You were determined to see action? I was going to go out on combat missions. I wanted to be with them. That was my choice. Traditionally, chaplains would be stationed at the aide station, but that was when there were front lines and the wounded would be brought back. That was brave of you.see url
Or maybe I was too inexperienced and young to know any better. That was my mission. And I decided I was not going to carry a weapon. The Geneva Convention precludes chaplains from carrying weapons, but many did. I decided that my job was to be with the guys out on patrol, wallow in the mud with them when they were getting shot at. My job was not to shoot but to be with my soldiers.
Now, I knew how to shoot and I could take apart an M and all that, but I figured if I needed a weapon, plenty would be available. You spent all of your time on the Delta with the Mobile Riverine Force? I was there for more than eight months. I have counted 22 firefights, 10 or which became major battles, and dozens of smaller actions. You describe a particularly harrowing last operation—and how you relived it. Once Tet started winding down, it was decided I would be taken out and put under division Headquarters. By that time, though, I was wrung out. I was dry, so to speak. The day before I got my reassignment, March 1, I tore up my shoulder real bad.
It was during my very last operation. I was blown into a small canal that, because it was low tide, was dry. I was in excruciating pain, totally immobile and absolutely petrified. Almost four decades later, I had injured my shoulder while I was in the hospital for minor surgery and I awoke in my hospital bed finding myself unable to move my arms. Suddenly I was back in Vietnam in that canal, the emotion and fear exploding out of control.
You were in an extraordinary amount of intense combat. Did you feel the effects of trauma while in Vietnam? At the time, I had no idea the experience would be with me for the rest of my life. When did PTSD symptoms start for you? I stayed in the Army, went to Fort Bliss and right away started having nightmares and occasional flashbacks. But what I did do was I started writing, not a book or anything, but what I now call therapeutic journaling. It just seemed to be a salve for my soul. I probably filled up a three-inch thick stack of legal pads over the next year and a half.
I would have been embarrassed to talk about my feelings anyway. But for sure the real terror and trauma continues to come out in dreams or flashbacks, things that cause you to have an unusual feeling. But by any measure you were successful in raising a family, pursuing a doctorate and having a career.
I functioned very well. I had a good career in the Army. Not even my wife, and we are very close, married now almost 50 years. She knew all of what had happened to me in Vietnam, I never kept that a secret. But no one ever knew the pain and anguish I felt in my gut, the same pain and anguish I think most combat infantrymen feel. When were you officially diagnosed with PTSD? Not until about I was in absolute denial for all those years. I had too much pride. Even as my life began to spiral down, I tried to diagnose myself. Intellectually I knew what it was, but dumb me was unwilling to make the connection from the intellect to what I was experiencing.
The long-term costs of traumatic stress: intertwined physical and psychological consequences
Did your role as a chaplain figure into that? Even though I was exposed to the same bullets, mortars, and combat terror as the men, I thought that since I was not doing the killing, I was somehow immune. It was part of my game: Well that was pure folly.
But finally things began to unravel? Even my wife did not realize what was happening. I was still good at the game, I was very effective as a therapist. But no one had any idea of what I was going through internally, the churning that was going on—just to keep all that stuff from bubbling up every day! My therapist used the term in describing me when I was first having significant problems and went to see him at local vet center. The term coming from the old Southern stock car racing circuit: I think it was a very apt description of what was and had happened to me, and what has and continues to happen to others.
How has reconnecting with your combat brothers been key to dealing with PTSD? I had been reconnected for many years with guys I served with, before I confronted my problems. By the mid 90s we had started having reunions.
Finally though, it was as a result of some of those guys who I reconnected with, guys I felt like I could talk to about what was going on with me, that I finally got help. They are my brothers. That is part of the objective of the book. We do have the ability to suppress. We can keep it all pushed down. They are not healing. Is exposure to combat life changing, and does just one experience do it or does it require repeated exposure?
Yes it does change anyone. I think that one dramatic instance of combat exposure can create these problems. Unlike an athlete in training who gets better and more capable, with combat I think the more you are exposed the more vulnerable you get to have it then have it bubble up at certain times in your life. I speak to this more from the posture of a therapist than a victim. I do believe the more exposure a soldier has to combat, the more likely that he will have prolonged problems later on, but a single exposure can do it.
What is the emotional cost of having to kill and destroy? The primary one is guilt. There is no other situation in life where we take or year-olds and put them in a situation of kill or be killed. How else does combat trauma distort a personality?
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You just become numb to the realities of what is happening around you. Or deal with the death and maiming of your comrades next to you. Trust is another casualty. Can I trust my government that forces me to do these things? For the typically young and fairly unsophisticated soldier, there are just so many of these ideas and questions that suddenly get swished around in you gut. It affects every facet of your life. But all have that place where the feelings can rise up daily. You use the Virginia Tech shootings as an example of how unnatural our expectations are for coping with combat.
Additionally, lifetime traumatic experiences were screened by using the event list mentioned at the beginning of the interview. In order to be sure that the symptom structure was being examined, the CIDI-typical skip rules were not applied; rather, each respondent was asked the full set of questions. Group differences for continuous variables were evaluated by means of Student t test.
Logistic regression analysis was accomplished to study relationships between education and diagnoses, between education and symptoms, between current PTSD and dissociative disorders, between psychological support and current diagnoses and symptoms. To this purpose, the symptom clusters' frequencies from the PTSD-section of CIDI which reflect, respectively, the symptoms of re-experiencing, avoidance, and arousal were summed to create an overall frequency of posttraumatic symptoms.
The average age at the time of arrest was Following arrest, there was a period of remand with an average duration of 4. This time period consisted of interrogations that usually took place at the closest secret police station from the persons' residence. The pre-trial detention was followed by a formal military trial and the victim was convicted to several years of political prison for allegedly committed crimes against the communist regime.
The distribution of reasons for imprisonment within the group of former political detainees. On the average, imprisonment lasted The imprisonment occurred in 4. Among the procedures of physical torture, the most common was the falanga, i. All measures have been associated with high distress as measured on a seven-point scale. When asked to specify the most stressful aspect of pre-trial detention, 24 respondents During punitive detention, 11 respondents On the average, Three of our participants had been imprisoned again in the 80ies, the last of them being released in Most of the former political detainees These post-prison repressive events lasted until the end of , when a rapid political change put an end to the communist regime.
The two groups differed significantly on PTSD and on most of the other clinical indicators. Such a difference was supported by significantly elevated depressions scores BDI in survivors of the imprisonment, compared to controls who scored within the normal range. Among somatization symptoms, pain and pseudoneurological symptoms were particularly common.
Both groups scored high on state and trait anxiety STAI as self-rating scales, whereby former political detainees had significantly higher scores than control subjects on state anxiety. Using a logistic regression, there was no significant association between education and any of the clinical conditions. The educational level measured in the number of school years had no covariate effect on the self-report measures except for anxiety rates state-trait anxiety: Psychiatric diagnoses and ratings on self-report scales of former political detainees and comparison subjects.
Dissociative disorders and substance abuse were also more frequently diagnosed among those who had not received psychological assistance.
Combat Trauma: A Personal Look at Long-Term Consequences
Differences between former political detainees who have and who have not had psychological support. The present study is based on the clinical assessment of a sample of 59 survivors of the political detention regime in Romania in their late life, and it aimed at exploring long-term psychological consequences of traumatic conditions during detention within this group. Participants in our sample were young or very young at the time of arrest. As compared to other studies on political victims of former communist regimes [ 15 , 17 ], our results show that the exposure to traumatic conditions within the Romanian sample was more severe in terms of subjection to traumatic conditions exposure to a mean of 8.
Traumatic conditions such as forced standing, threats and offences, starvation followed by solitary confinement, unsystematic beatings, and sleep deprivation were very frequent during both pre-trial and punitive detention. During punitive detention, these traumatic experiences were commonly accompanied by confinement in overcrowded cells, work in labor camps, exposure to extreme temperatures, and torture witnessing. In addition, political detainees were very often moved from one prison to the other. These data suggest that the Romanian political detention regime was an system based mainly on methods of gradual physical and psychological weakening, which was also demonstrated by means of historical analysis [ 22 ].
This conclusion is also consistent with the political detainees' accounts of their most disturbing experiences. The investigation of posttraumatic symptoms in our study was related to the experience of political imprisonment. Our results add evidence to the qualification of political detention among traumatic consequences with complex long-term consequences [ 1 ].
These results are similar to those of research on political victims of former Eastern Germany [ 15 , 17 ], as well as to those of studies dealing with psychological effects of the POW experiences in World War II and of the Holocaust after 40—50 years [ 4 , 10 ]. However, in contrast with the studies on former political prisoners from East Germany, most of the participants within the present group of survivors consisted of political activists or people who had expressed their anticommunist beliefs, in one way or another.
Although less common, others were arbitrary victims. Consequently, we could not prove the notion of a low rate of PTSD among victims of political imprisonment and torture who had been political activists [ 14 , 34 ]; further persecutions after the release from prison may have contributed to the maintenance of the disorder. High associations between the current PTSD diagnosis and the prevalence of dissociative disorders confirm their co-morbidity with PTSD, which has previously been found in aged survivors as well [ 11 , 35 ]. Also, PTSD score related to depression, supporting findings on Holocaust survivors [ 8 ], and to anxiety and physical health scores.
The association of PTSD with most of the other clinical conditions in our survivor group validated our assumption that political imprisonment leads to chronic PTSD and other long-term consequences. Other possible contributors to the prevalence of these co-morbid symptoms and disorders are persistent persecution after release, and lack of rehabilitation and of social support.
The high co-morbidity supports the notion of long-term complex severe psychological effects of prolonged, repeated trauma, and indicates that a current PTSD diagnosis would not capture the severe psychological harm present in such cases [ 1 , 2 ]. Moreover, this result is consistent with the studies conducted after a long post-trauma time interval on Holocaust survivors in old age, which have indicated that persistent posttraumatic symptoms may contribute to additional psychological and physical disturbances [ 10 , 13 ]. Some of our participants received psychological support within a clinical context.
Further analyses showed that a lack of psychological support was associated with current PTSD, dissociative disorders and substance abuse. As the assignment to these two groups was not done at random, we cannot ascertain a causal relationship. However, treatment seemed not to produce a reduction on the level of intrusion, somatization, and major depression. Possibly, psychological support was efficient only in the reduction of posttraumatic hyperarousal and avoidance, substance abuse, and dissociation. Alternatively, it might be that those who recovered from PTSD sought treatment for their remaining mental health problems, i.
Given that intrusions and somatization both result from implicit memories that are not sufficiently integrated with explicit autobiographical recollection [ 36 ], a trauma-focused treatment would probably be needed [ 37 ]. Recruitment strategies may not have allowed for the estimation of the epidemiological prevalence.
First, the participants recruited from one institution did not look for treatment, whereas the other ones had already been offered psychological assistance. However, other recruitment strategies without an institutional frame would have not allowed for the selection of a sufficient number of participants, since most victims are still extremely suspicious when asked to report their experiences [ 38 ].
The scarce participation of women in this study may explain why the present sample is representative of former political detainees from the Moldavian region of Romania in terms of age distribution, education and occupational status, but not of gender distribution. If highly traumatizing experience such as sexual violence or persistent high anxiety levels precluded subjects from participation in the study, the actual PTSD rate may thus be even higher. In addition, it may well be possible that, in a country with a years life expectancy, a higher fraction of former detainees with severe mental disorders died by the age of seventy, as opposed to those less affected by trauma [ 39 ].
The educational level of control subjects was lower than that of survivors. This difference was predictable, since a remarkably high educational level was a distinctive feature of the political detainees population, given that the bourgeoisie and the intelligentsia were the favorite target groups for political persecutions during the former Communist regimes [ 24 ]. The covariate effects of education showed that this factor explained the similarity of the two groups with respect to the high levels of anxiety.
In addition, hospitalization of controls for rheumatoid and arthritic problems may explain the lack of a difference with respect to physical problems between the two groups. The two groups also differed with respect to exposure to physical assault. The unusual high number of such experiences reported among former political detainees might be an aspect of their subjection to political violence, as suspected by most of them, although they had no proof of it.
Yet, none of the participants rated experiences of physical assault as the most traumatic experience. However, the inclusion of a culturally and sociodemographically equivalent comparison group helps validating our findings. We also acknowledge that the long period of time of On the other hand, the traumatic experiences, reported by the respondents involve "hot" memory, i.
The present study shows that PTSD and other mental disorders developed significantly in former political detainees of the Romanian communist regime as a consequence of trauma, maltreatment and other stress factors that acted during the political imprisonment. Across four decades, the disorder persisted in severe forms, particularly in the former political detainees who did not receive psychological assistance. Thus, political detention and post-detention life conditions are likely to have negative long-term effects on the mental health status of former political detainees that may last even into the latest stages of life when left untreated.
A high prevalence of co-morbid disorders and symptoms, including somatic complaints, add to the suffering of these survivors. Obviously, these victims need psychotherapeutic help and care that includes rigorous research concerning political persecution. However, in view of a highest efficiency, public recognition and political rehabilitation would also be necessary requirements. Further research on survivors of political persecution in the former Communist countries of Eastern Europe may add helpful data in understanding the psychological effects of this phenomenon.
DB conducted the study in Romania, performed the statistical analysis, and drafted the manuscript. MS designed the study and coordinated the studies activities in Romania. ES participated in the analyses. AN participated in the design of the study and its coordination. TE designed the study and revised the manuscript. FN designed the study and revised the manuscript. All authors read and approved the final version. We thank Christina Robert for comments on earlier versions of the ms. National Center for Biotechnology Information , U. Clin Pract Epidemiol Ment Health. Published online Sep Maggie Schauer 3 vivo, Cassela Postale no.
Received Jun 27; Accepted Sep This article has been cited by other articles in PMC. Abstract Background Research has suggested that organized violence and torture have long-term psychological effects that persist throughout the lifespan. Conclusion Our findings suggest that political detention may have long-term psychological consequences that outlast the changes in the political system.
Background Research on victims of organized violence and torture has suggested that prolonged severe traumata produce long-term psychological effects that persist even into old age. Methods Participants The study design included two groups: Table 1 Sociodemographic and other characteristics of former political detainees and control subjects 1. Open in a separate window. Instruments and Procedure An extensive evaluation of the psychological status for all participants was conducted by self-report and diagnostic clinical interview measures.
The Assisted Self-Report Section Every subject completed a series of self-report surveys with the assistance of an interviewer. The next sequence for the completion of these items was the following: The Diagnostic Interview Section Classically structured surveys were used in the assessment for a broad range of psychiatric disorders.
Data Analysis Group differences for continuous variables were evaluated by means of Student t test. Table 2 The distribution of reasons for imprisonment within the group of former political detainees. Table 3 Psychiatric diagnoses and ratings on self-report scales of former political detainees and comparison subjects. Table 4 Differences between former political detainees who have and who have not had psychological support. Dissociative disorders 7 23 13 46 Substance abuse 8 26 14 50 Discussion The present study is based on the clinical assessment of a sample of 59 survivors of the political detention regime in Romania in their late life, and it aimed at exploring long-term psychological consequences of traumatic conditions during detention within this group.
Limitations of the Study Recruitment strategies may not have allowed for the estimation of the epidemiological prevalence. Conclusion The present study shows that PTSD and other mental disorders developed significantly in former political detainees of the Romanian communist regime as a consequence of trauma, maltreatment and other stress factors that acted during the political imprisonment.
Competing interests The author s declare that they have no competing interests. Authors' contributions DB conducted the study in Romania, performed the statistical analysis, and drafted the manuscript. New York, Basic Books; Dissociation, Somatization, and Affect Dysregulation: The Complexity of Adaptation to Trauma. Adversity, stress and psychopathology. New York, Oxford University Press; Individuals under conditions of maximum adversit: J Nerv Ment Disease.
The late effects of Nazi persecution among elderly holocaust survivors. Symptoms of PTSD in survivors of the holocaust. Depressive features in Holocaust survivors with post-traumatic stress disorder. Impact of cumulative trauma and recent stress on current post-traumatic stress disorder symptoms in holocaust survivors. The Sydney Holocaust Study: Integration and self-healing in posttraumatic states:
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