiian veterans struggled with severe problems that they
and their families, friends, and communities did not understand or
know how to cope with:
Depression (hopelessness, loss of all interests, or suicidal
impulses)
Shame (feeling embarrassed, exposed, violated, or like a
misfit)
Guilt (feeling others should have lived and they should have
died, or feeling that they failed or made mistakes that had
terrible consequences)
Isolation and emotional emptiness (being very remote and
withdrawn)
Alienation (feeling that no one understands or that everyone
makes too much fuss about unimportant things and too little fuss
about big problems)
Unable to relax (restless, sleepless, silently tense or on
edge)
Addiction (compulsive overuse of alcohol)
Japanese American Veterans' Experiences Before, During, and
After the Vietnam War
"I was very dutiful and hardworking growing up, and quietly did
well in school. I respected elders in my family and community, and
sought to bring honor to them without attracting attention to
myself. I joined ROTC in college and was sent to Vietnam as a raw
second lieutenant in the Air Force. As an officer, I didn't see as
much combat as many others. I don't think the men really trusted me
because I looked too much like a Vietnamese to them, but I didn't
harass them and they didn't hassle me. Since Vietnam, I've done
well in my profession. I'm married and raising my children with the
same values I learned. I have nightmares of the war that can give
me a headache and high blood pressure for several days; sometimes
I'm Charlie and my own men are hunting and killing me."
Before Military Service
Japanese American veterans described growing up in close knit
and supportive extended family communities, learning to put
self-interest second to obedience and respect for authority. They
sought success in the mainstream by quietly achieving in school and
college, but their loyalty was to the extended family.
Entering Military Service
Japanese American veterans often enlisted in college and became
officers in order to advance their careers. They were proud to
protect their home and countryand valued military training and
discipline, but they felt isolated. Many faced close and personal
racial prejudice and discrimination for the first time because they
were Asian, and they felt not only disillusioned but also fearful
of being physically harmed ("fragged").
Japanese Americans' Trauma of Military Service in War
More than one in three Japanese Americans experienced war trauma
in Vietnam. Traumas included being under enemy fire or ambushed;
being attacked by sappers, snipers, artillery, or rockets;
witnessing death and terrible harm to their own or others' bodies;
and extreme conflict due to having to kill or be killed by Asians
that other American soldiers often dehumanized.
The Long Journey Home
Although American of Japanese Ancestry veterans often report
feeling happy in their family lives and being successful in their
education and careers, some have silently suffered the following
since returning from Vietnam:
Fears (of closed spaces, crowds, unfamiliar places, or sudden
attack)
Panic (terror of losing control, suffocating, or going
crazy)
Depression (hopelessness, loss of all interests, or suicidal
impulses)
Irritability (feeling constantly annoyed, on edge, and
critical)
Shame (feeling embarrassed, exposed, violated, or like a
misfit)
Guilt (feeling others should have lived and they should have
died, or feeling that they failed or made mistakes that had
terrible consequences)
Isolation and emotional emptiness (being very remote and
withdrawn)
Alienation (feeling that no one understands what's really
important in life)
Over controlling (being very demanding or controlling about
decisions)
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
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)
One in three Native Hawaiian and one in twenty Japanese American
in-country Vietnam veterans currently have full or partial PTSD.
More than one in two Native Hawaiian and one in seven Japanese
American in-country veterans have had full or partial PTSD sometime
since Vietnam. Native Hawaiians' PTSD prevalence is very high,
while the Japanese Americans' is quite low. However, veterans who
experienced war trauma, regardless of cultural or racial
background, are at risk for PTSD.
PTSD's Effect on Family and Friendships
Other people-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 who suffers from PTSD feeling
demoralized and alone. He may believe that his family or community
needs him to bear the burden of pain, fear, anger, shame, and guilt
silently. He may believe PTSD symptoms are a sign of weakness and
failure due to a lack of will power, self-discipline, or
self-control. He may think PTSD is a result of a shameful personal
flaw that must be hidden or corrected by behaving more correctly.
PTSD may be an extreme spiritual crisis. 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 thought I was doing
something 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:
"He tries so hard to be perfect that he can't admit when he
makes a mistake or needs help."
"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."
"It's his duty to behave honorably, so I don't want to shame
him by showing I know he is suffering."
PTSD and Physical Health
PTSD symptoms such as restlessness, tension, irritability,
anxiety, and poor sleep often are viewed by veterans and healthcare
providers as signs of physical illnesses such as high blood
pressure, stomach or bowel conditions, or pain. PTSD affects the
body, and can accompany or worsen physical illnesses.
Because many Native Hawaiian and Japanese American veterans
prefer medical to psychiatric clinics, doctors and nurses can help
veterans learn how PTSD affects the body and how to use good health
practices (such as relaxation, good nutrition, regular exercise,
not smoking, and limiting one's use of alcohol) to manage stress.
Traditional healing practices used in the Native Hawaiian or
Japanese American cultures also can help in the care of PTSD.
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 and work
toward regaining a healthy, happy, and satisfying life
together:
Talk frankly and privately to a trusted healer or counselor who
is sensitive to the understandable feelings of guilt or
embarrassment about emotional and physical stress.
Learn about psychological stress and trauma by reading or
enrolling in a class.
Books often recommended by veterans and families include:
Mason, P. (1990).
Recovering from war. New York: Viking Penguin.
Matsakis, A. (1992).
I can't get over it: A handbook for trauma survivors.
Oakland, California: New Harbinger Publications.
Books describing Native Hawaiian and Japanese American culture
and mental health include:
McCubbin, H., Thompson, E., Thompson, A., & Fromer, J.
(Eds.). (1995).
Resiliency in ethnic minority families: Volume 1: Native and
immigrant American families. University of Wisconsin
System.
McDermott, T., & McDermott, M.
People and cultures of Hawaii: A psychocultural profile.
Honolulu, Hawaii: University of Hawaii Press.
Articles describing Native Hawaiian and Japanese American
veterans' post-Vietnam experiences include:
Hamada, R.S., Chemlob, C.M., Sautner, B., & Sato, R. (1988).
Ethnic identity and Vietnam: A Japanese-American Vietnam veteran
with PTSD.
Hawaii Medical Journal 47, 100-106, 109.
Loo, C. (1994). Race-related PTSD: The Asian American Vietnam
veteran.
Journal of Traumatic Stress 7, 637-656.
Matsuoka, J.K., & Hamada, R.S. (1992). The wartime and
postwar experiences of Asian-Pacific American Vietnam veterans.
The Journal of Applied Social Sciences 16, 23-26.
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 needs to both help and be helped
Listen carefully to learn, provide moral support, and find
solutions rather than blaming or finding fault
Tell what's 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-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
Begin experimenting with small changes in your activities and
lifestyle that give you a feeling of greater satisfaction,
enjoyment, relaxation, and accomplishment in yourself and your
relationships. 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.
Help is available for Native Hawaiian and American of Japanese
Ancestry Vietnam veterans suffering from PTSD
Because of the publication of the Matsunaga Study's findings in
June 1997, medical and mental-health clinicians at all Department
of Veterans Affairs Vet Centers, Medical Centers, and Outpatient
Clinics are more aware than ever that Native Hawaiian and American
of Japanese Ancestry 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 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:
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
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 due 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
Call a VA medical center or outpatient clinic near you and
ask for an intake appointment for a thorough health check.
If you would like more information on programs and services
for veterans, consult the Department of Veterans Affairs home
page on the Internet. Visit your local library if you do not have
access to the Internet at home. The Internet address is:
www.va.gov.
For assistance in establishing eligibility for VA medical
care or for help in receiving VA financial benefits, make an
appointment to speak with a service officer from a veterans
service organization.
Every VA medical center and clinic has a PTSD specialist who is
familiar with readjustment problems caused by war trauma and who
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
Native Hawaiian and American of Japanese Ancestry 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
