Impact of Vietnam War Service on Veterans' Perceptions of Family Life
Author(s): Charles C. Hendrix and Lisa M. Anelli
Reviewed work(s):
Source: Family Relations, Vol. 42, No. 1 (Jan., 1993), pp. 87-92
Published by: National Council on Family Relations
Stable URL: http://www.jstor.org/stable/584927 .
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IMPACTOF VIETNAMWAR SERVICEON VETERANS'
PERCEPTIONSOF FAMILYLIFE*
Charles C. Hendrix and Lisa M. Anelli**
This study surveyed Vietnam veterans'perceptions of the impact of their wartime experiences on their currentfamily life. This
research used veterans' self-reports of combat exposure, the psychological impact of war service, and family satisfaction and
functioning. The results indicated direct effects of war service on psychological impact and direct effects of psychological
impact on family satisfaction and functioning. No direct effects were found between war service and family satisfaction and
functioning. Implications forfamily life educators and therapists are included.
Even
though the last U.S. military
forces were withdrawn from Vietnam in 1975, the effects of war service remain a significant part of the lives
of many of those who served. Now,
with U.S. military forces having recently
served in a hostile environment, greater
understanding of the long-term effects of
war service on veterans and their families is needed. Examining the long-term
experiences of veterans of our last war
and their families can help family life
educators and therapists to better prepare for the return of any future war veterans. Implications for educators and
therapists are addressed at the end of
this report. This research studies the
relationship between post-traumatic
stress disorder (PTSD) and family satisfaction and functioning variables. While
much research exists on the short-term
(up to three years) psychological aftermath of war service, a need exists for
research that investigates the long-term
and enduring nature of war stress and
war service on later family functioning.
This study represents an attempt to fill
this need by surveying Vietnam veterans
more than 20 years after their war service, and is unique in the long time
between the traumatic incident (Vietnam service) and the study.
Review of Research
Vietnam veterans returned to their
home countries at the end of their tour,
but many did not leave their Vietnam
experiences behind them. The enduring
nature of the psychological impact of
war service is indicated best by the
apparent prevalence of PTSD (American
Psychiatric Association, 1987) among
Vietnam veterans. The major symptoms
of PTSD are: (a) experiencing an event
that is outside the range of normal experience, (b) reexperiencing
the event
through intrusive thoughts or memories,
(c) avoiding of reminders of the traumatic event or general numbing of responsiveness, and (d) persisting symptoms of
increased arousal. The findings of the
January 1993
National Vietnam Veterans Readjustment
Study (Kulka et al., 1990) indicate that
nearly 500,000 Vietnam veterans currently have PTSD and that nearly 1.7 million will exhibit clinically significant
stress reactions at some time during
their lives. A study conducted by the
Centers for Disease Control found that
Vietnam veterans were twice as likely to
have enduring psychological problems
when compared to other military veterans (Roberts, 1988).
The effects of PTSD also extend to
the family members of affected veterans.
For many families of U. S. military veterans, Vietnam was, and continues to be, a
traumatic experience. War trauma can
impact families at each stage of the family life cycle (Scaturo & Hayman, 1992).
As time passes, both the PTSD and the
coping attempts often become embedded in the current symptomology of the
veteran's marriage and family (Figley &
Sprenkle, 1978). Family consequences
that arise from living with a veteran suffering from PTSD can include emotional
emptiness (from the veteran's learned
numbing response to stress), loss of the
father or husband from stage specific
tasks and routines of family life (often
due to the veteran's withdrawal or fear
of getting close), and the emergence of
family patterns, such as distance or violence (from the Vietnam experience,
where violence was necessary for survival), that increase distress and impede
resolution (Rosenheck
& Thomson,
1986). While emotional emptiness is
typically considered an individual symptom, in the case of veterans' families,
this individual symptom can be exhibited system wide.
While the intensity of combat exposure has the greatest direct effect on the
development of psychological impairment following a traumatic experience,
perceived social support has a significant indirect, or buffering, effect (Shehan, 1987; Solomon, Mikulincer, &
Avitzur, 1988; Solomon, Mikulincer, &
Hobfoll, 1986; Solomon, Waysman, &
FRELATIONSY
Mikulincer, 1990). In a study of Israeli
war veterans two years following combat exposure, Solomon, Mikulincer, and
Flum (1989), found that those veterans
identified as having PTSD reported more
frequent feelings of "social alienation"
(p. 46) than non-PTSD subjects.
Although many of the above studies
focused on social support from other
soldiers during the traumatic event, the
family may be a significant source of
social support for war veterans following their return. For example, Moos and
Moos (1981) describe the family environment factors of cohesion, flexibility,
and expressiveness
as facilitative of
social support within the family. This
study focused on measures of combat
exposure to assess the intensity of the
traumatic experience on measures of
family environment to assess social support, and on measures of satisfaction
with marital and parental relationships.
Rosenheck and Thomson (1986)
state that the veteran's preoccupations
with Vietnam experiences permeate and
continue to impair family life. This
impairment can be demonstrated by
lower levels of cohesion, flexibility, and
communication. The composite effect of
the family environment would be to further isolate the veteran, decreasing both
marital satisfaction and parental satisfaction. This research
an
represents
attempt to study the relationship
between PTSD and family satisfaction
and functioning variables. The major
The current study was funded by a Young Careerist's
Incentive Award by the College of HumnanEnvironmental
Sciences, Oklahoma State University, to the first author. The
authors gratefully acknowledge the assistance of Lorina S.
Evans and Jinnifer P. Gibbs in coding data for this project,
and to David G. Fournier for editorial assistance.
"Charles C. Hendrix is an Assistant Professor and
Director of Marriage and Family Therapy Training, and Lisa
M. Anelli is a graduate student in Marriage and Family Therapy, Department of Family Relations and Child Development,
College of Human Environmental Sciences, Oklahoma State
University, Stillwater, OK 74078.
Key Words: Circumplex model, Vietnam veteran.
(Family Relations, 1993, 42, 87-92.)
87
independent variables are the individual's Vietnam war experience and the
psychological
impact of war service.
These variables were chosen due to
their centrality to the concept of PTSD.
The dependent variables for this study
are marital and parental satisfaction,
cohesion, flexibility, and communication. These variables were chosen
because they provide a means to study
the impact of PTSD on the family system.
inFigley (1988) recommended
creased study of the recovery process
from specific trauma and expanding the
unit of study in research beyond individual dynamics. The current report represents an attempt to further examine the
long-term impact of war service as a specific traumatic event through the perceptions of those who fought in the
Vietnam war. The current research, conducted more than 20 years after the veterans' wartime service, assessed the
veterans' perceptions of the psychological impact of their war service and the
current levels of marital and parental satisfaction, cohesion, flexibility, and communication.
The primary theoretical basis for the
current research is the Double ABCX
Model (McCubbin & Figley, 1983). This
model postulates that the interaction of
the precipitating event (A), resources
(B), and the subjective perception of the
event (C) leads to the development of a
crisis (X). In this study, factor A is represented by Vietnam service, factor B by
the measures of family functioning, factor C is a latent variable implied from
the relationship between combat exposure and psychological impact of war
service, and factor X is represented by
satisfaction with marriage and parenting.
Because of the focus on past war service
and the impact this service continues to
have on the family, the life-course theory suggested by Gade (1991) is also
useful. In the life-course theory, experiences shape later life paths taken. The
experience of interest in this research is
Vietnam war service, short-term paths
would be the development of psychological impairment, and long-term paths
would be demonstrated by current family functioning and satisfaction.
Hypotheses
The authors formulated
three
hypotheses concerning the impact of
Vietnam war service on veterans and
their current psychological and family
functioning.
Hypothesis 1: Increasing levels of
wartime traumatic experiences would
be associated with higher levels of the
psychological impact of war service.
88
88~~~
Hypothesis 2: Increasing levels of
wartime traumatic experience would be
associated with lower levels of family
satisfaction and functioning.
Hypothesis 3: Increased levels of
the psychological impact of war service
would be associated with lower levels of
family satisfaction and functioning.
Sample
Subjects were randomly selected
from submissions to the newsletter of a
national organization of Vietnam veterans. A total of 135 Vietnam Veterans
(131 males, 4 females) responded to this
survey. The veterans' ages ranged from
39 to 57 (M = 45, SD = 3). Of the veterwere marans who responded, 93 (69%66)
42 (31%) were
ried or cohabiting;
divorced, widowed, separated, or single.
had chilOf the respondents, 129 (97%66)
dren, ranging in age from one year to 41
years. The veterans reported a mean
number of children of 2.63 (SD = 1.12),
with a minimum of one child and a maximum of seven. The majority of the veterans' ethnic group was "Caucasian" (n
= 122). Other ethnic groups represented
were "African American" (n = 5), "Native
Americans' (n = 4), "Hispanic" (n = 2),
"Asian-American" (n = 1), and "Other"
(n = 1). Because the ethnic minority
groups were not adequately represented
in the sample, no analyses were conducted to assess differences between
those groups on any of the research
instruments.
The majority of veterans who
responded had served in the Army (n =
81) or Marine Corps (n = 28); fewer
responding veterans served in the Navy
(n = 15), Air Force (n = 7), and Coast
Guard (n = 3), and one subject did not
respond to this question. While the
mean number of months served in Vietnam was 14 (SD = 8.1), the range was
from less than one month (n = 3) to 49
months (n = 1). Over one third (38%, n =
49) of the veterans reported being
wounded during their service. Most of
the respondents reported being in the
enlisted ranks (n = 119) during their
Vietnam service; fewer reported being
officers (n = 14). The veterans reported
that their age during their first tour of
duty in Vietnam ranged from 17 to 29
years (M= 21, SD= 2.5).
Instruments
were
domains
Three general
assessed: Vietnam war service, psychological impact of war service, and perceptions of current family satisfaction
and functioning. Subjects completed the
FAM IJLry
~
-xAT0N
~
~
Combat Exposure Scale (CES; Lund, Foy,
Sipprelle, & Strachan, 1984) and the
Abusive Violence Scale (AVS; Hendrix &
Schumm, 1990) to assess Vietnam war
service. To assess the psychological
impact of war service, the respondents
completed the Purdue Post-Traumatic
Stress Disorder Scale (PPTSDS; Figley,
1989). Perceptions of various aspects of
family functioning were assessed by the
Kansas Marital Satisfaction Scale (KMSS;
Schumm et al., 1986), the Kansas
Parental Satisfaction Scale (KPSS; James,
Schumm, Kennedy, Grigsby, Shectmann, & Nichols, 1985), the Family
Flexibility and Cohesion Evaluation Scale
III (FACES III; Olson, Portner, & Lavee,
1985), and the Couple Communication
Skills Scale (CCSS; Olson, Fournier, &
Druckman, 1987). All research instruments were self-report measures.
The CES (Lund et al., 1984) is an
instrument consisting of seven items
representing specific, stressful military
events that are hierarchically ordered
through Guttman scaling (McIver &
Carmines, 1981). An example of the
items on this scale is, "Fired Weapon/
Fired Upon in Combat." Respondents
checked either "Yes" or "No" for each
item. The scale's reliability was supported by a coefficient of reproducibility
(McIver & Carmines, 1981) of .93,
where .90 indicates a reliably constructed Guttman scale. Concurrent validity of
this scale was supported by significant
Pearson correlation (r = .86, p < .001)
with the longer combat scale used by
Egendorf, Kadushin, Laufer, Rothbart,
and Sloan (1981). In the current study,
the CES demonstrated reliability with a
coefficient of reproducibility of .95.
The AVS (Hendrix & Schumm,
1990) is a 5-item scale assessing the
degree of personal involvement in acts
of abusive violence, or "the arbitrary use
of violence against persons even when
not necessitated by self defense" (Laufer
& Gallops, 1985, p. 840). The questions
included different aspects of experience
and were
violence
with abusive
arranged hierarchically from least experience with abusive violence to most
experience. An example of the items is,
"I witnessed at least one episode of abusive violence by allied forces. " The origof the AVS scale
inal development
demonstrated adequate reliability with
Cronbach's (1951) coefficient alpha of
.81. The scale demonstrated validity
through significant Pearson correlations
(r = .64, p < .001) with the CES and
through factor analysis yielding one factor (abusive violence) accounting for
55% of the scale's total variance (Hendrix & Schumm, 1990). In the current
study, the AVS had an alpha coefficient
of .77.
Januar1993ir|
The PPTSDS (Figley, 1989) is a 15item scale based on the diagnostic criteria of PTSD from the Diagnostic and
Manual (Third Edition,
Statistical
Revised; APA, 1987). The items are
divided into two groups, 11 relating to
of the
the respondent's
experiences
prior 7 days, and 4 relating to the
respondent's experience since the end
of his/her wartime service. For this survey the questions are scored 1 Not at
all, 2 and 3 Moderately, and 4 Extremely. Figley (1989) states that the scale
appears to have no significant effect for
sex, age, or ethnic group and demonstrates adequate reliability with a coefficient alpha of .82. In this study, analysis
yielded a coefficient alpha of .94 for the
total scale, well above the .80 cutoff suggested by Carmines and Zeller (1979) for
widely used scales. Face validity is evidenced by the scales' similar wording to
the DSMIII diagnostic criteria. The scale
appears to measure three aspects of the
traumatic nature of war service, intrusion (seven items), avoidance (seven
items), and the global perception of distress (one item) (Hendrix, Anelli, Gibbs,
& Fournier, 1992). An example of the
items on this scale is, "How often have
you dreamed about the event?"
Marital satisfaction is the relative
an individual has with
contentment
his/her marriage and spousal relationship. Marital satisfaction was measured
by the KMSS (Schumm et al., 1986). The
KMSS is a 3-item scale assessing relative
satisfaction that an individual has with
three aspects of marriage. Schumm et al.
(I1986) demonstrated the concurrent
validity of the Kansas Marital Satisfaction
Scale through high Pearson correlations
with Spanier's (1976) Dyadic Adjustment Scale (DAS), with the Satisfaction
Subscale of the DAS, and with Norton's
(1983) Quality Marriage Index of 0.83,
0.77, and 0.91, respectively (all significant p < .001). In the same study the
KMSS produced a coefficient alpha of
0.93, indicating its high reliability. In the
current study, the KMSS had an alpha of
.96. An example of the items on this
scale is, "How satisfied are you with
your relationship with your wife?"
Parental satisfaction is the relative
contentment
an individual has with
three aspects of parenting: the behavior
of one's children, one's view of oneself
as a parent, and the relationship with
one's own children. Parenting satisfaction was measured by the three-question
KPSS (James et al., 1985). The KPSS is a
3-item scale assessing satisfaction with
the aspects of parenting mentioned
above. In two samples evaluating 84
married mothers (sample 1), and 52 married fathers and 85 married mothers
January1993
(sample 2), James et al. (1985) report
that the KPSS produced
Cronbach
alphas of 0.85 for fathers (sample 2),
and 0.84 (sample 1) and 0.78 (sample 2)
for mothers dames, et al., 1985; James,
Kennedy, & Schumm, 1985). These
results demonstrated the high reliability
of this scale. James et al., (1985) also
found the KPSS to be significantly correlated with the Rosenberg Self-Esteem
Scale as a demonstration of the concurrent validity of the KPSS. In the current
study, the KPSS had an alpha of .82. An
example of the items in this scale is
"How satisfied are you with yourself as a
parent?"
In order to assess family cohesion
and flexibility, this study used FACESIII
(Olson, Portner, & Lavee, 1985). This
20-item self-report instrument is based
on the Circumplex Model of family systems that proposes that famnilieswho are
balanced on cohesion and flexibility
tend to function more adequately than
extreme families (Olson et al., 1985).
Family cohesion is defined as emotional
bonding between family members, and
family flexibility is defined as the ability
of the family system to respond to situational or developmental stresses through
changes in power structure, role relationships, and relationship rules. The
FACES III instrument was administered
once, assessing current levels of cohesion and flexibility.
FACES III has
demonstrated very good face and content validity and adequate internal consistency
for cohesion,
reliability
flexibility, and total scale (r = .77, .62,
and .68) (Olson et al., 1985). In the current study, FACESIII yielded coefficient
alpha for cohesion, flexibility, and total
scale of .95, .85, and .94, respectively.
An example of the items in FACES III is
"Family members often keep their feelings to themselves."
Olson (1989) characterizes communication as the third dimension of the
Circumplex Model, a facilitating dimension. Communication facilitates a couple's movement along the cohesion and
flexibility dimensions of the Circumplex
Model. In the current study, communication was considered to be comprised
of the "individual's feelings, beliefs, and
attitudes about the communication in
his/her relationship" (Olson, Fournier, &
Druckman, 1987, p. 69). Communication was assessed by the 10-item CCSS
(Olson et al., 1987). The authors selected this scale because of the CCSS's theoretical and structural consistency with
FACES III. Olson et al. (1987) state that
the CCSS demonstrated good internal
consistency reliability (r = .85). In the
current study, the CCSS had a coefficient alpha of .80. On the CCSS, higher
F8AMTIONY
scores indicate higher levels of satisfaction with communication in the relationship. Lower scores indicate lower levels
of satisfaction. This scale was chosen
due to the theoretical link to the Circumplex Model and structural consistency with FACES III. An example of an
item from this scale is, "There are a lot
of spontaneous discussions in our family."
Only veterans who are currently
married (or cohabiting) and have children were included in the analysis. This
process reduced the sample for hypothesis testing to 82. The authors utilized
the Statistical Package for the Social Sciences procedure Correlations (Norusis,
1990) to test the hypotheses.
Correlation analysis was used to test
for association between the research
variables representing Vietnam war service and psychological impact of war
service (hypothesis 1). Combat experience, measured by the CES, demonstrated significant correlations
with the
variables measuring abusive violence
(AVS) (r = .48, p < .001), and the avoidance subscale (r = .27, p < .05). The CES
demonstrated nonsignificant
correlations with the PPTSDS intrusion subscale (r = .21) and the PPTSDS global
of distress subscale (r =
perception
-.04). Experience with abusive violence,
measured by the AVS, demonstrated significant correlations with the PPTSDS
intrusion subscale (r = .24, p < .10), the
PPTSDS avoidance subscale (r = .33, p <
.01), and nonsignificant
correlations
with the PPTSDS global perception of
distress subscale (r = -.07).
Correlation analysis was performed
to test for significant
associations
between the measures of Vietnam service (CES and AVS) and the measures of
family satisfaction
and functioning
(KMSS, KPSS, CCSS, and FACES III)
(hypothesis 2). FACES III was divided
into cohesion and flexibility subscales
for analysis. The CES did not demonstrate significant associations with any of
the measures of family functioning The
AVS demonstrated an association that
was moderately significant with the
CCSS (r = -.24, p < .10) and nonsignificant relationships with all others (see
Table 1).
Pearson correlations
were performed to test the third hypothesis concerning the associations between the
measure of the psychological impact of
Vietnam war service (PPTSDS) and the
measures of family satisfaction and functioning. Correlations were performed
using the three PPTSDS subscales: intru-
Table 1.
Correlation Matrix for Vietnam Service Variables and the Measures of Family Functioning
(N = 63)
Kansas
Marital
Satisfaction
Scale
Combat Exposure Scale
Abusive Violence Scale
Kansas
Couple
Family Flexibility
Parental Communication
and Cohesion
Satisfaction
Skills
Evaluation Scale III
Scale
Scale
Cohesion
Flexibility
.18
-.07
.06
.06
.02
-.24*
.12
.06
.19
.15
p <.10.
sion, avoidance, and global perception
of distress. The intrusion subscale
demonstrated significant negative correlations with the KMSS (r = -.35, p < .0 1),
the KPSS (r = -.28, p < .05), the CCSS (r
= -.31, p < .05), FACES III cohesion subscale (r = -.27, p < .05), and the FACES
III flexibility subscale (r = -.32, p < .01).
The PPTSDS avoidance subscale was significantly negatively correlated with the
KMSS (r = -.30, p < .05), the KPSS (r =
-.28, p < .05), the CCSS (r = -.31, p <
.05), the FACES III cohesion subscale
(r = -.30, p < .05), and the FACES III
flexibility subscale (r = - .33, p < .01).
The global perception of distress subscale demonstrated nonsignificant correlations with the KMSS (r= .05), the KPSS
(r = .11), the FACES III cohesion subscale (r = .00), and the FACESIII flexibil(r = .09). The global
ity subscale
perception of distress subscale marginally significantly correlated with the CCSS
(r = .24, p < .10) (see Table 2).
__~~I
In this study, the first and third
hypotheses received moderate support,
and the second was not supported. The
first hypothesis, that there would be a
significant relationship between Vietnam war combat exposure and the psychological impact of Vietnam service
was partially supported by the predominance of significant Pearson correlations
between the measures of combat exposure (CES and AVS) and the PPTSDS subscales. That neither combat experience
measure was strongly associated with
intrusion merits further investigation,
because other studies (Wilson & Kraus,
1985, Kulka et. al., 1990) have indicated
a strong link between the intensity of
the traumatic event and the degree to
which the event is reexperienced. The
lack of association between combat
experience and intrusion may be due to
the passage of time (20 years). The
results provide support for the contention that there is a direct effect of the
level of combat exposure on the psychological impact of war service.
The second hypothesis, that increasing levels of combat experience would
be associated with lower levels of family
satisfaction and functioning, was not
90
supported. The only association was a
low magnitude association between
exposure to abusive violence and communication. The results indicate that
there is no direct effect between the
traumatic event and later family functioning and satisfaction.
The third hypothesis, that increasing levels of the psychological impact of
war service would be associated with
lower levels of family satisfaction and
functioning, was partially supported.
The Pearson correlations demonstrated
associations
negative
significant
between the PPTSDS intrusion subscale
and avoidance subscale, as expected.
The PPTSDS global perception of distress subscale moderately demonstrated
a significant association with couple
communication. This indicates a direct
negative effect of the subjective evaluation of the traumatic event and later family functioning and satisfaction.
This study confirms previous results
by other researchers (Figley & Sprenkle,
1978; Rosenheck & Thomson, 1986)
pertaining to the potential impact of
wartime service on veterans and their
families. After more than 20 years, some
veteran's wartime experiences continue
to have an impact on their family relationships. The results indicate significant
associations between Vietnam combat
and the psychological
experience
impact of war service, and between the
psychological impact of war service and
and functioning.
family satisfaction
These associations may indicate that.
with the passage of time, war service
has a direct impact on the psychological
impact of trauma, and an indirect impact
on family satisfaction and functioning.
impact of trauma
The psychological
appears to have a direct effect on family
satisfaction and functioning. This relationship supports the contention that
with the passage of time, the traumatic
event is not as significant as the individual's subjective perception of the event.
These results support McCubbin and
Figley's (1983) Double ABCX Model,
which states that the individual's perception of an event is a key intervening
variable between the event and the
development of a crisis. The results also
support life-course theory (Gade, 1991),
in that war service as a significant experience appears to directly impact shortterm outcomes (PTSD), and to indirectly
impact long-term outcomes (family functioning and satisfaction).
Implications
Family professionals, such as family
life educators and marriage and family
therapists, often come into contact with
the families of Vietnam veterans. The
long-term impact of Vietnam service
should not be overlooked as a potential
impediment to current family satisfaction and functioning. This study provides further evidence for the potential
negative effects of war service through
the predominance of significant negative
associations between measures of the
impact of war service on family satisfaction and functioning. Even though this
study was a rather small, predominantly
male sample of Vietnam veterans, the
results can, with care, be generalized to
the larger category of Vietnam veterans
and their families. Further research can
attempt to link these results to families
with members who are survivors of
other traumatic events, such as violent
crime or natural disaster.
can be done
Because nothing
retroactively to reduce the amount of
received
combat exposure
during
wartime, helping professionals would
do well to take a systemic view and to
target the psychological impact of war
service as one means of improving family satisfaction and functioning. Educators and therapists should recognize that
the psychological impact of a traumatic
event experienced by one family mem-
Table 2.
Correlation Matrix for Purdue Post-Traumatic Stress Scale and the Measures of Family Functioning (N = 63)
Kansas
Marital
Satisfaction
Scale
-.35**
-.30**
Intrusion Subscale
Avoidance Subscale
Global Perception of
Distress Subscale
*< 10n **t,< 05.
.05
Family Flexibility
Couple
Kansas
and Cohesion
Parental Communication
Evaluation Scale III
Skills
Satisfaction
Flexibility
Cohesion
Scale
Scale
-.28**
-.28**
.11
-.31
-.31
.24*
-.27**
- 307
.00
-.32***
-33*
.09
***p< .01.
FAAELAm10NLsY
January
1993[
ber will affect the family system of
which that person is a member. Educators can assist veterans and family members to recognize Vietnam service as a
significant traumatic event for many veterans that can have a profound negative
impact on family satisfaction and functioning and can teach alternate coping
strategies. Family educators can help
family members to identify relevant
community and governmental resources
and to access those resources.
within a family focus. Isolating the veteran for treatment should be avoided,
because this isolation could reinforce
patterns of low cohesion, flexibility, and
Since these patterns
communication.
have evolved over many years, the family is the most relevant environment in
which to treat these patterns. Separate
treatment for PTSD should be used for
those most troubled by their war service, but only in concert with family
treatment.
Programs such as educational
of the
awareness
groups teaching
impact of a traumatic experience on the
individual and his or her family would
be helpful. Not only can veterans
receive assistance and education about
their experiences, but their families can
learn how to deal with the possible
impact the veteran's wartime experience can have on the family. Families
can learn how to better manage the
changes and struggles that they may be
facing and how to pull together for
more effective coping. These interventions can be done either in groups (such
as support or community groups), in
family therapy that personalizes assistance to the particular family system,
through marital therapy for couples
dealing with changes in their marriage,
or possibly via individual assistance and
education. The best format would be to
work with the family as a whole in
attempting to cope with the long-term
impact of war service. Subjects that
would be helpful for families coping
with the long-term impact of war service
could include: symptoms of PTSD,
impact of war service on individuals and
families, parenting skills, marital enrichment, family communication, problemsolving skills, and conflict resolution.
Therapists and educators can draw from
their own resources in helping families
deal with the subjects, as well as utilizing other community resources. Other
resources might include veterans' hospitals or veterans' outreach centers. Therapists and educators can also draw from
instruments that can facilitate identifying problem areas for the families and
help therapists construct future plans in
working with the families.
Additionally, with help from family
life educators and therapists, the family
can serve to detect the symptoms, confront the problems stemming from the
PTSD, recapitulate the traumatic events,
and resolve the trauma-inducing conflicts associated with the events (Figley,
1986). Assimilation and integration of
in
the traumatic events experienced
Vietnam are essential for the individual
to reach resolution of PTSD. When a
supportive recovery environment exists,
provided by significant others and a
meaningful community, the individual
may gradually work through the trauma
(Wilson & Kraus, 1985). Since PTSD also
seems to impact family satisfaction and
functioning, not only can the family be a
supportive environment for the veteran,
but the family can benefit through the
potential increase in family satisfaction
and functioning that can come from the
decrease in PTSD symptoms.
Family therapists should determine
whether client families have a member
who is a Vietnam veteran and assess the
extent to which there are still unresolved issues from this experience.
Using the diagnostic criteria for posttraumatic stress disorder can be a valuable addition to the family therapist's
assessment of family processes. The
potentially significant impact of Vietnam
service should not be overlooked. If
PTSD is a potential aspect of the family's
process, then PTSD should be treated
January 1993
Rosenheck and Thomson (1986)
also offer hope for Vietnam veterans and
their families. They see family relationships as significant keys to the future for
the veterans affected by PTSD. These
veterans committed courageous actions
during their time in Vietnam and may be
similarly courageous in facing current
challenges within their families. In addition, improving family functioning may
be a viable means for decreasing the
severity of the PTSD for the individual
Vietnam veteran. The best support for
this comes from findings of a significant
correlation between family functioning
and severity of PTSD (Silver & Iacono,
1986).
Suggestions for
Future Research
There are two major limitations to
this research that could be the bases for
future research on the impact of traumatic experience on later family life.
First, the subjects for this study were all
Vietnam veterans and predominantly
male. The narrow sample limits the
external validity of the results to the
rather specific group of Vietnam veterans. While there is theoretical justification for all traumatic experiences having
similar effects, there is need to conduct
F AMI
research that would allow for generalization beyond the current study. A second
limitation is the potential that the results.
of the bivariate correlations could reflect
the existence of another factor that causes the research variables to covary.
Future studies can expand on this
research in three ways. For those studylongitudinal
ing Vietnam veterans,
designs could assess the nature of the
current family functioning and satisfaction. The current research represented
only a snapshot of the veterans and their
families; a longitudinal design could give
a more accurate depiction of the family
through time. A second suggestion for
future research would be to interview
multiple members of the veterans' families. At minimum these interviews
should be conducted with the veterans
and their spouses. A third suggestion
would be to replicate this study with
survivors of other traumatic events, such
as survivors of violent crimes or natural
disasters. The impact of traumatic
events on families is a research area that
deserves more investigation, especially
concerning the long-term impact.
-
n ii 11's
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WORKAND FAMILY
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FAMILY
LITERATURE
Vol. XVIII 1991-92
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Approximately 500 sources crossreferenced in appropriate subject areas including:
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Solomon, Z., Mikulincer, M., & Avitzur, E. (1988). Coping,
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combat-related post-traumatic stress disorder. Social Psychiatry and Psychiatric Epidemiology, 24, 41-48.
Solomon, Z., Mikulincer, M., & Hobfoll, S. E. (1986). Objective versus subjective measurement of stress and social
support: Combat-related reactions.Journal of Consulting
and Clinical Psychology, 55, 577-583.
Solomon, Z., Waysman, M., & Mikulincer, M. (1990). Family
functioning, societal support, and combat-related psychopathology: The moderating role of loneliness. The
Journal of Social and Clinical Psychology, 9, 456472.
Spanier, G. B. (1976). Measuring dyadic adjustment: New
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dyads.Journal of Marriage and the Family, 38, 15-28.
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stress disorders among Vietnam veterans. In W. E. Kelly
(Ed.), Post-traumatic stress disorders and the war veteran patient (pp. 102-147). New York: Brunner/Mazel, Inc.
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