Memories of war: how Vietnam-era nurses are coping today

THE EXCELLENT performance of women who served in the Gulf War highlights the important contributions they have made during times of armed conflict. However, it only has been in the past five or six years that scientific and public attention has been paid to the approximately 11,000 American females who served in Vietnam. The majority functioned in health care positions, primarily as military nurses; additional numbers served as medical technicians or in other roles. Until recently, most people were not aware that a significant amount of women served there and were dealing with the psychological aftermath of these experiences, as were the men who had been involved in the war.

A number of women in the military during the Vietnam War were in the US. Navy on hospital ships off the coast, where they could see and hear the shelling; others were stationed overseas in Guam and Japan. While this article focuses primarily on nurses who served "in-country" in Vietnam, the types of psychological stresses undergone by these other groups were similar. The comments made regarding nurses who served during the Vietnam era are based on my research experience with them.

Clearly, the role of women stationed in Vietnam was quite different from that of the fighting soldier. In primarily medical positions, their major duties were to heal and provide nurturing to severely wounded and/or dying combat soldiers. This function was made more complicated by the fact that the nurses, many of whom were straight out of nursing school, were only a few years older than the wounded they cared for. A number reported that they ended up in a "big sister" role with their patients, providing psychological as well as medical comfort. This fit the societal stereotype of females as nurturers. However, this situation caused the nurses to be emotionally vulnerable. They had to deal with their own feelings in response to the devastating nature of the wounds of many of their patients and the number who died. For some, the only way they could cope with their feelings was to distance themselves psychologically from their patients, provide efficient and skilled medical care, yet not get too involved emotionally. They also avoided thinking about their job when off-duty. For others, coping with the reality of their nursing experiences meant spending extra time talking with their patients, perhaps writing letters to family members, and sharing the emotions they were experiencing with other military friends and associates.

Many reported that the general military message they received was that, as nurses, they were expected to be emotionally strong. Somehow, it was considered a lack of competence if they felt psychologically devastated by particular events or the accumulation of experiences related to the terrible wounds and deaths with which they had to deal. The inability or lack of opportunity to express one's feelings also continued when they returned home. Many nurses indicated after the US. withdrew from Vietnam that their general feeling was one of bitterness and anger. They perceived a tremendous waste of human life and felt that it had all been for nothing. A large proportion reported that they learned very quickly upon returning to the US. that they should not tell others they had served in Vietnam because of the strong hostility directed toward them by the general public. Unfortunately for the returning nurses, this shutting off of feelings and memories generalized to many aspects of their

lives. Some who were married to Vietnam veterans indicated that they never shared their wartime experiences with their spouses, although both would wake up at night in the midst of nightmares. Other nurses who were in psychotherapy for a number of years related that they never told their therapists they had served in Vietnam, nor did they associate their current psychological problems with what happened to them there.

The dedication of the Vietnam Memorial in Washington, D.C., caused an important psychological shift for many male and female veterans. For the first time, the general public became more sympathetic to the plight of those who served there, less hostile, and more openly supportive of the veterans' psychological and medical needs. In a sense, the veterans were given permission to acknowledge that they had been in Vietnam and that many of them were hurting because of their experiences. They also found comfort in talking to and sharing with each other.

At about this same time, the Vietnam Women's Memorial Project was formed in Minneapolis, Minn., with the aim of raising funds to build a memorial in Washington to acknowledge those females who had served during the war. Because of my interests in the study of the ways in which individuals cope with extreme stress, as well as a curiosity about the psychological effects of women functioning in a military setting in a role very different from that of the combat soldier, I decided to contact persons from the Project to gain their cooperation in conducting a study of Vietnam and Vietnam-era nurses. I particularly was interested in examining the relationship between specific patterns of coping while in Vietnam or at other duty stations and current psychological adjustment. With the help of the Vietnam women's organization and through ads in the media soliciting volunteers, our research group was able to interview 36 nurses who served in Vietnam and 32 Vietnam-era nurses--i.e., those who had served at other duty stations during this same period.