Achilles in Vietnam Combat Trauma and the

In this strikingly original and groundbreaking book, Dr. Shay examines the psychological devastation of war by comparing the soldiers of Homer'sIliadwith Vietnam veterans suffering from post-traumatic stress disorder. Although theIliadwas written twenty-seven centuries ago it has much to teach about combat trauma, as do the more recent, compelling voices and experiences of Vietnam vets.

Jonathan Shay is a Boston-area psychiatrist whose patients are Vietnam combat veterans with severe, chronic post-traumatic stress disorder in the Department of Veterans Affairs Outpatient Clinic. He is also on the faculty of Tufts Medical School. He lives in Cambridge, Massachusetts.

Acknowledgments

xi

Author's Caution to Veterans, Their Families, and Their Friends

xii

Introduction

xiii

PART I

Betrayal of ``What's Right''

3

(20)

An army is a moral construction

5

(1)

Victory, defeat, and the hovering dead

6

(3)

Some veterans' view---What is defeat? What is victory?

7

(2)

Dimensions of betrayal of ``what's right''

9

(11)

On danger in war

9

(1)

The fairness assumption

10

(4)

The fiduciary assumption

14

(6)

Soldiers' rage---The beginning

20

(3)

Shrinkage of the Social and Moral Horizon

23

(16)

One American soldier's social space

23

(1)

Tracking Achilles through social space

24

(4)

Desertion

26

(2)

Simplification of the social world to a single comrade

28

(1)

Achilles' character before his psychological injuries

28

(2)

Respect for the dead

29

(1)

Taking prisoners alive

29

(1)

Moral luck

30

(2)

War destroys the trustworthy social order of the mind

32

(3)

Combat is a condition of captivity and enslavement

35

(2)

``Don't mean nothin''---Destruction of ideals, ambitions, affiliations

37

(2)

Grief at the Death of a Special Comrade

39

(30)

Soldiers' love for special comrades---Vietnam and Troy

40

(4)

Homer on the relationship between Achilles and Patroklos

41

(2)

The specialness of the special comrade

43

(1)

Portrait of Patroklos

44

(5)

The grief of Achilles

49

(6)

Being already dead

51

(2)

Grief and the warrior's rage

53

(2)

Communalization of grief in the Iliad and in Vietnam

55

(12)

When were the dead brought to the rear?

57

(1)

Who brought the dead to the rear?

58

(1)

When were the dead mourned?

59

(1)

What was the level of trust, safety, and social cohesiveness in the rear during mourning?

60

(2)

Use of mind-altering substances

62

(1)

Who wept for the dead, and how were tears valued?

63

(2)

Who washed and prepared the dead for cremation/burial and shipment home?

65

(2)

The importance of thwarted grief

67

(2)

Guilt and Wrongful Substitution

69

(8)

Abandonment and wrongful substitution

69

(3)

Deserving the death sentence

72

(1)

Homecoming renounced

73

(1)

An unintended outcome of religious education?

74

(1)

Soldier's rage---Fatal convergence and completion

75

(2)

Berserk

77

(26)

Triggers of the berserk state

77

(4)

``Don't get sad. Get even!''

81

(1)

Characteristics of the berserk state

81

(13)

A beast

82

(2)

A god

84

(2)

Above and beneath---Disconnection from human community

86

(1)

Loss of all restraint

86

(3)

Revenge as reviving the dead

89

(1)

The berserker in the eyes of other soldiers

90

(1)

Flaming ice---Berserk physiology

91

(3)

Aristeiai of American soldiers in Vietnam---The differences

94

(4)

Naked berserkers and Achilles' invulnerability

97

(1)

Clinical importance of the berserk state

98

(5)

PART II

Dishonoring the Enemy

103

(18)

The enemy as enemy: Images in common to Vietnam and Troy

104

(1)

Image of the Vietnamese enemy

105

(1)

Homer: Valor does not depend on contempt for the enemy

106

(9)

Enemy soldiers talk to each other at Troy

107

(2)

Soldiers talk about the enemy at Troy

109

(2)

Religious roots of the enemy as vermin: Biblical anti-epic in 1 Samuel 17

111

(4)

Clinical importance of honoring or dishonoring the enemy

115

(6)

Abuse of the dead enemy

117

(4)

What Homer Left Out

121

(16)

Deprivation

121

(3)

Friendly fire

124

(1)

Fragging

125

(2)

Suffering of the wounded

127

(2)

Civilian suffering

129

(8)

Suffered by all civilians during war

129

(4)

Suffered exclusively or primarily by women after defeat

133

(4)

Soldiers' Luck and God's Will

137

(12)

The social spectrum of luck

137

(4)

Equipment failure

141

(3)

Attributing blame

144

(3)

Job's paradox and the possibility of virtue

147

(2)

Reclaiming the Iliad's Gods as a Metaphor of Social Power

149

(16)

Armies as creators of social power

150

(4)

Gods as REMFs

154

(6)

Heartlessness of the gods

154

(1)

Readiness to ``waste'' lives

155

(2)

Sunk-costs argument

157

(1)

Sinister demographic agendas

158

(1)

The gods as inconsistent, unreliable, inattentive, distractible

159

(1)

Homeric irony and god's love

160

(5)

PART III

The Breaking Points of Moral Existence---What Breaks?

165

(18)

The official diagnostic criteria for PTSD of the American Psychiatric Association

166

(3)

PTSD and the ruins of character

169

(1)

Persistence of the traumatic moment---Loss of authority over mental function

170

(3)

Untrustworthiness of perception

170

(2)

Memory

172

(1)

Persistence mobilization for danger

173

(2)

Persistence of survival skills

175

(3)

Persistence of betrayal

178

(1)

Persistence of isolation

179

(1)

Persistence of suicidality

179

(1)

Persistence of meaninglessness

180

(1)

Destruction of the capacity for democratic participation

180

(3)

Healing and Tragedy

183

(12)

Is recovery possible?

184

(3)

Return to ``normal'' is not possible

184

(1)

We don't know if recovery is possible

185

(1)

Yes---Recovery is possible

186

(1)

What is the best treatment?

187

(6)

Why and how does narrative heal?

188

(5)

The law of forgetting and denial

193

(2)

Conclusion

195

(16)

Prevention

196

(8)

Protect unit cohesion by unit rather than individual rotation

198

(1)

Value griefwork

198

(2)

Do not encourage berserking

200

(1)

Eliminate intentional injustice as a motivational technique

201

(1)

Respect the enemy as human

202

(1)

Acknowledge psychiatric casualties

203

(1)

War is not an industrial process

204

(1)

Pissing contests

205

(1)

Species ethic

206

(5)

Notes

211

(22)

Bibliography

233

(4)

Index

237

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Achilles in Vietnam Combat Trauma and the Undoing of Character

Summary

Author Biography

Table of Contents

Supplemental Materials