Cases that did arise were effectively treated, at least by military standards, by specialized and non-specialized psychiatric personnel applying the traditional military forward treatment doctrine (ie, brief, simple treatments such as safety, rest, wound care, and physical replenishment; peer support; and opportunities for emotional catharsis, all applied as close to the soldier’s unit as practical and accompanied by expectations of rapid recovery of duty, even combat, function). In many instances these treatments were augmented with psychotropic medications.
In time, and resonant with the growing anti-war movement, civilian psychiatrists began to question whether the soldiers so treated were at greater risk in subsequent combat or were more vulnerable to developing delayed psychiatric conditions as veterans. Whereas these doubts were new in the modern history of military psychiatry, the concerns were never systematically addressed.
As the war lengthened, mounting evidence suggested that the enemy’s guerrilla strategy and tactics, the bloody, ambiguous, and often discouraging nature of the fighting, and the rising opposition to the war at home, were causing increasing numbers of low-grade psychological and psychosomatic reactions as well as behavior disorders such as heavy drug use (typically marijuana at that point) and excessive combat aggression. Some deployed psychiatrists came to think that these symptoms and behaviors were collectively expressive of “partial trauma” or “strain trauma” (emotionally taxing events—singular or recurring—that were not of sufficient intensity at the time to make them disabling, but that were nonetheless psychologically injurious).
It is especially noteworthy that from the outset, military psychiatrists went to Vietnam supplied with medications not previously used on the battlefield: neuroleptics, anxiolytics, and the tricyclic antidepressants. In contrast to the sedatives that were used sparingly in earlier wars because they could produce sustained CNS depression and interfere with military performance, these new medications were widely prescribed and thought to produce salutary results. In this respect, the record reveals a great deal of improvisation in the use of these medications under unique war-time conditions.
Psychiatric matters became exponentially more difficult in the second half of the war following the enemy’s Tet Offensives in the winter of 1968 and the consequent social upheaval in the US. Opposition to the war at home rapidly accelerated to become highly charged and confrontational. Although American forces began to assume a secondary combat role to South Vietnam units, accompanied by a steady drop in casualties, the US military saw plummeting morale and widespread dissent, misconduct, racial incidents, and drug use (especially heroin). As a consequence, the Army’s psychiatric hospitalization rate quadrupled during these years compared with that in the buildup phase of the war.
In time, order and discipline became precarious as did military preparedness, while military leaders, law enforcement, and mental health services were all severely challenged. In July 1972, near the bitter end of the war, one out of every eight soldiers was medically evacuated from Vietnam for psychiatric reasons—primarily for drug dependency (especially heroin).
1. US Department of Defense. The United States of America Vietnam War Commemoration. http://www.vietnamwar50th.com/about/commemoration_objectives/. Accessed October 24, 2018.
2. Camp NM. US Army Psychiatry in the Vietnam War: New Challenges in Extended Counterinsurgency Warfare. Ft. Sam Houston Texas: Department of the Army, Office of the Surgeon General, Borden Institute; 2015. www.bit.ly/vietnampsych. Accessed October 25, 2018. (Copies can be purchased from the Government Printing Office bookstore at https://bookstore.gpo.gov/.) ❒