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Chapters 11-14 comprise this book's Section III - The victims of war and atrocity.
As usual, Ochberg presents this section and its authors, P.225-226.
As always, trigger warnings apply to all chapters of this book, with more or less emphasis and dependant on personal trigger factors.
John P. Wilson composed chapters 11, Understanding the Vietnam veteran, and 12, Treating the Vietnam veteran.
Chapter 11 (p. 227-251+reference) deals with the Vietnam veterans' nature and specific expressions of PTSD ; in how it differs from other war veterans, and other types of PTSD.
Wilson first discusses scholar and clinician attempts to better understand the model of human adaptation to traumatic events (in the broader sense, and not only about war) ; then, he moves on to the nature of stressors in this particular war ; normative identity diffusion ; PTSD among these veterans.
Then, through the use of a table of PTSD symptoms in Vietnam veterans, Wilson details each symptom, presented through the lens of the particular setting, actions and witnessing that these veterans experienced.
Now, I don't know any such a veteran, and I never were in their particular situation. I hadn't planned to read this part, but changed my mind, so I could better understand other aspects of PTSD, that aren't necessarily my experiences. I do see certain aspects that I can adapt, and shall discuss, probably, in relevant blog posts - if I didn't do so already.
This chapter finishes by discussing the relation of PTSD to personality disorders, by defining the link between hyper-arousal states and personality propensities, and P.251-253 are references.
I'll discuss some of this links in another post, as I found them quite interesting for my own case - which isn't an experience of Vietnam war, but that of a child, born straight into a set of traumas.
Chapter 12 is about the treatment of Vietnam veteran's PTSD. The author gives a short background historical approach of traumatic neurosis which Freud had written about in 1963, and offers afterwards the more modern approach of a phase-oriented therapy, as developed by Horowitz in the 1980's.
This chapter details the difficulties in diagnosis of PTSD, specifically to these veterans, as some of the symptoms are shared by personality disorders.
It also explains the most common symptoms expressed by patients according to their personality propensities.
It moves on to cultural considerations in treatment of PTSD ; offering the example of correlation between Native American Healing and purification rituals in the sweat lodge (based on the author's own 10 experiences) to group therapy, and shows their commonalities as well as their benefits.
Based on 12 years of research and clinical work with Vietnam veterans, Wilson proposes 15 preconditions for effective therapy, and concludes by summarizing the entire chapter into pages 273-276, followed by references (276-277).
> of note, even though these two chapters were geared specifically for the aforementioned veterans, I found a lot of interesting information that I can transpose to my own experiences and plan a series of additional entries regarding my cptsd's.
Chapter 13 is self-explanatory in its title, treating survivors and children of survivors of the Nazi Holocaust. It was write by Yael Danieli, the co-founder, in 1975, of the Group Project for Holocaust Survivors and their children, situated in NYC's area. This chapter details the basis of individual, family and group therapies for survivors and their children, by taking into account the specific kinds of traumas that were experienced collectively and as a group of people.
Beware that it includes a few case studies, and quick depictions of WWII atrocities, and that though they aren't the most graphic, are potentially triggering.
In the course if therapy, Danieli emphasises the importance in approaching therapy for these individuals and families in helping them to get better, and that it'd be counter-productive to try forcing the issues of a full recovery - as it's an unrealistic goal.
She also explains types of therapeutic approaches in view of these patient's trust issues and survivor guilt/syndrome.
The most difficult chapter to read in this third section is chapter 14, pertaining to The trauma story : the psychiatric care of refugee survivors of violence and torture. It was composed by Richard F. Mollica, explaining the-then limited knowledge of sequelae for these patients, and uses a few case studies. Some of the accounts are extremely graphic and thus the trigger warning applies to this chapter more than all the previous ones.
This therapist worked in the IPC (Indochinese Psychiatry Clinic), founded in 1985. He recounts the arduous tasks that he and his colleagues had to learn new therapy techniques et approaches to patients of extremely traumatic experiences, war trauma and torture, for which this team was unprepared. In this process, they had to add cultural cross-referencing, as Western and Asian approaches to trauma and life experiences are quite different.
He repeats several times that knowledge is limited - something that has changed in the past 30 years.
In this chapter, he explores variants of trauma stories, and the important role in telling them has in recovery, healing and post-traumatic growth (though he doesn't use these precise terms).
Thus ends section III, The victims of war and atrocity. It has been one of the toughest to read ; I had to divide some chapters, which slowed me down in completing this reading, whilst I took long breaks and read fiction instead.
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