The Politics of Challenged Disorders and Drug Development

Not until Vietnam did the military and medical establishments finally take seriously and accept the legitimacy of the injurious effects of traumatic experience. Prior to Vietnam, soldiers suffering from PTSD risked being viewed as cowards and malingerers, in some cases court martialed and executed. In fact, the diagnosis of PTSD was not included in the medical nomenclature until 1980, and only then after aggressive advocacy by two sympathetic psychiatrists, Chaim Shatan and Robert Jay Lifton. By attending “Rap Groups” with Vietnam vets, they meticulously assembled a clinical picture of wartime trauma.

On May 6, 1972, Shatan published an op-ed piece in the New York Times, of what he called “Post-Vietnam Syndrome.” In the article, Shatan wrote that Post-Vietnam Syndrome manifested “growing apathy, cynicism, alienation, depression, mistrust of people, as well as an inability to concentrate, insomnia, nightmares, restlessness, rootlessness, and impatience with almost any job or course of study.”

Shatan’s characterization became fodder for the media and popular culture. A 1975 Baltimore Sun headline referred to returning Vietnam veterans as “Time Bombs.” Four months later, New York Times columnist Tom Wicker told the story of a Vietnam veteran who slept with a gun under his pillow and shot his wife during a nightmare: “This is only one example of the serious but largely unnoticed problem of Post-Vietnam Syndrome.” Martin Scorsese’s 1976 film Taxi Driver portrayed the image of the Vietnam vet as a “trip-wire killer.” The main character, portrayed by Robert De Niro, is unable to distinguish between the New York present and his Vietnam past, impelling him to murder. In the 1978 film Coming Home, Bruce Dern plays a traumatized Vietnam vet, unable to readjust after returning to the States, who threatens to kill his wife (Jane Fonda) and his wife’s new paramour, a paraplegic vet played by Jon Voigt, before finally killing himself.

After having seen the invisible wounds of war firsthand, Shatan was outraged when he learned that there was no diagnosis for this condition in the medical nomenclature. He sought out Robert Spitzer, the Columbia University psychiatrist, who chaired the Committee on Diagnosis for the American Psychiatric Association, who agreed to have his committee review the evidence for Post Vietnam Syndrome. In doing so the committee noted the similarities between the Vietnam vets and descriptions of holocaust survivors, and disaster victims. Ultimately, the committee agreed with Shatan that the enduring effects of experiential trauma did constitute a real disorder that warranted study and treatment. However, since the condition was not limited to combat experience, and occurred in civilian life, they termed it Post Traumatic Stress Disorder.