PTSD: National Center for PTSD
Psychological Trauma for Native Hawaiians and Americans of Japanese Ancestry Who Served in Vietnam
Psychological Trauma for Native Hawaiians and Americans of Japanese Ancestry Who Served in Vietnam
The Department of Veterans Affairs Matsunaga Vietnam Veterans Project
Military personnel of many ethnic backgrounds served with distinction in the Vietnam War. The 1988 National Vietnam Veterans Readjustment Study (NVVRS) (1) demonstrated that Black and Hispanic Veterans who served in Vietnam experienced significantly greater readjustment problems and higher levels of Posttraumatic Stress Disorder (PTSD) than White Veterans.
To extend the study findings to other minority Veterans, the late Senator from Hawaii, Spark Matsunaga, initiated a major project to assess the readjustment experience of American Indian, Japanese American, and Native Hawaiian Veterans of the Vietnam War. This resulted in Public Law 101-507, which directed the VA's National Center for PTSD to conduct what became known as the Matsunaga Vietnam Veterans Project (2).
The Matsunaga Project involved two parallel studies. The American Indian Vietnam Veterans Project surveyed a sample of Vietnam in-country Veterans residing on or near two large tribal reservations, one in the Southwest and the other in the Northern Plains. These populations had sufficient numbers of Vietnam military Veterans to draw scientifically and culturally sound conclusions about the war and readjustment experiences.
The Hawaii Vietnam Veterans Project surveyed two samples, one of Native Hawaiians (the indigenous peoples of the Hawaiian Islands, who constitute about 22% of the permanent population in Hawaii) and another of Americans of Japanese Ancestry (the descendants of Japanese immigrants who comprise about 24% of the permanent population in Hawaii).
Matsunaga study participants were interviewed face-to-face for several hours with culturally sensitive questions about their prewar and war experiences; their PTSD and other health problems; their personal, family, work, and education readjustment experiences; and their use of Veterans Affairs health care services. Only men participated because, despite their key contributions to the military, there are few women Vietnam Veterans in these survey populations. Although many American Indian Veterans from other tribes and areas of the United States served in Vietnam, in a single study it is not possible to characterize every possible American Indian tribe or Veteran. The many American Indian experiences and cultures all require recognition and respect. The similarities and differences revealed by surveying hundreds of Vietnam Veterans from each of two large and different tribes bring to life the richness and diversity of the American Indian experience before, during, and after the Vietnam War.
The Matsunaga Study's key finding is that exposure to war zone stress and other military danger places Veterans at risk for PTSD several decades after military service. Native Hawaiian and American Indian Vietnam in-country Veterans had relatively high levels of exposure to war zone stress and high levels of PTSD. Caucasian and Japanese American Veterans tended to have somewhat lower levels of exposure to war zone stress and later PTSD.
The unique cultural traditions, society, and family experiences of each different ethnic group played an important role in the Veteran's homecoming and readjustment after Vietnam, but they do not appear to either cause or prevent PTSD. The following examples depict Veterans' experiences before, during, and after the Vietnam War:
Native Hawaiian Veterans
"I grew up close to my family and the land, protected from the outside world. I enlisted in the Army Reserves when I was working and going to college part time, and the military discipline was good for me. Everything fell apart in Vietnam; I felt cut off from my home and family, in a bloody nightmare. I re-upped for a second tour because I wanted to die in Vietnam. I came home, went back to work, got married-but never escaped the memories and dreams of death. I still feel dead inside much of the time, although I'm beginning to feel a part of my family as I tell my story in counseling and to my kupunas."
Japanese American Veterans
"I was very dutiful and hardworking growing up, and quietly did well in school. I respected elders in my family and community, and sought to bring honor to them without attracting attention to myself. I joined ROTC in college and was sent to Vietnam as a raw second lieutenant in the Air Force. As an officer, I didn't see as much combat as many others. I don't think the men really trusted me because I looked too much like a Vietnamese to them, but I didn't harass them and they didn't hassle me. Since Vietnam, I've done well in my profession. I'm married and raising my children with the same values I learned. I have nightmares of the war that can give me a headache and high blood pressure for several days; sometimes I'm Charlie and my own men are hunting and killing me."
Before military service
Native Hawaiian Veterans generally described a positive relationship with their parents while growing up and valued the support of their extended families and communities. Some Native Hawaiians, however, did encounter physical abuse and family substance abuse while growing up. They learned to trust and honor traditional values but to distrust the government and mainstream culture. These men were likely to attend and complete school, have friends, and be involved in organized activities such as athletics.
Japanese American Veterans described growing up in close knit and supportive extended family communities, learning to put self-interest second to obedience and respect for authority. They sought success in the mainstream by quietly achieving in school and college, but their loyalty was to the extended family.
Entering military service
More than half of the Native Hawaiian Veterans volunteered for duty in Vietnam to obtain opportunities for education, jobs, and travel, and they were proud to protect their home and country. Many re-enlisted and served more than one tour, and many attained the rank of noncommissioned officer. They tended to value the training and discipline of military service but often felt isolated from their fellow soldiers. Many faced close and personal racial prejudice and discrimination for the first time and felt disillusioned and angry when they encountered racial hostility or disrespect.
Japanese American Veterans often enlisted in college and became officers in order to advance their careers. Like the Native Hawaiian Veterans, they were proud to protect their home and country and valued military training and discipline, but they too felt isolated. Many encountered racial prejudice and discrimination because they were Asian, and they felt not only disillusioned but also fearful of being physically harmed ("fragged").
The trauma of military service in war
More than one out of every two Native Hawaiian Veterans experienced war-related trauma in Vietnam. The war traumas included being under fire on helicopters, cargo and reconnaissance aircraft, patrol boats, navy ships, or cargo and transport trucks; being on frequent or prolonged combat missions in enemy territory (including Cambodia and Laos); and encountering ambushes and firefights. Traumas also included being attacked by sappers, snipers, artillery, or rockets; witnessing death and terrible harm to their own or others' bodies; and performing very hazardous duties as walking point, radio operators, medics, scouts, tunnel rats, perimeter sentries, long range patrollers, or door gunners. Native Hawaiians and American Indians were more likely than any other survey group to receive combat service medals in recognition of their hazardous combat duty.
More than one in three Japanese Americans experienced war trauma in Vietnam. They were exposed to many of the same kinds of traumas as the Native Hawaiian Veterans. Traumas most often encountered by Japanese American Veterans included being under enemy fire or ambushed; being attacked by sappers, snipers, artillery, or rockets; witnessing death and terrible harm to their own or others' bodies; and extreme conflict due to having to kill or be killed by Asians that other American soldiers often dehumanized.
The Hidden Enemy: PTSD
Upon returning home after one or more tours in Vietnam, a number of Native Hawaiian and Japanese American Veterans struggled with severe problems that they and their families, friends, and communities did not understand or know how to cope with. Many of these Veterans were suffering from PTSD.
One in three Native Hawaiian and one in twenty Japanese American in-country Vietnam Veterans currently has full or partial PTSD. More than one in two Native Hawaiian and one in seven Japanese American in-country Veterans has had full or partial PTSD sometime since Vietnam. Native Hawaiians' PTSD prevalence is very high, while the Japanese Americans' is quite low. However, Veterans who experienced war trauma, regardless of cultural or racial background, are at risk for PTSD.
PTSD's effect on family and friendships
Other people-spouses, children, family members, friends, or coworkers-often are more aware of the Veteran's emotional distress than he is himself. Decades of haunting memories and overwhelming feelings leave the Veteran who suffers from PTSD feeling demoralized and alone. He may believe that his family or community needs him to bear the burden of pain, fear, anger, shame, and guilt silently. He may believe PTSD symptoms are a sign of weakness and failure due to a lack of will power, self-discipline, or self-control. He may think PTSD is a result of a shameful personal flaw that must be hidden or corrected by behaving more correctly. PTSD may be an extreme spiritual crisis. When family or friends see signs of the Veteran's inner turmoil, they don't know why it's happening and often blame themselves: "I thought I was doing something wrong, but I never knew what!" Nor do they know how to help: "I gave up trying to break through his emotional walls."
The family's view of PTSD may include:
- "He tries so hard to be perfect that he can't admit when he makes a mistake or needs help."
- "He tries to enjoy being with us, but his heart's not in it and his mind's always somewhere else."
- "For him, every problem's a disaster, and we're slow, stupid, and never careful or tough enough."
- "It's his duty to behave honorably, so I don't want to shame him by showing I know he is suffering."
PTSD and physical health
PTSD symptoms such as restlessness, tension, irritability, anxiety, and poor sleep often are viewed by Veterans and healthcare providers as signs of physical illnesses such as high blood pressure, stomach or bowel conditions, or pain. PTSD affects the body, and can accompany or worsen physical illnesses.
Because many Native Hawaiian and Japanese American Veterans prefer medical to psychiatric clinics, doctors and nurses can help Veterans learn how PTSD affects the body and how to use good health practices (such as relaxation, good nutrition, regular exercise, not smoking, and limiting one's use of alcohol) to manage stress. Traditional healing practices used in the Native Hawaiian or Japanese American cultures also can help in the care of PTSD.
Books describing Native Hawaiian and Japanese American culture and mental health include:
McCubbin, H., Thompson, E., Thompson, A., & Fromer, J. (Eds.). (1995). Resiliency in ethnic minority families: Volume 1: Native and immigrant American families. University of Wisconsin System.
McDermott, T., & McDermott, M. People and cultures of Hawaii: A psychocultural profile. Honolulu, Hawaii: University of Hawaii Press.
Articles describing Native Hawaiian and Japanese American Veterans' post-Vietnam experiences include:
Hamada, R.S., Chemlob, C.M., Sautner, B., & Sato, R. (1988). Ethnic identity and Vietnam: A Japanese-American Vietnam Veteran with PTSD. Hawaii Medical Journal 47, 100-106, 109.
Loo, C. (1994). Race-related PTSD: The Asian American Vietnam Veteran. Journal of Traumatic Stress 7, 637-656.
Matsuoka, J.K., & Hamada, R.S. (1992). The wartime and postwar experiences of Asian-Pacific American Vietnam Veterans. The Journal of Applied Social Sciences 16, 23-26.
- Kulka, R.A., Schlenger, W.A., Fairbanks, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R.,... Cranston, A.S. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
- Friedman, M.J., Ashcraft, M.L., Beals. J.L., Keane, T.M., Manson, S.M., & Marsella, A.J. (1997). Matsunaga Vietnam Veterans Project (Volumes 1 and 2). National Center for Posttraumatic Stress Disorder and National Center for American Indian and Alaska Native Mental Health Research.