Chap12 Army Psych in Vietnam-lessons learned (original) (raw)

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.

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 Although American combat personnel had been completely withdrawn 2 years earlier, it must be acknowledged that this was in response to great opposition to the war at home, 1 widespread demoralization in the theater, which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

Chap11 Army Psych in Vietnam-psychiatrist frustrations and ethical strain

. [As Vietnam veterans, it] was easy for us to get ourselves accepted as long as we maintained, for instance, that there was absolutely no excuse for American soldiers to be in any overseas theater, that military doctors were crude and inhuman, that poverty and misery in the U.S. was far more important and more horrible than such problems anywhere else in the world, that the Communists were not serious competitors of ours, and that the less we learned from Asia, Africa, and South America the better. For the home Americans seemed to "know" from the media that the Vietnam war was more immoral than the Civil War, the Spanish American War, or World War II. They explained how we soldiers should feel guilty for fighting such an immoral war. 1(p2) Colonel Matthew D Parrish, Medical Corps 3rd Neuropsychiatry Consultant to the Commanding General US Army, Republic of Vietnam (1972) P sychiatrists are specialized physicians who enter military service already committed to their profession's humanitarian ethical values, which emphasize care of the individual. However, like all soldiers, while serving in the military they also function in the ethical shadow of the institution's enormous and strict hierarchy, the central organizing principle of which is the subordination of individual values to those of the organization 2-presumably for the benefit of society. It follows that, in time of war, Army psychiatrists incur an obligation to support the US Army Medical Department's mission of contributing to the accomplishment of the combat mission, which means the clinical priority centers on the recovery of the individual soldier's

Patterns of Psychiatric Need and Intervention among U. S. Army Troops of the Vietnam Conflict

1982

Vietnam was America's most protracted and divisive war in modern times, however, evidently the US Army did not retain psychiatric records and related materials that would serve as a data base for analysis and formulation of "lessons learned" regarding the dynamics of psychiatric attrition or prevention in the theater. Yet Vietnam introduced a rich variety of unique or changing circumstances altering both the ecology of the battlefield and the rear, as well as provided a new technology for treatment of psychiatric disorders, i.e., relatively non-sedating psychotropic drugs. This report provides an alternative rationale , survey instrument, and methodology for ascertaining a comprehensive description of the dominant patterns of psychiatric and psychosocial breakdown among U.S. Army troops in Vietnam and the forms of intervention provided through the accumulation of survey data from Army psychiatrists who served there. 15. SUBJECT TERMS military psychiatry, combat psychiatry, Vietnam 16. SECURITY CLASSIFICATION OF: 17. LIMITATION 18, NUMBER u n c lassifie d

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.. . .

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)

Chap4 Army Psych in Vietnam-hosp svcs and theater psych leaders

A frequent source of contention between [division] psychiatrists and the KO team involves patients who are seen as psychotic. .. in the division setting, but who present essentially characterologic problems [on] our ward. Problems potentially get worse because of the. .. fact that character disorders are not removed through medical channels in the Army.. .. [W]e are [thus] left with a man who we feel is character disordered and cannot evacuate [from Vietnam] through medical channels with good conscience, but on the other hand [he is] a man whom [you] feel is psychotic and cannot be returned to duty with good conscience.. .. So, what to do?? 1(pp1-2)

Chap8 Army Psych in Vietnam-deployment stress and inverted morale

he need for clear and meaningful group missions. .. is simply another way in which good leaders can demonstrate to their units that they care-by seeing that their efforts and the risks (and losses) they incur are for something undeniably worthwhile. Certainly the discipline problems, wholesale drug abuse, and fraggings of the US Army in Vietnam came primarily in the latter years of the war, when it was clear that America had made the judgment that their task was not worth pursuing. Interpersonal bonding at the small unit level could not overcome the quite rational desire not to be the last one killed in an effort without glory or thanks 1(pp1-2) Frederick J Manning, PhD Military social psychologist C ombat-generated psychiatric conditions have traditionally been the most critical of the problems that military psychiatrists have faced; and, although a broad collection of stress-related factors have been determined to affect how well the soldier can withstand his combat ordeal, the predominant pathogenic one has obviously been its violent nature. However, there are additional challenges-deployment stress-that affect all who are sent to a theater of war, the majority of whom will not face combat directly. In fact history has shown that in a combat theater, commanders, medical personnel, and mental health specialists, as well as those in law enforcement and chaPter 8