Some of my best friends are dead: Treatment of the post-traumatic stress disorder patient and his family.

Abstract

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

Traumatic experiences in psychiatric outpatients

“…However, for this "great second chance" to work, a number of elements are required at the onset of adolescence. These are (i) a basic sense of trust in adults (Van der Kolk, 1987a), (ii) clear familial and societal values, ethics, and rules, (iii) caring support from family and peers (Haley, 1984).…”

Adolescent PTSD and developmental consequences of crack dealing.

“…The PTSD literature stemming from the Vietnam experience shows that adolescents have a particular vulnerability to PTSD because of the narcissistic self-object relationship characteristic of adolescent "buddy" relationships. Haley (1984) also observed the "buddy's death in combat served as a premature loss of an essential and life sustaining transitional object" Fox (1974), in studying combat buddy relationships in Vietnam veterans, found that "these relationships appear based on a kind of narcissistic extension in which the individual sees himself in the buddy and at the same time sees the buddy as an extension of himself' @.…”

Vietnam Veterans:

“…Research studies have identified problems such as alienation, poor impulse control, intense rage, unstable relationships, psychic numbing-a deadened response to events such as when the death of a parent is handled in an unemotional way, depression, flashbacks, and survivors guilt (Figley, 1986;Goderez, 1987;Haley, 1985;Lifton, 1973;U.S. Congress, 1981, among others).…”