ANDREA PLATE WRITES – For 15 years, I was a senior staff social worker at the United States federal government’s Department of Veterans Affairs—the country’s largest integrated healthcare system— in its largest branch, located in West Los Angeles, California. Each year, the system serves 9 million veterans nationwide.
One summer evening, on vacation in Vietnam, we were at dinner in a high-end home on a small suburban street south of Ho Chi Minh City.
“The war was thirty-two years ago. What troubles them so?” This former high-ranking Vietnamese ambassador to the European Union asking this was a teenager when Americans bombed her hometown of Hue.
Typically, I explained, PTSD surfaces years – sometimes very many years – after the trauma.
Then the dinner host, a Vietnamese media and government representative, wondered, “Why don’t our soldiers have PTSD?”
“Perhaps,” I said, “because your physicians don’t diagnose it.”
I did not like playing the Ugly American. I did not like being perceived as overly-dramatic, Western-centric,a know-it-all. In fact, in America, I had grown callous to questions like these. But to be asked this in Vietnam, of all places – with its history of warfare! Wasn’t it inevitable that soldiers would be traumatized by their gruesome war experiences, sometimes decades afterwards?
Even so, I was often pressed: Is PTSD really that real? Aren’t veterans just crybabies? Don’t they fake it for the financial benefits?
To me, the truth was clear: 1) PTSD, to quote the American Psychiatric Association, “can occur in all people, of any ethnicity, nationality or culture, and any age … who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault;” and 2) the so-called invisible wounds of war— traumatic brain injury; severe anxiety and depression; PTSD—are in fact easy for the trained clinician to detect.
By 2007—six years after the invasion of Afghanistan, four years after Iraq— the same year that an Army-funded study published in the “American Journal of Psychiatry“ determined that nearly one in five combat veterans who had been to Iraq suffered from PTSD—we were engulfed at the VA in Los Angeles especially by a tidal wave of returnees with classic symptoms: haunting thoughts; insomnia; anxiety; suicidal thoughts and plans; paranoia.
Ironically, these are the so-called “positive,” or “active,” symptoms of PTSD— the ones you can see and hear. Otherwise, the clinician could be stonewalled by granite-like faces, downcast eyes and patients’ inability to trust anyone, even as you tried to help. These are the so-called “negative” symptoms, marked by the near-complete absence of emotion and expression.
The layperson’s skepticism is maddening to me. If we don’t doubt the psychiatric realities of victims of floods, hurricanes and shootings, why do we turn skeptical fire onto victims of combat? Is it that the unbearable reality of the unbelievably gruesome effects of war, more than the warriors, compels us to want to look away?
Forget the complex jargon of psychiatrists for insight if you prefer and you listen instead to the late, noted American comedian George Carlin, in his famous telling riff on the evolution of terms used to describe PTSD. During World War I, he pointed out, PTSD symptoms were described as “shell shock.” Then “battle fatigue” (World War II). Then “operational exhaustion” (the Korean War). And finally, after the Vietnam War, “post – traumatic stress disorder.” Why now this particular complex term? Concludes Carlin, “The pain is completely hidden under the jargon.”
Of course there are PTSD impostors—men and women leeching off the government dole, profiteers of hyped-up media reports amid diagnostic-happy American clinicians; but certainly not all, and not, remotely, most.
For Asian Americans, the trauma of PTSD can be particularly intense. Roughly 1.5% of the American military population is made up of Asian Americans and Pacific Islanders, but it is “the fastest-growing racial/ethnic minority group in the United States, projected to grow more than 200% by 2050,” as pointed out in the American Journal of Public Health, with “higher suicide rates than all other racial/ethnic groups during [military] deployment, as well as those who had never been deployed.”
“You feel embarrassed to see a psychiatrist,” a half-Japanese, half-Korean young man explained to me, upon his return from Iraq. “You’re supposed to tough it out.” How he tried!—hiding inside his apartment, “watching TV,” his family urging him not to seek help—even his Japanese father, who himself had survived a California internment camp during World War II. “I did some terrible things,” said the grief-stricken young man, “and I’m afraid they are going to come back to haunt me.” Four days later, the son abandoned our Los Angeles PTSD program.
Jay, an inveterate gambler who squandered his wife’s college tuition money on blackjack and craps, thought I was crazy for advising him to seek family support. “It’s a Korean family!” he shot back. “I can’t! There is shame.” A few weeks later, he, too dropped out of our program.
Similarly, a twenty-year-old Japanese-American, who somehow connived his way into the Army despite a longstanding diagnosis of schizophrenia, told me he had been in foster care since age ten. Discharged dishonorably, he relapsed on drugs five times in as many months. “Asian patients can be our toughest cases,” explained a longtime VA psychologist specializing in combat PTSD. “And for Asian families to give up on their kids, the parents have to be totally desperate.”
Make no mistake. PTSD does not pick favorites. It does not discriminate by race, ethnicity, gender or class. As the wise-cracking George Carlin suggested, sanitizing the language won’t make it go away, nor will doubting its very existence. In fact, the end of his riff wasn’t funny at all. “…. Maybe if we had called it shell shock, some of those guys coming back from Vietnam might have gotten what they needed at the time.”
Former VA Secretary Robert McDonald, speaking at the mammoth West Los Angeles, California, VA, once stated that the effects of wars are felt throughout society “a full forty years” even after conclusion. With the “forever wars” of today—and more than forty years since the end of the Vietnam War—the very least we can do is admit that PTSD is real.
Andrea Plate, a licensed clinical social worker, state of California, ended her long Veterans Administration career in 2017. This summer, Marshall Cavendish International will publish her insider’s book about war veterans: Madness: In the Trenches of America’s Troubled Department of Veterans Affairs.