The Legacy of Psychological Trauma of the Vietnam War for Native Hawaiian
and American of Japanese Ancestry Military Personnel
A National Center for PTSD Fact Sheet
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)
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. 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 Posttraumatic Stress Disorder (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.
Native Hawaiian Veterans' Experiences Before, During, and After the Vietnam
War
"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."
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.
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.
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.
The Long Journey Home
Upon returning home after one or more tours in Vietnam, many Native Hawaiian
veterans struggled with severe problems that they and their families, friends,
and communities did not understand or know how to cope with:
- Depression (hopelessness,
loss of all interests, or suicidal impulses)
- Shame (feeling embarrassed,
exposed, violated, or like a misfit)
- Guilt (feeling others should
have lived and they should have died, or feeling that they failed or made
mistakes that had terrible consequences)
- Isolation and emotional
emptiness (being very remote and withdrawn)
- Alienation (feeling that no
one understands or that everyone makes too much fuss about unimportant
things and too little fuss about big problems)
- Unable to relax (restless,
sleepless, silently tense or on edge)
- Addiction (compulsive overuse
of alcohol)
Japanese American Veterans' Experiences Before, During, and After the
Vietnam War
"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
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
Japanese American veterans often enlisted in college and became officers in
order to advance their careers. They were proud to protect their home and
countryand valued military training and discipline, but they felt isolated.
Many faced close and personal racial prejudice and discrimination for the first
time because they were Asian, and they felt not only disillusioned but also
fearful of being physically harmed ("fragged").
Japanese Americans' Trauma of Military Service in War
More than one in three Japanese Americans experienced war trauma in Vietnam.
Traumas 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 Long Journey Home
Although American of Japanese Ancestry veterans often report feeling happy
in their family lives and being successful in their education and careers, some
have silently suffered the following since returning from Vietnam:
- Fears (of closed spaces,
crowds, unfamiliar places, or sudden attack)
- Anxiety (restlessness,
obsessive worries, compulsive rituals)
- Panic (terror of losing control,
suffocating, or going crazy)
- Depression (hopelessness,
loss of all interests, or suicidal impulses)
- Irritability (feeling
constantly annoyed, on edge, and critical)
- Shame (feeling embarrassed,
exposed, violated, or like a misfit)
- Guilt (feeling others should
have lived and they should have died, or feeling that they failed or made
mistakes that had terrible consequences)
- Isolation and emotional
emptiness (being very remote and withdrawn)
- Alienation (feeling that no
one understands what's really important in life)
- Over controlling (being very
demanding or controlling about decisions)
The Hidden Enemy: Posttraumatic Stress Disorder (PTSD)
What neither these veterans nor their families (nor even many VA counselors and
doctors) knew was that many of these veterans were suffering from PTSD. The
symptoms of PTSD include:
- Unwanted distressing memories
or a feeling of reliving traumatic Vietnam experiences (flashbacks)
- Nightmares and difficulty
falling or staying asleep restfully
- Bodily stress and tension,
especially when reminded of traumatic Vietnam experiences
- Loss of interest in
activities and difficulty concentrating on activities or projects
- Detachment or withdrawal from
emotional involvement in relationships
- Difficulty feeling or
expressing emotions other than irritability or frustration
- Feeling like there is no
future or their lives will be cut short by an untimely death
- Feeling jumpy, on edge, and
easily startled
- Feeling constantly unsafe and
unable to let down their guard (hyper-vigilant)
One in three Native Hawaiian and one in twenty Japanese American in-country
Vietnam veterans currently have full or partial PTSD. More than one in two
Native Hawaiian and one in seven Japanese American in-country veterans have 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.
Steps toward Recovery for the Veteran and Family
Recovery from PTSD involves several steps by which a veteran and family can
begin to recover from the emotional wounds and work toward regaining a healthy,
happy, and satisfying life together:
Talk frankly and privately to a trusted healer or counselor who is sensitive
to the understandable feelings of guilt or embarrassment about emotional and
physical stress.
Learn about psychological stress and trauma by reading or enrolling in a
class.
Books often recommended by veterans and families include:
Mason, P. (1990). Recovering from war. New York: Viking
Penguin.
Matsakis, A. (1992). I can't get over it: A handbook for trauma
survivors. Oakland,
California: New Harbinger Publications.
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.
Guidelines for productive and helpful discussion of stress and trauma:
- Each person has a different
point of view that should be stated honestly and respected, not criticized
or rejected
- Stress and trauma affect
everyone in a family or close relationship, so everyone needs to both help
and be helped
- Listen carefully to learn,
provide moral support, and find solutions rather than blaming or finding
fault
- Tell what's most important
to you, not what you think you are supposed to say to be polite or to
attract sympathy
- Take each person's feedback
seriously-we all see our own stress reactions less clearly than other
people see them
- If talking seems to make
things worse, or just doesn't help, find a helper such as a counselor,
elder, or a spiritual advisor
Begin experimenting with small changes in your activities and lifestyle that
give you a feeling of greater satisfaction, enjoyment, relaxation, and
accomplishment in yourself and your relationships. Every small step toward
feeling more in control of your own destiny brings emotional renewal and
genuine intimacy in relationships.
Become involved with traditional teachers and healing ceremonies in your
community. Rediscover traditions that have helped countless warriors return
home, heal the wounds of war, and become vital members of their families and
communities.
Seek medical or mental-health help from your nearest Department of Veterans Affairs
Vet Center, Medical Center, Outpatient Clinic, or Veteran Benefits Office.
Help is available for Native Hawaiian and American of Japanese Ancestry
Vietnam veterans suffering from PTSD
Because of the publication of the Matsunaga Study's findings in June 1997,
medical and mental-health clinicians at all Department of Veterans Affairs Vet
Centers, Medical Centers, and Outpatient Clinics are more aware than ever that
Native Hawaiian and American of Japanese Ancestry veterans who experienced
trauma in Vietnam may need help with PTSD. Vet Center counselors often provide
outreach services right in the community (as well as to prisons and schools) to
help veterans who are reluctant or unable to come to a VA hospital. VA
clinicians and counselors know how to privately and sensitively help veterans
recover from health or family problems that are the hidden result of PTSD.
If you have never sought or received care from a DVA hospital or clinic,
here are practical steps any veteran can take today to enroll in DVA medical
care:
- Call the VA Benefits Office
near you and ask for an initial appointment to discuss how to file an
application for healthcare eligibility or financial benefits from VA. This
toll-free number can also help you locate the other services listed below:
1-800-827-1000
- Call the Vet Center nearest
you and ask for an intake appointment to discuss with a counselor any
health, stress, or mental-health concerns that you suspect are due to Vietnam
military service or due to service in the military in any other war zone
before or since Vietnam. Consult your local telephone directory under
United States Government, Veterans Affairs, or call: 1-202-273-8967
- Call a VA medical center or
outpatient clinic near you and ask for an intake appointment for a
thorough health check.
- If you would like more
information on programs and services for veterans, consult the Department
of Veterans Affairs home page on the Internet. Visit your local library if
you do not have access to the Internet at home. The Internet address is: www.va.gov.
- For assistance in
establishing eligibility for VA medical care or for help in receiving VA
financial benefits, make an appointment to speak with a service officer
from a veterans service organization such as AmVets, American
Legion, Disabled American Veterans, Paralyzed Veterans of America, Military Order of the Purple Heart,
or Veterans of Foreign Wars .
Every VA medical center and clinic has a PTSD specialist who is familiar
with readjustment problems caused by war trauma and who can provide you with a
thorough evaluation and recommendations for treatment. PTSD treatment may
involve:
- Educational classes for veterans and for families about trauma, PTSD, and
recovery
- Educational and support groups for dealing with anger, depression, anxiety,
and stress
- Special supportive therapy and socialization groups for Native Hawaiian
and American of Japanese Ancestry veterans
- Special therapy groups for veterans with PTSD from war or other military
trauma
- One-to-one therapy and supportive guidance
- Evaluation to determine if medication would be beneficial and acceptable
to the veteran
- Counseling and education to assist in coping with the stress of chronic
medical problems
- Evaluation and treatment for alcohol abuse or dependence
Related Fact Sheets
Grief in veterans
Assessment and treatment of acute grief in returning veterans
Help for
veterans with PTSD
Answers to some questions about PTSD and service-connected disability that
are frequently asked by veterans and their families
Homecoming reactions
Homecoming after deployment: Dealing with changes and expectations
PTSD and
ethnicity
Describes the role of race and ethnicity as important variables for understanding
PTSD in ethnic minority veterans
The effect of
PTSD on families
Provides information about the effects of PTSD on family members, and how to
cope with the effects
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