Shook over hell: post-traumatic stress, Vietnam, and the civil war

However, in the final chapter, 'The price of success', Fye provides a valuable analysis to show how this success has also brought greed, prohibitive costs, the rise of managed care, fragmentation, new tensions, excessive numbers of cardiologists, high expectations, and a rise in consumer protection. Ironically, this is at the very moment when the quality of cardiac care in America has become the envy of other countries. He concludes with the cautionary note that "America's cardiologists and their college must work constructively in this new cost-sensitive environment to ensure that people benefit from what has already been learned about the diagnosis and treatment of heart disease-and that our nation's commitment to finding and applying new knowledge is maintained". The book more than serves its original purpose as a record of the American College of Cardiology, it provides a rich narrative account of the development, aspirations, organizations, politics, achievements, and eventual problems of the speciality of cardiology in America. In 1980, the American psychologist Charles Figley declared that the debate over the mental health of Vietnam veterans was effectively over; the issue had become "depoliticized". Yet, two decades later, the debate is very much alive and more political than ever-its flames fanned, not doused, by the "invention" of Post-Traumatic Stress Disorder (PTSD) and the establishment of Readjustment Counselling Centers. Eric Dean's important, but deeply flawed, book offers the now-standard right-wing revisionist critique, blaming anti-war psychiatrists, not the Vietnam war, for the psychological problems of veterans. In addition, though, it looks back at the American Civil War "through the lens of the Vietnam experience". Energetic, erudite and readable, it remains firmly bifurcated, a poor advertisement for the comparative method. Two chapters on Vietnam open and close the book. The first, essentially a reprint of a 1992 article, argues that psychiatrists and the American media became so obsessed by the stereotype of the psychologically damaged veteran that they ignored objective indicators showing that most returned soldiers had successfully readjusted to civilian life and come to feel positively about having served in Vietnam. The second is a sustained assault on the role of psychiatrists in foisting PTSD and, with it, a culture of compensation and victimhood, on American society. The tone here is more polemical than scholarly-in sharp contrast to Wilbur Scott's Politics of readjustment (1993). Telling points about the dependence on self-reporting in epidemiological surveys of PTSD, the erosion of moral responsibility, and …