The Evil Hours (24 page)

Participants spent much of the three-day conference describing the various methods they used in dealing with veterans' issues. Shatan and the New York cohort held workshops on the rap groups, emphasizing the need to let veterans “take charge of their own lives as part of the treatment.” They also established a coordinating committee composed of vets and shrinks whose mission it was to mobilize the various rap groups for political action and to designate experts to testify before Congress or in the media. By all accounts, the St. Louis summit was a huge success.
In Shatan's words, there emerged an ethos of “no leader and no followers—we were all peers on an equal footing.” Meshad, who would go on to found a number of influential veterans organizations, called it “the pivotal turn in American history for mental health on PTSD.”

The lone exception to this was the contingent of VA people, led by Charlie Stenger, a World War II veteran and former POW, and Dr. Jerome Jaffe, then chief of medicine for the VA, the man who Nixon had claimed the year before would “solve” the heroin problem in America.
According to Shatan, “The VA guys wanted to pooh-pooh the whole thing; and even if it was so [that the war caused some stress disorders] hardly anybody was suffering.” While they were in St. Louis, Lifton and Shatan gave an interview to a reporter from the
Chicago Tribune
, where they argued that 20 percent of Vietnam veterans were afflicted with some form of delayed stress caused by the war. The same reporter spoke to Jaffe, who claimed that at most 5 percent of veterans were mentally ill, and that clearly Lifton and Shatan were obsessed with the war. Moreover, he added, it was what the two were saying to the veterans that was the real problem, not the war itself, stating that their work was “an insult to brave men.”

Despite these official objections, which were unsurprising to the rap group crowd, St. Louis was a big step forward. A consensus of a sort had been reached, a network had been formed, and tellingly, a line in the sand had been drawn. On one side were the rap group insurgents with their bad war and their new ideas, while on the other side were largely members of what would later be called the “Greatest Generation” with their “good” war and wholly different ideas about how trauma should be borne. Speaking of the event years later, Jack Smith, a Marine veteran from the New York rap groups, said,

 

There were many friendships that were formed that exist to this day which came out of that conference . . . [But] it was a knockdown, dragout battle at that. I remember very vividly . . . Charlie Stegner getting up and saying, you know, “I'm a World War II POW and I really understand what's going on and I'm one of your brothers.” And I got up and launched into a tirade about how . . . everything he had written indicated he didn't have the foggiest notion of what was going on with us and how the hell could he call himself a brother? It was the beginning of a long and hostile relationship.

 

As the conference drew to a close, the attendees created an organization to carry on the work.
Called the National Veterans Resource Project (NVRP), they elected twelve of the St. Louis participants to a board, which a few weeks later chose Jack Smith as their president.

Around the same time, a number of rap group–inspired bodies began sprouting up around the country. In Detroit, a Holocaust survivor and psychiatrist, Emmanuel Tanay, began working with vets at nearby Macomb College.
Soon, another Holocaust survivor, Henry Krystal, was collaborating with Tanay. Back in New York, Al Singerman, a VVAW member and the son of Holocaust survivors, started organizing rap groups for Holocaust survivors and their families. All of this opened up Shatan's eyes to the “commonality” among all traumatic survivors, a connection that would become a tenet of modern trauma research.

While the movement had achieved a measure of success—they had some therapeutic ideas and a bare bones organization—what they seemed to lack now was money and a clear direction for their clinical agenda. With passage of the Case-Church Amendment in Congress two months after the St. Louis conference, which ended all U.S. aid to and involvement with Vietnam, the war was clearly and finally over, at least from an American standpoint. While certainly a boon for the VVAW, the war's end diminished the overall sense of urgency. The war was over, so what was the point of the organization anymore?

It would be years before the members of the VVAW would learn of the effect they had had on the White House, and in the meantime, there remained the burning question of what in the press had become known as “Post-Vietnam Syndrome,” after Shatan's
New York Times
op-ed.
Because of its still-speculative nature, Post-Vietnam Syndrome became something of a media catchall, a junk drawer for fears about returning veterans.
Ever since the early 1970s, there had been stories in the press about homeless, drug-addicted, violent, and in some cases suicidal vets, but as fears over this new breed of veteran continued to mount and fuse with the public's more general paranoia about hippies and the drug culture, it began to resemble something like an epidemic in the public mind. “Vietnam Veterans Called Time Bombs” read one
Baltimore Sun
headline of the time. Lifton, Shatan, and the VVAW had done historic work bringing attention to the readjustment problems of veterans, but the illness, whatever it was, remained largely undefined.

In a way, what had happened thus far was just a repeat of shell shock and the high drama of Craiglockhart. You had a few conscientious veterans who had found their way into the public consciousness (a harder task than it might seem at first, because the public tends to see the military as a faceless mob) and there was a new name for war-made madness that the press liked, in this case a neat little acronym that fit easily in a newspaper column: PVS. With the war winding down and Nixon on his way out, it all could have stopped right there, with PVS frozen in the amber of history along with the rap groups, an intriguing footnote to a deeply unpopular war. The NVRP's efforts in the beginning were scattered and ineffective, the interest in the cause waning.

In moments like these, on both the micro and macro levels, the tendency is toward a kind of amnesia, driven by powerful forces within the culture whose greatest desire is to achieve a sort of status quo antebellum. This deep-seated need of nations to forget, to simply “move on,” is universal and understandable and, coincidentally, one of the major drivers of combat-related post-traumatic stress. It is, perhaps, the fatal flaw of humankind, this failure to learn from conflict, and even after history's greatest catastrophes, as in the Soviet Union after World War II, there is evidence of this drive toward willful ignorance.
Randy Floyd, a former Marine attack pilot who flew fifty-five missions over North Vietnam, was interviewed in 1973 and said, “I think Americans have tried, we've all tried very hard to escape what we've learned in Vietnam, to not come to the logical conclusions of what's happened there.”
Needless to say, the historical deck was stacked against the NVRP.

What the movement and Shatan, in particular, hadn't counted on was a revolution in psychiatry on par with Freud's “discovery” of the unconscious.
In response to a series of scandals that had rocked psychiatry in the sixties and early seventies, the American Psychiatric Association decided in 1973 to let Robert Spitzer, a Columbia psychiatrist, oversee the next revision of the
Diagnostic and Statistical Manual
of Mental Disorders
, which was due for its third edition. Spitzer, who had volunteered for the job, had never really liked Freudian psychoanalysis, even though he'd been trained in it, and felt the time was right to introduce a new guiding philosophy for the DSM, one that emphasized close observation of symptoms and clinical data collection over the Freudian theory that had dominated the DSM-II. An empiricist to the core, Spitzer had, during his childhood summer camp, graphed his attraction to various female campers. He also had a proven track record with tricky assignments. Prior to taking on the revision job, he had refereed the process that had deleted nearly all references to homosexuality from the DSM, which had for decades listed it as a mental disorder. “I love controversy! I love it!” Spitzer would say years later.

Spitzer had had a number of opportunities to indulge this love of controversy during the homosexuality debate, and while psychiatry has always been a fraught discipline, the questions that the homosexuality debate raised continued to resonate in a way that gave fuel to psychiatry's many critics at the time.
Chief among the questions was how politics and lobbying by outside groups had driven the revision process. The removal of homosexuality was, taken in the larger context, the sort of clash that was deeply characteristic of the times: a minority group had for the first time found itself in a position to organize and mount an almost military-style campaign for redress. The difference in the case of homosexuality was that instead of the government being the target of the lobbying effort, it was a struggling medical discipline that was searching for a new identity and was only just finding its way out of Freud's long shadow. In 1973, it was the National Gay and Lesbian Task Force leading the charge, and while the APA's membership had voted decisively to delete almost all reference to homosexuality from the DSM, far from everyone was happy about it. “If groups of people march and raise hell, they can change anything in time. Will schizophrenia be next?” one psychiatrist complained.

In June 1974, Shatan got a phone call from a public defender in Asbury Park, New Jersey, who was trying to use a “traumatic war neurosis” defense to clear his client, a Vietnam veteran who'd been charged with breaking and entering.
The judge had thrown out his defense, saying there was no such disorder listed in the DSM-II. Shatan told the public defender to call Robert Spitzer, certain that the DSM czar had something in mind for the upcoming edition. Eventually, it came out that Spitzer had no plans for a “post-combat reaction” in DSM-III.
Shatan was horrified. He, along with Lifton, had dealt with so many veterans at this point that they simply assumed that their case had already been made. The idea that they would have to grapple with this new diagnostic cognoscenti had never occurred to them. Part of this disconnect could be chalked up to the growing cultural rift within psychiatry. Lifton and Shatan had both been trained in the psychoanalytic tradition, where the well-written case study, which owed as much to anthropology as to psychiatry, was the lingua franca. To Lifton, this new sort of empirical approach was a form of psychiatric “technicism,” akin to the body counts the military had kept in Vietnam. Spitzer's vision for the new DSM was more in line with the work of Emil Kraepelin, the father of psychobiology. Given that Kraepelin had once said, “Trying to understand another human being's emotional life is fraught with potential error . . . It can lead to gross self-deception in research,” Lifton and Shatan had their work cut out for them.

This clash of philosophies came to a head at the annual APA meeting at the Disneyland Hotel in Anaheim. “You don't have any evidence. You don't have any figures. You don't have any research,” Shatan recalled being told by Spitzer.
It was a grim time, and Shatan recalled that most of the researchers there seemed more interested in getting their pictures taken with Mickey Mouse than in talking about Vietnam. Also at Anaheim was a group of researchers from Washington University in St. Louis led by Lee Robbins, a psychiatrist who had conducted a study on Vietnam veterans and drug abuse. According to one psychiatrist sympathetic to Shatan's view who was there, Robbins essentially argued that “these guys are all character disorders. They came from rotten backgrounds. They were going to be malcontents and dysfunctional anyway. Vietnam probably just made them worse, but Vietnam is not the cause of their problems. They're alcoholics and drug addicts.”
This Washington University group, which from Shatan's point of view clearly had Spitzer's ear, was, in essence, making the same argument that the Nixon administration had been making all along: the people who are having problems with the war were troublemakers. In other words, there is no need for a delayed stress entry in the new DSM.

Virtually everyone from the VVAW camp who attended the Anaheim conference remembers it as one of the most demoralizing experiences of their lives. In the minds of Shatan, Lifton, Smith, and others, they had the moral high ground. They had spent years grappling with the inconvenient truths of Vietnam and had unearthed some deep insights about trauma only to find themselves on the losing end of an institutional power play within the APA. There was a new game in town, and the game, in Shatan's view, was about the rise of a biological model of human behavior. According to Shatan, “They were reluctant to accept the idea that social, psychological, political, and economic factors could have an influence on psychiatric symptoms in people.”
To this way of thinking, there could be no traumatic stress category in the DSM because the idea that an external event could cause mental illness didn't fit within their model.

Shatan was bruised by the Anaheim experience, but once back in New York, he set to work gathering data to support the VVAW position. He and Lifton had spoken with Spitzer and grasped that the battle would now turn on the numbers, on hard data that would support their position. With the help of Jack Smith and Sarah Haley at the VA hospital in Boston, the new Vietnam Veterans' Working Group began amassing data. What they found was astonishing. Sifting through stacks of VA records after hours, they discovered that, in the case of Boston, 90 percent of the Vietnam veterans admitted to the psych ward had been diagnosed as suffering from either a “depressive reaction” or “anxiety reaction.” Because many of the veterans were hearing voices and occasionally hallucinating, a number of them were diagnosed as schizophrenics.
After the official APA-approved diagnosis, Haley almost always found a working diagnosis provided in parentheses by the VA psychiatrist—“TWN,” an acronym for the old World War II term “traumatic war neurosis.” Sending out questionnaires, the group was eventually able to collect records on 724 veterans.