The post-Vietnam stress syndrome: some cautions.

Because of his alleged post-Vietnam stress disorder, a veteran was found not responsible by reason of mental disease in a shooting incident. The outcome of his subsequent malpractice suite against the Veterans Administration raises some important cautions. With the publication of DSM-III, the term posttraumatic stress disorder has increasingly come into use. I Yost and Williams, among others, have particularly applied this diagnosis, including the delayed type, to Vietnam veterans. Atkinson et al.3,4 have written about the increasing number of Veterans Administration claims for disability based on this disorder, and they believe that their studies do validate the DSM-II1 criteria. Having served as an Army psychiatrist in Vietnam in 1968 and 1969, I am well aware of the burdens which that unpopular war placed on our very young military personnel. As always, though, some cautions are in order. Baskir and Strauss have pointed out that those who served in Vietnam were primarily quite young Americans who had limited coping devices in civilian life. Staying in college with a certain grade point average, for example, was one way of avoiding the military. At the 67th Evacuation Hospital in Qui Nhon, where I worked, I studied 100 consecutive cases of soldiers who were having trouble adapting. I found that 99 of the 100 were high school dropouts. Even with all of the emotional and intellectual resources available to me personally and even though I was in a relatively protected setting, I returned from Vietnam with a lot of anger and mistrust which threatened my civilian adjustment. Surprisingly, though, our actual psychiatric casualty rate in the war zone was quite low when compared with that of Korea and World War 11.6 The one-year rotation, our overwhelming air and naval superiority, the usual absence of prolonged battles, and our extensive mental health services are some of the reasons given to explain this low rate. So the first caution involves not attributing too many current adjustment problems to Vietnam, especially if we sent there many individuals who had already demonstrated some impaired coping devices and who apparently did adequately while there. The interaction is a complicated one which defies easy analysis. Grant and Coons have warned against the simplistic connection of too much Current behavior to Vietnam duty, just because a person had had some