Thursday, March 15, 2007

Review of “Achilles in Vietnam” by Jonathan Shay, M.D., Ph.D.

One of the books I had been planning to read for several months is Dr. Jonathan Shay’s groundbreaking work: “Achilles in Vietnam – Combat Trauma and the Undoing of Character.” I am glad that I finally found the time to acquaint myself with its message. The book is remarkable for several reasons. On its surface, it is one of the most comprehensive examinations of the phenomenon of Post Traumatic Stress Disorder among Vietnam veterans. Beneath the surface level, it is a brilliant exposition of the experience of Vietnam veterans in comparison with - and in contrast to - the warriors whose battlefield experiences in Troy are described in Homer’s Iliad. To look at the tragedy of what our Vietnam veterans have experienced in returning home from that war through the lens of Homer’s epic adds a poignancy and depth that is utterly without peer in my knowledge of PTSD literature.

My reading of this book is both timely and relevant, in light of the ongoing investigation of current conditions and practices of treating veterans returning from deployments in Iraq and Afghanistan. It is also timely in that the televised coverage of the conflict in Mesopotamia has ripped open scabs and exposed unhealed emotional and psychological wounds in a large number of Baby Booker generation Vietnam veterans. They are returnign to VA hospitals and clinics in droves.

“Such unhealed PTSD can devastate life and incapacitate its victims from participation in the domestic, economic and political life of the nation. The painful paradox is that fighting for one’s country can render one unfit to be its citizen.” (Page xx)

Dr. Shay does a masterful job of using his own deep clinical experience of treating veterans at the VA Outpatient Clinic in Boston to lay out a clear and disturbing picture of how the way in which the Vietnam War was waged led to a staggeringly high percentage of returning veterans who are plagued with PTSD. I have enormous respect for the work he has done, for work as an author in sharing his understanding with the wider community. One caveat I must mention is that Dr. Shay clearly has a strong animus against traditional monotheistic religion in general - and the Judeo-Christian tradition in particular. He lays at the feet of organized religion much of the blame for the dire straits that our Vietnam veterans still find themselves. I do not necessarily agree with the conclusions that his philosophical position has led him to make, but with that exception, he lays out lucid and cogent explanations, diagnoses and prescriptions for addressing the troubling issue of persistent PTSD among Vietnam veterans.

An overarching principle that permeates the book is Shay’s belief that healing from PTSD can only begin to happen when veterans are empowered to tell the narrative of what they saw and experienced in Vietnam, and that narrative must be communalized among other veterans and then more widely among family, friends and the broader community. For most Vietnam veterans, the conditions have not always existed to foster and to enable such difficult and painful communication. A veteran shares his frustrations in trying to tell others about his Vietnam experiences:

“I had just come back [from Vietnam] and my first wife’s parents gave a dinner for me and my parents and her brothers and their wives. And after dinner we were all sitting in the living room and her father said: ‘So, tell us what it was like.’ And I started to tell them, and I told them. And do you know within five minutes the room was empty. They were all gone, except my wife. After that I didn’t tell anybody I had been in Vietnam.” (Page xxii)

Dr. Shay ends his introduction with a clarion call to his readers to take an active role in the healing that is long overdue and the prevention of future hurt:

“To all readers I say: Learn the psychological damage that war does. There is no contradiction between hating war and honoring the soldier. Learn how war damages the mind and spirit, and work to change those things in military institutions and culture that needlessly create or worsen these injuries. We don’t have to go on repeating the same mistakes. Just as the flak jacket has prevented many physical injuries, we can prevent many psychological injuries.” (Page xxiii)

A motif that runs throughout this book is the strong belief that everything about the way in which the Vietnam War was fought – by the enemy and by American leaders and policy-makers – violated fundamental assumption of what is right and wrong in the world. This violation of basic assumptions is seen, by Shay and others, as the root cause for many of the psychological problems that attend those who returned from Vietnam as different men than the innocents who had first landed in Southeast Asia.

“The moral dependence of the modern soldier on the military organization for everything he needs to survive is as great as that of a small child on his or her parents. One Vietnam combat veteran said: ‘The U.S. Army [in Vietnam] was like a mother who sold out her kids to be raped by [their] father to protect her own interests.’ (Page 5)

“When a leader destroys the legitimacy of the army’s moral order by betraying ‘what’s right,’ he inflicts manifold injuries on his men. The Iliad is a story of these immediate and devastating consequences. Vietnam has forced us to see that these consequences go beyond the war’s ‘loss upon bitter loss . . . leaving so many dead men’ to taint the lives of those who survive it.” (Page 6)

“Veterans can usually recover from horror, fear and grief once they return to civilian life, as long as ‘what’s right’ has not also been violated.” (Page 20)

In the chapter entitled “Grief at the Death of a Special Comrade,” Dr. Shay lays out his premise about the need for communalization of grief:

”Any blow in life will have longer-lasting and more serious consequences if there is no opportunity to communalize it. This means some mix of formal social ceremony and informal telling of the story with feeling to socially connected others who do not let the survivor go through it alone. The virtual suppression of social griefwork in Vietnam contrasts vividly with the powerful expressions of communal mourning recorded in Homeric epic. I believe that numerous military, cultural, institutional, and historical factors conspired to thwart the griefwork of Vietnam combat veterans, and I believe that this matters. The emerge of rage out of intense grief may be a human universal; long-term obstruction of grief and failure to communalize grief can imprison a person in endless swinging between rage and emotional deadness as a permanent way of being in the world.“ (Pages 39-40)

The author shares several vivid descriptions of those combat veterans who have devolved to a berserk state. He also points out, in contradistinction to the “berserkers,” the value of those who experience the horrors of war and yet somehow resist the pressure to become subhuman in their response:

“Gentle people who somehow survive the brutality of war are highly prized in a combat unit. They have the aura of priests, even though many of them were highly efficient killers.” (Page 44)

This arresting description of “gentle warriors” makes me think of many friends I know – Renaissance Men who are also patriotic soldiers, sailors, airmen and Marines – who have returned from their deployments to Iraq and Afghanistan. To be sure, they have returned changed – in terms of their frame of reference and the vast library of memories and experiences they amassed in war. But they have remained essentially unchanged in terms of basic character and temperament. As Shay has indicated in this book, they tend to be individuals who have strong networks of support that they have used as platforms for telling the narrative of their combat experiences. Many began that narrative process even before returning home – through e-mails, Blogs and published articles and books.

In the chapter, “What Homer Left Out,” Dr. Shay offers a very helpful and concise summary of the four kinds of traumatic war experiences that lead to PTSD:

“These four clusters are exposure to combat, exposure to abusive violence, deprivation, and loss of meaning and control. The four clusters are all aspects of war trauma, and PTSD symptoms are the lasting results for the veteran after the war.” (Page 123)

This is a book that will add value and insight to any individual who is committed to helping veterans – from the Vietnam era and the most recent wars in the Gulf – to find healing and wholeness after experiencing the devastations of war. Those of us, as civilians, who feel we are unqualified to participate in the communal healing that is sorely needed, will find comfort and challenges in the truths that Dr. Shay presents in this seminal work. If we, as a society, fail to respond – pro-actively and with compassion – to the chronic challenge of PTSD and those who suffer from it – it will remain our “Achilles’ heel.”


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