The Legacy of Psychological Trauma from the Vietnam War for
American Indian Military Personnel
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.
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 AmVets, American Legion, Disabled American Veterans, Paralyzed Veterans of America, Military Order of the
Purple Heart or Veterans of Foreign Wars (directory of VSOs).
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."
