International Society for Traumatic Stress Studies

Book Review

Posted 1 April 2005 in StressPoints by Mary Beth Williams

Raymond Scurfield is a pioneer in the field of posttraumatic stress. As he relates his own personal story of his rites of passage from in-country social worker to veteran advocate to early contributor to leader of vet group therapy and clinical operations of vet centers to social work professor, he speaks for and describes the plights and travails of many veterans—those in the front lines, in hospitals and field medical units, and in the rear echelons.

For any practitioner, family member, significant other or friend of Vietnam veterans and veterans of more recent wars, and the veterans whose ghosts, traumas and terrors continue to haunt them, this book is valuable. These men and women continue to struggle to ask for and receive services. The Veterans Administration continues to provide for some but has not reached out or offered to serve many others who suffer from what Scurfield describes as “the psychiatric, psychological and social impact of war—the 1:6 (15.2% of) Vietnam war veterans [who] suffer substantial war-related psychiatric pain and impairment (pp. 2–3) ... over 477,000 with full-blown and 345,000 veterans with partial war-related PTSD” as found 20 years postwar end.

According to Scurfield, “...War harms those who participate in it,” both in the immediate and long run, through inadequate service provision, inadequate numbers of trained personnel and through a “continuing collusion of silence and sanitization.” As new traumatized veterans return home from the latest wars in Iraq and Afghanistan, perhaps those circumstances and conditions will change. Scurfield’s personal story, entwined with descriptions of veterans’ symptoms and historical reflection on the development of the PTSD diagnosis and treatment programming, illustrates a variety of lessons learned from Vietnam that can be applied to the more recent wars as well. He addresses topics such as the dangers of prematurely removing a soldier from the war zone, the role of classic survival and coping techniques, and the problems with identifying soldiers’ reactions as behavioral rather than psychiatric problems.

As the Vietnam veteran began to demand help through nonviolent and sometimes violent means, Scurfield simultaneously was beginning his quest to advocate for a national policy of routine assessment of veterans’ military histories to determine any potential role of war experiences in subsequent diagnoses. In this volume, Scurfield concisely describes the travails of knowledgeable persons (some veterans) as they seek to develop VA hospital and vet center programs within the rubric of the 1980 DSM-III definition of PTSD. Scurfield also describes PTSD symptoms that continue to be missing from this definition and the more recent accepted definitions of PTSD including fear of loss of control, alteration in connectedness, preoccupation with blame, loss of faith, grief, rage and terror.

Journey of Healing
How do Vietnam veterans heal from their horrific experiences? What traditional and novel approaches help? Scurfield devotes the second part of his book to one of them, leading a group of veterans back to Vietnam. He also describes others: therapy focus groups; visits to The Wall and other memorials; participation in Native American healing rituals including the sweat lodge and intertribal dances; and helicopter rides.

On March 27, 2000, Scurfield looked at his journal of the 1989 trip—the first time he had re-read what he had written. This journal is included in the book. Fascinating for the reader are the reactions of the Vietnamese officials and ordinary citizens to these returnees, as well as Scurfield’s personal feelings of anger and grief over all the losses he and others experienced during the war. Myths held by many of the veterans were shattered by the trip as these men saw the Vietnamese people as human, as they observed many citizens who did not show hatred toward them, and as they felt some joy in their experiences. However, through his trip, Scurfield felt a loss that he could “never again connect the Nam of 20 years ago that I had been carrying all these years” with the Nam of 1989 (and the Nam of today). None of the group who returned to Vietnam had a complete catharsis while in country. “Two weeks does not wipe out a year ... and subsequent ... decades (p. 179).” Scurfield also relates his posttrip experiences in this volume, including dealing with disgruntled trip members, appearing in a “Nightline” special, and dealing with the trip’s uniqueness.

Scurfield makes a statement that is a truth recognized by veterans and their significant others, families, friends and counselors: “The journey of healing [turns] out to be much more stressful ... than I had ever imagined it would be.” The Persian Gulf War and recent wars have affected him greatly and reinforced and resurrected “the powerful collusion and sanitization about the true and full impact of war (p. 201).” Many veterans, if not the majority, have made a readjustment and have moved on with their lives. But to others, PTSD symptoms are “a familiar and trusted companion” that they may not want to give up, even if problematic (p. 205). Military war experiences leave what Scurfield terms an “indelible imprint on memory, attitude, physiology and behaviors ... [in a] Combat Cocktail (p. 208).”

A Relevant Guide
Scurfield’s book, and the insights it provides into the impact of war on veterans, looks to the present and future as well as to the past of the Vietnam veteran. It speaks to the pathos and healing facing the veterans of our present wars. Anyone who deals with these veterans will find guidance from this book. To conclude this review on a more personal note, both as a therapist and as the partner of a marine stationed in the Da Nang area in 1968–1969, I was moved to tears on several occasions as I read A Vietnam Trilogy. The book’s easy-to-read style will appeal to everyone, and its messages are compelling.