Posttraumatic Stress Disorder or Midlife Crisis in Vietnam Veterans?

Abstract

In October 1980 the Veterans Administration recognized posttraumatic stress disorder (PTSD) as a compensable disorder (Bitzer, 1980). An estimated 500,000 to 1.5 million combat and noncombat veterans suffer from the disorder (Sierles, Chen, McFarland, & Taylor, 1983). In one state, more than 40 claimants per month were being evaluated for PTSD by the Department of Veterans Benefits (Atkinson, Henderson, Sparr, & Deale, 1982). PTSD occurs in a cluster of interrelated symptoms (American Psychiatric Association, 1980). The individual must have at least one of the following: persistent intrusive distressing recollections of the trauma, recurrent distressing dreams of the event, or feelings that the event is recurring (American Psychiatric Association, 1987). Researchers Egendorf, Kadushin, and Laufer (1981) and Kadushin, Boulanger, and Martin (1981) developed a Stress Reaction Scale to more accurately measure symptoms particular to Vietnam veterans. Attempting to use most of the symptoms of PTSD contained in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, (American Psychiatric Association, 1980), they developed the following criteria for stress reaction: memory trouble, loss of interest, thought confusion, nightmares, feelings of loss of control, and panic attacks. In contrast, the symptoms most commonly found in Vietnam veterans diagnosed as having PTSD are substance abuse, depression, jumpiness, sleep disturbances, marital and legal problems, emotional confusion, guilt, anger, alienation, and physical and psychosomatic illnesses (LaGuardia, Smith, Francois, & Bachman, 1983; Langley, 1982; Walker, 1981; Walker & Nash, 1981). Although these symptoms suggest a diagnosis of PTSD in Vietnam veterans, the same symptoms are prevalent in middle-age men in crisis who are nonveterans (Downey, 1983; Keal & Hoag, 1984; Levinson, 1978; Medinger & Varghese, 1981; Peplau, 1975). When comparing the incidence of depressive symptoms and syndromes of Vietnam veterans to that of nonveterans, studies have shown little difference between the two groups (Helzer, Robins, Wish, & Hesselbock, 1979; Starr, Henry, & Bonner, 1973). The high rate of emotionally disturbed backgrounds of Vietnam veterans suggests that emotional problems would have surfaced during middle age regardless of their war experiences (LaGuardia et al., 1983). In some cases, PTSD in veterans could be predicted with the use of childhood behavioral assessments (Helzer, Robins, & McEvoy, 1987). Midlife Crisis Although no single event indicates middle age, definite physiological, behavioral, social, and psychological changes occur (Langley, 1982; Zacks, 1980). Next to facing his own death, a man's realization that he is aging may be the most profound shock of his life (Levinson, 1978). Middle age brings a sense of desperation to make the most out of what is left of one's life. A man may become confused, lose touch with his inner self, neglect his responsibilities, make a drastic career change, quit his job, or even abandon his family (Levinson, 1978; Medinger & Varghese, 1981; Peplau, 1975; Strickler, 1975). Levinson (1977) warned that such men are not "sick," but in a normal developmental period that "must involve emotional turmoil, despair, the sense of not knowing where to turn or being stagnant and unable to move at all". Perhaps it is this normal transitional period, and not PTSD, that many Vietnam veterans are experiencing. PTSD has become known as a "unique problem" among Vietnam veterans with psychological problems (Thienes-Hontos, Watson, & Kucala, 1982). When symptoms of PTSD and another syndrome overlap, PTSD generally becomes the primary target, taking the "either/or...position of excessive diagnostic parsimony" (Atkinson et al., 1982, p. 1120). Never before have so many labels been placed on war veterans. The following are a few: * emotional conflict: Withholding feelings and emotions is a common characteristic among American men who adhere to the masculine role stereotype (Downey, 1983; Goldberg, 1979; Harrison, 1978). …