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Letter to the Editor

By Edward Tick

Dear The Veteran,

I take this opportunity to respond to Rashid Patch's Letter to the Editor in the last issue, which was critical of my statement that the Vietnamese do not experience chronic wartime PTSD like Americans. John Ketwig quoted in his review of my book Coming Home in Vietnam. I thank and honor John for the review and Rashid for taking the time and effort to write. Clearly, Rashid is concerned with properly understanding PTSD and protecting all survivors from misinterpretation.

Rashid correctly stresses that when there is severe physical trauma of any kind, neurological changes occur in the survivor. These include war wounds as well as injuries from abuse, sports, accidents, etc.

However, Rashid reduces PTSD to a physiological trauma. It is a holistic condition that impacts the body, mind, heart, spirit, culture, and pursuit of meaning. Its impact includes psychology, ideology, culture, religion, and spirituality. Rashid is correct that all humans are wired the same, and it would be racist to say otherwise. I certainly do not claim that humans from any ethnic background are differently constructed. But Rashid is incorrect in not understanding how psychology, history, culture, and spirituality impact trauma processing. PTSD not only results from physical injury but is very much shaped by the family's, community's, and culture's responses to it. Otherwise, homecoming for veterans would not be so damaging.

Of course, human physiology is the same in the US and Vietnam. However, the surrounding cultural conditions are vastly different. Vietnam has been invaded for 2,000 years, and they have developed ways of coping that the US does not have. Moral injury is absent because they were invaded, not aggressors, and as they say, liberated their country, so their sacrifices were meaningful. Even many ARVNs who were aligned with the US felt like they were protecting their homeland. Buddhism, ancestor veneration, Confucianism, traditional practices, everyone in the struggle together, talking circles and other support from pagodas, national holidays that everyone honors, and countless other practices enable the Vietnamese to avoid the chronic breakdown that Americans experience with PTSD. These are the practices Vietnamese use for healing PTSD, not, as Rashid wonders, that they have "much better access to health and psychological care." Vietnam is still one of the poorest countries on the planet, and they do not have such care available. They have the highest levels of human, cultural, and spiritual caring and support.

I have led 19 healing and reconciliation journeys to Vietnam since 2000 and spent about two years in post-war Vietnam. I have researched this issue in depth with the Vietnamese Institute of Psychology in Ha Noi and several universities there. I have met with hundreds of Vietnamese veterans of the American War and others. They have the same conclusion—there is very little chronic wartime PTSD, though it certainly exists from other conditions. In fact, their veterans express concern and regret over the ongoing invisible wounding of American vets.

It is not only our physiological conditions that matter regarding trauma. Two people experiencing the same event may process it very differently. It deeply matters how a culture judges and supports its survivors—or fails to. Physiology is traumatizing, but culture, history, personality, religion, support, morality, and other factors all determine how we process our traumatic wounds.

Very Respectfully,

Edward Tick

I am a psychotherapist specializing in healing the invisible wounds of war in veterans and communities in the US, Vietnam, and internationally. I have been working in this field since the end of the Vietnam War and before PTSD was even a diagnosis. I have served as the military's subject matter expert in treating PTSD and Moral Injury. I am the author of War and the Soul, Warrior's Return, Coming Home In Vietnam, and other books. For anyone interested in exploring this issue of no wartime PTSD in Vietnam more deeply, I refer you to "Vietnam: No Traumatic Breakdown" in Chapter 6 of my book Warrior's Return and my article "Different Philosophy, Different Result: Why There is No PTSD Among Vietnamese Veterans of the American War," in PTSD Journal.