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Vietnam: A Casebook
First published in 1988. Routledge is an imprint of Taylor & Francis, an informa company.
353 pages, Hardcover
First published November 1, 1987
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May 23, 2017
Vietnam: A Casebook was written by clinicians working with Vietnam war vets during the early '80s. It is the product of a formal study conducted not long after PTSD was recognized as a bona fide psychiatric condition, and just as US society was beginning to realize how it had misused and mis-served those who fought in Vietnam. Although meant for a professional audience, it is readable and valuable to the layperson. In fact, it is a fascinating demonstration of how such therapy can work.
(While it's not actually an "auto-biography-memoir," I categorized it as such because I wanted to stick with my existing categories, and the case studies are, in a way, memoirs of the patient-therapist interaction, quite compelling and intimate. Also, by way of disclosure, I should say that my father worked on this project as a therapist and collaborator.)
Aside from case studies, the volume includes chapters of historical perspective on the Vietnam War, chapters that sum up the project, as well as more "scientific" or "clinical" chapters that discuss the vets' intake and exit interviews and related questionnaires and rating scales.
Even though some or all of the therapists had worked with patients with PTSD before, they found that they had to adjust their usual habits and methods in working with the vets. This journey is documented in the book, through their own reflections and in the summing-up chapters.
Through each case history, the reader comes to understand the more specific events that contribute to these young men's continuing distress some 12 years or so after leaving Vietnam. Giving examples here would make them seem trite, when in fact they were tremendously profound, so I will not attempt to do so. But as I read the therapists' accounts I came to care about each of these men. None were monsters; all were very human people who knew right from wrong and yearned for the possibility of a normal life.
There was a hopeful note struck at the end of the book, based on interviews conducted with the vets some 18 months after their therapy ended. The therapy had seemed to allow them to address and understand what had happened during their time in Vietnam, to view those events with new perspective, to forgive themselves when necessary, and in some way to make reparations. Therapy seemed to allow them to relegate difficult events to memory, rather than having them constantly intruding on the present, and/or, at least, to be able to better cope with them when they did intrude, understanding them as memories rather than as current happenings. This seemed to allow these men to begin to engage positively in the realms of relationships, work, and other activities.
However, the long-term mental health of these men has, as I understand it, been more problematic. I'd like to know what factors played into this - was it the sometimes too short duration of the therapy itself, that left too many loose ends? Were there other issues related to the therapy? Or were their experiences in Vietnam (and at home after their return) simply too much for a human being to handle?
To conclude, I want to share a quote from the book. It has to do with transference, the idea that, during therapy, the therapist temporarily comes to function as an important person in the patient's past - a mechanism that allows related issues to appear and to be addressed. Examples of positive transference could include, for example, medics or buddies that a vet had known during the war, but also could be "figures in the patient’s prewar family...older brothers, fathers, uncles, or cousins...Our patients frequently mentioned their desire for dialogue with an important family member, talks they looked forward to having once they returned home. All too often...these talks never took place, or at least not in a satisfactory manner. Treatment revives the potential for explaining to that person what happened in combat and what those experiences meant." (Italics are mine.)
To me, this expresses a particularly profound idea, one that says a lot about what these young men in general so desperately needed and, sadly, never received. It's nothing fancy or exotic - it's simply to be listened to, understood, and forgiven.
(While it's not actually an "auto-biography-memoir," I categorized it as such because I wanted to stick with my existing categories, and the case studies are, in a way, memoirs of the patient-therapist interaction, quite compelling and intimate. Also, by way of disclosure, I should say that my father worked on this project as a therapist and collaborator.)
Aside from case studies, the volume includes chapters of historical perspective on the Vietnam War, chapters that sum up the project, as well as more "scientific" or "clinical" chapters that discuss the vets' intake and exit interviews and related questionnaires and rating scales.
Even though some or all of the therapists had worked with patients with PTSD before, they found that they had to adjust their usual habits and methods in working with the vets. This journey is documented in the book, through their own reflections and in the summing-up chapters.
Through each case history, the reader comes to understand the more specific events that contribute to these young men's continuing distress some 12 years or so after leaving Vietnam. Giving examples here would make them seem trite, when in fact they were tremendously profound, so I will not attempt to do so. But as I read the therapists' accounts I came to care about each of these men. None were monsters; all were very human people who knew right from wrong and yearned for the possibility of a normal life.
There was a hopeful note struck at the end of the book, based on interviews conducted with the vets some 18 months after their therapy ended. The therapy had seemed to allow them to address and understand what had happened during their time in Vietnam, to view those events with new perspective, to forgive themselves when necessary, and in some way to make reparations. Therapy seemed to allow them to relegate difficult events to memory, rather than having them constantly intruding on the present, and/or, at least, to be able to better cope with them when they did intrude, understanding them as memories rather than as current happenings. This seemed to allow these men to begin to engage positively in the realms of relationships, work, and other activities.
However, the long-term mental health of these men has, as I understand it, been more problematic. I'd like to know what factors played into this - was it the sometimes too short duration of the therapy itself, that left too many loose ends? Were there other issues related to the therapy? Or were their experiences in Vietnam (and at home after their return) simply too much for a human being to handle?
To conclude, I want to share a quote from the book. It has to do with transference, the idea that, during therapy, the therapist temporarily comes to function as an important person in the patient's past - a mechanism that allows related issues to appear and to be addressed. Examples of positive transference could include, for example, medics or buddies that a vet had known during the war, but also could be "figures in the patient’s prewar family...older brothers, fathers, uncles, or cousins...Our patients frequently mentioned their desire for dialogue with an important family member, talks they looked forward to having once they returned home. All too often...these talks never took place, or at least not in a satisfactory manner. Treatment revives the potential for explaining to that person what happened in combat and what those experiences meant." (Italics are mine.)
To me, this expresses a particularly profound idea, one that says a lot about what these young men in general so desperately needed and, sadly, never received. It's nothing fancy or exotic - it's simply to be listened to, understood, and forgiven.
Displaying 1 of 1 review