Flashback. Posttraumatic Stress Disorder, Suicide, and the Lessons of War

Coleman provides a study of the links between military service in Vietnam, Posttraumatic Stress Disorder (PTSD), and the suicide of veterans, preceded by a brief review of the past experiences of war veterans and the development of the concept of PTSD. She describes herself as a documentary photographer and oral historian. Her interest in the topic of the book is personal as her husband committed suicide after Vietnam service. Interspersed in the text are twelve short personal accounts from the widows of veterans describing how their husbands killed themselves after returning from Vietnam. These deaths occurred at varying times from shortly after return to after up to twenty years of greatly disturbed, traumatic living. The book is therefore written very much from a woman’s viewpoint and part of its value lies in this. We are used to accounts of the problems of the veterans themselves, but less attention has been paid to their wives and families. Coleman forcefully presents the effects of PTSD upon these unfortunates and shows how the disorder reproduces itself through the community long after the causative event. A parallel is also shown between military service and the rape and battery of women as causative factors of PTSD. The book is not, however, a feminist polemic; in fact it is deserving of male readership in order to expand the perceived scope of PTSD.

The book starts with a review of the history of veterans’ problems and the various attempts of the military to cope with stress in combat and among the returned soldiers. The recent account by Weaver and Wright in Health and History (7, no. 1, 2005) of World War I veterans in New Zealand is relevant here. The usual military reaction was to deny the existence of any problem except cowardice and the lack of ‘moral fibre,’ whatever that is. Gradually through the two world wars, Korea, and Vietnam there arose an acceptance of the problem in more understanding terms which resulted in the definition of PTSD in 1980.

Coleman then goes on to show why Vietnam was different. The combatants were mostly draftees—88 percent of the infantry by 1969—and they were young, with an average age of nineteen as opposed to twenty-six for World War II. (These are US figures). They were fighting an enemy that came out of, and melted back into, the civilian population, not readily identifiable and separable. I would challenge this view that Vietnam was very different from previous wars. As a schoolboy in the UK I can remember nineteen-year-old National Servicemen returning from the Malayan Emergency to tell their school juniors of insurgents’ heads stuck on poles along the roadway. All wars have inevitably drawn in the civilian population; for example, read Charles Esdaile’s account of the Peninsular War (Penguin, 2002). Vietnam did, however, exhibit the beginning of a new trend in warfare engendered by the asymmetry in weaponry more obvious now in Iraq.

According to Coleman, the US veterans were not rejected by the civilian population upon their return from Vietnam, but later the Nixon administration cultivated a split into good and bad veterans and turned the public against the latter. Australian troops have stories about being spat upon when returning. Certainly there was a deal of indifference if not hostility among the public of both countries, an attitude the source of which the veterans claimed to identify in the respective administrations.

The accounts of the wives in this book give a catalogue of indifference towards the US servicemen from the administration. Their treatment was generally to be given a wide range of medications and then be told effectively to disappear. The wives or relatives were then left to cope, with many unable to and leaving the husband to his downfall. One can hardly blame the wives given that they had to care alone for psychological wrecks that had no capability of living normally in the community. The wives’ stress could continue for long periods, as one woman’s story illustrates: ‘It’s 1999 and my husband just died from the Vietnam War.’ She recounts, he shot himself on Fathers’ Day after years of therapy, drugs, and dope to allay anxiety and nightmares. These stories do not specify the precipitating factors for the development of stress; the returned soldiers did not elaborate on their experiences except to say how awful they were. Some were physically injured; one threw away his artificial legs in disgust. Exceptionally, one man identified his first kill as a sixteen-year-old youth. The stories are uniform in their histories of ineffective visits to the Veterans Administration’s offices and the accumulation of medication; fifty four bottles were removed by the police at the scene of one suicide.

Coleman is objective in stating that the true number of suicides by veterans is not known. It is extremely difficult to get accurate figures for the incidence of suicide in the civil population, so it is even more difficult to get them for the veteran community. We cannot, therefore, be entirely sure that war service has increased the rate of deaths by this means in the community. What is undeniable is that war service has induced many disastrous character changes in previously normal persons.

Toward the end of the book there is a relatively short discussion on the possible role of Agent Orange in the production of veterans’ problems. This seems an anomaly as it follows a very strong exposition of how PTSD can be generated in any war. Did the initial refusal to accept emotional and psychological stress as a cause lead to the selection of an easily understood factor in its place?

The emotional involvement in her husband’s suicide has not caused Coleman to produce a subjective, unscientific thesis. She gives references to support all of her statements and the text is copiously annotated. The references are to government and media reports, to personal accounts, and to books for the general reader. She does not cite papers on psychiatric or psychological theory and experiment, but nevertheless the book is to be accounted as scholarly as well as suitable for the general reader.

The book is well edited and free from typographical errors. Coleman writes clearly and the book is designed and set out well.

This is history, but as the author points out, it is in danger of being prophetic as well, in that the endemic health problems of veterans will extend into the future as we fight more wars like the Iraq engagement. The short-term answer is to continue to improve our treatment of returned soldiers, but the author optimistically notes that the final answer is the abolition of war.