Some of My Best Friends Are Dead:
Treatment of the Post-traumatic Stress
Disorder Patient and His Family
Sarah A. Haley, L.LC.S.W.
The psychotherapy of Vietnam combat veterans poses unusual challenges: Major trauma occur at a developmentally vulnerable time and
under conditions of minimal social support. Difficulties are often triggered by the death of a close "buddy." The psychotherapist is drawn
into this chaotic maelstrom and is necessarily at risk herself. In this paper
relevant principles are enunciated and a detailed case presentation provided.
Man-oh-man, Cowboy looks like a bag of leftovers from a V.F.W. barbecue.
Of course, I've got nothing against dead people. Why, some of my best friends
are dead. (10)
In previous papers (6, 7) I shared my experiences of the past 13 years in the
treatment of Vietnam combat veterans. My interest in—but actually my need to
write about—the treatment of these veterans initially stemmed from anxiety provoked in me by "the patient who reports atrocities." In a paper (6) by that name,
I called attention to the potential for a negative reaction when the patient revealed
participation in war atrocities.
In this article, I will present a brief historical review of combat psychiatry and
argue the inadequacy of earlier psychoanalytic theories to fully appreciate the deforming impact of catastrophic stress, particularly combat, on psychic structures.
The expanded conceptual framework available to clinicians today draws on our
greater understanding of: stress response syndromes (11); object relations theory
(12); issues of narcissism (13); and the work of investigators such as Mahler (15)
on separation-individuation. Since many Vietnam veterans served in combat during
Sarah A. Haley, L.LC.S.W., is Assistant Clinical Professor, Tufts Medical School and at the Boston
V.A. Outpatient Clinic, Boston, Massachusetts.
This paper is adapted from a longer chapter of the same title to be published in William E. Kelly (Ed.),
Post-traumatic Stress Disorder and the War Veteran Patient. New York: Brunner/Mazel, in press.
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late adolescence, it is crucial for clinicians to become knowledgeable about adolescent psychology and to assess the impact of combat (killing, fear of dying, loss of
buddies, atrocities) on the ego and, in particular, the superego and the ego ideal in
the still fluid adolescent psychic structures. I will offer a conceptual framework
regarding one aspect of catastrophic stress, namely the loss of a soldier's buddy,
that combat can induce.
Work with such men generates frustration and urgency in the clinician to understand the dynamics more fully and to bear up under the emotional intensity of
treatment more effectively. This sense of frustration and urgency in the healer often
arises because as Horowitz (11) has painfully concluded, "for some [victims of
catastrophic stress] the damage appears irreversible; the horror was too great, and
treatment can become only a reliving but not a dispelling of the nightmares" (p.
121).
NORMAL ADOLESCENCE AND THE SOLDIER
Because the majority of Vietnam combat soldiers were between the ages of 1721, I will be concentrating on a view of them as late adolescents. Bios (1) states
that, under normal environmental conditions, the adolescent ego is subject to temporary regressions as it attempts to consolidate ego functions and form an integrated
sexual identity, self-object representations, and a stable, autonomous ego. According
to Bios, aggressive and sexual drives are intensified in part by the adolescent's
increasing social freedom and responsibilities. The interaction between these instinctual drives and the environment can "stimulate certain ego functions toward accelerated development, [as well as] stunt and retard other ego functions." Further,
he states that typical American adolescents display the defenses of identification,
denial, isolation, and impulsivity—a "rushing into danger." Oedipal and separation
issues are reworked during the adolescent years, and resolution of the
separation/individuation stage is achieved by late adolescence. For such development
to occur, two elements are essential: 1) clearly defined societal/familial values, ethics,
and rules to guide the adolescent; and 2) consistent, caring, and supportive parents
and peer groups.
For the soldier, the combat experience in Vietnam placed extraordinary burdens
on the adolescent ego's needs for this first requirement, i.e., rules to guide him. The
Vietnam War itself also placed burdens on the soldier's parents, community, indeed
the nation as a whole, to provide the second requirement of consistency and support.
Most adolescent soldiers went to Vietnam with an amalgam of family, religious,
and cultural values that could be called the "good warrior ethos." This included
the ethic that "thou shalt not kill" except with the sanction of a higher authority
and the moral support of family and society.
The guerrilla warfare of Vietnam assaulted the adolescent as he attempted to
utilize the "good warrior ethos" as a coping device and a defense against precipitous
ego regressions. The stress of combat on the adolescent ego caused an adaptive split.
This phenomenon, according to Horowitz (11), occurs in any person exposed to
extreme stress. With this split, Vietnam became the "bad" environment, and home
became good and idealized, the "world." This splitting of good and bad objects,
however, stirred up inevitable feelings of loneliness, aloneness, and vulnerability in
the young men who were often experiencing their first real separation from home.
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As the realities of combat became more apparent, the soldier relied heavily on his
combat unit for support, limits, and values, in much the same way that the adolescent
relies on his peer group—which becomes even more valued than the parents themselves during adolescence.
The continued stress of guerrilla warfare and, most often, the lack of good leadership, led to a regression to earlier levels of psychic organization. The soldier often
turned to a single buddy, who then magically served to assuage anxiety, fear, and
abandonment panic because of the magical belief that this buddy—as long as the
soldier stayed physically close to him—could protect him and love him enough to
endure the dangers around him.
Modell (16) describes these relationships as having the "capacity for magical
thought [to] mitigate . . . the danger of catastrophic anxiety through the creation
of [a] lack of separateness between self and the object" (p. 148). In "Totem and
Taboo," Freud (5) felt that magical omnipotence compensated for the realities of
prolonged biological helplessness that all infants face from time to time and, by
extension, are faced by some/all survivors of catastrophic stress.
Combat psychiatry and literature attest that combat buddies are of major importance to the cohesiveness of both the group and the individual. Since Vietnam
soldiers entered the country as individuals, rather than with their unit, they were
referred to as the FNG (fucking new guy) by the unit until they had proved themselves. The combat imperative propelled them to "buddy up" as soon as possible.
Fox (4) describes soldiers who wore their buddy's socks or other clothing into battle
for good luck. In our own clinic we have treated many Vietnam veterans, as well
as World War II and Korean War veterans, who wore their buddy's clothing into
combat, and many who have kept articles from their deceased buddy, even years
after the war. Another indicator of the magical nature of the buddy-soldier relationship is that, following the military, most veterans do not contact their buddy.
It is as though that special, magical, and idealized relationship would be shattered
were the soldier to really know the mundane realities of his buddy's life.
With the buddy's death in combat the soldier suffered the loss of an essential and
life-sustaining object. The soldier was vulnerable as he felt abandoned, alone, and
faced with the unbearable realities of danger, loneliness, possible death, and annihilation. As Fox (4) indicates, the loss of the buddy did not arouse mature responses
to object loss but very early, primitive reactions.
In particular, the death of the buddy produced the states of "protest," "despair,"
and "detachment," all of which Bowlby (2) states are predictable responses when
a child is faced with the loss of an important love object, usually the mother.
Uncontrolled rage is unleashed, so that the heretofore obedient, content toddler
suddenly bites other children, or mistreats a favorite toy. There is a tendency for
"anger and hostility directed towards a [lost] loved person to be repressed and/or
redirected elsewhere, and also for anger to be attributed to others instead of the
self" (p. 32). This anger eventually gives way to a despairing pining for the lost
object, similar to mourning, and is eventually replaced by a numbed detachment.
Lifton (14) has described a similar phenomenon with survivors of catastrophic stress
as "psychic numbing."
In the face of annihilation anxiety, a similar psychotic disorganization may take
place. The enemy, or anyone else in the soldier's path (including women and children)
can become targets for unleashed aggressive impulses. The buddy's death was
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avenged by repetitive aggression against anyone and anything that represented a
reminder of the lost buddy. Mourning became suspended in time, and repetitive
self-defeating aggression and/or atrocity became for many the only restitution for
a disintegrating ego and the shattered transitional buddy bond. In his paper "Militarized Mourning and Ceremonial Vengeance," Shatan (19) explores the evolution
of combat grief into ceremonial vengence.
THE THERAPEUTIC TASK
In previous papers (6, 7, 8), I have delineated the nature of the therapeutic task
with combat veterans. Most crucial in the treatment situation to be discussed in
this paper is the development of a strong, trustful therapeutic alliance. Such an
alliance enables the veteran to tolerate remembering, reexperiencing, understanding,
and working through his stressful combat experiences and their symptomatic sequelae. Psychotherapy with Vietnam combat veterans is difficult for the veteran,
but sometimes equally difficult for the therapist. For the therapist, war is hell for
three reasons: 1) confrontation with one's own personal vulnerability to catastrophe;
2) the challenge to one's moral attitudes toward aggression and killing; and 3) the
almost unbearable intensity of the countertransference and the transference (6, 7,
8).
Because of the ambiguous nature of the Vietnam War, one of the most damaging
effects of the stress of combat for veterans was the stripping away of their adolescent
illusions and the tarnishing of their ideals. The deforming of psychic structures
under stress has occurred in all wars; such regressions and the taking on of the
group conscience permitted preservation of psychic integrity in the face of catastrophe. Returning from combat, the veteran was expected to forge a realignment
of psychic structures, with the ego once again in control of affects and instincts.
Vietnam veterans, however, are associated in the public imagination with the loss
of "their" war and have had few societal sanctions and reentry rituals to aid them
in this realignment which is most crucial in the reinstatement of a viable ego ideal
(6, 7, 8).
In our clinic, we have been particularly concerned with the pervasiveness of a
seeming trade-off to passivity in our Vietnam veteran population in order to counter
fears of their past and potential aggressiveness (18). Activity, initiation, assertion,
aggression, and murder have clearly become and remain fused in a dynamic continuum for many veterans (8). Although Vietnam veterans have been characterized
in the public and clinical media as having explosive aggressive reactions, Morrier
(17) has noted that these episodes are often punctuation marks in a more stultifying
passivity.
In the following case material, I hope that some of the theoretical therapeutic
parameters delineated above will come alive.
CASE REPORT
At the time of his referral in April, 1974, Mark was a 25-year-old, black, married,
Marine combat veteran, with an excellent work history for the preceeding two and
a half years, despite some earlier job failures in his first year back from Vietnam.
He presented himself at the local VA hospital seeking admission for two intersecting
stresses: 1) he had discovered that his wife of seven years was having an affair (in
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21
fact, one which had started while he was in Vietnam), and that she wanted a divorce;
and 2) he was about to be promoted to supervisor. He was held in very high esteem
as an electrician on his job where men worked under very dangerous conditions on
high-rise buildings. Mark commented that it was one thing for him to risk his life
daily, but it would be "too much like Vietnam to choose the dangerous assignments
for men under my command." He had both homicidal impulses toward his wife
and suicidal impulses on the job.
Mark was a tall, handsome man, who was visibly agitated, anxious, and enraged.
The intensity of his affects, the severe depression underlying the surface presentation,
convinced me that his suicidal/homicidal potential was significant. After some initial
resistance to talking to a "honky," and further evaluation by a black psychiatrist
(who placed him on an antidepresSant and a phenothiazine for daytime use for his
agitation), the veteran returned to me and embarked on a four-year treatment that
profoundly affected both of our lives.
Mark was the oldest son of four children in an upwardly mobile Southern family.
An emphasis on schooling and church involvement characterized a family where
both parents emerged as strong and loving. The father owned his own small farm
but, when he wanted to expand and buy some adjacent land owned by a white
family, he was shot by a group of hooded men who drove into the family's front
yard. The father was left a quadriplegic, and remained at home for two years until
his care became too complicated for the mother.
Remarkably, after the father was transferred to a nursing home, the family was
able to keep and work their farm. Mark, by then age 16, began to run with a rough
crowd, was truant from school, and his excellent grades fell drastically. His mother
feared for him because of his increasing insolence toward white people. Faced with
school failure and increasingly provocative behavior in his hometown, he enlisted
in the Marine Corps in 1967. An older cousin had also been in Vietnam and had
suffered a nervous breakdown. The family was embarrassed by his medical discharge
and his "crazy" and aggressive behavior.
Mark's approach to basic training, after his initial naivete and shock, was an
identification with the drill instructors and a posture of "You can't break me." He
excelled in Advanced Infantry Training and achieved a grade of E4 before being
sent to Vietnam. During this time he also met and married his wife who had two
children by a previous marriage. By his description, she was dependent and immature, unlike the women in his own family. She reacted with rage when he received
orders for Vietnam and she wrote to him only twice during his first tour of duty.
During this tour, he had the Red Cross contact her and learned she was living with
another man.
At the end of this first tour he returned home to his wife, effected a reconciliation,
and established her in a home in Boston where she had relatives. He stated that he
"re-uped" for a second tour in Vietnam because his company was being replaced
with new recruits and the upper command level was disorganized and demoralized.
Later, in therapy, he acknowledged that he was tight with his Lieutenant and wanted
to be with him, "to look out for him." During the second year, he attained a grade
of E7 and was awarded two Bronze Stars and a Navy Commendation Medal.
The first year of Mark's treatment was an obsessive, nearly day-by-day account
of his two years in Vietnam, coupled with painful, ambivalent feelings of love and
hate engendered by the separation from his wife. The regression to identification
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with the aggressor, which began following the attack on his home and his father's
injury, and which continued during his stateside service time, escalated gradually
but steadily during his first year in Vietnam.
As a therapist who had evaluated, treated, or supervised the treatment of nearly
500 combat veterans and who felt she had "heard it all," I was not prepared for
the descent into psychic hell that awaited me. As in Caputo's A Rumor of War (3),
I felt myself being dragged, kicking and screaming for release, down every jungle
trail, burned-out village, and terrorizing night patrol until the thin line between
control and its loss, between combat killing and murder/atrocities,'had been crossed.
The veteran's combat nightmares, night terrors, and startle responses, which had
plagued him since his return from Vietnam and which he had heretofore told to no
one, were alive and shared in the treatment hours. I came to dread those hours, to
have sleepless nights before them, and often an episode of crying or dry heaves
following them.
In a symposium on trauma at Beth Israel Hospital in Boston, Dr. Paul Russell
(18), commenting on my experiences with combat veterans, stated*,
One of the difficulties in understanding childhood traumata when treating
adults is the fact that a great deal has intervened in the meantime. There is
a lot to learn, therefore, when the trauma is recent. . . . Ms. Haley's experience
is such that she can tell, sometimes in advance, when a patient is going to
begin to bring himself to describe an atrocity, and there is a dread and foreboding and a steeling oneself against it, along with a sense that it is absolutely
imperative to hear what is going to be described. Then, as the horror of the
act emerges, the therapist is thrown back: "This cannot be! He is a monster,
an animal! No human could have done that." But the treatment process requires that the therapist be able to feel, "I could well have done that." It does
not have to be said, just felt; but there is a clear difference between being able
or not able to feel it. And the patient can tell. No matter how experienced,
it is always in some measure costly to the therapist each time it is felt, but the
treatment process requires that the therapist be able to. One cannot understand
the trauma unless one can feel what the patient felt.
During this first year of treatment, Mark relived his combat experience from a
regressed posture with no reaction formation evident. Gradually, however, as his
affects were shared and tolerated, he appeared to take strength from the therapeutic
relationship. He revealed that he had not seen his parents or returned to his hometown since his discharge. He feared his parents would "see the change in me, in my
eyes—my mother didn't raise me to be a killer." In fact, the early history only
emerged slowly, in fragments, during the second year of treatment.
The following excerpt from Mark's combat history is illustrative of the regression
from a state of separation anxiety on through to annihilation anxiety and its atrocious sequelae. Mark cut himself off physically from his parents following his return
from Vietnam, but my impression is that most veterans feel emotionally separate
and split off from their families despite geographical proximity.
CASE REPORT (CONTINUED)
Mark served in Vietnam between 1966-1968 and was at Quang Tri at the start
of the Tet offensive. He was a platoon sergeant and his CO, his "LT," was a white
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23
officer named Alan. Their friendship had been forged over the past two years across
the abyss of race and family backgrounds that separated them.
Returning to their base camp from a seemingly routine patrol, they came under
three-sided fire. Some died instantly, others crumpled like rag dolls, Alan was hit.
Those who could carried or dragged the wounded, and Mark brought up the rear,
as they moved toward the safety of the base camp.
Approximately 50 yards from the camp, Mark was thrown to the ground by the
impact of a rocket grenade. Shrapnel and dirt hit Mark's face and eyes. Unable to
see, he pressed his body to the ground holding his machine gun. The air continued
to be shattered with small arms and rocket fire.
Pinned down, the surviving Marines inside the camp were unable to assist Mark.
They yelled out to him that Alan "wasn't going to make it." As the next wave of
Vietcong massed to attack, the surviving Marines shouted directions to the blinded
Mark. Through their instructions, Mark was able to direct his machine gun toward
the advancing Vietcong. He fired, changed position at the directions of the survivors,
and was resupplied with ammunition belts thrown to him from inside the camp.
For the next 24 hours, the surviving Marines and Mark successfully held off the
Vietcong until the arrival of reinforcements ended the battle. Mark was returned
to the camp where his injuries were treated. His sight gradually returned, because
there had been only blood and dirt in his eyes, and no direct injury. For his heroism,
he later received several military awards.
He sought out Alan and was overwhelmed at the extent of his friend's injuries
and the inevitability of his death. As helicopters arrived to evacuate the wounded,
Mark became panicked and enraged as he realized that, because Alan was near
death, he would be one of the last to be evacuated. Although Mark had seen and
understood the rationale for the medical triage of casualties, his despair drove him
to rage tearfully at the triage officer. Restrained and comforted by his fellow survivors, he sat on the launch pad with Alan for two hours awaiting evacuation.
His most vivid memory of those hours was Alan's hand, which had been rendered
nearly skeletal, holding a cigarette, while Alan made jokes about the risks of lung
cancer. Mark remembers that their final conversation was similar to many they had
had in the past: family, friends, girlfriends, memories of R&R, and ethnic slurs and
jokes leveled at one another. This "gallows humor" continued even as Alan was
loaded into the helicopter and they parted, eyes riveted on each other saying, "See
you around."
Within the hour, Mark learned that Alan died during the flight. He remembered
returning to Alan's hootch, looking at and touching his belongings. He then threw
himself on his friend's cot, sobbing. He fell asleep for a number of hours and then
awoke feeling in a dreamlike state. His awareness of Alan's death and his anger at
himself for "not having the guts to say, 'I love you; don't leave me' " were experienced in a numbed, detached manner. Outside, newly arrived troops were busy
fortifying the camp and guarding 30 Vietcong who had been taken prisoner. As he
joined his fellow survivors, he noticed that most of them appeared dazed and detached, some were crying. The survivors quietly, calmly, and collectively gathered
weapons, mostly machine guns, and approached the 30 prisoners who were in a
wired enclosure. One survivor, another lieutenant who was the ranking officer in
the camp, motioned the guards to leave the enclosure. Without a word being spoken,
the majority of the survivors, including Mark, surrounded the prisoners and killed
them to the last man.
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Although Mark and Alan had seen atrocities committed by their fellow soldiers,
they had never participated. Mark's involvement in an atrocity followed a battle
of overwhelming threat to his own survival and the death of his closest friend.
I refer once again to the Beth Israel Hospital symposium on trauma. Dr. Edward
Payne stated, "When the veteran, or any of us, has committed acts which violently
conflict with his values, which he regards as atrocities, he is indeed alienated from
the internal representatives of his first-loved objects, whose values he has violated,
and is deprived of the protective shield which the relationship confers. The vulnerability to guilt is, of course, increased when he leaves the group which supported
his acts, and is once more dependent on the group which shares the values that he
violated." The necessity for the therapist, therefore, to be able genuinely to empathize
with and tolerate the experiences of the veteran who has committed atrocities, allows
for the "restoration of the protective relationship [real or internalized] which was
ruptured, making dissociation necessary. It is this which permits the toleration and
the assimilation of previously unacceptable experiences."
Mark's parents painfully suffered his injunction that they not meet, although he
kept in regular telephone contact with them. Midway through his second year of
treatment, however, his mother arrived unexpectedly, and much to Mark's shock
and disbelief. His mother stated that, despite his evident distress about his upcoming
divorce, she had noted a change, a softening in his voice, and had decided to "take
matters into her own hands." Mark's mother stayed two weeks. She was supportive
of him during his nightmares, night terrors, and harassing phone calls from his wife,
but was most curious about his "therapy" and this "white lady" he talked to. She
insisted on accompanying him to the clinic and asked if she could join us in the
interview. A born psychotherapist, Mark's mother said the family had expected that
war would leave its scars on him, as it had on the other Vietnam returnees in their
hometown and, indeed, on the combat veterans of World War II and Korea. Why,
she then asked, was Mark so "touchy" about coming home? 1 did my best to explain
and she seemed reassured he was "on the road back." I had apparently passed
muster but this diminutive, powerful lady had an agenda of her own. I was made
aware, in detail, of Mark's scholastic and athletic achievements and honors. She
and the family hoped that Mark would soon feel comfortable enough to visit them.
Throughout the exchange, Mark was visibly moved and, for the first time in his
treatment, he wept. He sealed a transference merger between his mother and myself
by stating to his mother, "Isn't she all I told you," and to me, "I told you my mother
was good people—the best."
Over the following months, the veteran was able to disengage from the combatlike, sadomasochistic relationship with his wife (9), and began to reflect on the boy
he had been raised to be and the man into which he had been deformed. For the
first time consciously he asked how I had tolerated his earlier presentation of combat
atrocities and instances of overkill. He began to fear that I would be repulsed by
him and ultimately reject him.
On the second anniversary of beginning treatment, Mark sat silently throughout
the interview and then told me quietly that he loved me and wanted to marry me.
After berating myself for having botched the treatment and precipitated a psychotic
transference, I took a deep breath and trusted to another voice inside: perhaps
rebirth—not regression—was in progress. I told Mark that I was "overjoyed he
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25
loved me . . . that I loved him also and that we had cause for celebration." Simply
put, "the man"—or any of society's impersonal opposers—had not won! I told him
that, despite the catastrophic assault on his father, the dehumanizing stresses of
combat, and the unleashing of the darkest forces within him, a spark of his humanity—his capacity for concern—had remained. It had required a tolerant atmosphere in which to rekindle. That he now experienced himself as lovable, and
able to love within the treatment, meant that he could use this rebirth to allow
available love objects into his life once again. As could be expected, the veteran took
the fact that I would remain his therapist and not his woman as a rejection of his
love.
There followed months of rage, depression, and the revelation of his pleasure and
guilt at watching atrocities, particularly ones involving women. As Mark tearfully
argued that no one else could love him if they knew the things I knew about him,
I found myself awash with feelings of revulsion. The negative countertransference
reaction that I cautioned fellow clinicians of threatened to overtake me. Gradually,
though, I began to hear less about Vietnam and more about beginning friendships
with men and some tentative dating. Just as I thought I saw closure in sight,however,
the veteran suffered a severe industrial accident, falling 40 feet, rupturing four
lumbar vertabrae. There followed a year of severely limited activity, three operations,
extensive physical therapy and, in the veteran's words "time alone to think with no
place to run." I, of course, was "left alone" to wonder to what extent the struggles
in the transference/countertransference interface had contributed to renewed suicidal
impulses in Mark and his subsequent "accident."
A psychotherapy wherein both veteran and therapist are "at risk" strengthens the
ego's ability to reestablish conscious, cognitive controls over heretofore terrifying
aggressive impulses. The therapist becomes a model of concern for others and
rekindles this capacity in the veteran. Strengthened ego ideals stand as a counterforce
to a perhaps permanently compromised conscience and offer hope for renewed
mastery of both affects and instincts. A psychotherapy wherein the therapist becomes
a new "buddy" enables the veteran to reconstruct a bridge back to his family and
their values.
Bios has stressed how much at risk the therapist is in the treatment of the combat
veteran. Veterans will need to borrow and sometimes take some quality from the
therapist. As with some adolescents, they may even need to take something tangible,
even if it is only a matchbook. "Tell them they can return it when they don't need
it anymore" (9).
In the case of Mark, treatment continued during the years following his accident
as his physical condition permitted. Toward the middle of the fourth year, having
returned to work at a desk job, the veteran presented himself for an interview
appearing calm and commenting on his physical condition and a recent visit to his
family. Imperceptibly it occurred to me that his eyes were "clear" and that no talk
of Vietnam had intruded. I commented on these changes. Mark stated that Vietnam
and what had happened there would always be with him but that somehow "It's
in a far place in my heart. You're someplace in the middle, but now there's someone
right up front. I brought her to meet you."
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REFERENCES
1. Bios, P. On adolescence: A psychoanalytic interpretation. New York: The Free Press,
1962.
2. Bowlby, J. Attachment and loss. Vol. II: Separation, anxiety and anger. New York: Basic
Books, 1973.
3. Caputo, P. A rumor of war. New York: Holt, Rinehart & Winston, 1977.
4. Fox, R. Narcissistic rage and the problem of combat aggression. Archives of General
Psychiatry, 1974, 31, 807-811.
5. Freud, S. (1913) Totem and taboo. In J. Strachey (Ed.), Standard Edition, Vol. 14.
London: Hogarth Press, 1957.
6. Haley, S. A. When the patient reports atrocities. Archives of General Psychiatry, 1974,
JO, 191-196.
7. Haley, S. A. Treatment implications of post-combat stress response syndromes for mental
health professionals. In C. Figley (Ed.), Stress disorders among Vietnam veterans: Theory,
research and treatment implications. New York: Brunner/Mazel, 1978.
8. Haley, S. A. The Vietnam veterans and his pre-school child; Child rearing as a delayed
stress in combat veterans. Journal of Contemporary Psychotherapy, 1983, 14(1), 112114.
9. Haley, S. A. "Warriors Women"—A film review. Community Mental Health Journal,
1983, i9(2), 85-87.
10. Hasford, G. The short timers. New York: Harper & Row, 1979, p. 153.
11. Horowitz, M. J. Stress response syndromes. New York: Jason Aronson, 1976.
12. Kernberg, O. Object relations theory and clinical psychoanalysis. New York: Jason
Aronson, 1976.
13. Kohut, H. Thoughts on narcissism and narcissistic rage. Psychoanalytic Study of the
Child, 1972, 27, 360-400.
14. Lifton, R. Home from the war: Vietnam veterans neither victims nor executioners. New
York: Simon & Schuster, 1973.
15. Mahler, M. On human symbiosis and the vicissitudes of individuation. New York:
International Universities Press, 1968.
16. Modell, A. Object love and reality. New York: International Universities Press, 1968.
17. Morrier, E. Passivity as a response to psychic trauma. Journal of Contemporary Psychotherapy, 1983, 14, 99-113.
18. Russell, P. Trauma and the cognitive function of affects. Unpublished manuscript.
19. Shatan, C. Militarized mourning and ceremonial vengeance. Paper presented at the
American Psychoanalytic Association, New York, NY, December 21, 1980.
Requests for reprints should be sent to Sarah A. Haley, L.I.S.C.W., 26 Aberdeen Road, Somerville,
MA 02143.