Achilles in Vietnam (PTSD)

[Anonymous]

ACHILLES IN VIETNAM : Combat Trauma and the Undoing of Character by Jonathan Shay

"We begin in the moral world of the soldier-what his culture understands to be right-and betrayal of that moral order by a commander..." (more)
SIPs: berserk state, many combat veterans, combat trauma, character damage, arming scene (more)
CAPs: Metaphor of Social Power, National Vietnam Veterans Readjustment Study, Carl von Clausewitz, Viet Cong, Persian Gulf War

Amazon.com
Shay works from an intriguing premise: that the study of the great Homeric epic of war, The Iliad, can illuminate our understanding of Vietnam, and vice versa. Along the way, he compares the battlefield experiences of men like Agamemnon and Patroclus with those of frontline grunts, analyzes the berserker rage that overcame Achilles and so many American soldiers alike, and considers the ways in which societies ancient and modern have accounted for and dealt with post-traumatic stress disorder---a malady only recently recognized in the medical literature, but well attested in Homer's pages. The novelist Tim O'Brien, who has written so affectingly about his experiences in combat, calls Shay's book "one of the most original and most important scholarly works to have emerged from the Vietnam war." He's right.

From Publishers Weekly
Shay is a psychiatrist specializing in treating Vietnam veterans with chronic post-traumatic stress syndrome. In this provocative monograph, he relates their experiences to Homer's portrait of Achilles in The Illiad. War, he argues, generates rage because of its intrinsic unfairness. Only one's special comrades can be trusted. The death of Patroklos drove Achilles first into passionate grief, then into berserk wrath. Shay establishes convincing parallels to combat in Vietnam, where the war was considered meaningless and mourning for dead friends was thwarted by an indifferent command structure. He convincingly recommends policies of unit rotation and unit "griefwork"--official recognition of combat losses--as keys to sustaining what he calls a moral existence during war's human encounters. The alternatives are unrestrained revenge-driven behavior, endless reliving of the guilt such behavior causes and the ruin of good character. Shay's ideas merit attention by soldiers and scholars alike.
Copyright 1994 Reed Business Information, Inc.

Customer Reviews

Please care for the warriors..., February 5, 2002
Reviewer:   Joy Marchand (Salem, MA USA)

As a student of the Classics, I did not read this book in order to understand the war in Vietnam and I'm fairly certain that the author is not trying to explain, condemn, or justify the conflict. What the author does, and masterfully, is to explain how a person's character can change, most often for the worse, by experiencing the various traumas of combat. In order to do this, he compares the experiences of Vietnam veterans with the experiences of Achilles in Homer's epic, the "Iliad". It is my understanding that his motive is to convince the powers that be, as well as the general public, to rethink their treatment of soldiers sent to war so that we might prevent the occurrence of Post Traumatic Stress Disorder. It's also my understanding that he chose to use the narratives of Vietnam veterans to illustrate his arguments because there has been more data collected from these people than any other combat survivors before. So this book is about how to properly care for the warrior, before and after battle, so that less might fall victim to psychiatric disorders upon returning home. It is simply amazing and wonderful to see how the words of the past, in this case Homer's Iliad, can help us in the present. This book, among other things, teaches us to value the entire canon of human writings and shows us the continued relevance of even the most ancient of texts.


We are not alone., June 26, 2005
Reviewer:  Allen J. Caruselle "VagabondStar"    
As a Marine recently returned from his second combat tour in Iraq, I have found this book to be immensely helpful in understanding the changes that have taken place in my life as a result of traumatic experience. While the vietnam war may be 30 years gone, the lessons of those who have experienced war first hand are as timeless and relevant today as they ever were.


The true use of art, December 31, 2004
Reviewer:  B. E. Huizenga "O. of H.F." (Chicago)
 
This book uses the story of Achilles in Homer's Iliad to talk about the kinds of experiences which can damage soldiers during combat, sometimes to the extent of creating that state of permanent trauma which we call Post-Traumatic Stress Disorder. I cannot over-emphasize the value of this book for a citizen during wartime. Shay shows how Homer's art is something close to a chart of the various destructive forces which attack a soldier's spirit and character, and thus gives us some glimpses into how to protect them from these evils. There is probably no higher goal which art can realize than this, the protection and healing of the minds of our fellow citizens, but it cannot do so without the constant enactment of its truths by people like Dr. Shay, and any of us in a position to help those in danger.



Why does it seem new?, November 16, 2004
Reviewer: Stratiotes Doxha Theon "Stratiotes" (Richmond, Missouri)

Why is war-related trauma so prevalent in a post-Vietnam era? This book explains why. Lessons we especially need to learn today as we welcome today's warriors home.


Odysseus cried..., July 16, 2004
Reviewer: Doug Todd (Warm Springs)

In "Healing and Tragedy" (Chapter 11) Shay says that "Healing is done by survivors, not to survivors" and he is right. He also speaks of the healing power of narrative and says, "The ancient Greeks revered Homer, the singer of tales, as a doctor of the soul. In the Odyssey, Homer paints a (self-)portrait of the epic singer whose healing art is to tell the stories of Troy with the truth that causes the old soldier, Odysseus, to weep and weep again. (Odyssey 8:78ff)"

Something like that seems to happen to Combat Veterans when they read this book. Shay is neither the bard telling the story nor the warrior who lived it, but he takes the stories of those who were there and presents them in such a way that, reading them, "the old soldier weeps and weeps again...".

The truth is here. Another reviewer has viewed some of the stories with a measure of skepticism -- and there are some "red flags" in some of the stories -- but that is the nature of "War Stories" and those who know what "the facts on the ground" were can see therough all that to the essential truth that Shay so eloquently presents.

I bought this book because it was recommended to me by readers of my own book, "Aftermath: A Song For Tyrone..." and I am glad I did! I wish I had read it years ago!

If you are a Veteran -- or if there is a veteran who means a lot to you -- or if you just want to understand more about war and what it does to the soldier and to those who love him and to society in general -- buy this book! Buy it -- read it -- give it as a gift!


BULL'S EYE, June 27, 2004

Shay's 'Achilles in Vietnam' is the best, most realistic book I've read about combat PTSD; it plumbs the depths of anguish and the consequences of torture (combat) on soldiers. Shay essentially, fully captures the forces occurring within a combatant's system, during and after battle (if imbrued with moderate to severe chronic PTSD). Want to know the possible result of war on young men that you inadvertantly finance through your tax dollars? Read this book. Those young men may now be living on the same block as you, ready to launch into deadly combat at the slightest twig snap, if not treated. We've heard advice to Bush before invading Iraq--'break it and it's yours.' Ditto for veterans 'broken' physically or mentally. You sent them. Want to now understand the consequences?

[Anonymous]

A Political Debate On Stress Disorder
As Claims Rise, VA Takes Stock

By Shankar Vedantam
Washington Post Staff Writer
Tuesday, December 27, 2005; Page A01

The spiraling cost of post-traumatic stress disorder among war veterans has triggered a politically charged debate and ignited fears that the government is trying to limit expensive benefits for emotionally scarred troops returning from Iraq and Afghanistan.

In the past five years, the number of veterans receiving compensation for the disorder commonly called PTSD has grown nearly seven times as fast as the number receiving benefits for disabilities in general, according to a report this year by the inspector general of the Department of Veterans Affairs. A total of 215,871 veterans received PTSD benefit payments last year at a cost of $4.3 billion, up from $1.7 billion in 1999 -- a jump of more than 150 percent.
   
Army Reserve Sgt. Jared Myers is shown with his mother, Judy Smith, who admitted him to the Dwight D. Eisenhower Veterans Affairs Medical Center in Leavenworth, Kan., where he spent three weeks being diagnosed and treated for post-traumatic stress disorder.

Experts say the sharp increase does not begin to factor in the potential impact of the wars in Iraq and Afghanistan, because the increase is largely the result of Vietnam War vets seeking treatment decades after their combat experiences. Facing a budget crunch, experts within and outside the Veterans Affairs Department are raising concerns about fraudulent claims, wondering whether the structure of government benefits discourages healing, and even questioning the utility and objectivity of the diagnosis itself.

"On the one hand, it is good that people are reaching out for help," said Jeff Schrade, communications director for the Senate Veterans Affairs Committee. "At the same time, as more people reach out for help, it squeezes the budget further."

Among the issues being discussed, he said, was whether veterans who show signs of recovery should continue to receive disability compensation: "Whether anyone has the political courage to cut them off -- I don't know that Congress has that will, but we'll see."

Much of the debate is taking place out of public sight, including an internal VA meeting in Philadelphia this month. The department has also been in negotiations with the Institute of Medicine over a review of the "utility and objectiveness" of PTSD diagnostic criteria and the validity of screening techniques, a process that could have profound implications for returning soldiers.

The growing national debate over the Iraq war has changed the nature of the discussion over PTSD, some participants said. "It has become a pro-war-versus-antiwar issue," said one VA official who spoke on the condition of anonymity because politics is not supposed to enter the debate. "If we show that PTSD is prevalent and severe, that becomes one more little reason we should stop waging war. If, on the other hand, PTSD rates are low . . . that is convenient for the Bush administration."

As to whether budget issues and politics are playing a role in the agency's review of PTSD diagnosis and treatment, VA spokesman Scott Hogenson said: "The debate is over how to provide the best medical services possible for veterans."

People with PTSD have paralyzing memories of traumatic episodes they experienced or witnessed, a range of emotional problems, and significant impairments in day-to-day functioning. Underlying the political and budget issues, many experts acknowledged, is a broader scientific debate over how best to diagnose trauma-related pathology, what the goal of treatment should be -- even what constitutes trauma.

Harvard psychologist Richard J. McNally argues that the diagnosis equates sexual abuse, car accidents and concentration camps, when they are entirely different experiences: A PTSD diagnosis has become "a way of moral claims-making," he said. "To underscore the reprehensibility of the perpetrator, we say someone has been through a traumatic event."

Chris Frueh, director of the VA clinic in Charleston, S.C., said the department's disability system encourages some veterans to exaggerate symptoms and prolong problems in order to maintain eligibility for benefits.

"We have young men and women coming back from Iraq who are having PTSD and getting the message that this is a disorder they can't be treated for, and they will have to be on disability for the rest of their lives," said Frueh, a professor of public psychiatry at the Medical University of South Carolina. "My concern about the policies is that they create perverse incentives to stay ill. It is very tough to get better when you are trying to demonstrate how ill you are."

[Anonymous]

A Political Debate On Stress Disorder

Most veterans whom Frueh treats for PTSD are seeking disability compensation, he said. Veterans Affairs uses a sliding scale; veterans who are granted 100 percent disability status receive payments starting at around $2,300 a month. The VA inspector general's report found that benefit payments varied widely in states and said that was because VA centers in some states are more likely to grant veterans 100 percent disability.

Psychiatrist Sally Satel, who is affiliated with the conservative American Enterprise Institute, said an underground network advises veterans where to go for the best chance of being declared disabled. The institute organized a recent meeting to discuss PTSD among veterans.

Once veterans are declared disabled, they retain that status indefinitely, Frueh and Satel said. The system creates an adversarial relationship between doctors and patients, in which veterans sometimes take legal action if doctors decline to diagnose PTSD, Frueh said. The clinician added that some patients who really need help never get it because they are unwilling to undergo the lengthy process of qualifying for disability benefits, which often requires them to repeatedly revisit the painful episodes they experienced.

The concern by Frueh and Satel about overdiagnosis and fraud -- what researchers call "false positives" -- has drawn the ire of veterans groups and many other mental health experts.

A far bigger problem is the many veterans who seek help but do not get it or who never seek help, a number of experts said. Studies have shown that large numbers of veterans with PTSD never seek treatment, possibly because of the stigma surrounding mental illness.

"There are periodic false positives, but there are also a lot of false negatives out there," said Terence M. Keane, one of the nation's best-known PTSD researchers, who cited a 1988 study on the numbers of veterans who do not get treatment. "Less than one-fourth of people with combat-related PTSD have used VA-related services."

Larry Scott, who runs the clearinghouse http://www.vawatchdog.org/ , said conservative groups are trying to cut VA disability programs by unfairly comparing them to welfare.

Compensating people for disabilities is a cost of war, he said: "Veterans benefits are like workmen's comp. You went to war. You were injured. Either your body or your mind was injured, and that prevents you from doing certain duties and you are compensated for that."

Scott said Veterans Affairs' objectives were made clear in the department's request to the Institute of Medicine for a $1.3 million study to review how PTSD is diagnosed and treated. Among other things, the department asked the institute -- a branch of the National Academies chartered by Congress to advise the government on science policy -- to review the American Psychiatric Association's criteria for diagnosing PTSD. Effectively, Scott said, Veterans Affairs was trying to get one scientific organization to second-guess another.

PTSD experts summoned to Philadelphia for the two-day internal "expert panel" meeting were asked to discuss "evidence regarding validity, reliability, and feasibility" of the department's PTSD assessment and treatment practices, according to an e-mail invitation obtained by The Washington Post. The goal, the e-mail added, is "to improve clinical exams used to help determine benefit payments for veterans with Post Traumatic Stress Disorder."

"What they are trying to do is figure out a way not to diagnose vets with PTSD," said Steve Robinson, executive director of the National Gulf War Resource Center, a veterans advocacy group. "It's like telling a patient with cancer, 'if we tell you, you don't have cancer, then you won't suffer from cancer.' "

Hogenson, the VA spokesman, said the department is not seeking to overturn the established psychiatric criteria for diagnosing PTSD.

"We are reviewing the utility and the objectivity of the criteria . . . and are commenting on the screening instruments used by VA," he said. "We want to make sure what we do for screening comports with the latest information out there."