Winter 1989, Vol.41 No. 3, pp. 319-340.

Joel Brende and Elmer McDonald:
      Post-Traumatic Spiritual Alienation and Recovery
           in Vietnam Combat Veterans

Soldiers deeply wounded in spirit by the violence and evil of the war in Vietnam are able, through moral and spiritual reintegration, to recover meaning and value in life.

Dr. Joel O. Brende, M.D., practices psychiatry and is Director of Adult Outpatient Services at the Bradley Center, Inc., Columbus, GA, where he lives with his wife. He is also clinical professor of psychiatry at Mercer University Medical School in Macon. Fr. Elmer McDonald, M.Div., is Chief of Chaplain Service at Bay Pines V.A. Medical Center, Bay Pines, Florida.

One day it will be realized that men are distinguishable from one another as much by the forms their memories take as by their characters.(1)
DURING the late 1960s and early 1970s, the problems of Vietnam veterans were too often ignored, misdiagnosed, and mistreated. Only a handful of mental health professionals became interested. Psychiatrists Robert Lifton and Chaim Shatan were among those few. They and their colleagues established 'rap groups' for Vietnam Veterans against the War. Lifton's account of these groups revealed the moral dilemma these men experienced as they found themselves suffering identity 'splits' -- 'both victims and executioners' -- caused by a war they came to believe was immoral.(2)

During the war, most Americans either remained detached from or protested the 'Vietnam conflict.' When American Soldiers came home from their one-year tour of duty, civilians greeted them with disinterest or disdain, an indication of how the war stirred up conflicting emotions and ethics. Moral considerations may also have contributed to the slow response of the federal government to Vietnam veterans' emotional and spiritual needs. For it wasn't until 1979 that Congress officially mandated the Veterans Administration to provide special mental health services for these veterans. It wasn't until 1980 that Vietnam veterans' symptoms were given a name -- "Post-traumatic Stress Disorder" (PTSD).(3) And not until the early 1980s did V.A. hospitals begin to provide special hospital treatment programs for Vietnam veterans.

But even with the presence of special treatment programs, most mental health professionals have neglected to recognize and help Vietnam veterans with spiritual alienation and moral conflict. Although one of us (Joel Brende) had recognized in the early 1980s that these men suffered from identity 'splits' and personality disorders as a result of their war experiences,(4) no connection was made to moral conflicts.

Mental health professionals have given morality a place of little importance as a factor in the production of psychological symptoms. But unresolved moral and spiritual problems cannot be overlooked when an estimated 800,000 Vietnam veterans continue to suffer from guilt-ridden memories and festering emotional wounds that have never healed.(5) Unresolved moral and spiritual problems must be taken into account when these veterans suffer from an unprecedented degree of destructive and self-destructive behaviors. Approximately 400,000 veterans were arrested or convicted of crimes by 1978,(6) and between 12,000 and 14,000 are estimated to be victims of suicide and self-destructive behavior yearly.

In 1984-86, while working as psychiatrist and chaplain in one of the designated treatment programs for Vietnam veterans in Bay Pines, Florida, V.A. Medical Center, we became very interested in the relationship of chronic post-traumatic symptoms to their unresolved moral problems. We became convinced that chronic symptoms were perpetuated by unresolved moral conflicts, guilt-ridden memories, and spiritual alienation.


Little has been written about relationships of Vietnam veterans' identity changes to their deep-seated sense of guilt and shame. Most will openly describe righteous indignation at having been victimized, denying that there is anything to feel ashamed of. Instead, they angrily cite the factors which contribute to their problems -- inadequate treatment, loss of jobs, marriage breakups, a rejecting society, deaths of close friends, unstable environment, etc. Clearly, these men have many losses to grieve but cannot.(7) If they break down and cry, it is only with tears associated with guilt and anger. Consequently, these combat veterans remain alienated when they appear to be normal because just under the surface are the unintegrated personality fragments that cannot grieve, cannot feel fear, and cannot express anger without something self-destructive happening.

Are they ashamed? Yes, they are. Those who seek help will eventually acknowledge their shame about many things: mainly losing the war, being rejected by society and family, and not being able to control their own lives. However, a close look at the origin of their guilt reveals a number of other factors.

We asked sixty-eight combat veterans to complete a questionnaire and rank seventy-eight different disturbing experiences on a scale of 1 to 10 (10 being the most severely disturbing). The six most disturbing (and presumably most guilt-ridden) experiences were the following: accidentally killing other Americans, seeing close friends killed, seeing Americans killed, placing American bodies in body bags, seeing atrocities committed against Americans, and holding a friend as he was dying.

The most significant sources of guilt among these veterans were killing and death. Consequently, we have listed the following eight general categories of combat-related guilt, keeping killing human life at the top of the list:

First, there is the guilt about having taken human life. As William Mahedy has observed,

taking human life carries with it so much moral weight... [and] combat induced psychological stress involves a strain on the conscience... present in many cases even when a person has performed no acts for which he feels personally guilty. Just as psychological stress has continued for years after the war, so has the residue of moral strain. It is still another source of desolation of the spirit.(8)
Second, veterans suffer significantly from the guilt of having lost prior moral values, permitting them freely to kill and commit atrocities. Many of these combat veterans had believed in God and the Ten Commandments during pre-war adolescence. A survey of thirty Vietnam veterans at the Bay Pines V.A. Medical Center revealed that seventy-five percent came from a religious background, but combat experiences and the deaths of close friends often caused them to lose faith that God had any power to help. Mahedy comments, "[The] sense of an intimate tenderness is exactly what one loses in a combat zone or in the other wastelands of the world" (p. 206).

Third, when soldiers lost their moral values during combat, they generally developed a combat identity in the form of a 'killer self' which later caused them considerable guilt during civilian life. Young soldiers, potentially overwhelmed with fear, grief, and guilt, controlled their vulnerability by hardening themselves to the loss of friends killed by enemy fire and became conscience-less, taking God-like powers of life and death into their own hands. One veteran who recalled this feeling said, "I loved the 'adrenalin rush' of killing. The best high I had in Vietnam was the thrill of the kill. I 'got off' on the feeling of having power over life and death. My God was an M-16."

Fourth, the enormity of unresolved guilt about past and present violent acts and wishes is a source of self-destructive symptoms about which they also feel guilty. Ninety percent of the Vietnam veterans surveyed believed they survived combat in order to be made to suffer, and forty-eight percent believed that suffering was a punishment for things they had done in Vietnam.

Fifth, the guilt of veterans is perpetuated by their inability to control violent thoughts and urges. A survey of thirty of the Vietnam veterans receiving hospital treatment for PTSD at Bay Pines V.A. Medical Center showed that many have persistent violent thoughts and behaviors: seventy percent had made one or more suicide attempts, ninety-eight percent had homicidal fantasies when angry, sixty percent had homicidal fantasies daily, seventy-three percent have been arrested for criminal behavior.

Sixth, soldiers in combat often permitted themselves to be instruments of evil forces, either knowingly or unknowingly. Many have recalled making spoken or unspoken pacts with the devil to bolster feelings of omnipotence over death, and later felt guilty. As one veteran related, "I laid out in a field with twelve bullet holes in me for four hours and I have the feeling that I made a pledge to some spiritual power that I would do anything if he kept me alive. Ever since then, I have had a feeling of dread that I 'sold out' to the devil."

Seventh, combat veterans often suffer the additional guilt of turning themselves against God and becoming spiritually hardened. One army soldier -- a 'born-again' Baptist church member before military service -- related, "Our whole unit was sent into a battle after receiving last rites because they didn't expect us to come back alive. It was then that the God I had believed in no longer seemed real to me. When I came back from Vietnam, I cursed God and anyone that said they believed in him."

Many, like this veteran, became spiritually and emotionally numb when the myth of a joint supremacy of God and America died in Vietnam. As Mahedy observes, they became victims of

an unprecedented and totally unexpected deadening of the soul. The spirit went numb. The reservoir of moral resources went dry. The 'juice and joy' feeling that Americans believe to be the essence of religion and spirituality was no longer possible for large numbers of Vietnam veterans. A terrible bleakness had overwhelmed the soul. Moreover, Vietnam combat sowed seeds of doubt about the foundations of faith. Not only the American religious experience but authentic biblical faith was called into serious question. Where indeed was God in Vietnam? Why did God do nothing about the slaughter? Is religious faith possible after Vietnam? Can life ever have meaning again? (p. 32).
Finally, many felt the guilt of being part of a morally corrupt system. It was not only individual soldiers who lost their sense of morality, but a similar loss occurred at every level of society and authority in Vietnam:
The most serious corruption went through all strata of authority -- right to the top. The 'war of attrition' strategy required that everyone play the numbers game. Body counts became a necessity. The troops in the field knew that enemy body counts were inflated, and they also suspected that American casualty reports were not accurate. They also knew from terrible experience that some aggressive commanders were willing to get their career tickets punched by leading troops into the right kind of combat action, even if this entailed a needless expenditure of their own men's lives. The troops new also that individuals and corporations back in the world were making big money on the war. Body counts, the military careers of their leaders, and big bucks for the folks back home -- this was what the war was all about (pp. 26-27).
Those who felt morally outraged when their leaders attempted to justify this war believed, like William Mahedy, a chaplain in Vietnam, that it could not be justified. As a young American soldier put it, "Chaplain,.. it's all bullshit .... Fighting for peace is like fucking for virginity" (p. 29).


What happened to many of these men when they returned to a civilian society? Emotionally and morally outraged, they became victims of a multitude of physical and emotional symptoms alcoholism, drug addiction, anti-social behavior (many became hired killers), and suicide. Nearly a half-million Vietnam veterans have been arrested one or more times, are on probation, awaiting court appearances, serving sentences, or on parole. Many described their loss of human sensitivity and emotional and spiritual responsiveness by saying, "I lost my soul in Vietnam." Rather than feeling guilt and grief, it was easier to express rage towards God, country, military leaders, friends, society, and the V.A. system.

A number of Vietnam veterans first sought relief from their spiritual alienation and guilt by seeking out ministers, priests, or rabbis shortly after returning to this country. Commonly, however, they found little relief, which only intensified their feelings of abandonment and betrayal by Church and God, about whom they said "Where was God when we needed him? He abandoned our friends, he abandoned us, and we have no use for him any more."

Reports of spiritual transformations have been uncommon in guilt-ridden combat veterans. This may be because of at least two factors. First, the complex guilt of combat veterans requires interventions at several levels -- psychological, emotional, and spiritual. Second, there are few personnel who are well-prepared to make those interventions, both individually and in collaboration.


Who is best qualified to make these interventions? Many clergy are skilled in psychological concepts and counseling techniques learned in Clinical Pastoral Education (CPE) Programs.(9) Nonetheless, they were first trained to make spiritual interventions and provide spiritual counseling, a fact often ignored in the treatment of guilt-related emotional disturbances.

Perhaps Vietnam veterans' complex problems might best be helped when members of the clergy work in collaboration with psychotherapists. Of course that would require that psychiatric personnel recognize the important role of clergy in the recovery process. Similarly, the former president of the American psychiatric Association, Alan Stone, has suggested that psychiatrists consider matters of morality as they treat their patients:

Psychiatry does not stand outside history or morality .... Psychiatrists are taught to avoid value judgments in their dealing with s patients, but I do not believe I make a radical claim when I assert that history and morality are a presence in the therapist's office .... I am deeply suspicious of anyone who makes the contrary claim that history, morality, and human values are all irrelevant to psychiatry ....(10)
Founded on psychoanalytic principles, traditional psychotherapy has been limited in its effectiveness because it lacks a comprehensive approach for resolving guilt. Psychoanalytic theory holds that neurotic guilt, caused by conflicts between id impulses and super-ego constraints, can be treated effectively. Indeed, traditionally trained psychotherapists apply this theory to resolve their patients' neurotic guilt. This theory has some applicability to combat veterans, particularly in regard to basic training, when recruits suspend the super-ego restraints of traditional moral values and collective guilt by believing they are fighting a 'just war' (like their fathers fought in World War II).(11) But this principle had limited effectiveness at relieving the collective guilt of American soldiers in a war that was neither officially declared nor sanctioned by the American people.

Other traditional psychological and psychoanalytic theories can be helpful in understanding the proper treatment of men with personality disorders. For example, applied object-relations theory can help therapists in their treatment of men whose symptoms are associated with persistent identifications with idealized dead comrades or idealized maternal introjects (the group of men they become closely identified with). For these persistent attachments can be partly understood to be a defense against unresolved abandonment depression.(12) Yet these theories still fall short and so not help resolve persistent and unrelenting post-Vietnam memories related to actual guilt and shame.

Less traditional in his approach, Lifton developed useful concepts related to survival guilt, which included the guilt caused by four factors: surviving while others died, invulnerability, destructive effects on others (the 'death taint'), and failing to fulfill their purpose (winning the war and saving the South Vietnamese from Communism). During the 'rap groups' which Lifton and his colleagues, Shatan and Shapiro, began during the early 1970s, many veterans made strides towards resolving guilt-related problems by talking about their experiences in supportive groups with other veterans.(13) As they recovered, they were able to convert 'lacerating guilt' into 'animating guilt.' In doing so, many became free to move ahead in life, receive further training or education, and provide help for others, particularly other veterans.

The common factors which limit therapists who treat combat veterans are personal ones, unrelated to the theoretical bases for therapy. Commonly, mental health professions avoid treating these men. They are rarely able to 'stomach' their violent stories during individual and group therapy, and consequently avoid asking detailed questions. Although many inexperienced therapists are willing to learn, they are unaccustomed to reports of atrocities. Hence, they are unprepared to explore veterans' experiences in depth, a necessary step in resolving guilt. Marin has reported 'vets groups' where this problem occurred. Therapists were unable to respond therapeutically to the descriptions of violent experiences: "the first was the planned slaughter of civilian village populations suspected of being VC sympathizers, and the second was the 'recreational' violence in which a GI might, for the fun of it, gun down a woman crossing a field or a child on the road."(14)

Other young therapists have been overwhelmed with feelings they've never had before:

The tales of such atrocities stimulated... feelings of anxiety and disgust [in us as group therapists].., so much so that one of us had nightmares about Vietnam. We also experienced a kind of primitive admiration, awe, and even envy about the depth and intensity of their experiences with life and death, and at times found ourselves getting caught up in the excitement of their sadism.(15)

In spite of empathic therapists who apply known therapeutic techniques and theories towards helping combat veterans, there is a limit as to the degree of guilt-resolution that be accomplished. Is it possible for combat veterans to find guilt resolution and spiritual transformation through Judeo-Christian spiritual principles? We found several biographical accounts which suggested that this could happen. A very dramatic self-report came from John Steer, a Marine combat veteran in Vietnam, who wrote an autobiography in 1982 wherein he described his traumatic childhood and combat related experiences.(16)

Steer suffered from a personality disorder before entering military service; upon discharge he developed the symptoms of Post-traumatic Stress Disorder and alcoholism for which he sought psychiatric help with little or no help. Then, seven years after the war, he had a Christian conversion experience which brought about a remarkable change in his life. His nearly broken marriage was restored and his recurring traumatic dreams, rage attacks, and alcoholism ceased to be problems. Furthermore, his sense of pervasive meaningless was replaced by a desire to help others. Since then he has maintained a normal family life and developed a self-supporting spiritual ministry for helping people in need, particularly other combat veterans.

In another example, a former patient of the Bay Pines Stress Recovery Program who left the hospital treatment program abruptly when he assaulted another patient, reported a Christian conversion experience nine months after discharge. His symptoms included rage attacks, nightmares, intrusive imagery, guilt feelings, emotional detachment, alcoholism, flashbacks, episodes of dissociation, and feelings that his body was possessed by evil spirits. He described lying in bed one night, fearful of going to sleep: "I felt that if I went to sleep, the Devil would get hold of me and I'd wake up in hell. So I called out to my wife and asked her to pray for me. She did, and I asked Jesus to take over my life. Within one or two days, I began to get a sense of peace and a new feeling of self-control that I had never had during the previous fifteen years."

Among references sought to provide guidance in helping combat veterans with guilt, the Bible may be the most widely used. Those who have found spiritual help believe that the Bible is source of comfort and direction for them. The story of the fall of Adam and Eve in the third chapter of Genesis contains a description of the consequences of seeking power for selfish purposes rather than obeying God which is applicable to the combat veteran's experience of alienation from God from taking the power of life and death in his own hands (Gen. 3). In the Book of Psalms, the authors vividly describe symptoms that could easily come out of the mouth of a Vietnam veteran with PTSD, including death-related imagery, fear, tremors, and isolation:

My heart is severely pained within me
  and the terrors of death have fallen upon me,
  and horror has overwhelmed me...
Oh, that I had wings like a dove.
For then I would fly away and be at rest.
Indeed, I would wander far off
  and remain in the wilderness. (Psalm 55:4-8)
Feelings of alienation from God are described perfectly:
O God, you have cast us off.
  You have broken us down:
  you have been displeased; Oh restore us again! (Psalm 60:1)
For combat veterans from Christian backgrounds (eighty-five percent of our patients) the New Testament has been suggested as a reference pertaining to the following themes: Jesus healing the sick (Matt. 4:24, Luke 3, John 5, Mark 5), the positive power which follows belief in Jesus (Mark 9: 17-29), the results of unbelief (Luke 1: 18-23), forgiveness (John 21, Mark 15:69-72) help for despair and loneliness (Matt. 27:46, Mark 15:34, Luke, 22:39-47), and Jesus' mission of forgiveness and healing (Mark 11:24-25, Luke 23:32-35, 42-43; Matt 5:17-26, 6:17-20).

William Mahedy, a combat chaplain who became a social worker in the Vietnam veterans Outreach Program in 1979, was one of the first counsellors to recognize veterans' spiritual desolation. In his book, Out of the Night, he successfully used Biblical references in his interpretation of combat veterans' problems: "Having confronted God in the desert of their souls, the vets provide a contemporary model for the anguish of Job, the cry of the Psalmist, and even of the agony of Jesus himself" (p. 195). Combat veterans often remain enraged -- yet helpless to combat evil: "Serious encounters with evils like hunger, poverty, homelessness, and war almost always result in a sense of personal powerlessness, emptiness, and spiritual darkness" (p. 201).

Mahedy has suggested that combat veterans seek spiritual transformation to gain "freedom from the violence of the soul which is a residue from the violence of war." Their spiritual quest may be best guided by counsellors who have had similar experiences, even if unrelated to war: "Touched by evil on a much larger scale than that of mere personal suffering, these true servants of the Lord experienced a deep anguish, sometimes bordering on the despair" (p. 201). He believes that

Vietnam vets and others who have felt the desolation of humanity's gulags have ample resources to negotiate their journey out of the night. Scripture, the writings of the mystics, and guidance from those with personal experience of winter in the spirit are sufficient maps for the journey as long as one remembers that God alone is the light at the end of the tunnel (p. 201).
Many avoid spiritual help or feel abandoned primarily because of their intense anger at God. Mahedy encourages these men to express their angry feelings to God honestly and then listen for God's response. Such rage may be traced to the evil which surrounded combat veterans and made them victims of spiritual alienation, as Mahedy comments:
War is an explosion of hatred into systematic and ruthless violence. Its savagery is beyond description. War represents a complete breakdown in the virtue of love among those who share a common humanity under God. If we take seriously the passage from 1 John, we must admit that the love of God is incompatible with the kind of hatred war unleashes. Cut off from love, we are cut off from God in the only avenue of access our limited nature really possesses. Isolation from God under these conditions brings about a different kind of spiritual night .... [It is a] darkness that closes in upon us when our souls are pervaded with hatred... (p. 208).
Mahedy discovered that God's help is important to combat the power of evil in the world. Recovery is not possible until these men are willing to "walk away from the anger, rage, and hatred that are the war's continuing residue. One cannot make a lifetime career out of hating the Vietnamese -- or Lyndon Johnson, Richard Nixon, and Jane Fonda, either" (p. 209).

Mahedy encourages veterans to seek God in a personal way, however obscure God may seem to be:

The God revealed in the Hebrew Scripture is intensely personal but always obscure, and he is frequently encountered in a desert or on a lonely mountaintop. In the New Testament, Jesus is recognized as Lord in His resurrection from the dead, but the risen Lord always goes on ahead of His disciples into Galilee and then ascends to the Father .... I believe the journey in spiritual darkness ultimately brings one to perceive God in this fashion. Perhaps a more intimate and tender sense of divine presence returns for a time -- I know a number of combat veterans who have regained or acquired for the first time a powerful awareness of Jesus as friend -- but most often the Lord seems to be saying, as he did to Mary Magdalene, 'Do not touch me' (p. 206).
DEVELOPING A SPECIALIZED PROGRAM FOR COMBAT VETERANS At the Bay Pines V.A. Medical Center, we have recognized the moral and spiritual needs of Vietnam combat veterans. Working in collaboration as psychiatrist and chaplain, we first introduced a moral issues group into the ninety-day hospital treatment program for PTSD patients in early 1985. There veterans could discuss their guilt feelings, loss of conscience, hopelessness about finding peace of mind and alienation from God, although ten percent of the patients initially resisted participation out of fear that "God would be pushed on them."

Eventually we developed a structured approach to integrate psychological and spiritual topics by using twelve themes and spiritual steps which were presented to interested combat veterans over an eight-week period. The steps were patterned in a small way after the Alcoholics Anonymous (AA) Twelve Step Program,(17) integrating some of the following AA principles:

    1) Recovery -- an on-going process rather than a cure.
    2) Education -- how to live a meaningful life.
    3) Inter-dependency of group members.
    4) Dependency on God or a "Higher Power" -- to be interpreted in a personal way.
Additional themes and steps were devised specific for combat veterans which included the following principles:
    1) Education pertaining to controlling target PTSD symptoms and self-destructive, destructive, and revengeful behaviors unique to the survivors of war.
    2) Discussion and sharing of traumatic emotions and memories.


Spiritual Step One: We acknowledge that we have become essentially powerless to live meaningful lives. Hence we hope to discover the presence of a 'Good Higher Power' who can help.

Combat veterans were often victims of power and have also used it destructively. Recovery means to begin reversing patterns of victimization by seeking positive sources of power outside of themselves: "Like the alcoholic who must admit that he is powerless over alcohol and then make minute-by-minute decisions not to drink, a vet must admit to being powerless in the face of hatred and violence and then make continual decisions not to imbibe" (p. 209).


Spiritual Step Two: We recognize that our lives have little or no meaning, hence we seek a purpose in having survived and open our minds to a 'Good Higher Power' to show us that purpose.

Combat veterans often found that surviving was an end in itself and used destructive means to accomplish it. Recovery means something more than just barely surviving one crisis after another; it means, among other things, gaining an understanding of painful post-traumatic symptoms and seeking a meaning for having survived.


Spiritual Step Three: We seek the capacity to trust, not only friends and professionals who wish to help us, but God, as individually understood, who seeks our well-being.

Combat veterans often lost all capacity to trust anyone except themselves, causing them to be completely alienated. They have also come to doubt themselves or trust their own feelings and behaviors. To break the cycle of alienation means building trust -- with friends, therapists, and God. Mahedy has effectively described the challenge of breaking through the alienation from God:

The challenge is simply to call Him 'Father; as Jesus did. When we do this in terms of the prayer that Jesus taught us, we first concentrate on God exclusively: 'Our Father, who art in heaven, hallowed by Thy Name ....' Once we have focused on God in the Lord's Prayer, we immediately shift to present needs, for we are also demanding of God that His kingdom come, His will be done on earth as it is in heaven. We pray for daily bread and deliverance from evil (p. 209).

Spiritual Step Four: We will make a searching self-inventory of both negative and positive traits, acknowledge those traits to someone we trust and God as individually understood, accept those which are positive, and ask for help to change those which are negative.

Recovery for Vietnam veterans is an ongoing process, requiring repeated self-examination, being open to feed-back of both positive and negative qualities, and being willing to change:

In order to complete the journey out of spiritual night, a vet must do a real moral inventory, discovering whom he still hates and what kind of violence still lurks within his soul. He must then decide to walk away from it -- filter it out of his thinking and feelings. In this regard, the 'healing of memories' is crucial. One must confront the memories that engender hate -- in therapy if necessary -- then let go of them. In a religious sense this means handing them over to God. If this means laying aside the 'warrior myth; so be it. It may be that a vet was indeed 'the best there was' in combat and that he never lost a battle,' but that's all in the past (p. 209).

Spiritual Step Five: We acknowledge our rage toward God and those we believe abandoned or betrayed us and hope to understand the other sources of our continuing anger. We seek, with the help of those we trust and a 'Good Higher Power,' to control destructive rage and channel anger constructively.

Combat veterans are readily angry but their anger often covers other feelings. Being unable to express them easily, they soon find that anger becomes self-destructive. Recovery means learning to control the destructive aspects of anger, to understand the emotions which anger covers up, and to channel anger constructively.


Spiritual Step Six: We seek to relinquish the 'wall' around our feelings and with help from those we trust and God, face the fear and withstand the terrifying moments we feel during day or night.

Combat veterans learned to suppress fear during combat in order to maintain control. But hidden fear and terror causes a variety of mental, physical, behavioral, and emotional symptoms. Recovery means gaining an understanding of the sources of fear, the relationship of various symptoms to fear, accepting fear as a normal emotion, and finding ways to control it when it's self-destructive.


Spiritual Step Seven: We face our guilty secrets, revealing them to someone we trust and to God from whom we seek and accept forgiveness and help to forgive ourselves.

Combat veterans suffer from the destructive consequences of guilt, including horrifying and guilt-ridden thoughts, dreams, and images. However, guilt is also a normal and important emotion -- something that soldiers learned to suppress as they turned off their consciences to fight an inhumane war. Recovery means understanding the relationship of symptoms to destructive guilt, accepting those guilt feelings which are normal, finding a source of forgiveness from beyond and within one's self.


Spiritual Step Eight: We seek finally to grieve friends and loved ones who died and the death of parts of ourselves -- our youth and innocence. We will face these painful memories, with the comfort of those we trust and our 'Good Higher Power,' and be thankful that our tears can heal our sorrows.

Combat veterans have often been unable to finish their 'grief work.' They've lost friends and they've lost significant parts of their own lives. Recovery means understanding how they have blocked normal phases of grief, finding ways to remove those blocks, completing the grieving process, saying good-bye to love one, and finding new purposes and meaningful relationships again.


Spiritual Step Nine: We reveal to someone we trust and a 'Good Higher Power' all suicidal plans and wishes, and seek, with help, to replace them with a commitment to life.

Combat veterans often remain depressed, frequently think more of death than life, and often believe they would be better off dead with the friends they left behind than to attempt to live a life of failure. Recovery means understanding the consequences of suicide, believing that those who love them and care for them want them to stay alive, 'letting go' of suicide plans, and embracing life fully.


Spiritual step Ten: We acknowledge to ourselves, to another person, and to our 'Good Higher Power,' all those whom we continue to hate. We seek to relinquish our revengeful wishes and be a channel for forgiveness -- flowing from a forgiving 'Good Higher Power' to those we have hated.

Combat veterans learned to hate their enemies. Hate gave birth to the 'killer' within them and continues to be the fuel which feeds it. Many have found no identity to replace it. To feel more alive, many even feel a need to make "frequent trips to the source of psychic energy that fuels... hatred, rage, love of violence..." (p. 209).

Veterans continue to hang on to the idea that they will be vulnerable to those who would destroy them if they stop hating, but in fact, they will become the victims of their own hatred. Recovery for combat veterans remains blocked "As long as hatred persists .... The journey of night requires that we shed our hatred of fellow men and women. If we are unwilling to take this step, we condemn ourselves to flounder for the rest of our lives in a state of oppressive and even unbearable spiritual darkness" (p. 208). "When we ask God's forgiveness... we ask God to make His forgiveness of us contingent upon our own forgiveness of our enemies" (pp. 215-216).


Spiritual Step Eleven: We seek to discover who we are and why we are here, not only from those who wish to help us, but from God, so that we may find a personal relationship with Him and seek His direction for our lives.

Two descriptions of biblical characters provide example of searching, discovering, and living out one's purpose. Job, who lost his family, property, and health, eventually discovered his purpose when he put himself completely in the hands of his God. As Mahedy observes, "When Job finally experienced God as the one who had stretched out the measuring line of the world, he was awestruck and speechless before God, his question no longer had any meaning. There was indeed a cloud of forgetting between Job and his world. At that moment he was in contact with God, and nothing else mattered..." (p. 214).

Jesus, the second example, had been the object of hatred and a victim of violence. He had been consumed in one of the worlds' gulags. As death approached, he cried out in terrible agony of spirit: 'My God, my God, why have you forsaken me?' (Matt. 27:46).

That Jesus was overcome by the darkest of spiritual nights is not in question. Even when overcome by the power of the surrounding darkness, however, Jesus placed everything in the hands of the Father: 'Father, into your hands I commend my spirit (Luke 46). His agony was unrelieved, and yet Jesus gave Himself and the world -- over into the hands of God. This example of Jesus in the most difficult of all transitions -- from despair to trust in God -- is the model.

Spiritual Step Twelve: We commit ourselves to those whose love we have taken for granted, help those who have suffered as we have suffered, and seek God's strength to love those we have not been able to love.

Mahedy has described love as

The penultimate step in the journey out of night. It is not enough to walk away from monstrous evil. Its power is too strong. It pursues us into the corners of our soul. Love is a positive virtue demanding its own kind of action. [It] requires action in the face of pervasive hatred and its multiple offspring. The raw material for action of this kind is abundant among Vietnam vets .... Men who previously could not admit love into lives have become loving husbands and fathers. Women who went to the limits of their capacities for healing as nurses in Vietnam continue on as healers in the larger community... (p. 211).

Severe and intractable symptoms of Post-traumatic Stress Disorder in Vietnam combat veterans are related to entrenched guilt and shame. These symptoms include changes in self-identity and destructive and self-destructive behaviors. Surveys of hospitalized combat veterans reveal many sources of guilt, including survival guilt, guilt from taking human life, guilt about losing the war, shame about losing prior moral values and enjoying destructive powers, guilt about being instruments of evil and being part of a morally corrupt system, and guilt about causing pain and destructive effects on their families after the war.

Veterans reporting atrocities and experiences of violence are difficult to treat and provoke mixed feelings of helplessness and awe in therapists who hear their stories. Moreover, traditional therapies are inadequate and recovery unlikely or even impossible without spiritual change. Therefore, we urged these men to obtain spiritual counseling as part of a comprehensive approach to treatment. And we incorporated a spiritual dimension to our own treatment, drawing strongly from William Mahedy's work.

Many veterans were reluctant to become involved in anything that included the name God. Further, the Veterans Administration was cautious -- even hostile -- towards any program which incorporated Christian concepts. But we found that these men were more likely to sustain their recovery when involved in a spiritual group similar to that found in Alcoholics Anonymous. Thus, the most significant aspect of our treatment was the addition of a special twelve-step program for combat veterans.

  1. Andr Malraux, Anti-Memoirs (New York: Bantam Books, 1970), p. 125.
  2. Robert J. Lifton, Home from the War: Vietnam Veterans, Neither Victims nor Executioners (New York: Simon and Schuster, 1973).
  3. See Diagnostic and Statistical Manual of Mental Disorders, third edition (Washington, D.C.: American Psychiatric Association, 1980).
  4. See Joel Brende, "Electrodermal Responses in Post-traumatic Syndromes: A Pilot Study of Cerebral Hemisphere Functioning in Vietnam Veterans," Journal of Nervous and Mental Disorders 170 (1982): 352-61, and Joel Brende, "Psychodynamic View of of Character Pathology in Vietnam Combat Veterans," Bulletin of the Menninger Clinic 47 (1983): 193-216.
  5. See Joel Brende and E. R. Parson, Vietnam Veterans: The Road to Recovery (New York: Plenum Publishing, 1985).
  6. Ibid.
  7. See Chaim Shatan, "The Grief of Soldiers: Vietnam Combat Veterans' Self-Help Movement;' American Journal of Orthopsychiatry 43 (1973): 640-53.
  8. William Mahedy, Out of the Night (New York: Ballantine, 1986), p. 22. Further references to this work will be included within parenthesis in the text.
  9. M. Galanter and H. Westermeyer, "Special Section: Modern Religious Experience and Psychiatry," American Journal of Psychiatry 137 (1980).
  10. Ibid.
  11. J. R. Smith, "Veterans and Combat: Towards a Model of the Stress Recovery Process" (Paper prepared for the V.A. Outreach Program, 1981).
  12. D. B. Rinsley, Borderline and Other Self Disorders: A Developmental and Object Relations Perspective (New York: Jason Aronson, 1982).
  13. Shatan, art. cit., and R. Shapiro, Working Through the War with Vietnam Vets, Group 2: pp. 156-85.
  14. P. Marin, "Living in Moral Pain," Psychology Today (Nov. 1981): 680.
  15. R. Frick and L. Bogart, "Transference and Countertransference in Group Therapy with Vietnam Veterans," Bulletin of the Menninger Clinic 46 (1982): 429-44.
  16. John Steer, Vietnam: Curse or Blessing? (Green Forest, AR: New Leaf Press, 1982).
  17. See Alcoholics Anonymous World Services, "Twelve Steps and Twelve Traditions " (A. A. Publishing, Inc., 1952).

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