The killing is always traumatic. But when you have to kill women and children, or when you have to kill men in their homes, in front of their wives and children, and when you have to do it not from twenty thousand feet but up close where you can watch them die, the horror appears to transcend description or understanding.

Much of the war in Vietnam was conducted against an insurgent force. Against men, women, and children who were often defending their own homes and who were dressed in civilian clothing. This resulted in a deterioration of traditional conventions and an increase in civilian casualties, atrocities, and resultant trauma. Neither the ideological reasons for the war, nor the target population, was the same as that associated with previous wars.

The standard methods of on-the-scene rationalization fail when the enemy’s child comes out to mourn over her father’s body or when the enemy is a child throwing a hand grenade. And the North Vietnamese and Vietcong understood this. Among the many excellent narratives gained from personal interviews in Al Santoli’s book To Bear Any Burden is the story of Troung “Mealy,” a former Vietcong agent in the Mekong Delta. “Children were trained,” said Mealy, “to throw grenades, not only for the terror factor, but so the government or American soldiers would have to shoot them. Then the Americans feel very ashamed. And they blame themselves and call their soldiers war criminals.”

And it worked.

When a soldier shoots a child who is throwing a grenade the child’s weapon explodes, and there is only the mutilated body left to rationalize. There is no convenient weapon indisputably telling the world of the victim’s lethality and the killer’s innocence; there is only a dead child, speaking mutely of horror and innocence lost. The innocence of childhood, soldiers, and nations, all lost in a single act reenacted countless times for ten endless years until a weary nation finally retreats in horror and dismay from its long nightmare.

The Inescapable War

There were no real lines of demarcation, and just about any area was subject to attack…. It was an endless war with invisible enemies and no ground gains—just a constant flow of troops in and out of the country. The only observable outcome was an interminable production of maimed, crippled bodies and countless corpses.

— Jim Goodwin Post-Traumatic Stress Disorders

In The Face of Battle, John Keegan traces conflicts across the centuries, noting in particular how the duration of a battle and the depth of the battlefield increased over the years. From a duration of a few hours and a depth of only a few hundred yards in the Middle Ages, battle grew to the point where, in this century, the depth of the danger zone extended for miles into the rear areas, and the battles could last for months, even blending into one another to create one endless conflict that would last for years.

In World War I and World War II we discovered that this endless battle would take a horrendous psychological toll on the combatant, and we were able to deal with this endless battle by rotating soldiers into the rear lines. Within Vietnam, the danger zone increased exponentially, and for ten years we fought a war unlike any we had experienced before. In Vietnam there were no rear lines to escape to, there was no escape from the stress of combat, and the psychological stress of continuously existing at “the front” took an enormous, if delayed, toll.

The Lonely War

Prior to Vietnam the American soldier’s first experience with the battlefield was usually as a member of a unit that had been trained and bonded together prior to combat. The soldier in these wars usually knew that he was in for the duration or until he had established sufficient points on some type of scale that kept track of his combat exposure; either way the end of combat for him was at some vague point in an uncertain future.

Vietnam was distinctly different from any war we have fought before or since, in that it was a war of individuals. With very few exceptions, every combatant arrived in Vietnam as an individual replacement on a twelve-month tour — thirteen months for the U.S. Marines.

The average soldier had only to survive his year in hell and thus, for the first time, had a clear-cut way out of combat other than as a physical or psychological casualty. In this environment it was far more possible, even natural, that many soldiers would remain aloof, and their bonding would never develop into the full, mature, lifelong relationships of previous wars. This policy (combined with the use of drugs, maintenance of proximity to the combat zone, and establishment of an expectancy of returning to combat) resulted in an all-time-record low number of psychiatric casualties in Vietnam.

Military psychiatrists and leaders believed that they had found a solution for the age-old problem of battlefield psychiatric casualties, a problem that, at one point in World War II, was creating casualties faster than we could replace them. Given a less traumatic war and an unconditionally positive World War II-style welcome to the returning veteran, this might have been an acceptable system, but in Vietnam what appears to have happened is that many a combatant simply endured traumatic experiences (experiences that might otherwise have been unbearable) by refusing to come to terms with his grief and guilt and turned instead to the escapist therapy of a “short timer’s calendar” and the promise of “only forty-five days and a wake-up.”

This rotation policy (combined with the extensive use of psychiatrically and self-prescribed drugs) did create an environment in which the incidence of psychiatric casualties on the battlefield was much lower than that of past wan in this century. But a tragic, long-term price, a price that was far too high, was paid for the short-term gains of this policy.

World War II soldiers joined for the duration. A soldier may have come into combat as an individual replacement, but he knew that he would be with his unit for the rest of the war. He was very invested in establishing himself with his newfound unit, and those who were already in the unit had equal cause to bond with this individual, who they knew would be their comrade until the war was over. These individuals developed very mature, fulfilling relationships that for most of them have lasted throughout their lives.

In Vietnam most soldiers arrived on the battlefield alone, afraid, and without friends. A soldier joined a unit where he was an FNG, a “f***ing new guy,” whose inexperience and incompetence represented a threat to the continued survival of those in the unit. In a few months, for a brief period, he became an old hand who was bonded to a few friends and able to function well in combat. But then, all too soon, his friends left him via death, injury, or the end of their tours, and he too became a short timer, whose only concern was surviving until the end of his tour of duty. Unit morale, cohesion, and bonding suffered tremendously. All but the best of units became just a collection of men experiencing endless leavings and arrivals, and that sacred process of bonding, which makes it possible for men to do what they must do in combat, became a tattered and torn remnant of the support structure experienced by veterans of past American wars.

That does not mean that no bonds were forged, for men will always forge strong bonds in the face of death, but they were few and all too fleeting, destined never to last longer than a year and usually much less than that.

The First Pharmacological War

One of the major factors that combined with the rotation policy to suppress or delay dealing with psychological trauma was the use of a powerful new family of drugs. Soldiers in past wars often drank themselves into numbness, and Vietnam was no exception. But Vietnam was also the first war in which the forces of modern

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