Personal Responsibility in
Traumatic Stress Reactions (excerpt)
NAM VET Newsletter, Page 20, Volume 3, Number 6,
June 10, 1989
By John Russell Smith, Reprinted from PSYCHIATRIC ANNALS 12(11):1021-1030, 1982.
Quite often, when there is not an initial working through and resolution
of traumatic experience, the return to normal functioning forces the working through of
the traumatic action to take place at the subconscious level. Thus, in many survivors, the
playing out of the traumatic action often takes the form of very concrete undoing, as in
the above case. In another case, the clinician may see a veteran who flew aircraft
spraying chemical defoliant in Vietnam who denies that the war had any impact on his life,
but now works as a chemical safety officer for a major chemical firm. Subconscious undoing
of the past "fault," frequently by being intensely involved in directly helping
victims similar to those in Vietnam, is a common and effective pattern in medics,
corpsmen, doctors, nurses and chaplains for avoiding conscious confrontation with one's
own wartime actions. This pattern is especially dramatic in former combat nurses who not
only persist in healing roles but often find themselves continuing to function in crisis
and emergency situations, where the circumstances of their current positions play out
concretely the stresses of their own traumatic war experience. These helping professionals
will often devote large amounts of time to counseling others even in groups where they are
ostensibly members seeking help. Frequently, only a dramatic episode will trigger the
recognition that they also have personal experience which needs to be explored.
M, a Boston nurse who had served in Vietnam, described her current difficulties in a
recent interview. She was haunted by troubling thoughts of Vietnam and described her
inability to stay in bed at night without the light on. Since her return, she indicated
that not a week had gone by without recurrent thoughts about the decisions she had made in
Vietnam. She gave the example of one night when, with a short-handed unit, she became the
triage officer whose duty it was to asses the gravity of injuries and then select, given
the limited treatment resources, those soldiers with salvageable wounds who would receive
treatment, leaving those soldiers too severely wounded to die. As ostensibly neutral
non-combatants, despite their vigorous objections, the medical staff was required to treat
both Americans and any wounded North Vietnamese prisoners. Torn over an oath to care for
all the injured, she followed common practice and selected Americans with even minor
injury for treatment while leaving North Vietnamese prisoners, with severe but treatable
injuries, to die.
Despite objections, American and North Vietnamese patients were often placed on the same
ward. The nursing staff, loyal to their American charges, were often reluctant to care for
the Vietnamese. One evening M volunteered to change dressings on a severely burned
Vietnamese for whom no one else would care. As she was changing his bandages and cleaning
the wounds, the prisoner suddenly grabbed a pair of scissors and lunged at her. Narrowly
escaping, she called for a pair of military guards to "take care" of him. The
military guards quickly hustled him off the ward. A short while later, they returned to
assure her that he would no longer bother her and that he had been taken care of. She has
a recurrent nightmare about this incident.
Because of a recent flashback experience she no longer carries scissors. On this
particular day in the
operating room, a fellow nurse announced that she was reaching into the pocket of M's
uniform for a pair of scissors. As the nurse did so, M panicked, turned and struck the
other nurse.
Until her interview, she had never spoken with anyone about the earlier incident. Though
highly regarded by her peers, she feels ashamed and inadequate about her performance as a
nurse in Vietnam. Afraid to look into the future, she refused to look at the past, feeling
that if she did, she would start crying and never stop.
Blank <27> has noted that such personal traumatic episodes, repressed and unexamined
for years, yet still powerfully charged affectively, may result later in an unconscious
re-enactment of the episode in vivid concrete detail. Such later recapitulations and
undoing of the past personal action in a traumatic incident may be the key to recapturing
an integrity which opens a channel to recovery.
27 Blank AS Jr: The unconscious flashback to the war in Vietnam veterans: Clinical mystery, legal defense, and community problem. AM J PSYCHIATRY, to be published.
My Vietnam Related Websites:
Women in
Vietnam ~ Read about ALL the women who served . . .
Dusty's Home
Page
The
Irish on the Wall ~ An effort to locate the Irish who died in Vietnam
Tim
O'Brien's Home Page ~ National Book Award Winner and Americal Vet
Emily's Poetry
~ By a Red Cross Donut Dolly
Shrapnel in
the Heart ~ The most moving book you will read on Vietnam
All About
Vietnam ~ An annotated bibliography of books about Vietnam for
sale thru Amazon Worldwide!
Battle
Dressing ~
Project Hearts
and Minds ~ Help put Viet Nam back together
Photos
from a Holts' Military History Tour ~ My trip to Vietnam, February 1998
My Other Websites:
Maybe
Later . . . ~ My Creative Nonfiction
Irish
in Korea ~ Irish men and women who gave their lives in the Korean War
Literature
of the Korean War ~ Don't let the literature be forgotten
Samuel
Pepys ~ One of my favorite authors
Chicago
Theatre Z - A ~ This is the best theater town in the country!
Soccer
Literature ~ I'm a fan and I read
O'Leary Lantern
~ Fire! Fire! Fire!
Gil
Thorp ~ THE Coach (apologies to The General!)
Poetry
of the First World War ~ Owen, Hardy and others
Chi-COW-go
~ Cowz plus Commentary (this used to be a cow town)
Graham
Fulton, Scottish Poet ~ Charles Manson Auditions for the Monkees
Other Important Websites:
The
Truth About Caroline ~ a really good Young Adult book by
my niece, Stacey M. Lane Grosh
Remember
Oklahoma City ~
The Civil Service and Military will
NEVER forget!
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