Vietnamese veterans of the Vietnam War have not experienced the same level of PTSD as American soldiers. Could the country’s cultures explain the difference?
By Dr. Edward Tick
Jim did not want to go to war. But in 1968, like several million others in America, he was drafted and sent to Vietnam. He had wanted to be a Navy chaplain but was made an electrician and assigned to swift boats prowling the Mekong River, where he often had to operate .50-caliber machine guns. He shot blindly into the jungles, villages, at sampans, killing civilians and livestock as well as combatants. He liked it—very much. He re-upped twice, turning down the fourth tour when he had pushed his luck as far as he dared.
Linh was Jim’s age. He did not want to go to war, either. He and his brother volunteered to fight for their country after their village in the northern Vietnamese countryside was bombed. Seeing his neighbors’ bodies scattered like grains of rice was too much to take. He marched south and fought in Quang Tri Province, “the meat grinder,” for a decade until the Americans withdrew, and the southern forces were defeated. His brother was killed during a battle in the Mekong Delta, and his remains were never found.
Jim returned home, disturbed by his experience. Despite developing symptoms of Post Traumatic Stress Disorder, he became a minister at poor and remote churches for 35 years. Jim divorced three times, married a fourth, became an alcoholic, manipulative and secretive. He suffered nightmares, insecurities, and hypervigilance. He had hoped his ministerial career would win him redemption but, instead, his suffering only worsened until he was labeled 100 percent disabled.
Linh returned to his home, too. He took up farming again, attended his local pagoda, and studied Buddhism. He slept and ate well and married once and happily. Linh eventually became a Buddhist monk and master of the pagoda. He spent 35 years teaching, praying, and tending the poor and needy. Linh is serene, sleeps in peace, never touches alcohol, or raises his voice. He feels no anger, only compassion, and forgiveness.
Jim and Linh lived parallel lives: they went to the same war at the same age; they served in ministry for the same number of years, but the war left Jim ravaged while Linh found peace. Each man’s story is emblematic of his culture.
In the United States, PTSD is an epidemic among Vietnam veterans. According to the Veterans Administration, at least 30 percent of those who served developed the condition at some time, a rate more than four times the national average for PTSD for adults. In contrast, in Vietnam, research by its Institute of Psychology, War Remnants Museum, its veteran organizations, and other in-country experts, show the American form of chronic and comprehensive breakdown is absent among Vietnamese veterans of what they call the American War.
What accounts for these drastic differences in post-war functioning? How must these astonishing differences influence our understanding of PTSD?
Combat is inherently wounding and disturbing. It is impossible to emerge from battle without some emotional and psychospiritual wounding. It is impossible to serve in the combat zone without contributing to the war effort and have some exposure to its trauma. But the reasons for serving, the training, the degree to which you experience the bestial during warfare, the homecoming, the way society welcomes or does not welcome you home—all profoundly shape the impact of horror upon the psyche.
A multitude of factors in the Vietnamese experience prevent the chronic form of debilitation that American veterans suffer. They include personal, interpersonal, communal, collective, religious, spiritual, cultural, political, and historical factors. Taken together, Dr. Hao Van Le, vice director of the Institute of Psychology in Hanoi, calls them “Vietnam’s protective factors.”
Kate Dahlstedt, a co-founder of Soldier’s Heart, has facilitated nine healing journeys through Vietnam. She says, “it seems counterintuitive given current Western medical explanations for PTSD, but the Vietnamese do have such ‘protective factors’ infused into the very fabric of their culture that appears to make them immune.” These factors reveal complicated matters regarding our American version of PTSD and why our veterans often do not heal and instead suffer without relief for life.
The Viet Cong and the North Vietnamese Army (NVA) forces universally believed they were defending their nation as did many southern army vets aligned with the U.S. Nguyen Tam Ho, a veteran of both the Viet Minh against the Japanese and French and Viet Cong against the Americans, said, “I was never fighting America. I was only fighting invaders. An invader is someone who comes into your country, bombs your schools, and kills your children.” There is little moral injury–a wound at the core of PTSD–among those whose only choice was to fight to defend their homes and families. In contrast, many American GIs felt they were indeed invaders, in Vietnamese eyes, if not their own.
Vietnam has been a Buddhist culture for millennia. Much about Buddhism helps protect against long-term traumatic breakdown. The belief in reincarnation means that this life is not the only life we will live, so Vietnamese do not fear death as we do. Belief in karma means that doing one’s honorable duty creates good karma and contributes to a better future. An elderly man who lost three sons in the war saying, “My sons did their duty for their country and met their proper karma. I miss them, but I am at peace.” Karma also includes the concept of no’, meaning the accumulation of bad debt. Doing wrong, inevitable during wartime, incur debts on the soul; over time, they can be crushing. Vietnamese work to repay their karmic debts, and believe in historical and collective karma. They think that the American War was their payback for conquering indigenous peoples of Southeast Asia–the Cham, Khmer, and others–millennia ago. They had to suffer the pain they had once caused others. Thus they accept their war suffering without blame or complaint. Karma also enables the Vietnamese to take survival without guilt. It was one person’s karma to fall in war, and another’s to live. Neither is wrong, and no one is to blame. As Nguyen Tam Ho said, “The bullet is the messenger of karma. Learn to see from the point of view of the bullet.”
Vietnam is a collectivist society, the U.S. individualistic. Vietnamese work for all of the homeland, and were willing to die for the whole. In contrast, Americans believe in the individual and were not fighting with their families at their backs. Vietnamese sacrifice was defensive, honorable, and willing. Americans only wanted to get themselves and their buddies home. Further, in Vietnam, the war was “a people’s war.” As NVA General Hoang Minh Thao explained, “The whole country was at war,” and the U.S. never grasped that.
The Vietnamese practice ancestor veneration, a spiritual discipline older than Buddhism. They pray for, care for, and tend the souls of their fallen for a full century after death. They practice not speaking ill of the departed. Veterans know any harm they did will not follow their reputations after they are gone. They die in peace.
They developed practices that we in the U.S. are trying to offer our veterans. They have held veteran story-telling circles, prayer, blessing and honoring ceremonies, holidays for the missing and dead all this time. They have the means for good homecoming and reintegration built into their age-old traditional community practices.
The Vietnamese do not boast that they “won the war,” but rather, “we reunified our country” and “we restored the peace.” This gentle and affirming attitude helps them accept the tragic necessity of war but neither revel in victory nor sink in despair over their enormous losses.
For all these reasons and more, there is very little chronic and life-shattering PTSD among the Vietnamese veterans of the American War. Their psychological experts report that there was a short-term traumatic breakdown in the 1970s after the war, but that the worst cases only lasted a few months, then healed and reintegrated. The beliefs and practices above enabled their sufferers to recover.
Vietnamese veterans do experience trauma suffering. With so much loss–three million killed and over five million wounded–their veteran and civilian survivors experienced chronic grief. Their veterans sometimes wander off by themselves with intrusive thoughts and memories. But these symptoms are kept in abeyance by the practices mentioned above. They do not collapse into lifelong and life-shattering disability. If PTSD were, as modern psychiatry teaches, primarily a disorder of cerebral functioning, the Vietnamese would have it in epidemic proportions. They do not, so it cannot be limited to brain functioning. The Vietnamese demonstrate that while trauma is universal, the forms of breakdown are, to a significant degree, culturally specific and can be mitigated by proper protective practices.
As Nguyen Tam Ho said, “In America, you believe the wound is here,” and he pointed to his brain. “In Vietnam we know it is here,” and he pointed to his heart.
Maybe that’s all our veterans need, love.