Vietnam veterans of the Vietnam War have not experienced the same level of PTSD as American soldiers. Could each country’s culture 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 man .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 a 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. From the northern Vietnamese countryside, he only enlisted when his village was bombed and his neighbors’ bodies were “scattered like grains of rice.” On the same day in 1965 Linh and his brother volunteered to fight for their country and marched south. Linh was a combatant in Quang Tri Province, “the meat grinder,” for a full decade, until the Americans withdrew and the southern forces were defeated. His brother was killed in the Mekong Delta and his remains never found.
Jim returned home. Deeply troubled by his experiences, his enjoyment of them. He developed PTSD symptoms. He became a minister, serving as a pastor in poor and remote churches for 35 years. He divorced three times, married a fourth, became 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 village. 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 his 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. Afterward they served in ministry for the same number of years. But the war ravaged three-tour combat vet Jim while 10-year combat vet Linh found peace. Each man’s story is emblematic of his culture. In the United States, PTSD is epidemic among Vietnam veterans. According to the Veterans Administration at least 30 percent of those who served have the condition at some time, a rate more than four times the national average for PTSD for all 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 combat without some kinds of emotional and psychospiritual wounding. It is impossible to serve in the combat zone without contributing to the war effort and having some kind of exposure to its trauma. But the reasons for serving, the training, the degree to which you experience the bestial during warfare, the homecoming you are given, 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, 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 appear to make them immune.” These factors reveal difficult matters regarding our American version of PTSD and why our veterans often do not heal and instead suffer without relief for life.
Viet Cong and 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; its beliefs are thoroughly inculcated throughout. 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, incurs debts on the soul; over time they can be crushing. Vietnamese work to repay their karmic debts. They also believe in historical and collective karma. They believe 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 Vietnamese to accept 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. The Vietnamese work for the good of all, the survival 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 strictly practice not speaking ill of the departed. Veterans know they will be remembered forever and 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 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 heal.
This is not to say that Vietnamese veterans do not experience any traumatic suffering. With so much loss–the Vietnamese had 3 million killed and over 5 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 life-long 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 and should not be reduced 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 American 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. The Vietnamese heal themselves, and us, with the very conditions our veterans need from all of us: spirituality, community and love.