From: jewell@mace.cc.purdue.edu (Larry Jewell)
Subject: 'NamVet Newsletter, Vol.4, no.3 (5/8)
Organization: Purdue University
Date: Mon, 14 Dec 1992 17:52:03 GMT

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     Volume  4, Number  3                               March  7, 1990



     =================================================================
          T h e   N a m V e t   C h a p l a i n ' s   C o r n e r
     =================================================================

            A PASTORAL RESPONSE TO THE TROUBLED VIETNAM VETERAN
     
                            By: Melvin R. Jacob
      In: POST TRAUMATIC STRESS DISORDERS: a handbook for clinicians
                    (c) 1987 DAV National Headquarters
     
                         Input by: G. Joseph Peck
                         NAM VETs Managing Editor
                        VETLink #1 - Pittsfield, MA
                              (413) 443-6313
     
     PTSD  OF  THE VIETNAM VETERAN was first published by the  Disabled 
     American Veterans (DAV) in 1980 (Williams, 1980).   This book gave 
     affirmation to Vietnam veterans,  especially the ones experiencing 
     adjustment problems.  It gave insight and help for the health care 
     provider  working with the troubled Vietnam veteran.   I benefited 
     from  this book,  and was especially pleased to learn that the DAV 
     was  planning  a  sequel and was broadening its  observations  and 
     recommendations  for  treatment  of  the veteran and  his  or  her 
     family.
     
     Jim  Goodwin,  in  his chapter on the etiology  of  combat-related 
     PTSD, wrote of the life-sucking symptoms of this disorder:
        Many  veterans find it extremely uncomfortable to feel  love
        and compassion for others.   To do this,  they would have to 
        thaw  their  numb  reactions to the death  and  horror  that 
        surrounded  them in Vietnam....,  many of these veterans  go 
        through  life with an impaired capacity to love and care for 
        others.   They  have  no feeling of direction or purpose  in 
        life.  They are not sure why they even exist.  (Goodwin,  in 
        Williams, 1980, p.14)
     Goodwin  identified  in this dilemma a symptom that  psychological
     treatment alone has not addressed.   Laufer (1985)  described this 
     issue quite clearly: "The problem can be seen as the difficulty in 
     answering  the question,  'Who am I?' after learning more than one 
     wants about the question, 'What am I capable of?'" (p.51)
     
     The  existential  dilemma challenges their reason and purpose  for 
     human existence.  I assert it also points to the Vietnam veteran's 
     need  for spiritual,  pastoral care,  a need that has largely been 
     avoided in the literature on the treatment of PTSD.   This article 
     is an attempt to respond to this need.   My purposes are fivefold: 
     (1)  to  present pastoral problems with Vietnam veterans;  (2)  to 
     reframe PTSD symptoms from a pastoral perspective; (3)  to examine 
     pastoral goals within the reality of PTSD symptoms;  (4)  to offer 
     pastoral interventions for these goals;  and (5)  to theologically 
     describe forms of positive change.
     
     My  response to the pastoral care needs of the Vietnam veteran has 
     developed within my ministry over the past six years.  During this 
     period,  I  have worked extensively with veterans (on both an  in- 
     and  outpatient basis)  who have sought treatment at the  Augusta, 
     Georgia,  VA  Medical  Center.   They  have taught  me  much.   My 
     response  to  them  has  been formulated  from  a  Judeo-Christian 
     philosophy that presupposes that life,  as a creation of God,  has 
     
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     direction and purpose and that recognizes a redemptive hope within 
     human  brokenness and pain.   My response acknowledges renewal  in 
     the human spirit above and beyond human ability to effect change.
     
                             PASTORAL PROBLEMS
     The  reality  of  Vietnam ate away at the spirit of  many  of  its 
     soldiers.   The  constant inconsistencies and  incongruities,  the 
     gut-wretching  absurdities,  and the endless emptiness left  their 
     indelible marks on the hearts of American warriors.  A 35-year-old 
     veteran, diagnosed with PTSD,  recently allowed me into the horror 
     and fear inside him.   He recalled a night his company was overrun 
     by  the Viet Cong.   Graphically and painfully,  he described  the 
     vigilance  he  maintained while picking up the pieces of  a  buddy 
     "held  together  at his middle by a thin stretch of  skin."   This 
     vigilance replaced grief, and fear was his constant companion.  He 
     walked  in  the valley of the shadow of  death,  but,  unlike  the 
     psalmist, he concluded that, "God was not there on that hill."
     
     A  religious  or spiritual vacuum was created by the Vietnam  war.  
     Many  soldiers  sought to theologize their experiences  (that  is, 
     bring  spiritual  significance  to them),  but  found  it  futile;  
     emptiness engulfed their attempts for theological meaning,  which, 
     itself, was challenged with demonic interpretations.   Many looked 
     to the chaplain for meaning and strength.   (Some veterans readily 
     affirm  the  importance  of the chaplain and the  relationship  he 
     gave;  meaning  and  strength  were  caringly  incarnated  in  his 
     presence.)  Others recall negative memories of the chaplain.
     
     Lifton  (1978)  described  an  "ironic  rage"   directed  at  both 
     chaplains and psychiatrists ("shrinks") by Vietnam veterans.  This 
     rage  flowed  from the soldiers'  perceptions that the  chaplains' 
     battlefield   work  was  incongruent.    Lifton  elaborates  these 
     incongruities:  (1)  the  chaplains blessed the  troops,  mission, 
     guns,  and killing;  (2)  they endorsed "phoniness"  in advocating 
     confession  of meaningless transgressions -  for example,  use  of 
     drugs  -   while  holding  back  accountability  to  the  ultimate 
     transgression: killing; (3)  they promoted "false witness"  by not 
     acknowledging  loss (in the intrinsic and extrinsic experience  of 
     war),  but  affirming and legitimizing the death and  destruction; 
     and  (4)  they sanctioned an "unholy alliance"  between themselves 
     and  the military in perpetuating the ironies and incongruities of 
     Vietnam.   Lifton  concluded:  "It was one thing to be ordered  by 
     command  into a situation they came to perceive as both absurd and 
     evil,  but  it was quite another to have that process rationalized 
     and  justified  by ultimate authorities of the spirit and  mind  - 
     that is, by chaplains and psychiatrists." (p. 220)
     
     Other  pastoral  problems  are present in the  interventions  with 
     veterans diagnosed as having PTSD.   These problems are summarized 
     in  the negative transference that accrued to the  chaplain.   The 
     chaplain is often seen as God's representative.  If God was viewed 
     as  not present in Vietnam,  then the chaplain's  legitimacy,  his 
     reason  for existence,  was in question.   The chaplain is seen as 
     the  embodiment of what was felt as God's betrayal,  and his post-
     war  interventions  may receive the brunt of the rage felt  toward 
     his  role in Vietnam.   The veteran is often unable to distinguish 
     between   the  chaplain  who  was  perceived  as  sanctioning  the 
     incongruities of Vietnam and the one who now offers purpose, hope, 
     and renewal in the brokenness and pain of PTSD symptomatology.
     
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     Volume  4, Number  3                               March  7, 1990

     
     Arnold  (1985)  presents  basic  principles in  the  treatment  of 
     Vietnam  veterans  with PTSD,  and lists an assortment of  therapy 
     interventions.   He  identifies  "religious  counseling"   as  one 
     intervention,  thus giving some legitimacy to the clergy's role in 
     treatment  (although he does not define what is meant by religious 
     counseling).   He  warns against certain theological emphases  and 
     highlights possibilities with others:
        Religious  or spiritual counseling has been very helpful  to 
        some veterans,  but great sensitivity is required to arrange 
        it.   The clergy have an acknowledged legitimacy in the area 
        of  morality,  but  if the tenets of faith of  a  particular 
        clergyman  stress  sin  and punishment or  portray  expected 
        human  nature  as  being incredibly  pure,  veterans  having 
        serious   problems  with  self-acceptance  may  reject   the 
        counseling   which   is  offered.    On  the   other   hand, 
        nonjudgemental  guidance in dealing with combat  experiences 
        in moral terms may lead to the formulation of a new personal 
        moral position which enhances productive living.(p. 253)
     The  possibilities  for ameliorative pastoral work  with  troubled 
     Vietnam veterans necessitate a look at how this intervention takes 
     place.   I  believe the first step in this process is to  consider 
     the troubled veteran from a pastoral perspective.
     
                           PASTORAL PERSPECTIVE
     Much  has  been  written on the veteran and  PTSD.   The  American 
     Psychiatric Association's (APA)  DIAGNOSTIC AND STATISTICAL MANUAL 
     III (APA, 1980) provided the psychiatric diagnostic criteria.   It 
     describes  the  symptoms  of this disorder as developing  after  a 
     psychologically traumatic event that is outside the range of usual 
     human  experience.   I seek to examine the behaviors and  feelings 
     from which this psychiatric diagnosis is derived.  But, instead of 
     using a psychological perspective,  I will use a pastoral one that 
     involves  analyzing  events,   behaviors,   and  emotions  from  a 
     theological  or  spiritual  point  of view  and  that  embraces  a 
     holistic view of the person.
     
     The   pastoral   perspective   recognizes   the   complexity   and 
     interrelationships  existing  among  the components of  the  whole 
     person - the emotional, social,  mental,  physical,  and spiritual 
     aspects of the person.   The spiritual component provides a unique 
     perspective from which to examine events, behavior,  and emotions.  
     Like the psychological perspective,  the pastoral view has its own 
     terminology  to  explain  the observations.   I use some  of  this 
     terminology,  rooted  in Judeo-Christian thought,  to describe the 
     adjustment  difficulties  and internal struggles of  the  troubled 
     Vietnam veteran.
     
     A  veteran  in his late thirties requested some private time  with 
     me.  He had been hospitalized for two or three months,  and I knew 
     him very well, but his initiative for an appointment surprised me.  
     In  our meeting,  he described that on a recent trip home he found 
     something  he thought he had lost.   Pulling a bent and worn Bible 
     from his pocket,  he said,  "Chaplain,  this Bible was with me all 
     the time I was in Vietnam...  I survived and it was in my pocket."  
     He  described  his attachment to it,  although he never  spoke  of 
     actually  opening  or  reading  from  it.   He  continued,  "I  am 
     struggling now...  this Bible helped me before.   I would like you 
     to  bless  it the way it was blessed in Vietnam so it can help  me 
     
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     Volume  4, Number  3                               March  7, 1990

     now."  I observed his fear;  there was uncertainty in his eyes and 
     hesitancy  in his voice.   His request seemed to involve more than 
     "getting all the help you can get"  -  it appeared consistent with 
     the  teaching  of his faith tradition about the Bible.  He  shared 
     doubt  and  vulnerability.   I  listened to him and  recalled  how 
     Thomas,  in  the New Testament,  following the awesome mystery  of 
     Jesus' resurrection, was filled with fear and doubt.  Thomas, like 
     this  veteran,  asked for visible reassurance.   He wanted to feel 
     something tangible in his uncertainty.  Jesus'  response to Thomas 
     spoke to his deepest fear and doubt.
     
     This  illustration exemplifies the use of a pastoral  perspective.  
     In  my  work  with  Vietnam  veterans,  I  have  discovered  seven 
     categories   that   illustrate  PTSD  symptoms  from  a   pastoral 
     perspective.  These are (1) distrust and fear,  (2)  rejection and 
     betrayal, (3) futility, (4) alienation and estrangement, (5)  loss 
     and grief, (6) guilt and shame, and (7)  isolation and withdrawal.  
     After discussing the use of Biblical analogies,  an important part 
     of  pastoral  work,  I  will explore each of these  categories  in 
     detail.
     
     BIBLICAL ANALOGIES
     Biblical  analogies  provide  an historical  perspective  to  PTSD 
     symptomatology.    I   have   found   them  useful   as   didactic 
     presentations on PTSD and religious faith.   Like the illustration 
     of  Thomas  associated  with the discussion of distrust  and  fear 
     (below),  Biblical  analogies are applicable to the remaining  six 
     categories  of  PTSD  symptoms.   The  Biblical  character  Joseph 
     illustrates  the  experience  of  rejection  and  betrayal.    His 
     brothers, selling him into slavery, rejected him;  Pharaoh's wife, 
     lying  about  him,  unjustly  caused his  imprisonment.   THe  Old 
     Testament book of Ecclesiastes describes the emotions of futility, 
     darkly depicted in the injustices and frustrations of many Vietnam 
     veterans.   Reflecting  on  the contradictions of life,  with  its 
     injustices  and  frustrations,  the  writer  concludes,   "All  is 
     vanity."  Alienation  and  estrangement are seen in the person  of 
     Moses.   Born  a Hebrew,  but raised an Egyptian,  he struggled to 
     find moorings, his real self.   Loss and grief are clearly evident 
     in  the Biblical character of Job,  who lost all his children  and 
     property and was afflicted with a repulsive disease.  The Biblical 
     analogy  of  the disciple Peter,  who went out and  wept  bitterly 
     after his denial of Jesus, gives us an example of guilt and shame.  
     The  experiences of isolation and withdrawal are vividly portrayed 
     in  Adam  and Eve,  who sought to hide after  their  transgression 
     against God.
     
     DISTRUST AND FEAR
     The  association  of distrust and fear links the  consequences  of 
     failed  trust  with  the fear of death  and  annihilation.   Fear, 
     cultured  in a petri dish of broken trust and  confidence,  breeds 
     greater  distrust  that  deepens the fear.   The  cycle  feeds  on 
     itself,  creating  larger  distances between oneself and  a  world 
     perceived as cold, callous, and uncaring.
     
     Vietnam is a saga of broken trust and confidence.   Friend and foe 
     looked  much  alike.   Friendly  villagers by day were  Viet  Cong 
     sympathizers by night.  A child's innocent smile made one cautious 
     to  the  danger of the hidden explosive charge she  carried.   The 
     children  and elderly who responded warmly to the GIs likely  were 
     
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     the  offspring and parents of the enemy lurking  nearby.   Healthy 
     distrust was learned, and fear was a bosom companion.
     
     The  soldiers  distrusted  the  governments  for  whom  they  were 
     fighting.   The  government  of  South  Vietnam had  a  legacy  of 
     instability and fraud;   the black market flourished;  vice was as 
     abundant  as a natural resource.   The environment of the  Vietnam 
     war  was  different and foreign to the values and  standards  most 
     young  soldiers  had  been taught,  and this  difference  fostered 
     distrust and made an easy target for personal fears.
     
     The government that sent them to fight in such an environment over 
     6000 miles from home was also viewed with distrust and fear.   The 
     statements of U.S.  political leaders simply did not mesh with the 
     war's  reality.   Enemy body counts were valued over ground taken. 
     Military  tactics were compromised for political expediency.   The 
     soldier  was caught in the middle,  and catch-22 was the order  of 
     the day.  Hearts could not absorb what eyes saw.   War protests at 
     home  seemed  to  make  no  sense to the  soldier  in  the  field.  
     Patriotism  waned,  and distrust gradually deepened.   One veteran 
     said to me:  "If you can't trust your own government,  who can you 
     trust?"
     
     Possibly  the  most  frightening source of distrust and  fear  was 
     inside each soldier himself.  Many experienced their own potential 
     for  violence -  for the first time.   The real fight for survival 
     unleashed  emotions and actions that remain horrifying to  recall.  
     Many  want to hide their destructive past,  but find it flares  up 
     under  the  stresses of daily living:  an inconsiderate  motorists 
     fails to use his turn signal; a child slams the back door;  a boss 
     vents anxiety.  Such stresses may precipitate violent, destructive 
     outbursts.   Tremendous  amounts of emotional energy are spent  to 
     control the urge to destroy again.
     
     In one of my groups,  a veteran yelled at me,  "You don't know how 
     close  I  came to knocking your head off!"   I was  surprised  and 
     threatened.   He  later  was  able  to share  his  distrust  of  a 
     particular  facial expression that reminded him of someone he felt 
     was untrustworthy.
     
     I  sense  a  constant  readiness or state  of  alertness  in  many 
     veterans  -  their necks and shoulders are tense,  their movements 
     are  sudden and jerky,  their eyes dart about warily.   Some  keep 
     their bodies in a defensive posture, constantly sitting with their 
     backs  to  the  wall (see Williams  on  "Peacetime  Combat,"  this 
     volume);  it  often  seems to me that time bombs are ticking  away 
     inside these veterans.   Some refuse to handle guns lest they lose 
     their ability to control their violent impulses.
     
     The  veterans  frequently  talk  of the  dehumanizing  process  in 
     becoming  a combat soldier.   Basic training reinforces  defensive 
     action and erodes trust of caring emotions.  A bright,  articulate 
     college graduate described this process to me.  "They take who you 
     are,  or who you think you are.   They knock you down and take you 
     apart.  Then they put you back together piece by piece...  the way 
     they  want you to be.   You are taught not to think but to react."  
     Another  veteran echoed these feelings.   "You are taught to be an 
     animal.  Then you're expected suddenly to forget you're trained to 
     function as an animal."   A third veteran tearfully amplified this 
     
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     thought:  "I know how to act like an animal.   I don't know how to 
     be human."
     
     Many  veterans  distrust their capacity to enter into  significant 
     relationships  without  eventually  finding  themselves  exploding 
     violently.   On  the battlefield,  this distrust was  exacerbated.  
     Relationships   with   buddies  who  offered   understanding   and 
     affirmation were shortlived.  Each soldier had his own DEROS (date 
     of  expected  return from overseas);  ESPIRIT DE CORPS waned  (see 
     Goodwin, this volume).   Combat took its toll with the wounded and 
     killed.
     
     New  faces too easily filled the gaps left by old,  familiar  ones 
     and,  because combat soldiers distrust anyone whose actions affect 
     their own life or well-being,  establishing relationships was even 
     more  difficult  -  and  these  were tested literally  by  fire  - 
     gunfire.   A mortar crew member told me that he once lay awake all 
     night  because  there  was a new man on the crew:  "I  was  nearly 
     killed once by a new crew member who didn't know what to do."
     
     Only  when  the  fear of death and survival are  shared  can  real 
     significance  be given to a peer relationship.   Until this mutual 
     struggle  for  survival was shared,  there could be little  or  no 
     understanding,  much less affirmation,  given and received.   Unit 
     cohesiveness  suffered;  the  structure  of  survival  in  Vietnam 
     inhibited  such understanding and affirmation.   Trust diminished.  
     With the endless leavings and arrivals,  impermanence was inherent 
     in every fighting unit.
     
     This  distrust  and  the  accompanying fear  still  spill  out  to 
     institutions  and  their  representatives  who seek  to  help  the 
     troubled  Vietnam veteran.   Leventman (1978)  gave the  following 
     description:  "Bureaucratic formalism and inefficiency,  inept and 
     ill-informed  policy-making,  political and military gamesmanship, 
     all  capped  by  revelations of high-level  executive  misconduct, 
     produced  an  unprecedented  crisis  of faith  and  confidence  in 
     American institutions." (p. 293)
     
     The  Veterans Administration (VA)  is often not distinguished from 
     the  government  that  sent  men and women to war  but  failed  to 
     support them, so the VA as an institution is distrusted, too.  Its 
     employees are often not distinguished from the institution, and so 
     they, too, are not trusted by the people they want to serve.  Once 
     veteran said: "The VA is like Vietnam.   It's a survival trip.   I 
     have to fight and struggle every step of the way."   Some veterans 
     even  suspect  secret alliances between the care givers in the  VA 
     and the government that fostered their troubles.
     
     The institutionalized church has also been unfavorably regarded by 
     veterans.   Many accuse the church of hypocrisy;  they believe the 
     church  has  been  phony and that it has no comprehension  of  the 
     harsh realities they learned in war.  And,  as with the VA,  these 
     feelings  have  been transferred to individuals who represent  the 
     institution - ministers and chaplains.   One veteran lashed out at 
     me: "You are just a hypocrite... any chaplain is a hypocrite.  You 
     profess to be something you can't be."  Such feelings present both 
     an  obstacle  and a challenge to those who seek to alleviate  this 
     distrust and fear.
     
     
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     Finally,  distrust and fear are associated with God.   One veteran 
     angrily  demanded:  "Where  was God when I need Him (in  Vietnam)?  
     Now  that I don't need Him,  why should I trust that He is  here?"  
     The  presence of God and the conviction of faith are often  viewed 
     in direct relationship.   As faith waxes and wanes,  so does God's 
     reality  and  the  clarity  that  comes  for  questions  of  life.  
     Ambiguity  clouds God's presence and suffocates the conviction  of 
     faith; Vietnam was filled with ambiguity.
     
     Battlefield  pleas to God became confused with distrust of  sacred 
     institutions (government and church) and the contorted maladies of 
     the  war.   The symbols of faith -  like the corner church -  have 
     done little to alleviate the distrust.   Many veterans put God and 
     faith on hold until a happy marriage between the war's reality and 
     the  message  of  the church could be realized.  Many  refused  or 
     feared  the process of integrating Vietnam's reality into  renewed 
     faith.  If old understandings of God failed them in Vietnam,  then 
     "...to  hell with Him;  I know how to survive by myself."   I have 
     heard this phrase often.
     
     Distrust   and   fear  come  in  waves  that  burden  a   pastoral 
     relationship.   The negative transference creates an undertow that 
     takes  pastoral intervention out to sea;  it eventually  increases 
     distrust and fear - and we see again the vicious cycle.  To resist 
     the undertow threatens conflict; to give in to9 it exacerbates the 
     symptom.  A veteran told me poignantly that if he did not distrust 
     people he would have to trust them.   "I'm just not ready to trust 
     others."
     
     The next symptoms in the pastoral perspective - fears of rejection
     and  betrayal - are  discussed now,  as they  follow from the more
     general fear and distrust.
     
     REJECTION AND BETRAYAL
     The  experiences  of  rejection and betrayal are  closely  linked.  
     Rejection  means  not  being  accepted,  in spite  of  efforts  by 
     significant   individuals  or  a  significant   group.    Betrayal 
     expresses  a more deeply felt experience of injustice.   Rightness 
     has  been  bypassed  and  ignored.    Often,   reactions  to  such 
     injustices  funnel  into strong negative responses,  spilling  out 
     into  rage  toward  the perceived perpetrators or  turning  inward 
     toward depression.
     
     Many   Vietnam   combat  veterans  have  a  litany  of   rejection 
     experiences.   This  rejection arose on the battlefield when  they 
     were  not  allowed to advance against the enemy;  they felt  hands 
     were  tied by political powers who squelched their mission.   They 
     experienced  rejection  from  the authority that sent  them  on  a 
     mission of war.
     
     Other  veterans  contort  in rage when they call reports  in  ARMY 
     TIMES  about well-known public figures back home questioning their 
     sacrifices  or about blood drives for the enemy.   They felt their 
     sacrifices and deeds in a foreign country had been rejected.  This 
     thought  was expressed by a veteran who said,  "I didn't ask to go 
     there.   I  was  sent there!   They (the  American  public)  don't 
     understand."   Many  feel their legitimacy and integrity have been 
     disavowed.
     
     
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     The  welcome  home was experienced as  rejection.   Many  veterans 
     recall  vividly a cold reception,  highlighted with an attitude of 
     "we  need to hurry and forget Vietnam."   The nation's  collective 
     difficulty  with  the  war  and  its  ambiguous  termination  were 
     frequently internalized as an invalidation of their struggle.  "We 
     did our job and we did it well, but, nobody accepted it (us),"  is 
     an often-heard statement.
     
     A  sequel  to  the  initial  "welcome  home"   was  the  lingering 
     adjustments  to society again.   Goodwin (1980)  describes how the 
     Vietnam  experience  differed from previous wars and  subsequently 
     predisposed  the  combatants  to PTSD.   These  maladjustments  to 
     society  raised  the  question  of acceptability  of  the  Vietnam 
     veteran.   "If  so  many  of us are having problems  with  society 
     either  something is wrong with society or something is wrong with 
     us," a veteran said to an adjustment group.   A sense of rejection 
     seemed to be the catalyst for his comment.
     
     Rejections deepens into a sense of betrayal.  Conventional notions 
     of  good  soldiering  in  Vietnam  were  sacrificed  to  political 
     expediency;   soldiers  felt betrayed even by battlefield tactics.  
     A block of land might be secured,  but the unit would withdraw and 
     engage in other nearby conflicts,  only to be ordered to return to 
     the  initial  block  of land and retake it,  often with  the  only 
     results  being  maimed and crippled bodies and corpses.   A  clear 
     sense  of  mission  was  clouded  by  battlefield  realities.   In 
     addition,  enemy  tactics  of  booby  trapping  the  villages  and 
     villagers and the surprise ambushes with quick retreats created an 
     elusive  foe.   Guerilla warfare conflicted with Western  mindset, 
     which raised questions about the validity of the war.  The Vietnam 
     veteran searches for purpose with cries of betrayal and injustice.  
     "Our country sent us to war, but would not support us,"  a veteran 
     concluded.
     
     Rejection  and betrayal accumulated and grew into a rage that many 
     veterans  still  struggle  to quell.   Often  closest  family  and 
     friends  are  the  recipients of this rage as the  veteran  breaks 
     inanimate  objects,   puts  his  fists  through  walls,   or  even 
     physically abuses another person.  This rage breeds a new cycle of 
     rejection  and  betrayal.    Employers  do  not  understand,   are 
     threatened,  and  unable  to  tolerate it,  especially  as  it  is 
     frequently  directed toward authority figures.   Health caregivers 
     are  frightened  by  its lethal potential.   All  too  often,  the 
     veteran is himself afraid and rejects others, lest they reject him 
     first.
     
     This  rage  is exacerbated by other emotional experiences  of  the 
     war, one of which was the seeming futility of the fighting.   This 
     sense of futility is now discussed.
     
     FUTILITY
     The  Old Testament book of Ecclesiastes describes the emotions  of 
     many  Vietnam veterans:  life is filled with weariness;  absurdity 
     overcomes  congruency.   The wisdom (of the)  writer of this  book 
     reflects  deeply on how short and contradictory life is,  with its 
     seemingly endless injustices and frustrations.  He concludes, "All 
     is vanity.  Life is useless."  He could not understand the ways of 
     God among life's contradictions and ambiguities.
     
     
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     The  soldier in Vietnam encountered continuous contradictions  and 
     ambiguities.  Wilson (1977)  identified eight existentially absurd 
     situations  in Vietnam that conflicted with the role for which the 
     soldier was trained.  These were:
       > The limited military operation
       > The lack of positive commitment from the South Vietnamese
       > The intricacies of guerrilla warfare
       > The black market operations
       > The limited tour of duty in a depersonalized war
       > Difficulty and helplessness in distinguishing the enemy
       > The seemingly meaningless death of friends
       > Faulty reentry from the war.
     
     Laufer  (1985)  advanced a conceptual approach to this war trauma, 
     focusing  on the disruptive formative experiences inflicted on the 
     soldier:
        The young soldier,  prior to his entry into the war,  can be 
        described  as  a cauldron of  emotions,  ideas,  and  themes 
        waiting  to  be  forged.   War is a force  which  turns  the 
        emotional  and moral world young men grow up in on its head.  
        For  example,  the archetypical foundation of civil society, 
        the  injunction  "Thou shall not kill,"  is waived  in  war. 
        (p.46)
     Death, destruction, and survival were ironically intimate.  Laufer
     (1985) called this "a premature encounter with mortality."
     
     With  the  failure to integrate the stress of  war,  many  Vietnam 
     veterans  experienced  a profound shattering of basic concepts  of 
     humanity.   The  endless supply of emptiness led them to  conclude 
     with  the Biblical writer that "everything leads to weariness -  a 
     weariness too great for words."
     
     Marching  along with futility,  the soldier experienced separation 
     and detachment from life's meaning.  As one confided in me,  "It's 
     like walking in a bad dream that you can't wake up from..."   This 
     sense  of alienation and estrangement from self and others is  the 
     next symptom we will consider.
     
     ALIENATION AND ESTRANGEMENT
     The  sources  of  identity  were confused for  the  young  Vietnam 
     combatant,  whose  average  age  was 19.5 years.   He  was  easily 
     separated  from a sense of self by the threatening,  violent waves 
     of war.
     
     According  to  Erikson  (1963),  the average age of  the  American 
     soldier   in   Vietnam   corresponded  to  a  crucial   state   in 
     psychological  maturity,  Erikson's  fifth  stage  of  personality 
     development, identity versus role confusion.   In this age period, 
     a  person  requires a basic sense of harmony,  and congruency  for 
     healthy  psychological  maturity to occur.   But  Vietnam  offered 
     discord and incongruity,  inhibiting ego synthesis,  and fostering 
     negative  identity and role confusion.   It was easy to cope  with 
     the  absurdities  by becoming numb to their emotional  impact  and 
     warped in integrating them to one's own time,  space,  and person.  
     The  eyes and ears had seen and heard too much;  the heart  became 
     separated from feeling.
     
     Erikson's  conceptualization of personality development informs  a 
     pastoral understanding of alienation and estrangement.  Alienation 
     
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     is a separation from groundedness, the loss of a sense of purpose.  
     This  separation  fosters  detachment from previous  identity  and 
     community, and the person shifts from place to place and person to 
     person,  seemingly  disintegrated  and impermanent.   "I  feel  so 
     freakish,"  a  veteran said to explain his peripatetic  lifestyle.  
     A  gulf of estrangement lies between the individual and his  sense 
     of  meaning and purpose -  estrangement and alienation from  self, 
     others,   and   God.    There  is  a  strangeness  that   pervades 
     interpersonal and intrapersonal activity,  and no firm attachments 
     to meaning to one course of action over another.
     
     The alienation and estrangement toward others are often fed by the 
     veteran's  fear of closeness.   Wartime experiences of closeness - 
     and  loss  -  are painfully remembered.   Personal  confusion  and 
     unsure  identity  leave  him cautious lest more hurt and  pain  be 
     encountered.  This estrangement fuels a suspicious attitude, which 
     is  often  felt  by  others  who  steer  clear,  exacerbating  the 
     veteran's  freakish,  unnatural  feeling,   and  intensifying  his 
     separateness.
     
     The  veteran  settles  for  less and for  dullness.   There  is  a 
     tendency for continual lateral or backward movement -  from job to 
     job,  school to school,  drifting without progress toward goals or 
     achieving significant closeness.  A magic "cure,"  meaning removal 
     of  all  symptoms,  is  sought  to  deal  with  interpersonal  and 
     intrapersonal problems.  A "born-to-lose" attitude develops.
     
     The  wives of many veterans complain of their cold (see  Williams, 
     "Women Partners," this volume), emotionally detached husbands, who 
     seem  unable to experience the joys of life,  although some create 
     transient  joy through alcohol and a wide variety of street  drugs 
     (see Jelinek and Williams, this volume).  Estrangement builds.
     
     Alienation  and estrangement are exhibited in separation from God.  
     A  massive cavern of religious incongruity exists in the minds  of 
     many  Vietnam veterans because the creations of God encountered in 
     Vietnam  so  starkly  contrasted with the presentation of  God  in 
     churches  and synagogues at home.   Rites and rituals learned as a 
     child appeared removed from the death,  destruction,  and survival 
     in  Vietnam.   Limited  and unstructured patterns of devotion  and 
     spiritual   development   have  left  the  veteran  open  to   the 
     vicissitudes  of  thought and feeling remaining from the evils  of 
     war.  The veteran tends to invent his own gods to fill his gaps of 
     religious meaning.
     
     The  personal  creations  of  God  have  a  blend  of  fundamental 
     theology, cultural practices,  and interpersonal and intrapersonal 
     needs.  They tend not to stand the test of time.   These self-made 
     creations are replaced as new insights,  cultural change,  altered 
     and  personal  dynamics are presented.   The  unredemptive,  ever-
     changing  results  of  the personal creations  lead  to  increased 
     alienation  from  God.   With a face filled with rage,  a  veteran 
     cried  out  to me,  "Chaplain,  I went to Vietnam  expecting  some 
     grace, but I found only more hell!  Tell me what I should think of 
     God?  I dare you to tell me!"
     
     Out  of a pastoral perspective,  the chaplain observes  alienation 
     and  estrangement as symptomatic of the troubled Vietnam  veteran.  
     Alienation and estrangement are often aligned with another symptom 
     
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     that  is the focus of the next section -  the reaction to loss and 
     the consequent grief.
     
     LOSS AND GRIEF
     Loss  occurs before grief.   Loss is the behavioral or existential 
     experience  in  which  someone or something significant  is  taken 
     away.   Grief is the emotional response to the loss.   The process 
     of grief is the healing of the emotional hurt and pain that result 
     with  the loss.   If the healing act is significantly hindered  or 
     blocked,  the reaction to the loss may impair the life functioning 
     of the person in grief.
     
     Losses  come  constantly  with  war.    The  Vietnam  war  was  no 
     exception.   Human  relationships in Vietnam were lost in  several 
     ways:  (1)  a tour of duty ended,  (2)  a change of orders meant a 
     change of location and often of friends,(3)  a wounded friend left 
     for  extended treatment,  and (4)  death brought finality to many.  
     With  flat  affect,  a veteran detailed the horrible  ambush  that 
     wiped out all but a few of his company.   He survived in the river 
     by  breathing  through a water reed.   Another  veteran  stoically 
     shared  a traumatic loss.   His arms tensed and eyes winced as  he 
     pictured  picking  up  the pieces of a dead  friend.   It  is  not 
     uncommon  for  me to hear veterans say,  "I've never been able  to 
     cry,"  and  reveal  that  the healing process of grief  has  never 
     begun.
     
     Other  losses occurred in the Vietnam experience.   The  innocence 
     lost  will  never be regained or even relived at  a  slower,  more 
     easily accepted pace.   As one veteran powerfully put it:  "I grew 
     old  too  fast and too soon...  Once you've killed,  your life  is 
     forever  changed."   Constant  fear  and  weariness  were  strange 
     motivations  to deadly,  atrocious acts.   No one can describe  it 
     all.   The  discovery of youth was lost in the horror of  repeated 
     deaths and the constant struggle for survival.
     
     The  loss  of faith and ideals accompanied the loss of  innocence.  
     The valor, the wounds,  and the deaths appeared meaningless in the 
     struggle  of  conflicting forces,  most of which were not  on  the 
     battlefield.    Confidence   in  government  declined  in   direct 
     relationship  to unproductive,  repetitious policy.   The sense of 
     duty,  honor,  and  prestige were lost in the cyclical patterns of 
     deadly action.
     
     These losses inflicted pain and sorrow that could not be forgotten 
     by  many upon return home.   Because crying on the battlefield had 
     been  an  extreme  liability and threat to  survival,  many  never 
     grieved.   And,  because  survival instincts are so intense,  some 
     could  not  grieve at home.   Feelings of loss are not  alleviated 
     just because one wants them to go away.
     
     As the losses increased, so did the need to grieve.   But grieving 
     was  impossible  in  battle,  so the reactions  to  losses  became 
     bottled up,  impacted.   With some,  the grief is enormous:  "I am 
     afraid that if I start (to grieve) I don't think I can quit....  I 
     will lose control and it (survival) will be all over."
     
     The  fear  of  loss of control is associated with  how  grief  was 
     frequently handled on the battlefield -  namely,  through violent, 
     deadly acts that created destruction.  Such behavior, which helped 
     
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     release  bottled  emotions  on  the  battlefield,  was  completely 
     unacceptable at home, and the veteran feared others'  reactions to 
     his real grief.  On the one hand, people might be "grossed out" by 
     the blood and destruction of more war stories;  on the other hand, 
     they might see expressions of grief as weakness or unbecoming of a 
     good  soldier.   These  fears were provoked by a  population  that 
     wanted to forget the unpopular war.
     
     The cliche "time heals all wounds" was wrongly thought to apply to 
     the grief from Vietnam;  veterans expended more and more energy to 
     keep  it  inside.   Alcohol  and illegal drugs often  became  easy 
     buffers  for  the  pain.   Escapes  into the woods  or  away  from 
     responsibility  did  not leave the hurt behind,  and created  new, 
     self-inflicted losses that increased the need for healthy grief.
     
     Impacted  grief may often be confused with another symptom of  the 
     troubled Vietnam veteran: guilt and shame.
     
     GUILT AND SHAME
     Guilt describes the emotional pain that results from behavior that 
     is  judged  to be wrong.   This judgement is internalized  and  is 
     often  supported by external forces.   Breaking a commandment  may 
     not create guilt,  even though the external commandment is broken.  
     Guilt  begins when the person realizes his wrong,  feels  accused, 
     and seeks relief from the emotional discomfort.  Guilt,  when left 
     unattended,  leads to lethargy and decreased responsiveness to the 
     spirit in life.
     
     Shame  takes  the  experience  of guilt into  a  deeper  level  of 
     emotional pain.  Wrong behavior is exposed.   A person feels as if 
     fingers are accusingly and laughingly pointed at him.  Shame takes 
     guilt out into the open and, thus, increases its pain.
     
     The  Vietnam veteran describes guilt and shame.   His pain  arises 
     from   passive   and   active   behaviors,    covert   and   overt 
     transgressions.  Like a heavy yoke carried on his shoulders, guilt 
     burdens the veteran and diminishes creative energy and vitality.
     
     A  veteran in his mid-30s described a life-altering event that had 
     occurred  15 years earlier.   He was driving in a truck convoy  in 
     Vietnam.   His  sergeant ordered him to change positions with  the 
     driver  behind  him.   Within  minutes  after  the  exchange,  his 
     original  truck  was  hit by a mortar and the  driver  immediately 
     killed.  "I've  asked  myself a thousand times,  why  wasn't  that 
     me?...  I  can't seem to get it out of my mind."   Another veteran 
     told me, "What I did in Vietnam went against everything I had been 
     taught.   I've  been  told  by  well-meaning  types  that  war  is 
     different and I should feel different about it...  The bottom line 
     is  I killed and I got to where I enjoyed it...  I don't like that 
     about  me."   The guilt arose from his actual behavior and how  he 
     reacted  to  it.   He  is perplexed that he could  become  such  a 
     person.
     
     Vietnam veterans describe different sources of their guilt.   They 
     note how they inflicted pain, suffering, and death not only to the 
     enemy,  but  on those who were only thought to be the  enemy,  and 
     this  uncertainty  brought on clear emotional pain and  multiplied 
     their guilt.   A forward observer related to me the day he did his 
     job  perfectly and called for artillery on an enemy company.   His 
     
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     successful operation destroyed the entire VC company and saved his 
     own.  "I know, chaplain,  it makes no sense,  but I feel guilty as 
     hell.   I  know my action saved countless lives in my company.   I 
     know that I was following orders.  But,  something inside me tells 
     me I did an abhorrent act."   He later shared how he now has found 
     community  with  a group that seeks to protect the dignity of  all 
     forms of life; but, "I still feel guilty," he concluded.
     
     The guilt that springs from overt behavior is also associated with 
     inhumane,  animalistic  acts  outside  the  line  of  fire.   Some 
     describe  horrible escapes into drugs and alcohol.   Some describe 
     the  misery of selfishness where you religiously apply the "first-
     take-care-of-yourself"  attitude.   The inevitable result was that 
     self-indulgence  did  not satisfy,  but it did produce twinges  of 
     guilt or a desire to increase the indulgence to avoid honesty with 
     oneself.
     
     Guilt  arose from other aspects of the Vietnam  experience.   When 
     some die and others do not, the survivors often ask, "Why not me?" 
     (see T.  Williams,  this volume).   This painful emotion is called 
     survivor guilt.  Goodwin (1980) wrote: "It (survivor guilt) is not 
     based  on  anything  hypothetical.   Rather,  it is based  on  the 
     harshest  of  realities,  the actual death of  comrades,  and  the 
     struggle  of the survivor to live.   Often the survivor has had to 
     compromise  himself or the life of someone else in order to live." 
     (p. 14)
     
     Associated  with  survivor guilt is its cold,  cruel  companion  - 
     namely,  helplessness.   A sense of powerlessness is remembered as 
     one  recalls his inability to change a bad  situation.   Powerless 
     and impotent to alter past events,  the veteran may turn his guilt 
     inward  into  self-destructive behavior.   Suicide has  taken  its 
     toll.
     
     Many  veterans  vow  never to be caught where they do not  have  a 
     weapon with them.   This emotion is carried by some into provoking 
     antagonism  from  others  and possibly losing their life  to  take 
     their place beside fallen comrades.   In contrast,  other veterans 
     react  differently  with survivor guilt:  they remove all  weapons 
     from  their homes.   One recently told me,  "I vowed never to hurt 
     anybody again.  I've done enough of that.... there's no way you'll 
     find  a weapon around me!"   This contrast was sharply noted  when 
     another  man described the difference between him and his brother, 
     both  combat veterans.   "My brother has weapons inside his  house 
     and in his truck."  He continued, "He loves guns.   He talks about 
     guns and studies about them.  Me, I don't want to have anything to 
     do with them.  If I never see another one, that would be okay."
     
     A  final sense of guilt from Vietnam is the feeling of not  having 
     done enough.   This guilt may have diffuse origins.   It may arise 
     from a generalized self-blame for the lost war.  It may arise from 
     unrealistic beliefs of what one should have done when a friend was 
     killed.   It  may arise from a clear failure to perform as trained 
     in a traumatic fire-fight.  A tormented, tensed veteran shared the 
     horror of being overrun on a never-to-be-forgotten night.  He told 
     how  a  friend chose to go up a hill while he stayed  below.   His 
     friend died.  He said, "I should have made him stay with me."
     
     The  burden  of  guilt  weighs heavily,  and  is  intensified  for 
     
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     veterans  who have had the appropriateness of their guilty feeling 
     verified  by  others.    The  label  "baby  killers"   has  evoked 
     especially  bitter  reactions.   A veteran who killed a  child  to 
     protect his squad from the child's hidden explosives expressed his 
     vulnerability  to this label.   "I have to live with the knowledge 
     of what I did.  To be reminded of it does not help me either."  He 
     then defended himself as a caring person caught between two evils.
     
     The undeclared nature of the war and the low public support tended 
     to increase the shame experienced by many of the Vietnam veterans.  
     They  sought  validation of the pain,  but  experienced  coldness, 
     misunderstanding  and  accusation.   For some,  this shame  became 
     confused  with anger at a society that would send them to war  but 
     not support them.
     
     These  feelings  of guilt and shame were often  ignored.   A  good 
     soldier supposedly does not look back.  They sought to avoid their 
     real selves.   What sadly occurred was that many made this venture 
     of  escape a life-style.   They found that they maintained control 
     of  themselves,  including  their guilt and  shame,  by  isolating 
     themselves  from others.   They withdrew to paradoxically maintain 
     contact with themselves and others.   The subject of isolation and 
     withdrawal is now discussed from a pastoral perspective.
     
     ISOLATION AND WITHDRAWAL
     Isolation  and  withdrawal are often concomitant behaviors to  the 
     emotions  of guilt and shame,  and are frequent companions of  the 
     Vietnam  veteran  with PTSD.   A struggling veteran  paradoxically 
     said,  "Loneliness is my true companion."   A common litany within 
     my  outpatient group is,  "Society does not understand me...  so I 
     isolate myself."  This statement is often followed by: "This group 
     of  fellow Vietnam veterans are the only people I feel comfortable 
     around."
     
     The wounds of war escape the description of words.   Some veterans 
     feel  that words cheapen the experience of combat and disgrace the 
     sacrifices  of  battle.   Only fellow combat veterans  understand.  
     There is a fraternity with closed initiation rites.  The ritual of 
     the  fraternity includes the unspoken message,  "You don't need to 
     say a word.  I understand."   What often grows from this ritual is 
     an  increase  in  loneliness  and  isolation  (see  Hickman,  this 
     volume).
     
     The fraternal ritual is esteemed and remains sacred.  When someone 
     begins  to break out of the patterns of withdrawal,  suspicion  is 
     often  cast  on  him,  or a subdued questioning begins  about  the 
     authenticity  of his combat experiences.   The scars of  traumatic 
     experiences in combat run deep,  often leaving rough calluses that 
     are  insensitive  to individual desires to escape the  rituals  of 
     isolating behavior.
     
     The   terms  of  isolation  and  withdrawal  are  viewed  hear  as 
     uncreative  behaviors.   They  are seen as means of avoidance  and 
     escape,  rather  than creative behaviors of joining and  aligning.  
     Isolation  is  living with the self to avoid contact with  others.  
     Withdrawal is the action of fleeing contact with others.
     
     The  experience  of combat redefined closeness for many  veterans.  
     Closeness   that   is   based  on  intimacy  and   that   embraces 
     
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     vulnerabilities is often feared.  To share oneself is perceived as 
     sharing  the wounds of war that are,  themselves,  too frightening 
     and painful for the veteran himself.  Some veterans say that their 
     attempts to share vulnerabilities from the war were met with abuse 
     and mocking laughter.  With such receptions, some veterans develop 
     defenses patterned after combat training; they know how to survive 
     alone:  create  a  safe place and do not  expose  yourself.   Many 
     veterans  spoke succinctly of the benefits of his  isolation:  "No 
     one bugs me.  I'm doing what I do well - surviving alone."
     
     Agoraphobic behavior and the fear of intimacy remove veterans from 
     others,  yet  many  cite discomfort with their lonely  lifestyles.  
     They want ot change, but are afraid.  Some truly see themselves as 
     strangers in their native land.   They search for a home,  a place 
     that  offers  embrace.   Countless veterans  describe  innumerable 
     moves, validating their inability to find this place.  "The woods" 
     become a symbol of this nomadic, lonely life style.
     
     Isolation  and  withdrawal are more than just physical  behaviors.  
     They  are also manifestations of emotional detachment.   Intimacy, 
     although  desired,  is  seldom described.   The mask  of  symptoms 
     covers a real person,  capable of giving and responding creatively 
     to closeness and caring.   Inevitably the mask (the symptoms)  has 
     become  so much a part of the person that the veteran stays behind 
     it.  Intimacy is yearned for and avoided.
     
     Wives  report  detachment.   Flashbacks,  violent  outbursts,  and 
     avoidant   behavior   create   great  stress   on   the   marriage 
     relationship.   Families  adjust  by  avoiding the father  who  is 
     withdrawn  and unpredictable.   Wives feel bound to a person in  a 
     struggle they cannot fully comprehend.   Children experience anger 
     toward and resentment of a daddy they cannot talk to.
     
     Triangulation  occurs with the family unit (see  Williams,  "Women 
     Partners," this volume).  There is the husband (father) behind the 
     mask, and there is the husband (father) with PTSD symptoms.  There 
     is often the husband relating to veterans or the VA.  There is the 
     husband's (father's) allegiance to fellow veterans and ties to the 
     VA.   Many  family  members  separate  from  the  veteran  who  is 
     permanently  alienated  from the person and his mask of  symptoms.  
     Other  family  members  struggle  with  the  burden  of  continued 
     attachment;   some  are able to protect themselves and detach  the 
     symptoms from the person.
     
     A  pastoral perspective looks for the person behind the  symptoms.  
     A  pastoral perspective seeks to distinguish the "sins"  from  the 
     "sinner."  The symptoms are often interrelated and enmeshed in the 
     life style and relationships of the veteran.   These symptoms tend 
     to wax and wane in intensity.  Some may be more burdened with loss 
     and  grief,  for instance,  and less burdened with alienation  and 
     estrangement.  The intensity and frequency of each symptom combine 
     to  define  the  set of symptoms (mask)  that is  unique  to  each 
     veteran.  A pastoral perspective seeks to gain entrance behind the 
     mask  of  symptoms and offer healing and wholeness to the  person.  
     The  next  section  describes the veteran's need for  healing  and 
     wholeness from a pastoral perspective.
     
                          PASTORAL POSSIBILITIES
     These  seven  distinct  symptoms describe maladies  of  the  human 
     
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     spirit.    The   chaplain   offers  good  news  -   the   pastoral 
     possibilities for increased healing and wholeness,  beginning with 
     a  deep  understanding of the troubles and a commitment  to  care. 
     (The  term  "pastoral possibilities"  describes the goals  of  the 
     chaplain's caring.)
     
                  (Continued in future issues of NamVet)
     

































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