Patterns of Psychiatric Need and Intervention among U. S. Army Troops of the Vietnam Conflict (original) (raw)
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Chap00 Army Psych in Vietnam-contents and preface
Camp N.M. 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. ISBN 978-0-16-092550-4, 2015
The Preface and Table of Content serve as the introduction to the author's study of the military psychiatric challenge in Vietnam--especially for the Army--the services provided, and results (1965-73). The study was necessitated by the rampant soldier mental and behavioral disturbances that arose in the second half of the war and the decades of institutional disregard for this unprecedented, dangerous, and damaging state of affairs. The methodology utilized was that of assembling and synthesizing information drawn from a wide variety of available sources documenting the successes and failures of the deployed Army psychiatrists and allied mental health and medical personnel, altho much is also said about parallel challenges faced by those caring for the deployed Marines. This approach was augmented by data from the author’s 1982 survey of the veteran psychiatrists who served with the Army in Vietnam. Whereas this review was intended to serve as a historical record, it is not the comprehensive history that should have been developed by the Army. Nonetheless, it does define many of the most salient “lessons learned” with respect to the variables that affected the morale, discipline, mental health, and performance of the troops deployed in Vietnam, as well as those bearing on the mental health specialists sent to support them.
The US Psychiatric Response in the 20 th Century Military
Involvement in warfare can have dramatic consequences for the mental health and well-being of military personnel. During the 20th century, US military psychiatrists tried to deal with these consequences while contributing to the military goal of preserving manpower and reducing the debilitating impact of psychiatric syndromes by implementing screening programs to detect factors that predispose individuals to mental disorders, providing early intervention strategies for acute war-related syndromes, and treating long-term psychiatric disability after deployment. The success of screening has proven disappointing, the effects of treatment near the front lines are unclear, and the results of treatment for chronic postwar syndromes are mixed. After the Persian Gulf War, a number of military physicians made innovative proposals for a population-based approach, anchored in primary care instead of specialty-based care. This approach appears to hold the most promise for the future. The US Psy...
Chap5 Army Psych in Vietnam-veteran psychiatrists survey
Conversion [r]eactions and [m]alingering. .. are not of major importance to the civilian psychiatrist whose patients exchange money, inconvenience, time, and in some cases an initial loss of self-esteem for the hope that the physician will relieve his discomfort. In the military, where cost is not a factor (and in fact illness could provide compensation), where time out of the field is a convenience (the longer the better), and where any medical procedure is preferable to the dangers and stress of combat, these topics become extremely important in the medical officer's daily workload. 1(ChapIX,pp5-6)
Psychiatry in the Army: A Brief Historical Perspective and Current Developments
Psychiatric Services, 1991
fight with bows and arrows or with hydrogen bombs, involves such items as leadership, courage, morale, motivation, perseverance, derelic tion, malingering, and the age-old problems ofdnink and breach of dis cipline. Psychiatry in the military setting finds itself inexorably drawn into consideration of these eternal verities ofmilitany life.― World War I brought the â€oe¿ eternal verities― ofmilitary life into sharp focus, which helped psychiatrists to evolve the basic tenets of military psychiatry. These principles were refined, redefined, and sometimes obscured during World War II and the wars in Korea and Vietnam, as well as in more recent military opera tions. This paper briefly reviews the history ofpsychiatry in the United States Army in the 20th century and outlines the evolution of its prin ciples. The structure of psychiatric practice in the United States Army and its current areas of interest, in cluding combat and crisis strategies and community and family psychia try, are examined. Military psychia try's effects on and contributions to general civilian psychiatry are also emphasized. Historical overview The battles in Europe during World War I resulted in a large number of patients presenting to physicians with a syndrome called ‘¿ ‘¿ battle shock. â€oe¿ Symptoms of dizziness, blindness, deafness, muteness, shaki ness, crying, and general inability to perform were considered to have a neurological origin and to be caused by artillery blasts (2). When the United States entered the war, the psychiatric consultant to the Army Surgeon General assigned Major Thomas Salmon to direct the Army's psychiatric program in Northern Europe (1â€"3). Salmon noted that the British evacuated their battle shock casual tics to neuropsychiatric wards in civilian hospitals, often at home in England. These practices resulted in a low percentage of casualties being returned to duty and a high percent age of entrenched, chronic symp toms. The French, on the other hand, instituted treatment of psychiatric casualties near the battle front, rarely evacuating soldiers to the rear or dis charging them from military service. The French military psychiatrists were sensitive to the concept of 5cc ondary gain from â€oe¿ battle shock.― They understood that soldiers could use these symptoms as a means of separation from the front line, from the unit, or from military service at together. The French military psy chiatnists instituted aversive tech niques, including loss of privileges, for nonpsychotic psychiatric casual ties. These interventions seemed to communicate to the servicemen that they were expected to become func tional again and were to remain on active duty. Salmon sought to create a pro gram for United States troops that would incorporate the compassion of the British but would also provide for the successful retention and rein tegration ofpsychiatnic casualties, as he had seen in France. He initiated the concepts of proximity, imme diacy, and expectancy. Psychiatric casuaLties were to be treated as near to the battle front as possible (prox imity), in as short a time as possible (immediacy), and with the belief that many, if not all, would be able to return to the front to support their â€oe¿ buddies― after a briefrest (cxpectan cy). Treatment interventions were
Chap12 Army Psych in Vietnam-lessons learned
. [I]t is important that the psychiatric experience of Vietnam and its aftermath be subjected to continuous re-evaluation utilizing new source material, operational concepts and conceptual procedures so that the important lessons in military psychiatry hidden within the heart of human tragedies like Vietnam be perceived and applied to the mitigation of human suffering in the practice of psychiatry and in future conflicts. 1(p19)
War & Military Mental Health: the US Psychiatric Response In the 20th Century
American Journal of Public Health, 2007
Involvement in warfare can have dramatic consequences for the mental health and well-being of military personnel. During the 20th century, US military psychiatrists tried to deal with these consequences while contributing to the military goal of preserving manpower and ...
Chap10 Army Psych in Vietnam-preventive psychiatry and command consultation
The removal of the characterological is necessary to the functioning of the unit. From one standpoint the referral to the psychiatrist means a breakdown of group integrity. Sometimes it is not clear whether the patient does not feel a part of the group or whether he is not perceived as such. The passive aggressive, of course, was our stock in trade. With these referrals I had to consider whether the referral was honestly made. I think this is an important point because with time people's secret motives become apparent.. . .
Background: After extensive review of official military records, government investigations, and news media accounts, the authors provide the first-ever examination of repetitive mental health crises after every major American war since the 20 th century. Method: Compelling evidence of generational crises is established using direct testimony from credible first-hand sources, clearly indicating that over the past century American society has continued to replicate preventable mental health crises. Results: This has largely been caused by repetitive failure to learn from and improve upon lessons learned about the psychiatric effects of war. The authors identify ten super ordinate " foundational lessons " essential to meeting wartime needs. Conclusion: Antiquated medical dualism, dysfunctional organizational structure, and leadership ambivalence toward mental health services are believed to promulgate a culture of mental health stigma, discrimination, and disparity. The key to transforming military mental healthcare and ending the cycle is to adopt a contemporary holistic mind-body approach emphasizing full-parity with medical services.
Chap0 Army Psych in Vietnam-prologue with authors experience in Vietnam
elling the story of the Army's psychiatric problems in Vietnam requires that one start at the end so that the beginning and middle have context. As for the bitter end, the war in Vietnam came to a dramatic close 30 April 1975, when America's ally, the government of South Vietnam, surrendered to the overwhelming military force of North Vietnam. For the United States this represented a resounding strategic failure, if not a tactical one. Although American combat personnel had been completely withdrawn 2 years earlier, it must be acknowledged that this was in response to great opposition to the war at home, 1 widespread demoralization in the theater, which was often expressed in psychiatric conditions and behavioral problems (see Chapter 2, Figure 2-2 and Chapter 8, Figure 8-1), and a military leadership that was on its heels. This degradation of military order and discipline, as well as a general compromise of the mental health of the force, was unprecedented and mostly unanticipated because American troop strength had been dropping steadily since mid-prologue