Vietnamese Amerasians and the former political prisoners of South Vietnam are living legacies of the Vietnam War. Now that many live in the United States, it is important for psychiatrists to have an understanding of their life experiences and be able to recognize psychiatric disorders that are common among them. Both groups present diagnostic and therapeutic challenges because of their extensive histories of trauma and cultural traditions that differ from mainstream patients. Their stories illustrate the multiple stressors that affect immigrant and refugee populations, such as adapting to unfamiliar cultural practices, learning new languages, finding ways to support themselves and their families, and crafting an identity that integrates who they were and who they have become. Finally, they demonstrate a resilience that allows them to overcome seemingly insurmountable obstacles and move on despite overwhelming experiences and losses.
Vietnamese Amerasians are the children of American men and Vietnamese women born during the years of major United States involvement in Vietnam—1962 to 1975. Unlike the French, who offered citizenship and the opportunity to live and be educated in France to their "Eurasian" offspring,1 the US government exhibited a highly ambivalent attitude toward its children in Vietnam, initially denying responsibility for them and then (beginning in 1979) processing their applications for immigration to the United States under the Orderly Departure Program (ODP).2
In 1987 Vietnamese Amerasians were given special priority status under the ODP with the Amerasian Homecoming Act (AHA).3 Between 1979 and 1999 a total of 89,467 Amerasians and their family members entered the United States under the terms of the ODP and AHA.4
Vietnamese Amerasians' status changed radically after the passage of the AHA. As if by an alchemist's hand, the "dust of life" were transformed into "golden passports" (a Vietnamese metaphor used to describe Amerasians), which allowed them and their close relatives to immigrate to the United States.3,5 Vietnamese persons claiming to be Amerasian or family members of Amerasians could immigrate to the United States with relative ease and safety. By 1993 immigration fraud had become so acute that it was difficult for legitimate Amerasians and their relatives to gain acceptance to the resettlement program, and the Amerasian Transit Center in Saigon, a collecting point for Amerasians and their families, closed.6,3 There are still an undetermined number of Amerasians in Vietnam, but their chances of ever reaching the United States are remote.
Adjusting to a new country
An early study of Vietnamese Amerasian children placed in the United States by the US Catholic Conference found serious adjustment problems, including running away, depression, and withdrawal—behaviors correlated with not living with their biological mothers and having had no formal education in Vietnam.7 This study also contradicted the perception that Amerasians were the products of brief liaisons, noting that their mothers had on average lived with their fathers for 2 years.
Subsequently, Nicassio and associates,8 using the Personality Inventory for Children, found higher levels of psychological distress in Amerasians than would typically be found in a nonclinical US sample. In addition, problems adjusting to American life were reported to Mutual Assistance Associations by 83% of Amerasians during their first 2 years in the United States, and after 4 years, 62% reported difficulties related to having an unstable home, being male, having a father from a minority group, and living outside the Southeast Asian community.9
Two later studies comparing the lives of Amerasians in the United States with those of Vietnamese immigrants found that despite early adversity and ongoing psychological distress, most Amerasians were able to adapt to life in the United States at levels comparable to those of other Vietnamese immigrants.3,10 Amerasians' higher levels of psychological distress were often related to their experiences of discrimination and poverty in Vietnam,6,11 paternal loss,12 maternal abandonment,13 identity issues related to mixed ethnicity,1,6,14 and a perceived lack of like-ethnic community support in the United States.10
FORMER POLITICAL PRISONERS OF VIETNAM
Former US allies in the South Vietnamese government and military faced a different set of challenges. Those who were unable or unwilling to leave Vietnam at war's end were quickly rounded up and sent to reeducation camps, ostensibly to learn about the new government and its policies, but really to be isolated as potentially dangerous enemies and subjected to forced labor, brainwashing, and torture.2 Depending on the government's perception of their "crimes," prisoners remained in the camps from a few months to more than 20 years.
After being released, former prisoners had to adjust to life in a country that had been turned upside down. Once privileged, they were now outcasts and struggled to provide for themselves and their families. Many became sick under the camps' brutal conditions and had to depend on their families for support. Their wives often took on the head-of-household duties—traditionally not a woman's role in Vietnam—and this led to painful readjustments in marital and familial relationships. Eventually granted special refugee status by the United States, former political prisoners who had spent 3 or more years in reeducation camps were permitted to immigrate to the United States with their families.2
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