The Persian Gulf War had an emotional and psychological effect worldwide. For Vietnam veterans, the Persian Gulf War was a reminder of a time in their lives when they, voluntarily or involuntarily, went to war for their country. For some Vietnam veterans who suffer from posttraumatic stress disorder (PTSD), the conflict in the Middle East intensified their flashbacks to traumatic incidents in Vietnam and reactivated feelings of frustration, anger, and depression. Even for Vietnam veterans who are not suffering from PTSD, the conflict may have reawakened memories--some positive, some negative, and most long-repressed--from the Vietnam era.
In 1980, the American Psychiatric Association (APA) officially recognized what is now referred to as PTSD (APA, 1980, 1987) "after much research by various veterans' task forces and recommendations by those involved in treatment of civilian post-trauma clients" (Goodwin, 1982, p. 7). The idea that individuals such as combat veterans could suffer from intrusive memories and flashbacks was not new; these reactions have been observed, although not fully understood or treated, for centuries.
Because the mental health profession is only in its infancy in treating PTSD, the idea that subsequent wars can have a psychologically disturbing effect on any veteran has not been examined. For example, no literature exists on whether World War II had a psychologically disturbing effect on World War I veterans. No publications discuss the reactions of World War II veterans to the Korean or Vietnam wars. Whether this paucity of literature is a precursor or an outgrowth of the mental health profession's delay in recognizing PTSD as a legitimate disorder, the omission is unfortunate.
In examining the reaction of Vietnam veterans to the Persian Gulf War, it is important to note that there was no typical reaction to the conflict. Veterans, like the rest of the population, had diverse opinions and reactions to the war, running from patriotism to protest, from horror to pride, and from jealousy to paternalism (Hall, 1991). Regardless of a veteran's reaction, by becoming sensitized to the fact that veterans' war experiences can be reawakened on exposure to subsequent wars, social workers can help veteran clients to examine, gain insight, and make peace with their wartime experiences.
Evolution of Combat-Related PTSD
Ancient Greek and Roman literature may have provided the first writings of soldiers' traumatic reactions on return from the battlefield (Kelly, 1985). In World War I, the idea that high pressure from exploding shells caused not only physiological damage but also mental infirmity led to the concept of "shell shock." About 6 percent of soldiers during World War I were evacuated from the battlefield with symptoms of shell shock (Goodwin, 1982). The emphasis on predisposing personality factors changed the concept of shell shock to the concept of "war neurosis" (Kardiner, 1941).
With the onset of World War II, there was a greater awareness of the psychological consequences of combat on soldiers. Investigations of soldiers who suffered from battlefield-related trauma led to the labels of "traumatic war neurosis" (Kardiner & Spiegel, 1947), "combat exhaustion" (Swank, 1949), and "operational fatigue" (Grinker & Spiegel, 1945). These studies furthered the idea that the combat situation, and not predisposing personality factors, played a more critical role in the number of psychiatric casualties observed. Because of this awareness, psychiatric evacuations from the battlefield totaled 23 percent in World War II, an increase of almost 300 percent from World War I (Goodwin, 1982).
The on-site treatment of psychiatric casualties began in the Korean War. Soldiers who were treated were expected to return to duty (Glass, 1954). Because of this procedure, psychiatric evacuations were only 6 percent during the war (Goodwin, 1982).
Korean War veterans have rarely been studied on their own, and therefore literature is scarce. …